Depression

Depression is a mood disorder and is also called depressive disorder niche.
Depression is characterized by a depressed mood and loss of interest in almost all daily activities.

Different types

A distinction is made between mild, moderate and severe depression; although the distinction is not always clear. The distinction is particularly important for the type of assistance that is applied.

In the case of mild depression, the symptoms often persist for no longer than three months. Someone can usually continue to function independently or with little help. The general practitioner can keep an eye on the course of these symptoms.

In a moderately serious or severe depression, things will get worse with someone in a number of weeks, and he will get more and more serious complaints. There is little chance that the symptoms will pass away by themselves. Quick help from experienced care providers is needed in this group.

In addition to these most common depressions, there are various subtypes, such as postpartum depression, seasonal depression or manic-depressive disorder (bipolar disorder).

Causes of depression

Depression is a complex condition in which the brain plays an important role. Scientists believe that depression is caused by a combination of biological, social and psychological factors.

Biological factors

Research has shown that brain areas involved in emotion and mood, such as the amygdala, show changes in depression patients. The hippocampus, involved in memory, appears to be smaller in people during a depressive episode.
People with another mental disorder or chronic physical illness, such as dementia or Parkinson’s disease, have an increased risk of depression. Depression can also occur after contracting non-born brain injury, such as stroke or contusion.

Social factors

Drastic life events lead to an increased risk of depression. Think of the death of a close relative, divorce, moving house or leaving home of children. Traumatic childhood experiences such as abuse also increase the risk of depression.

Psychological factors

Certain personal characteristics or character traits lead to an increased risk of depression. Examples are low self-confidence, perfectionism and difficulty asking for support.

Symptoms

A person has a depressive disorder if he or she suffers from the following symptoms for at least two weeks to such an extent that he or she suffers from severe functional limitations.

At least one of two core symptoms must be present:

• A depressed mood (gloominess) for most of the day, almost every day (in children, adolescents or the elderly this can be a irritable mood)
• Severe loss of interest in almost all activities for most of the day, almost every day

And at least three of the symptoms below are present:

• Eating problems and changes in weight
•  Sleep problems (more or less sleep)
• Being agitated and restless or inhibited
• Fatigue and loss of energy
• Feelings of worthlessness or excessive guilt
• Concentration problems, delayed thinking and indecisiveness
• Recurring thoughts of death or suicide.

Other common symptoms of depression include anxiety, constipation, libido loss and memory problems. Psychomotor symptoms such as delayed motor skills, reduced facial expressions, collapsed posture and depressed vision can also occur.

Diagnosis of depression

Depression cannot (yet) be determined by means of a physical examination. The diagnosis is entirely based on a psychiatric examination and what someone says about their medical history. Depression is not always easy to recognize, because physical complaints can also occur first.

Treatment

Depression is often easy to treat. The GP is the first designated person for this. The treatment is, according to the national Depression Guideline, step by step from as light as possible to heavy; also called ‘stepped care’. This means minimal help if possible and intensive help if necessary. Therapies that can be applied include e-health, conversation therapy, mindfulness training or treatment with medication.

Special attention for home treatment is for Colorlight Therapy (see www.tweaklite.com).

Consequences of depression

Depression has a variable and erratic course and its duration varies from person to person. Depression can occur during a certain period, disappear again and never return. The chance that a depression will return is 40% to 60%. At 15%, the depression becomes chronic.

When the depression does not recover well, people are often severely restricted in their social and societal functioning. Living with someone who has a depression is heavy and stressful. Partners of people with depression can, for example, end up in social isolation, get the feeling that they are losing their partner or are confronted with changes in their relationship.

Prevention

Some preventive interventions have now been shown to actually prevent new cases of depression. If beginning, mildly depressive symptoms are noticed early, internet interventions or group courses can prevent them from developing into a complete depression.

Figures

Every year, more than 285,000 adults develop their first depression. Depression is more common among women than among men. Of the adult Dutch population up to the age of 65, 18.7% have ever had a depressive disorder in life. Depression mainly occurs between the ages of 25 and 45 and is less common among the elderly and children. Severe forms of depression occur mainly in people over the age of 40.