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Prior to COVID, an estimated one in 15 adults was affected by depression in any given year – and since then the pandemic has caused a significant increase in cases of depression. Understanding this complex illness is not easy, but learning as much as possible how to recognize it, the root causes, and tips on self-treatment can help to manage it and create a recovery plan.

Sadness versus clinical depression

Experiencing occasional bouts of sadness is entirely natural and simply unavoidable. As a human being, you have to deal with stress related to work, relationship issues, and sometimes losing a loved one. Sadness is a natural emotion, often triggered by a painful or challenging situation. When that event passes, the sadness starts to fade and eventually disappears.

The real problem starts when these short-lived, self-limited episodes become more intense, persist for a long time, and interfere with daily activities.

Clinical depression is a disproportionate emotional state, affecting thinking, perception and behavior. It often occurs without a trigger, and a person feels depressed about everything. Feelings of joy and pleasure are replaced by feeling guilty, unworthy, and fatigued. Some may experience more anger and irritability.

The diagnosis of a major depressive episode is based on specific criteria and is defined by having at least five out of nine symptoms (see below), including depressed mood or decreased pleasure. Furthermore, these symptoms must be experienced daily, or almost daily, for at least two weeks, and be severe enough to interfere with different areas of life – for example, work and relationships. Finally, other medical conditions that mimic depression, or lead to it, need evaluation before one can arrive at the diagnosis of clinical (or major) depression.

What are the symptoms of clinical depression?

The following nine symptoms are the main symptoms of depression:

  • Depressed mood
  • Significant decreased interest or pleasure in daily activities
  • Significant and unplanned weight loss or gain, changes in appetite (increased or decreased)
  • Feelings of restlessness or slowing down
  • Fatigue, sluggishness, or lack of energy
  • Insomnia or excessive sleeping
  • Feelings of worthlessness or excessive guilt
  • Diminished ability to think, focus, be creative, or make decisions
  • Thoughts of dying or suicide

Depression can be associated with certain features. For example, perinatal depression and premenstrual dysphoric disorder are unique to women. Other types include manic-depression (bipolar) disorder, seasonal affective disorder (SAD), or depression with psychotic features.

What is the real cause of depression?

Depression is a complex condition, as many factors play a role, including genetic and environmental factors. There is a genetic link in some cases, as children, siblings and parents of those with severe depression are at higher risk of developing the illness compared with someone that has no family history of it. Genetic tests may suggest which antidepressants may work better than others, in some cases. Chronic illnesses, including those that cause persistent pain, and certain medications and life factors, can also increase risk of developing depression.

According to one theory, depression is caused by neurotransmitter imbalances. Antidepressants aim to correct the shortage of brain chemicals, particularly serotonin, dopamine and norepinephrine.

Advanced brain-imaging techniques like MRI and CT scans found that the brain shrinks and degenerates in certain areas and lacks optimal levels of oxygen in individuals affected by depression.

Chronic inflammation of the brain is a newer theory that aims at understanding depression. Studies found that individuals with clinical depression have an increased level of inflammation.

The role of the gut flora is gaining more and more attention, too. Also considered the “second brain” the gut contains millions of neurons. The gut flora is important for digestion, supports the immune system and is also a key player in regulating mood. Depression is associated with altered gut flora imbalances.

Is depression a lifelong illness?

Symptoms may disappear spontaneously, especially when they are mild. Those who have had more than one episode of depression are at higher risk of having another and experiencing long-term depression.

However, there is more hope now than ever to find an effective treatment for depression. In addition to antidepressant drugs, psychotherapy and electroconvulsive therapy (ECT), new therapies are currently available: other medications, repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation, and vagus nerve stimulation.

What are the best self-help tips for depression?

In addition to standard treatment and regular follow-ups with your doctor, consider the following tips for depression:

  • Regular exercise is a natural mood booster, increasing the levels of the feelgood chemicals serotonin, dopamine, and GABA as well as oxygen in the brain. Aim for 30-45 minutes most days of the week, alternating strength training, aerobic or HIIT (high intensity interval training) and yoga.
  • Make sure you get enough sleep. Do this in a completely dark, cool, room. Avoid eating large meals or using electronic devices before bedtime. Reduce exposure to news from social media or TV.
  • Eat a clean, healthy, balanced diet. Research found that following the Mediterranean diet helps lower the risk of depression and decreases inflammation. Probiotic rich foods like kefir, yogurt and pickled vegetables help improve the gut flora. Probiotic supplements may also help – a review of multiple studies shows that probiotic use was linked to a significant decrease in depression.

References:

https://www.psychiatry.org/patients-families/depression/what-is-depression

https://www.massgeneral.org/news/coronavirus/depression-on-rise-during-covid-19

https://floridabhcenter.cbcs.usf.edu/wp-content/uploads/2021/03/MDD_Adult-Guidelines-2019-2020.pdf

https://www.merckmanuals.com/professional/psychiatric-disorders/mood-disorders/depressive-disorders?query=Depression

https://academic.oup.com/bmb/article/101/1/127/262645

https://pubmed.ncbi.nlm.nih.gov/30368652/

https://pubmed.ncbi.nlm.nih.gov/32506238/

https://insights.ovid.com/crossref?an=00005792-201707210-00011

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627099/

https://pubmed.ncbi.nlm.nih.gov/27509521/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009747/

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