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  • Andrea Nizic

Depression


What is depression?

Depression falls under the category of mood disorders and is characterized by continuous feelings of sadness, emptiness, and/or irritability along with somatic and cognitive changes which are significant enough to impact daily life (American Psychiatric Association, 2013). In 2019, 280 million people worldwide were living with depressive disorders, a number which rose significantly due to the COVID-19 pandemic (World Health Organization, 2022) and it is a disorder which affects individuals of all walks of life.

 

Stressful life events, such as loss, romantic break up, bullying, and parent-child conflicts, often precede the occurrence of depressive symptoms in adolescents, especially among girls and overall, the prevalence of depression is higher amongst women than men (WHO, 2022). Although the exact underlying cause of this is unknown, it is thought that the increased prevalence of depression may be triggered by hormonal fluctuations such as during puberty, following pregnancy, and at perimenopause (Albert, 2015). The reasoning behind this could also be due to the female tendency to ruminate, increases in stress and maladaptive responses to these stressors (Garber, 2006). 

 

Males are more likely to report externalizing symptoms such as aggression, substance use, and risk-taking behaviours which do not fit the diagnostic criteria in the first stages of depression, and this could result in a possible under-diagnosis of male depression cases (Cavanagh et al., 2016).

 

The diagnosis of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders 5th ed. (DSM-5)

Although there are different types of mood disorders, the most common form is known as Major Depressive Disorder. This disorder is characterized by episodes lasting at least 2 weeks, but often lasting longer. To be diagnosed with this disorder, the DSM-5 requires 5 or more of the following symptoms:

  • Depressed mood

  • Loss of interest or pleasure in many activities

  • Significant unintentional weight loss/gain or decrease/increase in appetite

  • Sleep disturbances

  • Severe psychomotor changes (agitation or retardation)

  • Tiredness or low energy

  • Sense of worthlessness or excessive guilt which may be delusional

  • Impaired ability to think, concentrate, or make decisions

  • Recurrent thoughts about death, suicide, or suicide attempts

 

These symptoms must lead to significant distress or dysfunction in daily functioning and are not due to direct physiological effects of a substance or a medical condition.

 

Depression Across the Lifespan

Although depression can affect a wide range of individuals from different age groups, it may present itself in similar, but not identical ways from childhood to adulthood.


Depressive symptoms within younger children mainly present themselves as somatic symptoms such as loss of appetite, sleeping problems, and stomach pain, where no cause can be established (Mehler-Wex & Kölch, 2008). Older children may experience reduced psychomotor activity, mood swings, sadness, and withdrawal from others. It has also been found that children display a lack of interest in activities they previously enjoyed and have difficulty concentrating in school (Hazell, 2002).

 

Within adolescents, depressive disorders may present themselves through an inability to concentrate, frequent lack of or excessive amount of sleep, lack of energy, decrease in appetite and interest, and a depressed mood (Friedman et al., 1983). It is during these teenage years where symptoms can lead to greater disruptions in daily functioning as compared to children since adolescents may have more responsibilities such as jobs, succeeding in school, and maintaining more advanced social relationships.

 

Symptoms within adults may appear as they do within adolescents, but daily functioning may be more impaired as adults typically have a further increase in responsibility when it comes to family life, careers, and relationships. Within older adults, feelings of sadness or dysphoria are often absent, and depressive symptoms may present themselves through a lack of interest, sleep difficulties, lack of hope, loss of appetite, and thoughts of death (Balsamo et al., 2018).

 

It is important to note that suicidal ideation and thoughts of death may occur amongst all ages.

 

Irritability and Insomnia

Two of the more prominent symptoms of depression include irritability and insomnia. The presence of irritability has been linked to greater severity of depressive symptoms, an earlier age at onset, and a poorer quality of life (Jha et al., 2019). It has also been found that patients who have reported irritability are more likely to experience a chronic course of the disorder with greater number of weeks in a depressive episode.


Insomnia and major depressive disorder also co-occur, and this comorbidity may lead to poorer outcomes for individuals managing both conditions. Further, symptoms of insomnia have been linked to greater severity of depression symptoms (Bei et al., 2015), slower rates of remission from depression, and higher risk of relapse (Franzen & Buysse, 2008). It has been thought that these issues with sleep can occur either as a symptom of depression or as a side effect of treatment.

 

Treatments for depression, such as the introduction of pharmacotherapy via antidepressant use, or

depression-focused psychotherapy have been effective ways to manage numerous forms of depression, especially during the acute phases of a depressive episode (Karrouri et al., 2021). Depression within the later stages of life that is undiagnosed or untreated may result in an increased risk of morbidity, decreased social, cognitive, and physical functioning, and an increase in the dependence on others (Balsamo et al., 2018). With this health problem affecting an immense amount of people worldwide, it is essential that we work to combat and treat symptoms to improve the lives of those impacted. Completing regular screening and assessments for depression is important in this regard.

 

 

Albert, P. R. (2015). Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience, 40(4), 219–221. https://doi.org/10.1503/jpn.150205


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (5th ed.).


Balsamo, M., Cataldi, F., Carlucci, L., Padulo, C., & Fairfield, B. (2018). Assessment of late-life depression via self-report measures: a review. Clinical Interventions in Aging, 13, 2021–2044. https://doi.org/10.2147/CIA.S178943


Bei, B., Ong, J. C., Rajaratnam, S. M. W., & Manber, R. (2015). Chronotype and Improved Sleep Efficiency Independently Predict Depressive Symptom Reduction after Group Cognitive Behavioral Therapy for Insomnia. Journal of Clinical Sleep Medicine, 11(9), 1021–1027. https://doi.org/10.5664/jcsm.5018


Cavanagh A, Wilson C. J., Caputi P., Kavanagh D. J. (2016). Symptom endorsement in men versus women with a diagnosis of depression: A differential item functioning approach. International Journal of Social Psychiatry. 62(6), 549-559. https://doi:10.1177/0020764016653980


Franzen, P. L., & Buysse, D. J. (2008). Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues in Clinical Neuroscience, 10(4), 473–481. https://doi.org/10.31887/DCNS.2008.10.4/plfranzen


Friedman, R. C., Hurt, S. W., Clarkin, J. F., Corn, R., & Aronoff, M. S. (1983). Symptoms of depression among adolescents and young adults. Journal of Affective Disorders, 5(1), 37–43. https://doi.org/10.1016/0165-0327(83)90034-4


Garber, J. (2006). Depression in children and adolescents - Linking risk research and prevention. American Journal of Preventive Medicine, 31(6), S104–S125. https://doi.org/10.1016/j.amepre.2006.07.007


Hazell, P. (2002). Depression in children. BMJ, 325(7358), 229–230. https://doi.org/10.1136/bmj.325.7358.229


Jha, M. K., Minhajuddin, A., South, C., Rush, A. J., & Trivedi, M. H. (2019). Irritability and Its Clinical Utility in Major Depressive Disorder: Prediction of Individual-Level Acute-Phase Outcomes Using Early Changes in Irritability and Depression Severity. The American Journal of Psychiatry, 176(5), 358–366. https://doi.org/10.1176/appi.ajp.2018.18030355


Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges. World journal of clinical cases9(31), 9350–9367. https://doi.org/10.12998/wjcc.v9.i31.9350


Mehler-Wex, C., & Kölch, M. (2008). Depression in children and adolescents. Deutsches Ärzteblatt International, 105(9), 149–155. https://doi.org/10.3238/arztebl.2008.0149


World Health Organization. (2022). World Mental Health Report: Transforming mental health for all. World Health Organization. https://www.who.int/publications/i/item/9789240049338 (accessed May 6, 2024)

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