Recognizing symptoms and treating – Clinical Depression

March 18 09:33 2022 Print This Article

Human life is full of ups and downs, and it’s natural to feel low when things are not going our way. However, if the negative sentiment lasts for several days, weeks or months at a stretch, it could be a sign of Clinical Depression (CD). Clinical Depression is not the same as intense grief that one feels after a tragedy such as death of a dear one, loss of a job, a major health crisis, divorce or breakup, not making it to a desired college, gruesome accident or injury, etc. One gets over these incidents sooner or later. These eventualities can however trigger CD.

Clinical Depression is a lot serious than that. It affects millions of people around the world, and can have a disabling effect on one’s daily life. It is a lot more common than previously suspected. A dear one may be suffering from Clinical Depression and we may not even be aware of it.

That is why, it’s important to recognize the symptoms in order to seek medical help at the earliest. Not doing so can worsen the condition and lead to untoward outcomes such as suicide. Further, Clinical Depression is known to worsen the symptoms of existing conditions such as obesity, arthritis, diabetes, asthma, cancer and cardiovascular diseases. This is because depression weakens the immune system and hence its ability to fight disease.

Types of Clinical Depression

Clinical Depression is an umbrella term and includes various types of depression.

• Major Depressive Disorder (MDD): This is a more severe form of depression and can last up to 2 weeks. The person feels sad, hopeless, worthless, guilty and suicidal.
• Persistent Depressive Disorder (PDD): Also called dysthymia, this is a less intense but more long-term version of depression. The changes happen very gradually, so the symptoms are easy to miss.
• Peri-natal (PND) and Post-partum (PPD) Depression: Pregnant women in the last days of the 3^rd trimester experience a mild form of depression. After birth of the baby, this condition continues. The mother feels sad, stressed-out and starts to worry unnecessarily.
• Bipolar Depression (BD): Bipolar disorder is a condition in which people experience extreme states of emotion, frequently. They could be very happy one moment, very sad the next moment, very angry and very calm, very energetic and very exhausted, and so on. Such patients also experience depression during the low state.
• Pre-menstrual Dysphoric Depression (PMDD): A week to 10 days before the period, some women experience a low state characterized by sadness, anger, bitterness, guilt, worthlessness, etc. These are often confused with PMS (pre-menstrual symptoms) and ignored. However, if they are intense every-time, the lady must consult a doctor.
• Psychotic Depression (PD): In this condition, along with the depressed state, the person may also experience delusions or hallucinations. Delusions are unrealistic beliefs in things that are not based on reality, while hallucinations involve seeing, feeling, touching or experiencing things that are not really there.
• Seasonal Affective Disorder (SAD): We all know that sunlight, and the natural Vitamin-D that it helps the body generate, are good for our mood. In countries where winters are long, cold and harsh, or where the skies are always grey or cloud-cast and where there is less sunshine through the year, some people are greatly affected by this and show symptoms of depression.

Symptoms of Clinical Depression

Symptoms across the above types of Depression include the below-mentioned, and can vary depending on the age and gender of the person. Depending on whether they are children, adolescents, adults and seniors or older adults, they may experience one or more but not all of the symptoms listed below. Again males experience different symptoms compared to females. An exhaustive list of symptoms is given below. If you notice your dear one showing one or more of these symptoms, it’s time to ring the alarm bell.

• Mood swings that include being irritable, angry, sad or crying a lot
• Feeling helpless or incompetent, saying self-defeatist statements like “I can’t get anything right”, feelings of despair, bitterness or intense sadness
• Getting into trouble at school, refusing to attend school or extracurricular activities, avoiding friends, siblings or relatives, thoughts of death or suicide, thoughts about hurting self or others
• Difficulty in concentrating on studies, poor performance in school, or a drop in grades
• Difficulty in sleeping or sleeping too much, restless sleep, not sleeping through the night and sleeping through the day
• Low energy, digestion issues, poor appetite (eating too much or too little), headaches, weight loss or weight gain, feeling tired easily and increased cramps
• Being angry, aggressive, irritable, anxious or restless
• Feeling empty, despondent, sad, or hopeless
• No longer having interest or finding pleasure in hobbies or preferred activities, drinking excessively, drug abuse, recklessness or engaging in high-risk activities
• Lack of interest in sex, low libido and poor sexual performance
• Difficulty in completing tasks or meeting deadlines, delayed responses during conversations
• Withdrawing from social engagements, avoiding routines and people
• Thinking, talking or moving slower than usual
• Feeling hopeless, worthless, and pessimistic
• Difficulty in remembering, or making decisions
• Chronic physical pain with no clear cause and which does not improve with treatment (headaches, aches or pains, digestive problems, cramps)
• Angry outbursts, irritability or frustration, even over small matters
• Increased cravings for food, especially unhealthy or junk food, and weight gain
• Feelings of worthlessness, self-blame or guilt, fixating on past failures
• Visual or audible hallucinations
• Feeling too tired to take care of oneself or others
• Increase in purposeless physical activities, such as inability to sit still, pacing up and down, wringing hands, chewing on pen or finger-nails
• Symptoms of Obsessive Compulsive Disorder (OCD) such as repeatedly checking things

Complications of Clinical Depression

If left untreated, depression can cause a wide range of complications that include:

• Weight gain or weight-loss
• Physical pain in different parts of the body
• Alcohol and drug abuse
• Panic attacks for no reason
• Relationship issues with spouse, children, family and friends
• Increased social isolation and social withdrawal
• Attempts at suicide, or violence against others
• The above listed symptoms becoming worse
• Increased risk of health conditions like dementia
• The above-listed symptoms recur even if they had been cured before

Treatment Options for Clinical Depression

There are a wide range of treatment options and therapies. Qualified doctors will pursue one or more option depending on the age and gender of patient, severity and type of depression.

• Medications: This is always the first line of treatment as they give quick relief. Medicines include

1. SSRI: Selective Serotonin Reuptake Inhibitors such as citalopram, sertraline, escitalopram, paroxetine and fluvoxamine. As the name implies, these increase the availability of the neurotransmitter Serotonin in the brain.
2. SNRI: Serotonin and Norepinephrine Reuptake Inhibitors such as desvenlafaxine, venlafaxine, levomilnacipran, duloxetine and milnacipran. As the name implies, they increase the availability of the neurotransmitters Serotonin and Norepinephrine in the brain.
3. Tricyclic and tetracyclic anti-depressants: Like the above, these too increase the availability of the neurotransmitters Serotonin and Norepinephrine in the brain. These include amitriptyline, protriptyline, nortriptyline, trimipramine, doxepin, desipramine and imipramine.
4. NDRIs: Noradrenaline and Dopamine Reuptake Inhibitors like bupropion increase the availability of the neurotransmitters Noradrenaline and Dopamine in the brain.
5. MAOIs: Monoamine oxidase inhibitors (MAOIs) increase the availability of the neurotransmitters Noradrenaline, Dopamine, Serotonin and Tyramine in the brain.
6. NMDA: N-methyl D-aspartate Antagonists such as esketamine increase the availability of the neurotransmitter glutamate in the brain.

• Psycho-therapy: As the name implies, this therapy involves frequent discussions with a psychologist. A trained psychologist knows how to bring out the negative feelings in the patient, and coax him/her into talking about their inner feelings. Over several sessions, the patient is able to understand himself/herself and notice the triggers that cause depression. Combined with medication, this therapy can bring relief to many patients.
• Cognitive Behaviour Therapy (CBT): As the name implies, the patient must change his/her behavior in order to reduce the symptoms of depression. A qualified therapist will train the patient on how to substitute negative thoughts and behaviours with positive ones.
• Dialectical Behaviour Therapy (DBT): In this therapy, the therapist works with the patient to help acknowledge or notice the negative thoughts and behaviours and then explore ways of overcoming them. Here, the emphasis is not on fighting the negative sentiments but to accept, understand and then overcome them.
• Psychodynamic Therapy: This is similar to Psychotherapy, but here, the therapist takes the patient on his/her journey right from childhood till date. Hidden triggers for depression may have come from anytime in the person’s life. The therapy will identify such triggers and then analyze them in order to overcome the negative sentiments.
• Light therapy: This is generally applied to people suffering from Seasonal Affective Disorder described earlier. Here, the therapist uses white light in every session to regulate the person’s mood and hence the symptoms of depression.
• Electroconvulsive therapy (ECT): A controversial therapy because of the side-effects, and generally used for patients with intense depression. The patient is first anesthetized. Four electrodes are placed on 4 points on the head and a cardiac monitoring-pad on the chest. Short bursts of electrical current are passed to the head. There is no convulsion nor does the patient feel the electrical pulses. He/she wakes 10 minutes later feeling better.
• Repetitive Transcranial Magnetic Stimulation (rTMS): Similar to ECT, except this uses magnetic pulses instead of electrical pulses.
• Alternative therapies:

1. Meditation: Meditation techniques taught by a therapist will help the person overcome negative feelings and stay balanced which minimizes the symptoms of depression.
2. Acupuncture: Acupuncture is known to be as effective as psychotherapy when it comes to treating depression.

• Natural remedies and lifestyle changes

1. Exercise: Exercise in any form helps release feel-good hormones called endorphins in the brain. This automatically reduces the symptoms of depression.
2. Substance use: The person should quit drug usage and minimize consumption of alcohol as both these substances can aggravate the symptoms of depression.
3. Managing emotions: The patient will be trained on how to set limits on the negative feelings, and take immediate action when the limits are breached.
4. Self-caring: The patient is advised on consuming a healthy diet, sleeping well, indulging in hobbies and avoiding negative people, in an effort to reduce symptoms.

• Supplements: This includes S-adenosyl-L-methionine (SAMe), 5-hydroxytryptophan (5-HTP), Omega-3 fatty acids, Vitamin B12, B6 and D. All these should be taken only under medical supervision and prescribed by the case doctor.

Outlook

If you or any of your dear ones are showing one or more of the symptoms of depression listed above, do not ignore. Depression can do both short-term and long-term damage if left untreated. In the same way, timely treatment can cure the problem and prevent a relapse. Consult a reputed hospital. A qualified team of specialists will examine the person thoroughly and then arrive at the best course of treatment for quick recovery and rehabilitation.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801