Depression is an extremely common illness that approximately 27% of people globally experience; the next largest illness below anxiety. Every human being will feel depressed at some time in their life, though there is a difference from the act of feeling depressed, being mood or grief, compared with suffering clinical depression, where it physically impacts the quality of life and becomes a risk to your health / life.

Mood / Grief vs. Depression

Everyone feels down, or depressed, at some stage within their life. Whether it be the death of a loved one, losing your job, a friends trust betrayed or other life event. These are all normal physical and/or environmental factors that change our mood on a day by day basis. The big difference is that moods come and go for the most part, and grief is a perfectly normal part of losing a loved one or relationship. Where depression is more persistent beyond two constant weeks and is impacting your ability to function in daily life.

If you think of it like this, normal moods and grieving lessen over-time, where true clinical depression worsens over-time.

PTSD & Depression

Depression is typically a co-morbid diagnosis to Posttraumatic Stress Disorder (PTSD), which means, without the PTSD, the depression didn’t exist prior to the trauma. If the depression existed prior to the trauma, then you have a depressive disorder regardless of PTSD. Depression is often more severe with PTSD due to the nature that is PTSD. The symptoms of PTSD exacerbate depression. It is extremely common that major depressive disorder is diagnosed in combination with PTSD.

Signs & Symptoms

Some typical signs and symptoms to depression consist:

  • Low self esteem
  • Moodiness that is out of character, increased irritability and frustration
  • Finding it hard to take minor personal criticisms
  • Spending less time with friends and family
  • Loss of interest in food, sex, exercise or other pleasurable activities
  • Changes in sleep patterns
  • Increased alcohol and drug use
  • Staying home from work or school
  • Increased physical health complaints like fatigue or pain
  • Being reckless or taking unnecessary risks (e.g. driving fast or dangerously)
  • Slowing down of thoughts and actions
  • Increase or decrease in food consumption

Signs and symptoms of depression, in combination with PTSD, have overlapping symptoms with the PTSD diagnosis, hence how worsening symptoms occur.

Suicide Prevention

For some people, a symptom of depression may include the feeling of wanting to end their life. Whilst there are some key signs to identifying suicidal preparation, there is no single formula or method to alleviate or stop suicide occurring, as depression has so many unique methods in which the act is performed, where sometimes there are no real indicators. The prevention is achieved through a collective of methods, psychotherapy, pharmacology, support, education and more.

The inherit problem with PTSD and depression, is that its normal to be depressed, so its an aspect that must be managed. Try to remember that thoughts about taking your life are just thoughts. They do not mean you have to act on them, no matter how overwhelming they are or how often you have them. They also don’t mean that you will always have those thoughts.

The #1 rule to suicide prevention is that if you feel someone is depressed, then say something to them, don’t just sit in the background saying nothing. As well for the individual, if you know you’re depressed, then use your countries emergency suicide hotline and talk to a professional that can assist.

Mental Imagery

There is one method that I have used and experienced that has so far been completely bullet-proof to identify suicidal ideation, surrounding thoughts of death and actual risk of suicide itself, before the event. This is mental imagery from Dr Robert Roerich, called “The Road Interview”. A person either thinking of killing themselves, lost someone / about to lose / fear of losing to death or preparing for the act of suicide and making plans, has every time been identified through this method, of which is really not used due to the stigma of mental imagery’s validity within the psychiatric community.

Risk Factors

People assume that depression is caused simply by recent personal difficulties. Depression however, is often caused by a mix of recent events and longer-term personal risk factors.

Research indicates that ongoing difficulties, such as long-term unemployment or living in an abusive relationship, are more likely to cause depression than current life stressors. Sickness and illness is a significant cause of depression. Whilst depression has some genetic markers for increased risk, this doesn’t mean that you will automatically become depressed if a parent or close relative has had the illness. In fact, research has indicated that genetics has little to do with depression, and more life’s traumatic circumstance are the proven significant cause of depression.

Childhood abuse is one of the most prominent causative factors for developing a depressive disorder in adolescence and adulthood, usually in combination with other disorders.

Types of Depression

There are four broad groups in which depression can be categorized, each being explained uniquely. Unfortunately, there is no exact categorization to depression itself outside official diagnostic labels, though this attempts to show some differences in types suffered:

  1. Melancholic (Biological)
  2. Non-Melancholic (Psychological)
  3. Psychotic
  4. Atypical

Melancholic

This type of depression is rare, as it is purely biological causation. The treatment is physical, being pharmacology based. It is not expected to respond to any type of psychotherapy. Those with melancholic depression will often be more severe type, will lack effect to external stimulus, ie. trying to be cheered up or made smile. It will encompass low energy, poor concentration and slowed or agitated movements.

Non-Melancholic

This type of depression is the most common, even in combination with Atypical, in that it is psychological based to stressful events and lifestyle. This type of depression is usually easy to cheer the person up. The normal signs and symptoms of a depressed mood fit this style of depression, with minor social impairment. This type of depression responds well to psychotherapy, pharmacology and alternative treatment options.

Psychotic

This type of depression is less likely than the above two. Psychotic depression often comes with a more severe depressed mood, more severe low energy, concentration and movements, and encompass either delusions or hallucinations with guilt rumination. This type of depression only normally responds to physical treatments, such as pharmacological based treatments.

Atypical

This type of depression is a direct contrast to the primary signs and symptoms associated with other types of depression, in that instead of lacking sleep, you can’t stop sleeping; instead of lacking appetite, you constantly eat for comfort. It is normal to have significant weight gain, excessive sleeping, arms and legs feel heavy and often feel rejected by others.

Treatment Options

There are three main types of treatment for depression, each outlined uniquely. Whilst some types of depression will only respond to a physical treatment, (biological, psychotic or bipolar) such as antidepressants, the majority of depression sufferers will use a combination of all three to achieve recovery:

  1. Psychotherapy (Talk therapy)
  2. Pharmacological (Antidepressant)
  3. Alternatives (Naturopathy)

Psychotherapy

Talk therapy can assist psychological based depression types, or those that encompass psychological basis. Whilst some depressions require primarily a biological treatment, some psychotherapy may also be required to help shift activeness within life if the depression has been longterm, ie. getting someone from being stuck in their negative habits due to biological depression.

The main types of talk therapy used to treat depression are Cognitive Behavioral Therapy (CBT) and Person Centered Therapy (PCT), both being about allowing the patient to more or less find their own solutions through some well structured guidance. Both are very effective in treating clinical depression.

Pharmacology

The first line of defense for biological or psychotic based depression types is Selective Serotonin Reuptake Inhibitor’s (SSRI’s) and Serotonin and Noradrenaline Reuptake Inhibitor’s (SNRI’s). There are then older medication types such as Tricyclic’s (TCA’s) and Irreversible Monoamine Oxidase Inhibitor’s (MAOI’s). Other common medications prescribed may include, anti-psychotics, mood stabilizers and augmenting agents.

Whilst one medication may work well for one person, it may not for another, so as per pharmacological methods dictate, trial and error may be required in order to find the right antidepressant per person.

Alternatives

Whilst some alternative medicine may only be a placebo, if the effect is symptom reduction, then it is just as effective for the individual as another who uses pharmacological treatment. Naturopathy and alternative medicine has a long standing, and in some cases, science backed, accreditation for effectiveness. Whether it be from St John’s Wart, Omega-3 to meditation, relaxation exercises or acupuncture, alternative medicine is valid if it works, regardless whether placebo effect or not.

Regardless of alternative used, it is well documented that with or without other forms of treatment, exercise is a leading method to decrease depression symptoms, whether biological, psychological or both. Whilst by itself, results are marginal, in combination with other treatments, it creates energy which stimulates motivation. For lesser depression it can be extremely effective by itself, though the cause must still be explored and targeted as the root of the issue, typically only psychological based depression.