Depression

What Types Exist?

The classic expression of Depression corresponds to Major Depressive Disorder (symptoms described below), but there are various forms of this illness based on its characteristics and causes:

Persistent Depressive Disorder: Lasts for at least 2 years in adults and 1 year in children.

Pre-Menstrual Dysphoric Disorder: Begins after ovulation and remits a few days after menstruation.

Dysthymia: A depressive mood state that may persist discreetly over years or decades and is irregularly accompanied by major depressive episodes.

Depressive Disorder Induced by Medication / Substance / Medical Condition: Depressive symptoms associated with substance intoxication, withdrawal, medical treatment, or as a physiological consequence of another medical condition.

Disruptive Mood Dysregulation Disorder: Manifests in children and adolescents aged 6 to 18 years (see the 'Child and Adolescent Depression' section).

What Are the Main Signs and Symptoms?

The main symptoms of a Major Depressive Episode are characterized by a depressive mood state observed by oneself (the person may feel sad, empty, or hopeless) or by others (others may notice increased irritability or crying spells) and the loss of interest or pleasure in most activities. These symptoms may be accompanied by other signs, including:

• Changes in weight or appetite, unrelated to diet;
• Insomnia (difficulty falling asleep, waking up during the night, or waking up too early) or hypersomnia (excessive need for sleep);
• Psychomotor agitation or retardation;
• Fatigue or loss of energy;
• Feelings of excessive or even delusional guilt or worthlessness;
• Difficulty concentrating, remembering, and making decisions;
• Recurrent thoughts of death, suicidal ideation, specific suicide plans, or, in severe cases, suicide attempts.

We may be dealing with a depressive episode when these symptoms occur for two consecutive weeks, most of the time. The consequences can vary - while some depressed individuals, even with extra effort, can maintain almost normal functioning, others may be unable to work or care for themselves.

What Are the Possible Causes and Risk Factors?

Biological Factors

• Neurochemical function: Low Dopamine and Serotonin and dysregulation in Adrenaline and Noradrenaline.
• Hormonal function: Changes in Estrogen (stimulates Serotonin production); Testosterone (affects libido and physical and psychological vitality); Progesterone (regulates Estrogen); Cortisol (linked to stress); Hypothyroidism.
• Physical illnesses: Epilepsy; Stroke; Parkinson's disease; Multiple sclerosis; Degenerative brain diseases, among others.
• Genetics: Can explain up to half of the etiology, with Depression being more common in first-degree relatives of depressed patients.

Environmental Factors

• Trauma;
• Physical, psychological, and/or sexual abuse;
• Various losses (relational, professional, etc.);
• Sudden life changes;
• Substance use;
• Social isolation;
• Dysfunctional family contexts;
• Low socioeconomic status and/or limited formal education;
• Racism and other forms of discrimination.

Can It Be Associated with Other Disorders?

Individuals with chronic depressive states are more likely to have anxiety disorders (Panic Disorder, Generalized Anxiety Disorder), Obsessive-Compulsive Disorder, Bipolar Disorder, Post-Traumatic Stress Disorder, eating and body image disorders, substance abuse, or personality disorders, especially Borderline Personality Disorder.

What Is the Prevalence and Mortality?

Statistical data show that Depression is the most prevalent health problem in the European Union, with Portugal being the 5th most prevalent country in the EU and the 7th in the world.

Two-thirds of people who commit suicide suffer from Depression at the time of their death. It is estimated that over 700,000 people commit suicide every year, equivalent to one person every 40 seconds. It is estimated that in Portugal alone, more than 3 people commit suicide every day, and this number may be even higher.

How Can Psychotherapy Help?

First and foremost, seeking help does not mean you are weak or incapable. Do not be ashamed to ask for help. Depression is an international public health issue that can be fatal, and the earlier you seek help, the easier recovery will be.

Psychotherapy, within the context of a safe therapeutic relationship, can help through in-depth work on emotions, thoughts, and behaviors, promoting recovery and change. The effect of psychotherapy on Depression can be as or even more effective than pharmacological treatment, especially in the long term. It can also enhance the effect of medication, preventing relapses. The effectiveness of psychotherapy (individual, couples, or family) has been scientifically proven through different psychotherapeutic approaches:

• Cognitive-Behavioral Therapy (CBT);
• Emotion-Focused Therapy (EFT);
• Existential Therapy;
• Eye Movement Desensitization and Reprocessing (EMDR);
• Mindfulness.

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Association. Coimbra de Matos, A. (2001). Depression. Lisbon: Climepsi.

Cuijpers, P., Quero, S., Noma, H., Ciharova, M., Miguel, C., Karyotaki, E., Cipriani, A., Cristea, I. A., & Furukawa, T. A. (2021). Psychotherapies for depression: A network meta-analysis covering efficacy, acceptability, and long-term outcomes of all main treatment types. World Psychiatry, 20(2).

http://www.eaad.net/
https://www.sppsm.org/
https://www.who.int/news-room/fact-sheets/detail/suicide