By Dr Rabin Bista

Everyone has felt sad or depressed at times. But when feelings of intense sadness — including feeling helpless, hopeless and worthless lasting for many days to weeks and which keep you from functioning normally, your depression may be something more than sadness. It may be clinical depression — a treatable medical condition.
Depression is when feelings of loss, anger, sadness, or frustration make it hard for a person to do things he enjoys in everyday life. Although everyone feels sad at times, depression lasts longer and interferes with your daily life.
The World Health Organisation (WHO) ranks depression as one of the world’s most disabling diseases. Yet with treatment, 70% of people with clinical depression can improve, often in a matter of weeks.
It can be mild, moderate, or severe. One can have a single episode of depression, or depression that comes back or lasts a long time (more than 2 years). Many experts think that depression is a chronic illness that needs long-term treatment. The primary types of depression include:
Major depression: A person must be depressed for at least 2 weeks but often for as long as 20 weeks.
Dysthymia:  A long-lasting, less severe form of depression. Symptoms are like those of major depression but more mild. People with dysthymia have a greater risk of major depression.
Atypical depression: Unlike those with major depression, people with atypical depression can feel better for a while when something good happens. In addition, people with atypical depression have different symptoms than those with major depression. Despite its name, atypical depression may be the most common type of depression. Adjustment disorder occurs when someone’s response to a major life event, such as the death of a loved one, causes symptoms of depression.

How do I know?
A person with depression has trouble enjoying things that they used to love to do. How severe they are, how frequent, and how long they last will vary depending on the individual and his or her particular illness. Here are common symptoms people with depression experience:
l Difficulty concentrating, remembering details and making decisions.
l Fatigue and decreased energy.
l Feelings of guilt, worthlessness, and/or helplessness.
l Feelings of hopelessness and/or pessimism.
l Insomnia, early morning wakefulness, or excessive sleeping.
l Irritability, restlessness.
l Loss of interest in activities or hobbies once pleasurable, including sex.
l Loss of pleasure in life.
l Overeating or appetite loss.
l Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.
l Persistent sad, anxious, or “empty” feelings.
l Thoughts of suicide or suicide attempts.
l For a diagnosis of depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. Generally, symptoms that occur within two months of the loss of a loved one are not considered to be clinical depression.

Causes of depression
Although exact reasons causing depression is not known, it is considered to be a combination of physical, genetic and environmental factors. People with depression may have abnormal levels of brain chemicals called neurotransmitters, including serotonin, dopamine, and norepinephrine. These things may contribute to having depression:
l Heredity — a gene called SERT that controls the brain chemical serotonin has been linked to depression. In addition, some studies show that people with depressed family members are more likely to be depressed.
l Changes in the brain – few studies suggest that people with depression may have physical changes in their brains.
l Long-term stress, such as from loss, abuse, or being deprived as a child.
l Being exposed to low levels of light, in seasonal affective disorder (SAD).
l Sleep problems.
l Social isolation.
l Lack of sufficient vitamins and minerals.
l Serious medical conditions, such as heart attack or cancer.
l Certain medications, including those for high blood pressure, high cholesterol, or irregular heartbeat.

Are you getting
treatment for it?
If not, you’re not alone. About two-thirds of people with major depression never seek appropriate treatment, and the consequences can be devastating: personal suffering missed work, broken marriages, health problems and sometimes even death. People with depression have different options for treatment. Most experts think a combination of psychotherapy and antidepressants is best, especially for people with major depression.

Lifestyle factors
Exercise
Studies show that regular exercise — either aerobic or strength and flexibility training — can reduce depression in people with mild-to-moderate depression.  Exercise has also proven to improve the mood of the people with severe depression. Some studies even suggest that exercise may work as well as psychotherapy for people with mild-to-moderate depression. In the meantime, it makes sense to get exercise while you are having any other treatment, including medications.

Light therapy
Light therapy is being exposed to a bright light as soon as the person wakes up in the morning. It is known to make a difference for people with seasonal affective disorder (SAD).

Medications
There are different classes of antidepressant medications and each type has different side effects. Fortunately, all classes of antidepressants are effective. The patient and doctor just have to find the one that works best for the individual. In fact, 60 to 70% of depressed patients who are given an antidepressant recover from their depression in three to six weeks, provided that the dose is sufficient and that the patients take their medication each day as prescribed.
Most medications take 2-4 weeks to start working, and may take up to 12 weeks to have their full effects. Antidepressants can have side effects such as insomnia, sexual dysfunction, headache, stomach upset, weight gain etc, making it hard for some people to keep taking their medications. Often you and your doctor can work together to find a medication that has fewer side effects. Do not stop your medication without talking to your doctor. Most antidepressants cause withdrawal symptoms if they are not stopped slowly over time or tapered down.

Surgery and other procedures
Electroconvulsive Therapy (ECT) for depression is usually used when all other therapies have not worked. In ECT, a small electrical current is passed through the brain to cause a seizure. Scientists aren’t sure how ECT works, but it may boost levels of neurotransmitters in the brain. It may cause temporary confusion and memory loss, headache, muscle aches, irregular heart rhythm, or nausea. For some people, it relieves severe depression and works quickly.

Nutrition and dietary supplements
A treatment plan for depression may include complementary and alternative therapies. Preliminary studies suggest that some nutritional supplements may reduce the symptoms of depression for some people. It’s important to talk to your team of healthcare providers about the best ways to use these therapies in your overall treatment plan.
Don’t try to treat moderate or severe depression on your own. Always tell your healthcare provider about the herbs and supplements you are using or considering using.
Supplements such as SAMe (s-adenosyl-L-methionine), 5-HTP (5-hydroxytryptophan), Omega-3 fatty acids, Vitamin B6  may help reduce symptoms, but it is utmost important to consult the concerned doctor before taking these supplements.

Acupuncture
Two randomised clinical trials suggest that electroacupuncture may reduce symptoms of depression. In electroacupuncture, a small current runs through acupuncture needles. Other studies suggest that acupuncture may help people with mild depression and those with depression related to a chronic medical illness. More research is needed.

Massage and physical therapy
Studies of depressed mothers, children hospitalised for depression, and women with eating disorders suggest that massage can help reduce stress, anxiety, and symptoms of depression.

Mind-body medicine
Mind-body therapies and techniques may be useful as a part of an overall treatment regimen for depression. Tai chi, yoga and meditation work well for people with mild-to-moderate depression and sometimes even prevent depressions from coming back.

- Dr Rabin Bista is a general practitioner at Aster Medical Centre in Industrial Area.