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Depression

 

 

Depression is a widespread mental illness characterized by sadness, loss of interest, and reduced energy. If you or someone you know have depression there are ways to get help.

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What are the symptoms of depression?

The main symptoms of depression are: 

 

  1. Feelings of sadness or depression dominate the emotional life far beyond what is usual
  2. Loss of interests and desire. You no longer feel like what you are used to, life seems meaningless, and what has previously given joy has become a chore
  3. Reduced energy and feeling tired or tired. You simply have less stamina, and small tasks can feel like insurmountable efforts

Other symptoms may include guilt or bad conscience, feelings of inferiority or low self-esteem, suicidal ideation, difficulty concentrating, psychomotor disorders (restlessness, restlessness, agitation or inhibition), sleep disturbances, decreased appetite or weight loss.

  

I had a black dog - his name was depression...

Video: An information film on depression (World Health Organization)

 

A formal description of the diagnosis of depression

A more formal description of depression can be found in the ICD-10 manual [ICD-10][1] , which states the following description of what characterizes a depression:

- In typically mild, moderate or severe depressive episodes, the patient suffers from lowered mood swings (depression), reduced energy and activity level. The ability to enjoy, feel interest and concentration is impaired, and a pronounced fatigue and tiredness is common even after the slightest effort. Usually sleep is disturbed and appetite is reduced.

- Self-esteem and self-confidence are almost always weakened, and even in the mild form, notions of guilt and worthlessness are often present. The lowered mood changes little from day to day, does not vary with the circumstances and can be accompanied by so-called "somatic" (melancholyform) symptoms, such as loss of interest and feelings of pleasure, waking up in the morning several hours earlier than usual, depression that is heaviest in the morning , pronounced psychomotor retardation, restlessness, loss of appetite, weight loss and loss of sexual drive. Depending on the number and severity of symptoms, a depressive episode may be specified as mild, moderate or severe.

A duration of at least two weeks of this condition is usually required, and a distinction is made between severe, moderate and mild depression based on the number and intensity of the symptoms.

 

How common is depression?

Depression is one of the leading causes of illness worldwide [Richards, 2011][2]

Around 14 to 21% of the adult population will meet the criteria for an affective disorder during their lifetime, i.e. depression or bipolar disorder. In the course of a year, the prevalence of depression is between 4 and 11%. 

Based on the article "Depression" in the Norwegian Electronic Medical Handbook [NHI, 2019][3] , NHI.no writes the following:

- The incidence of depression has increased in recent decades, especially the mild and moderate ones. Probably at least 25% of all women and 15% of all men get a depression that needs treatment during their lifetime.

NHI. no also writes:

- 75-85% have repeated episodes. Calculations show that patients with clinical depression on average will experience 4 periods of depression during their lifetime. A study shows that after treatment for depression, 2 out of 3 experience a new depressive period within 10 years. 

 

Causes of depression

There can be many causes of depression. NHI.no writes [NHI, 2019] :

In many cases, the depressed person prior to the depression has experienced events that are described as painful or shameful. The event can be a real loss, but it can also be linked to one's own expectations of others or oneself. Negative emotions directed at the individual self may have arisen as a result of disappointments and losses in childhood, poor regulation of self-esteem, anger directed at oneself, and feelings of helplessness and hopelessness are typical. By repeating childhood experiences, the unconscious vulnerability will form the basis of depressive episodes.

Importantly, there is seldom only one reason that a person develop a depression. Rather, many develop depression when the total load of stressors get to high. In a sense, a person with depression has often been "too strong for a too long period of time" - and a depression could be seen as a exhaustion reaction. It is often observed that it takes time to develop a depression - and that it takes time to recover from a depression.

One is also concerned about biological conditions that may be contributing causes of depression. NHI.no mentions a lack of neurotransmitters (e.g. serotonin) in the brain, low metabolism, and a lack of light in winter depression as examples [NHI, 2019] .

 

Diagnosis of affective disorders

When it comes to deciding whether or not to suffer from depression, this is something the doctor has an important role to play. One reason why the doctor is important is to assess and possibly rule out that there are underlying medical problems that may be the cause of, or that aggravate, the depression.

If necessary, the doctor can refer to the specialist health service, which will be able to make a more thorough assessment of the mental health condition, and where one can access various treatment options.

In order to be able to make a depression diagnosis, a thorough assessment will be made of what symptoms the patient has, and to what extent this can be said to meet the formal criteria for a depression. It is not uncommon to have other mental disorders at the same time as depression, eg anxiety disorders, and then you will also need simultaneous treatment of these conditions.

When depression is suspected, standardized screening tests will usually be performed. An example of this is MADRS  [Montgomery & Åsberg, 1977] . The test is an important tool for the doctor when he or she is to diagnose depression, and when the doctor is to follow the depressed patient over time.

 

Treatment of depression

Treatment of depression involves treating the current depression, but also measures that can help prevent the person from suffering from new depressions later. 

 

Drug treatment of depressive disorders

Antidepressant drugs (also called antidepressants) are used for severe depression that does not go away on its own, and in many cases with MADRS scores higher than 20. Such drugs work mainly in three different ways, according to NHI.no:

 

  1. They make you more active, and that fatigue and apathy go back.
  2. They also act, naturally enough, antidepressant, but this effect does not have to strike until after a while, ie one to two weeks.
  3. At first, the medication may also be a little sedative and sleep-inducing. This is one of the reasons why patients with panic disorder can also use such medications. Should one experience difficulty sleeping during such treatment, sleeping pills may be necessary.

 

Psychotherapy for depression

Conversational therapy, also called psychotherapy, is another treatment that can be used for depression. Several types of psychotherapy are offered that can be effective in getting out of depression.

A common form of treatment is cognitive behavioral therapy. Here, an attempt is made to identify the presence of so-called automatic negative thoughts and thought structures, which are believed to help maintain the depression. These thoughts are then tried to process and change in a positive direction.

Another form of treatment that is related to cognitive behavioral therapies is metacognitive therapy. In this treatment, one learns strategies for breaking negative patterns with chronic worry and brooding - and many can tell that learning to spend less time on negative thoughts in itself is very effective on the way out of depression.

Psychodynamically oriented therapies are also offered for depression. A review study of short-term psychodynamic therapies for depression concludes that there are promising results of the therapies, but that more studies are needed to provide clearer answers as to when this is the right choice of treatment [Abbass et al., 2014][4] .

  

Marital therapy as a treatment for depression

Working with relationships and family functioning can in some cases be beneficial where one partner (or for that matter both) has experience with depression.

Attempts have been made to offer couples therapy as a method of helping people with depression, based on the assumption that stress and dissatisfaction in relationships and family can be an important factor in depression for some people. A review study concludes that there is no research basis for saying whether such a type of therapy is neither better nor worse than drug treatment and / or ordinary conversational treatment [Barbato & D'Avanzo, 2006][5] .

 

Physical activity / exercise as therapy for depression

When you suffer from depression, you should, as best you can, find ways to stay active. Physical exercise has been shown to have a beneficial effect on depression. A review study on the use of exercise as a treatment method for depression concludes that exercise can have an effect in the treatment of depression, but that based on available studies today there is no basis for saying that exercise works better than drug treatment or psychotherapy [Cooney et al., 2013][6] .

 

Self-help in depression

There are studies that show that therapist-guided self-help programs or other internet-based forms of cognitive behavior therapies can have a positive effect against depression [Vallury et al., 2015][7] .

 

Prognosis in depression

The majority of those who have a depression recover from it [NHI, 2019] . However, recovery is not always permanent - that is, there may be new episodes of depression - and for people who have many repeated episodes of depression, there is a risk that this will become a more chronic pattern.

It is emphasized that the extent to which one has other medical or psychiatric diagnoses in addition to the depression episode proves to be of great importance in relation to the prognosis for improvement and relapse.

NHI.no writes: 

- Most depressions have a fluctuating course, and many can therefore expect to be without symptoms for long periods. A new episode of depression may suddenly occur, e.g. after a mentally disturbed event, loss of a close person or an accident. With the right diagnosis and treatment (psychological treatment, medication and supportive therapy), one can expect that 85% of the patients are healthy or have a good response after 6 months.

 

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Different forms of help

 

  1. Psychotherapy

     

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    Psychotherapy / treatment is a process characterized by a time-limited contact between a therapist and a patient / client, in which specific problems are thematized and worked with. Include different therapeutic traditions (for example cognitive behavioral therapy (CBT), psychodynamic therapy, family therapy, and more)

    A useful source that evaluate the effectiveness of specific therapies for different mental health problems is the website to the Cochrane Institute [Cochrane Institute][8] .

     

  2. Online therapy

     

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    Online therapy is similar to traditional therapy or treatment, but is provided by digital means (either phone, video conference, or similar). Digital interventions can include a broader range of options, such as therapist-guided self-help programs online.

    The current research literature provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity [Barak et al., 2008][9] .

     

  3. Support / self-help groups

     

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    Support / self-help groups can take a variety of forms, from providing a safe and supportive social environment; more or less structured group meetings; information and guidance relating to how to use available help services; and a lot more.

    While it is difficult to know the effectiveness of such services, due to very different compositions of support and self-help services, the research generally show the self-help groups may have important benefits for the participants [Kurouz et al., 2002][10] .

     

  4. Helplines and chats

     

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    Different helplines and chats exist. Some helplines are specialized in providing you with information and guidance, while others are more specialized in providing emotional support. Some helplines are highly professional, while others are more based on voluntary workers, that merely wish to be a caring listener.

    It is difficult to evalute how effective such services are, and it probably depends on many factors. For example, while the state of the science regarding the effectiveness of crisis response services remains limited, overall results provide support for such services [Hoffberg et al, 2020][11] .

     

  5. Online communities and forums

     

    find-help-mental-health-problems

     

    Online communities and forums are options to get in contact with other individuals that struggle with something similar to you or someone you know. Some communities are moderated by professional health workers, while most of them are not.

    Online communities is traditionally not understood as a support or health service, but rather a social area - that may have the potential of being supportive for the individual that uses it. Importantly, research has shown that "people with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours" [Naslund et al., 2016][12] .

    This seems to indicate that online communites should not be underevaluated as a potential resource to recovery, coping and enhanced quality of life for people affected by mental health problems.

     

 

Find help for depression where you live

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References & Footnotes
  1. ICD-10: World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research (Vol. 2). World Health Organization.
  2. Richards, 2011: Richards, D. (2011). Prevalence and clinical course of depression: a review. Clinical psychology review31(7), 1117-1125.
  3. NHI, 2019: Depresjon, en oversikt [Depression, an overview] (2019). NHI. Retrieved 9th of February 2021 from: https://nhi.no/sykdommer/psykisk-helse/depresjon/depresjon-en-oversikt/
  4. Abbass et al., 2014: Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., ... & Crowe, E. (2014). Short‐term psychodynamic psychotherapies for common mental disorders. Cochrane database of systematic reviews, (7).
  5. Barbato & D'Avanzo, 2006: Barbato, A., & D'Avanzo, B. B. (2006). Marital therapy for depression. Cochrane Database of Systematic Reviews, (2).
  6. Cooney et al., 2013: Cooney, G. M., Dwan, K., Greig, C. A., Lawlor, D. A., Rimer, J., Waugh, F. R., ... & Mead, G. E. (2013). Exercise for depression. Cochrane database of systematic reviews, (9).
  7. Vallury et al., 2015: Vallury, K. D., Jones, M., & Oosterbroek, C. (2015). Computerized cognitive behavior therapy for anxiety and depression in rural areas: a systematic review. Journal of medical Internet research17(6), e139.
  8. Cochrane Institute: Cochrane Institute: "Trusted evidence. Informed decisions. Better health." Retrieved 9th of February 2020 from: https://www.cochrane.org/
  9. Barak et al., 2008: Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services26(2-4), 109-160.
  10. Kurouz et al., 2002: Kyrouz, E. M., Humphreys, K., & Loomis, C. (2002). A review of research on the effectiveness of self-help mutual aid groups. British Journal of Clinical Psychology33, 198-200.
  11. Hoffberg et al, 2020: Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in public health7, 399.
  12. Naslund et al., 2016: Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences25(2), 113-122.