Unmasking the invisible struggle: taking a closer look at depression
Behind the seemingly ordinary façade of daily life, it is normal to experience challenges that may impact a person’s view of the world. Daily stressors have always been a part of life – but for some, these may also become evidently disabling.
Depression affects about 280 million people worldwide and has been defined as one of the most common mental health disorders by the World Health Organisation (2023). Its latent nature is among the reasons why it may be challenging to identify to the untrained eye and also to the patients themselves.
This article aims to demystify and destigmatise depression by offering an overview of the symptoms and characteristics of depression, its treatment and ways in which one can recognise and help an individual recover from a mental health crisis.
“Let us all work together to destigmatise mental health issues
According to the American Psychiatric Association (2022), depression is primarily characterised by a period of persistent low mood; defined by feelings of worthlessness, hopelessness and loss of pleasure in daily activities.
In tandem with these symptoms, an individual must also experience at least five of the following symptoms, for a minimum period of two weeks, in order to be diagnosed: “lack of energy, poor concentration, appetite changes, agitation, a lack of sleep or daytime somnolence, and in some cases, suicidal ideation.” (Abdijadid & Bains, 2023).
Depression in children may have a similar presentation to adults, albeit they may also have a tendency to present with irritability rather than low mood. The severity of the symptoms may vary according to the patient and may span from mild to severe depression. Rarely, depression may also present with psychotic features, where the individual may also experience hallucinations or delusions, which tend to detach the patient from reality.
Depression is a highly prevalent disorder with an average lifetime prevalence of about 12 per cent, with the rate being almost doubled in women than in men. It is believed that the cause of this distinction is multifaceted, including a “greater hormonal imbalance in women, childbirth effects and other different psychological stressors that women are faced with” (Abdijadid & Bains, 2023).
Although depression may appear at any age and may also be present in children, the likelihood of onset statistically increases with puberty, hence placing the peak age at 20-25 years. Despite this, many studies show that a first onset of depression in later life is not uncommon.
It has also been found that “depression is more common in people without close interpersonal relationships” due to a lack of intimate interactions (Abdijadid & Bains, 2023). In such cases, pets have proven to be highly beneficial in offering a safe space and a non-judgemental companion which may improve the patient’s feelings of loneliness.
Unfortunately, depressed patients often have other co-morbidities that may further stimulate the progression of the disorder, hence making treatment and remission more challenging. Among the most common co-morbidities associated with depression are anxiety disorders, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), eating disorders, panic disorder and bipolar disorder. Substance misuse disorders may also be present.
The most immediately threatening co-occurrence is suicidal behaviour due to the immediate danger that it poses to the patient’s life. Unfortunately, certain meta-analyses have found that “about two-thirds of individuals with depression do contemplate suicide, and about 10 to 15% eventually commit suicide, with men being the most likely to do so” (Abdijadid & Bains, 2023).
Untreated depressive episodes tend to last for six to 12 months, and in most cases become chronic “with a recurrence rate of up to 50% after the first episode and 90% after the third episode” (Abdijadid & Bains, 2023). When treated, the prognosis is very good in patients with mild to moderate depression, although this may vary according to social resources, support system and co-morbidities.
Treatment for depression usually includes specific drug therapy, according to the patient’s needs. It is good to note that patients who are started on depression medication do not experience the full therapeutic effect immediately and may take around six to eight weeks to do so. Thus, it is highly advised that the therapeutic regime is adhered to.
In many cases, psychotherapy may be very effective, even without drug therapy, and may offer significant enlightenment as to how a person may deal with certain feelings and get through certain difficult situations. For some, the use of psychotherapy alone may be enough to combat depression. In patients who need medication or are already on it, therapy may be used in combination in order to complement the drugs’ effects by learning how to alter perception and deal with life’s challenges in a more mindful and psychologically enlightened way.
Patient education has a profound impact on the overall outcome of depression. Unfortunately, many people in different parts of the world are still hesitant to discuss and seek treatment for depression due to the stigma associated with mental illnesses (Abdijadid & Bains, 2023).
Let us all work together to destigmatise mental health issues, so that patients and their relatives will be able to seek early professional help whenever needed.
If you need immediate emotional support, need practical advice or would like to know more about available services, call the mental health helpline 1579.
Georgiana Farrugia Bonnici is a medical doctor and Gabriel Falzon is a psychology and English university student.