Depressive disorder

In everyday life, the word ‘depression’ may refer to many different things. The phenomenon becomes hard to understand as the word is used to describe both an emotion and a mental disorder. ‘Depression’ may refer to temporarily feeling bad as part of life’s normal disappointments, fatigue, melancholy and sadness. Normally these feelings help people change and develop, and no treatment is needed to handle these feelings.

Sometimes ‘depression’ can refer to a depressed state of mind, which can last for a few days or even months, but it does not involve other symptoms that would make life more difficult. Feeling temporarily bad, due to a disappointment in life, for example, or a depressed state of mind are not mental disorders; experiencing these feelings is not a sign of illness, nor are they treated as one.

The difference between grief and depression lies in the fact that grief usually has an object and a cause, such as loosing a job or someone close. Normally a person in mourning handles the feelings and memories concerning the loss inside their own head. Depression, however, rarely has one clear cause.

Depression as a mental disorder involves long-term lowering of mood, as well as other symptoms involving thoughts, feelings, behaviour and the entire body. Once depression is recognised, it can be efficiently treated. 

De­pres­sion rarely has one sin­gle cause

The reasons for depression that needs treatment may vary. Usually depression is a combination of biological, psychological and social factors – there is rarely one obvious cause for depression. Genes, early living environment and events in life will affect how prone to depression the person will become.

For example, a particularly difficult childhood, such as being subjected to physical, mental or sexual abuse or abandonment, will increase the probability of depression. Depression may result when a person is faced with something extremely burdensome, painful or difficult.

Sometimes depression may be caused by a physical factor, such as dementia, hypothyroidism or Parkinson’s disease. The side effects of certain medications, drugs or use of alcohol in general can cause depression in some people. Hormonal factors or the lack of bright light during the winter months may cause depression, as well.

Symp­toms of de­pres­sion

Depending on the severity of the symptoms, the depression may be specified as mild, moderate or severe. Typical symptoms of depression include:

De­pres­sive mood

A depressive mood involves feelings of melancholy, grief, numbness and irritability. The future seems bleak or insignificant. In addition, crying may increase a lot.

Loss of plea­sure

Things that used to bring joy no longer feel pleasing or interesting. The joy of life has been lost.

Fa­tigue

A depressed person is overwhelmed by lack of initiative, inertia and fatigue, and he/she no longer seems to have the energy for even the smallest of things.

Loss of self-con­fi­dence or self-es­teem

Thoughts about inferiority and worthlessness are common; the person no longer has confidence in his/her survival.

Un­rea­son­able self-crit­i­cism or un­founded feel­ings of guilt

Feelings of guilt and deserving to be punished. Feelings of guilt often emerge in connection to situations the person has had no control over or where he/she had done nothing wrong.

Re­peated thoughts of death or self-de­struc­tion or self-de­struc­tive be­hav­iour

A depressed person may harbour thoughts of death and hopes of dying, as well as have suicidal thoughts.

Feel­ings of in­de­ci­sion or the in­abil­ity to con­cen­trate

The person is no longer able to concentrate or take action in matters that used to feel effortless.

Psy­chomo­toric re­tar­da­tion or ag­i­ta­tion

The person may either become paralysed or anxiously hyperactive.

Sleep dis­or­der

A sleep disorder may present itself as difficulties in falling asleep, interrupted sleep and waking up during the early hours of the day, or it may present itself as hypersomnia.

Changes in ap­petite and body weight

The person may lose their appetite and lose weight, or their appetite may be increased and weight gained.

The symptoms of depression can be quite different from one person to another. Sometimes depression presents itself through vague physical pain and discomfort, making it difficult to detect. In addition, a person suffering from depression may find it difficult to describe his/her feelings to the people close to him/her or to the health care professionals. Instead of talking about depression, he/she may talk about personal relationships, sleeping problems, financial troubles or health problems.

Depression is a common mental disorder

De­pres­sion causes dis­abil­ity

Depression is a serious public health problem. Alongside musculoskeletal disorders, it is the biggest reason for disability retirement in Finland. Depression as a mental disorder is now better recognised than before, resulting in a significant statistical increase in the number of people suffering from depression.

However, generalisation about depression cannot be explained unambiguously. For example, it is possible that the stress and uncertainty of the modern work life, as well as the performance-based way of life, consume so much energy that the ability of those suffering from depression to function normally is lower than before, therefore resulting in increased disability caused by depression. 

De­pres­sion in­volves the risk of sui­cide

It is very common for a person suffering from depression to have self-destructive thoughts. Hopes of dying and suicidal thoughts express the person’s will to get out of an extremely tormenting state brought on by severe depression. However, the hopelessness and pain caused by depression are not permanent. Depression can be treated effectively and in a way that promotes recovery.

People who have recovered from depression often say they feel like life makes sense again, even though nothing in it made sense during the height of the depression. The longer and more serious the depression, the higher the risk of suicide. This is why treatment must always be sought in time. Suicidal talks of a depressed friend or family member should always be taken seriously and he/she should be encouraged to seek professional help. Read more about SUICIDE.

De­pres­sion may re­cur

Depression has a tendency to recur. The more serious the depression and the higher the number of previous depressive episodes, the higher the probability of recurrence. Early identification and treatment of depression is the best way to prevent new depressive episodes. Read more about seeking treatment.

De­pres­sion and the el­derly

Changes in health and life situations brought on by old age may put a strain on mental health. The increased need for assistance, dependency on other people, and coping with grief and loss are demanding to mental resources. Depression in old age is often concerned with losing friends and family members, as well as the deterioration of personal physical health. Loneliness can also be very taxing to the mental health of many seniors. 

De­pres­sion in el­derly peo­ple may eas­ily go un­no­ticed

Depression in old age easily goes unnoticed as many of the symptoms of depression, such as sleep disorders, fatigue and loss of appetite, are often considered as natural changes coming with old age. On the other hand, the condition of apparently demented seniors may have been significantly improved once the depression has been identified and treated. Isolation, vague pains, delusions and memory disorders in the elderly may be signs of depression, as well as of other illnesses. Depression in the elderly may be hard to identify if the depressed person attempts to sugarcoat his/her condition as a result of personal negative images and fears concerning mental disorders.

Post­par­tum de­pres­sion

The birth of a child re­sults in emo­tion­al­ity

Most mothers become more emotional after childbirth, to some extent at least. Emotionality is often characterised by crying, mood swings, irritability, and problems with sleep and appetite. The baby may feel strange and the mother may not feel as she would like. Often the love for the baby develops little by little. Unrealistic expectations and stories of infancy automatically being the most wonderful time of a mother’s life can result in strong feelings of guilt.

Postpartum emotionality is perfectly normal; it is brought on by the changes in life caused by having a baby, the birth experience, and the hormonal changes caused by birth. More than anything, a mother experiencing postpartum emotionality needs understanding and support from people close to her and from health care professionals.

The prog­no­sis for post­par­tum de­pres­sion is good

Actual postpartum depression is a condition that requires treatment. There is a thin line between emotionality and depression, and sometimes the depression develops slowly. Postpartum depression develops within one year from the delivery. Its symptoms are similar to other depressive episodes. However, in addition to exhaustion, lack of initiative and anxiety, the mother may have obsessive thoughts and fears concerning the baby and the baby’s care; for example, the mother may think she may harm the baby.

These fears are very rarely justified, but it is always important to seek help for postpartum depression. Postpartum depression often involves unfounded feelings of guilt, which, at first, may prevent the mother from seeking help. The mother may start to think that she cannot tell about her depression to anyone, because everyone expects her to be happy about the baby. However, postpartum depression is a mental disorder which has nothing to do with how much the mother loves her baby. The prognosis for postpartum depression is good.

Phys­i­cal ill­ness and de­pres­sion

A severe physical illness can put one’s mind to test, as well. Cancer, for example, increases the risk of depression. There are various support groups for people with different illnesses. People can contact these groups when they feel down over their illness or when they simply need peer support.

Severe physical illnesses affect the mood; the changed situation in life and different kinds of fears brought on by the illness put a strain on the mental health of an individual. Sometimes these changes may cause so much stress that they lead to depression. Thus, the depression should also be treated.

Proper treatment of physical illnesses will prevent depression from developing: sufficient information on the illness and its treatment, availability of medical personnel and the smoothness of treatment in general are extremely important to the mental health of the patient.

Sea­sonal af­fec­tive dis­or­der

In case depression mostly occurs during wintertime, it may be a case of seasonal affective disorder. During the dark months of the year, a considerable number of Finns feel the need to sleep late, become easily irritated, are constantly tired, crave for something sweet to eat and gain weight. For a small number of people, these symptoms become so strong, they must be interpreted as seasonal affective disorder. Seasonal affective disorder involves anxiety, hopelessness and self-destructive thoughts.

In addition to various other treatment methods, seasonal affective disorder may be treated with light therapy, i.e. by using an efficient bright light luminaire. Exercise, and outdoor activities in particular, often have a positive effect on the mood. Fitness training is definitely worth trying when fighting back seasonal affective disorder.