Do you feel tired too? Let's talk about depression.

It's normal to feel sad and anxious at times. But sometimes, if this sadness and lack of interest continues for weeks, it can be more than just normal sadness. Today we are going to talk about such a condition, that is, depression, or as many people call it, ``Depression``. This is a topic that is really common among many people, but is not really discussed.

What exactly is depression?

Simply put, depression is a condition that affects your mood, a ``mood disorder'' as doctors call it. In this, you feel constantly sad, frustrated, and hopeless. You may lose interest in doing things you used to enjoy. Imagine, you no longer have the desire to see a movie, meet a friend, or read a book. Not only that, but it can also greatly affect the way you think, remember things, eat, and sleep at night.

It's normal to feel sad and depressed during difficult times in life, like when you lose your job, lose a loved one, or face a major problem. It's human nature. But depression is something completely different. It 's a constant feeling of sadness that lasts for at least two weeks, and it's accompanied by a host of other symptoms.

There are different types of depression. We doctors call it ``Clinical depression'' or ``major depressive disorder (MDD)'', which is often referred to as ''depression''. This is the most severe and most common type of depression in society.

The important thing is that if left untreated, depression can get worse, last a long time, and have a significant impact on your life. In some severe cases, you may even have thoughts of harming yourself or ending your life. But the good news is that with the right treatment, these symptoms can be largely controlled and managed. So there is nothing to be afraid of or ashamed of.

What are the main types of depression?

According to the American Psychiatric Association's classification (DSM-5), there are several types of depression. Let's take a look at the main ones, and try to understand them simply:

• Clinical depression / major depressive disorder (MDD): In this, you feel unbearably sad, hopeless, and worthless for several days, at least two weeks. Along with this, you may have symptoms such as sleep problems (insomnia or excessive sleeping), loss of interest in things you used to enjoy, significant changes in appetite (increased or decreased), weight changes, fatigue, and difficulty concentrating. This is the most severe and common form of depression.
• Persistent depressive disorder (PDD): This is a condition in which mild to moderate depression persists for at least two years. The symptoms are not as severe as those of major depressive disorder, but they can be life-threatening because they last for a long time. This was previously called dysthymia.
• Disruptive mood dysregulation disorder (DMDD): This is a condition that is seen in young children. They often have severe temper tantrums, lose their temper over minor issues, and are often irritable. Symptoms usually begin before the age of 10.
• Premenstrual dysphoric disorder (PMDD): This is a condition that affects women. Along with the typical PMS symptoms, there are also severe psychological symptoms such as intense anger, anxiety, irritability, or depression. Although these symptoms subside within a few days after menstruation begins, they can sometimes be so severe that they interfere with daily activities.
• Depressive disorder due to another medical condition: Some physical illnesses can cause depression by causing hormonal and chemical changes in the body. For example, hypothyroidism (underactive thyroid), heart disease, Parkinson's disease, cancer, and chronic pain conditions. Treating the underlying condition often helps with depression.

In addition, there are specific forms of ``major depressive disorder'':

• Seasonal affective disorder (SAD): This is also a type of `(major depressive disorder)`. It appears especially in certain seasons, for example, during the cold, rainy season (in our country, it can affect some people during the rainy season), and then disappears during the sunny, dry season.
• Prenatal depression and postpartum depression: Depression that occurs during pregnancy is called ``Prenatal depression.'' Depression that occurs within four weeks of giving birth is called ``Postpartum depression.'' This is a problem that affects many mothers, but is not talked about. Doctors call both ``major depressive disorder (MDD) with peripartum onset.''
• Atypical depression: The symptoms of this type are a little different from "typical" depression. The main difference is that when something good happens, or someone says something nice, the mood temporarily improves (mood reactivity). But the happiness does not increase. Other symptoms include increased appetite (especially for carbohydrates), sleeping more than necessary, feeling heavy in the limbs, and fear of rejection by others (rejection sensitivity).

Important: People with bipolar disorder can experience periods of depression, along with periods of high activity, excitement, and mania, or hypomania. Therefore, it is essential to differentiate these conditions for treatment.

Who is most affected by depression?

In fact, depression can affect anyone . It can affect children, teenagers, adults, men, women, and everyone. It doesn't matter what your social status, economic status, or education level is.

However, there are certain risk factors that can increase your risk of developing depression. For example, depression is more common in people with the following conditions:

• Diseases that gradually deteriorate the nervous system, such as Alzheimer's disease and Parkinson's disease.
• Stroke.
• `Multiple sclerosis`.
• Seizure disorders like epilepsy.
• Cancer.
• Macular degeneration.
• Chronic pain (e.g., persistent back pain, joint pain).

How common is depression?

Depression is actually a very common condition. According to the World Health Organization, millions of people around the world suffer from depression. Some research suggests that one in six adults will experience depression at some point in their lives.

However, experts believe that these figures are lower than they actually are because many people are reluctant to talk about their mental health problems, do not seek medical advice for symptoms of depression, and do not receive a diagnosis. This situation can be seen in Sri Lanka to a greater or lesser extent. Perhaps someone you know, or someone in your family, has had a similar experience, but they may not be talking about it.

What are the symptoms of depression?

The symptoms of depression can vary slightly depending on the type. They can range from mild to severe. Not everyone will experience all of the symptoms. In general, you may experience one or more of the following:

• A persistent feeling of extreme sadness, hopelessness, emptiness, or worry. Young children and adolescents who are depressed may show more anger, irritability, and aggression than sadness.
• Things that used to be enjoyable and enjoyable are no longer enjoyable or interesting (e.g. hobbies, spending time with friends, listening to music).
• Getting angry easily, getting agitated, losing patience.
• Eating more than you should or losing your appetite completely. This can lead to sudden weight gain or loss.
• Sleep problems: Insomnia, excessive sleepiness during the day, or excessive sleeping (hypersomnia).
• Fatigue is a feeling of lack of energy, a feeling of being tired all the time. You may feel very tired even after doing a small task.
• Difficulty concentrating, making decisions, and remembering things. It can feel like your head is covered in fog.
• Physical discomfort: Things like headaches, stomach aches, muscle pain, or sexual dysfunction that come without an obvious cause.
• Feeling guilty about yourself, feeling worthless.
• Frequent thoughts of death, self-harm, or suicide.

Very important: If you or someone you know is having suicidal thoughts, please don't keep it to yourself. It's not a sign of weakness, it's a cry for help. Call Friends of Sri Lanka (phone numbers: 0112692909, 0112682535) or the National Mental Health Helpline 1926. They are ready to listen and help you. Or go to the nearest hospital emergency department immediately.

What are the causes of depression?

Researchers still don't know exactly what the single cause of depression is. But it is currently accepted that several factors come together to cause this condition. They are:

• Brain chemistry: An imbalance in the chemicals in our brain called neurotransmitters (such as serotonin, dopamine, and norepinephrine) is a major contributor to depression. These help regulate things like our mood, sleep, and appetite. It's like a malfunction in a switch or circuit that controls our mood.
• Genetics: If someone in your family (whether a biological parent, sibling, or child) has depression, you are slightly more likely to develop it than the average person. This means that there may be a genetic predisposition. However, it is important to remember that depression can also develop without a family history.
• Stressful life events: Depression can be triggered by difficult experiences such as the sudden loss of a loved one, a serious accident, sexual or physical abuse, divorce, job loss, financial problems, loneliness, social isolation, and lack of support. Sometimes, a series of small problems can come together to cause this condition.
• Medical conditions: Some chronic physical illnesses can also cause depression. For example, thyroid disease, heart disease, diabetes, Parkinson's disease, cancer, and chronic pain. The physical discomfort, lifestyle changes, and stress that come with these illnesses can lead to depression.
• Medication and Substance Use: Depression can be a side effect of certain medications (e.g., some high blood pressure medications, hormones). Alcohol and other drug use are also major causes of depression or can worsen existing depression.

How to diagnose depression? (Diagnosis)

Depression is diagnosed by a qualified doctor, psychiatrist, or psychologist. They will ask you a detailed question about your symptoms. This includes what symptoms you have, how long they have been present, and how they are affecting your daily life. They will also ask about your family history of mental illness, your medical history, and any medications you are taking.

To be diagnosed with depression, you must have five or more of the above symptoms, usually every day, for at least two weeks. And the symptoms must significantly interfere with your social, occupational, or other important areas of life.

Your doctor may also order medical tests, such as blood tests, to determine if your depression symptoms are caused by another underlying physical condition (e.g., thyroid problems, vitamin deficiencies).

How is depression treated?

Depression is a very treatable mental health condition. In fact, a significant number of people who seek treatment, between 80% and 90%, respond well to treatment and recover. So, don't think, "This will never get better."

There are several treatment options, and often a combination of one or more of these is used:

• Psychotherapy: This is also called talk therapy. This involves talking to a mental health professional (psychologist, psychotherapist) about your problems, feelings, and thoughts. Your therapist will help you identify and change unhealthy feelings, thought patterns, and behaviors, and find better ways to cope with your problems. There are many types of psychotherapy. Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) are two of the most commonly used. Sometimes, only a short-term treatment (a few sessions) is needed. For others, therapy may continue for months or even years.
• Medication: Prescription medications called antidepressants help correct the chemical imbalances in the brain that cause depression. There are different types of antidepressants (e.g., SSRIs, SNRIs, TCAs). Your doctor will choose the one that works best for you and has the fewest side effects. These medications may not work right away; it may take several weeks. Also, some antidepressants can have side effects (such as drowsiness, dizziness, and stomach upset), but these usually go away over time. If they don't go away, or if they become intolerable, talk to your doctor. Never stop taking your medication or change the dosage without your doctor's advice.
• Complementary medicine: These are treatments that can be used alongside or in addition to conventional Western medicine. For people with mild depression or persistent symptoms, treatments such as acupuncture, massage, hypnosis, and biofeedback may provide some relief. However, it is important to talk to a doctor before using these as a replacement for mainstream treatment.
• Brain stimulation therapy: These treatments can help people with severe depression or depression accompanied by psychosis who have not responded well to other treatments. Examples include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and vagus nerve stimulation (VNS). These are done under the supervision of a specialist in a hospital setting.

In addition, there are things you can do at home, through small changes in your lifestyle, to reduce symptoms of depression and help with the healing process:

• Regular exercise: Anything from walking, running, swimming, dancing, etc. Exercise releases chemicals in the brain that improve mood.
• Get good, adequate sleep (not too little, not too much). Get into the habit of going to bed and waking up at the same time every day.
• Eat a healthy, balanced diet. Eat more vegetables, fruits, legumes, and whole grains. Reduce sugary, oily, and processed foods as much as possible.
• Completely abstain from alcohol and drugs. Alcohol is a substance that increases depression and interferes with the effectiveness of antidepressants.
• Spend time with people you love, care about, and support you. Don't be alone.
• Engage in hobbies that bring you joy and relax your mind.
• Practice stress management techniques: things like meditation, yoga, and deep breathing exercises.

What is the prognosis of depression?

The outlook for depression, that is, the nature and timing of recovery, can vary from person to person. It depends on several factors:

• Severity and type of depression.
• Whether it is temporary (e.g. caused by an event) or long-term.
• Whether or not they received proper treatment, and how quickly they started treatment.
• Whether you have other mental illnesses (e.g. anxiety), physical illnesses, or co-occurring conditions such as substance abuse.

The good news is that with proper diagnosis and proper treatment, the vast majority of people with depression can live healthy, fulfilling, and normal lives. However, even after treatment, some people can have a relapse. Therefore, it is important to seek medical advice as early as possible if you feel that your symptoms are starting to return.

Depression if left untreated:

• It could get worse, and the symptoms could worsen.
• Other health problems, such as dementia, can increase the risk of developing conditions such as dementia.
• It can aggravate existing health problems, such as diabetes or chronic pain.
• It can affect every aspect of life, including personal relationships, work, and education.
• Ultimately, it can lead to self-harm or even death.

Depression and other mental illnesses have been identified as a major cause of suicide in Sri Lanka. Therefore , if you or someone you know is having suicidal thoughts, please do not ignore it. Seek professional help immediately. Call Sumithrayo (0112692909, 0112682535) or the National Mental Health Helpline 1926. Or go to the nearest hospital emergency room.

Can depression be prevented?

While depression can't always be prevented, there are things you can do to reduce your risk and help keep your mental health strong:

• Maintaining a healthy sleep (7-8 hours a day).
• Using healthy ways to manage stress. For example, talking to a trusted person without keeping problems bottled up inside, breathing exercises, meditation.
• Engage in self-care activities like regular exercise, meditation, and yoga. Make time for things that bring you joy.
• Maintain strong social relationships. Keep good relationships with family and friends.
• Stay away from alcohol and drugs.

If you've had depression before, you're more likely to have it again. So, as soon as you start experiencing symptoms of depression, don't just wait for it to go away, but get help as soon as possible.

When should you see a doctor about depression?

If you have any of the symptoms of depression mentioned in this article for more than two weeks, and if they are affecting your daily life, work, or relationships, see a doctor or mental health counselor immediately. They can give you an accurate diagnosis and suggest the best treatment options for you.

If you've started treatment for depression and it doesn't seem to be working, or you're having unpleasant side effects that you can't bear, don't be afraid to talk to your doctor. He or she may be able to change the type or dosage of your medication, or recommend a different treatment plan.

Finally, remember (Take-Home Message)

Depression is a very common and potentially serious condition that affects millions of people every year. Anyone can get depressed, even for no apparent reason. It is not a weakness or a symptom. It is a medical condition that requires treatment.

The good news is that depression is a treatable condition. If you have symptoms of depression, don't be afraid, don't be ashamed, and don't suffer alone. Talk to your doctor or someone you trust. The sooner you seek help, the sooner you can get better and enjoy your life again. Don't fight this battle alone, there are many people who can help you and listen to you.

` Depression, mental health, sadness, anxiety, treatment, symptoms