Everyone suffers from a dip sometimes, but if such a dip lasts longer, it is not just harmless. You may then suffer from depression.

Difference depressed mood and depression

A depressed mood is different from being depressed. A gloomy depressive mood is often a normal reaction to disappointment or the loss of something or someone. It is then logical that there is a mood drop. Therefore, no antidepressant needs to be given. With depression you have a persistent, continuous (almost daily) depressive mood. This is often accompanied by cognitive disorders (including inability to focus attention, memory defects, orientation problems, language disorder), abnormal behavior and physical complaints.

Symptoms

Depression is a syndrome diagnosis. A syndrome is a series of interrelated phenomena, a complex of symptoms, often characteristic of a particular disease. Depression involves an almost daily occurrence of 3 or more of the following symptoms for at least 2 weeks, with at least one of the first two symptoms being obligate:

1. Sad mood during most of the day
2. Loss of interest or pleasure, no longer being able to be happy
3. Indecision or difficulty concentrating
4. Feelings of worthlessness or guilt
5. Thoughts of death or suicide
6. Agitation or inhibition
7. Fatigue or loss of energy
8. Insomnia or excessive sleeping
9. Change in appetite or weight

The severity of depression

With depression you can also distinguish between mild and severe depression. Mild depression means that you have 3 or 4 of the above symptoms. Mild depression often occurs in the elderly. With severe depression you have 5 or more. This form of depression is more common in people between the ages of 25 and 45. The severity is partly determined by the duration and intensity of symptoms and the consequences for daily life and social functioning.

Prevent

Depression is not a rare disease. 1 in 5 women and 1 in 10 men suffer from depression. Depression is more common in people from a lower income group, and also more often in single people. Many people only suffer from depression for one period in their lives. 40% to 50% of patients have recurrent (recurring) depressive episodes. 15% have chronic depression. Of these, 15% to 20% commit suicide

Types of depression

1. Exogenous or reactive depression

The origin of this form is psychological. And then usually as a result of a traumatizing event or an emotional shock. In this case, the depression is a more or less normal reaction, a period of mourning following a loss. Depending on the loss, such a period can last from 6 months to 1 year.

2. Somatogenous depression

This depression is linked to disease states: cancer, brain damage, chronic diseases, surgical procedures, and can also begin after childbirth.

3. Endogenous depression

The origin of this depression comes from within the body; it has to do with changes within the organism. People think of biochemical disorders in the brain. It can occur without triggering factors. It can also disappear spontaneously, but the disease usually recurs. It must be treated with care. This depression is painful for the person and those around him. There is a high risk of suicide. There are two forms of this type of depression: unipolar and bipolar.Unipolar: This is the most common depression. Comes back in 50 % of cases. In some it can become chronic. Usually the vital functions are affected (eating, sleeping, having sex, etc.).Example: Dysthymic disorder or chronic depression, postpartum depression, winter or seasonal depression, depression in the elderly, depression in the young,

• Dysthymic disorder: mild depression. It lasts at least 2 years. Severity can vary: long periods of being sad, alternating with short periods of being better. Ordinary depression can also occur (double depression).
• Postpartum depression: can begin several weeks to months after delivery. All symptoms of unipolar depression can occur. The priority is not being able to enjoy the baby.
• Winter depression: Functioning worse during winter than during summer. Complaints may include: sadness, depression, sleeping a lot, eating a lot (mainly carbohydrate-rich food), weight gain, irritability, fatigue, withdrawal behavior. You have this for at least two years in a row.
• Depression in the elderly: physical complaints are in the foreground (headache, stomach ache, etc.) the depression is often not recognized. There is not always a sad depressive mood or loss of interest or pleasure. Mood is rather dull, flattened or resigned. You may also suffer from forgetfulness, concentration problems, confusion (DD dementia!)
• Depression in young people: this is often difficult to recognize. Behavioral changes can be examined. In primary school children: are more withdrawn than normal, less interested in things they normally enjoy. And asking for more attention and making trouble. In young people in secondary school: abnormal learning behaviour; worse presentation. In boys, depression takes out on environment. In girls, withdrawing into themselves, worrying, becoming quiet and dull.

Bipolar depression: This is manic depressive disorder (MDS). Its characteristics are extremes in mood and activity. Extremely exuberant and decisive, this is the manic side. And extremely withdrawn and inactive is the depressive side. This depression can have major consequences for the patient himself, for his environment and at work. During the period of extremes, admission to a psychiatric hospital may be necessary.

4. Psychotic depression

This is severe depression. Accompanied by hallucinations and delusions. Occurs following an intense trauma (violence of war, natural disaster, rape, loss of a key figure).

Etiology (cause) and pathogenesis (mode of origin and development)

1. Biological factors:

Could be due to genetic factors. There is a biochemical background (disturbed balance between substances in the brain). Hormonal changes. It can also be caused by a physical illness, such as cerebral hemorrhage, cerebral infarction, diabetes, Parkinson’s disease, cancer, thyroid disorders. It can also be caused by medications such as corticosteroids, medication for high blood pressure, sleeping pills, or by abuse of substances, alcohol, hashish, amphetamines, cocaine and other drugs

2. Psychological factors:

Major life events with a loss or disappointment character. Personal attitude and lifestyle can also be a factor, e.g. a pessimist is more vulnerable than an optimist. Personal skills also determine the extent to which problems are solved, grief is processed or support can be requested. Early psychotrauma (incest, abuse, neglect can result in an increased vulnerability of the personality) can also cause depression.

3. Social factors:

Usually the person has little social and emotional support in his or her environment. The lack of a confidant is also a factor. Single or divorced people are more likely to suffer from depression. And there are more people with depression in the city than in the countryside.

Diagnostics

The GP does not recognize depression in 50%. Mild forms of depression are often hidden behind other physical complaints such as pain, insomnia, fatigue, and weight loss. This is also called masked depression.

Consider depression if:

If there are complaints about a depressed mood, or the person appears gloomy. Little eye contact is made. And the person has monotonous speech and slow motor skills. The person often visits the doctor and has varying complaints. The complaints may include nervousness or insomnia, persistent fatigue without a physical cause and chronic pain. They often request to receive sleeping pills or sedatives. You should pay attention to whether these people have an alcohol or drug problem, anxiety or panic disorders, serious physical illness. You should also pay attention to patients who have had severe depression(s) or suicide attempt(s) in the past. Or in patients with (first-degree) relatives with severe depression(s) or suicide attempt(s)

Anamnesis (the history of a disease)

The purpose of an anamnesis is to determine whether depression exists, to determine the severity of the depression, to detect possible causes and to rule out other conditions. During an anamnesis, attention is paid to the way in which the patient responds. The feeling that the doctor gets, he must avoid a hasty impression. It is important not to interrupt a patient and to accept silences. It should be determined whether there is a depressed mood or loss of interest or pleasure. If the answer is yes to one of those questions, you should inquire about the duration, course (almost daily) and other symptoms (indecisiveness, concentration problems, agitation, inhibition, fatigue, sleep problems, appetite, worthlessness, feelings of guilt, suicide, etc.).It is also important to assess suicide risk!

• How strong is the death wish?
• How compelling are the suicidal thoughts?
• Is there a detailed suicide plan?
• Suicide (attempts) in the family?
• Patient already attempted suicide in the past? (if attempt is recent, chance of new attempt is high)
• The severity and solvability of any psychosocial problems help determine the suicide risk

Furthermore, questions are asked about living and working conditions. Whether the patient has had manic episodes, hallucinations, delusions, anxiety, and alcohol or drug problems. The behavior is observed (agitation = restlessness, inhibition = slow motor skills and delayed speech). And physical conditions are excluded (hyperthyroidism, dementia, Parkinson’s disease, etc.).

Physical and additional examination

This is not necessary to diagnose depression. Only when there are indications of other conditions. With the exception of the elderly, as differential diagnosis is often difficult

Evaluation

It is determined whether the depression is a mild form or a serious one. There is a separate policy for:

• Significantly increased suicide risk following acute psychiatric assistance
• Bipolar disorder or psychotic depression à psychiatrist
• Treat alcohol or drug problems in a targeted manner
• Physical comorbidity – optimally treat physical disorders in addition to depression

Therapy

Guidance and talking:

Complaints, course and suicide risk are evaluated here. And attention is paid to emotion. If the patient is at risk of suicide, key figures can be informed (only with the patient’s agreement!). You are also asked about your performance at home and at work. and the background of the depression is further investigated. This is talk therapy or psychotherapy. Short-term goals are set together with the patient.

Drug therapy:

Antidepressant: This has little effect on mild depression. But with severe depression, yes, provided there is also talk. However, the effect of the medication only occurs after 2 to 4 weeks. It is important that the patient is adherent to treatment! The side effects of the medications are mainly at the beginning of the treatment, these are palpitations, dizziness, dry mouth, drowsiness. The chemically disturbed balance in the brain must be adjusted. The therapy must be continued for 6 to 9 months, after which it should not be stopped suddenly, but gradually reduced. The medication can become addictive, this should be avoided.Sedatives or sleeping pills: These can be given temporarily at the beginning of the treatment. This medication works immediately. However, it has no direct influence on depression. This drug is also addictive and at some point you get used to the drug.Light therapy With light therapy, the patient is exposed to strong light without UV radiation. This influences the day /night rhythm. It is used in people with winter depression. It is not addictive and is a very safe method. The therapy lasts about 5 to 10 days.Electro Convulsion Therapy During electroshock treatment, the brain is influenced with electrical current. This is done under anesthesia.

Consequences for the environment

Those close to you can suffer greatly from depression. There are social consequences such as absenteeism, medical consumption is high, consultation of specialists, many medications, many unnecessary examinations.