Depression

Depression Definition

The DSM-5 (diagnostic and statistical manual of mental disorders) classifies depression as a persistent mood disorder. According to the World Health Organization (WHO; 2015), approximately 4% of the world’s population suffered from depression, which is increasing.

Although people can sometimes have bad days or tough weeks, depression sets itself apart due to its persistent low mood for prolonged periods. While people can feel sad because of a traumatic event, people with depression might have negative experiences. They have a low mood because of their depression rather than any experiences.

Depression Symptoms

Although you are probably familiar with the term depression, do you know the symptoms necessary to be diagnosed with it?

There are three categories that the symptoms can fall into – behavioural, emotional, and cognitive.

Depression: Behavioural Symptoms

First, let’s talk about the behavioural symptoms of depression. These symptoms are behavioural changes that a close friend or a family member can observe.

If someone struggling with depression does not share their emotional or cognitive symptoms, a loved one can observe their behavioural symptoms and encourage them to get help.

Behavioural symptoms include:

• Loss of sleep (insomnia) or hypersomnia (depends on person to person)

• Loss of energy for daily activities

• Disturbed appetite (some eat less, and some eat more)

• Withdrawal from others

Fig. 1. Avoiding others is a behavioural symptom of depression.

Depression: Emotional Symptoms

Emotional symptoms or characteristics are the signs you observe in the emotions of a person suffering from depression.

They can sometimes be easy to observe in loved ones, while other times, people hide their emotional symptoms not to worry others.

Emotional symptoms include:

• Intense sadness

• Loss of interest in pleasure activities (apathy)

• Feeling worthless

• Feeling irritable

• Exhibiting anger towards oneself and others

Depression: Cognitive Symptoms

Finally, let’s talk about the cognitive symptoms of depression. Cognitive symptoms or characteristics reflect the thought patterns of a person suffering from depression. Since these are internal, it is difficult for loved ones to be aware of these cognitive changes without being informed.

Cognitive symptoms include:

• Disturbed concentration and focus

• Low self-esteem and confidence

• Affected memory

• Negative thought patterns

• Suicidal thoughts

Negative thoughts are typical cognitive characteristics of depression. They are sometimes irrational and create self-fulfilling prophecies (such as a person believing they are going to fail at something, so they do not try as hard, resulting in a lower score or failure).

To be diagnosed with depression, someone does not have to be experiencing all of the symptoms listed above. However, they have to experience some of them, and those symptoms have to impact their lives negatively.

Causes of Depression

Just like other mental health disorders, depression does not have one definite cause. There can be multiple causes of depression, such as genetic vulnerability, stressful life incidents, medical problems, and side effects of medicines.

There is a genetic component to developing depression. If you have a close family member who has depression, you are at a higher risk of also developing it. It does not mean that you will get it, but rather that you have a higher chance of developing it than if your family member did not have it.

Neurotransmitters can also be attributed to the development of depression. Researchers have found that there can be a correlation between depression and lower serotonin levels.

Most depression medications focus on increasing serotonin levels in the brain to improve the person’s mood.

According to the cognitive approach to depression, there are two main explanations – the three-stage model by Ellis (1977) and Beck’s cognitive triad (1967).

Depression: Three-Stage Model by Ellis (1977)

Ellis suggested one negative event does not trigger depression but that depression results from irrational thoughts triggered by negative events. Ellis proposed the ABC three-stage model that explains how depression can result from irrational thinking.

1. Activating event

2. Belief (irrational or rational)

3. Consequences (beliefs lead to emotions)

According to Ellis, rational beliefs lead to happy and healthy emotions (i.e., avoiding catastrophising an issue or situation). On the other hand, irrational beliefs lead to unhealthy and unhappy emotions (i.e., catastrophising an issue or situation). A tendency towards either rational or irrational thinking leads to different consequences in behaviour.

Depression: Beck’s Cognitive Triad (1967)

Beck’s theory proposed a cognitive explanation of depression that consists of three components:

• Cognitive bias (distorting information, catastrophising it)

• Negative self-schemas (expect themselves to fail, for example)

• Negative triad (maintained by negative self-views, negative world view, and negative view of the future)

According to Beck, cognitive bias and negative self-schemas maintain the negative triad. They occur automatically and regardless of the actual situation.

Depression and Anxiety

Depression and anxiety are two mental health disorders prevalent in today’s society. We have already unpacked the characteristics of depression, so let’s take a closer look at anxiety.

Anxiety is a general term used to describe various symptoms and definitions.

We can say we have anxiety when in a stressful situation, but the actual diagnosis is called generalised anxiety disorder.

People with general anxiety disorder struggle with concentrating, fatigue, sleep, headaches, and worrying.

You can think of depression and anxiety as a two-way street. In some cases, people with depression have anxiety as a symptom of their depression. Other times, people have an anxiety disorder that evolves into depression. Both of these disorders have overlapping symptoms, making them have high comorbidity.

You can have general anxiety and depression, depression with anxiety as a symptom, or generalised anxiety disorder with some depression symptoms. It’s important to research the differences between these two disorders since they are so similar.

Postpartum Depression

After childbirth, moms experience a wide range of emotions – excitement about giving birth, exhaustion from the delivery, and sometimes sadness. Right after birth, moms may experience what is called the “baby blues.”

Most mothers will experience some of these symptoms, but for others, it can persist long past a week postpartum.

Fig. 2. Difficulty connecting with their baby is a symptom of a mother with postpartum depression.

Symptoms of postpartum depression can look like symptoms of depression and can include:

• Crying

• Struggling to connect with the baby

• Fatigue

• Insomnia

• Anger

• Hopelessness

• Panic attacks

• Suicidal thoughts or ideation

Women who experience postpartum depression are more likely to develop depression later on.