Depression is a medical condition that can cause a wide variety of psychological and physical symptoms. Extreme sadness is often the most pronounced symptom. Some people experience loss of interests or pleasure rather than sadness. Depression can be distinguished from occasional sadness because depression is persistent, often interfering with daily activities and relationships. Depression is a common mental disorder. According to the World Health Organisation, globally, an estimated 350 million people of all ages suffer from depression. Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease and at its worst, depression can lead to suicide. Over 800,000 people die due to suicide every year, and it is the second leading cause of death in 15-29 year olds after road traffic injuries. The risk of suffering from a major depressive episode at some time during a person’s life is up to 12 percent for men and 25 per cent for women. The condition can affect people of all ages, including children and older adults. The cause of depression Although the exact cause of depression is still uncertain, research points to depression being accompanied by changes in neurochemicals in the brain, such serotonin, norepinephrine, and dopamine. These neurochemicals allow cells to communicate with each other and play an essential role in all brain functions, including movement, sensation, memory, and emotions. Social factors may be involved, including isolation and criticism from family members. Losses and interpersonal problems may also contribute to onset of depression. Risk groups for depression Although anyone can develop depression, certain factors increase a person’s risk for this condition, including; Female sex, a history of depression in one’s family (parent, sibling, child), a prior episode of major depression. Other associated risk factors include; a history of depression in a distant relative,lack of social supports, significant stressful life events, current alcohol or substance abuse Symptoms of depression Unfortunately, there is no single sign or symptom that serves as a marker for depression, and the condition can be tricky to identify. In fact, many people do not recognize that they are depressed or that their physical symptoms (aches and pain, appetite and sleep changes) are related to depression. Extreme sadness may be the best known symptom of depression, although depression also includes other psychological and physical symptoms. The commonest symptoms of depression include; feeling sad for most of the day especially in the morning, markedly diminished pleasure or loss of interest in almost all activities nearly every day, significant weight loss or weight gain, insomnia or excessive sleep, agitated movements or very slow movement, fatigue or loss of energy, feelings of worthlessness or guilt, impaired concentration and indecisiveness, recurring thoughts of death or suicide. In major depression, at least 5 of these symptoms of which either sad mood or loss of interest in daily activities is among, are present and for at least 2 weeks and one can have mild, moderate, or severe major depression. It is important to know that grief is different from depression although the two can coexist in which there would be need for seeking medical care. It is a normal reaction to many situations, following the death of a loved one, loss of a close relationship or job, or the loss of health or independence. Diagnosing depression The diagnosis of depression is based upon a patient’s symptoms, the duration of symptoms, and the overall effects of these symptoms on a patient’s life. There is currently no medical test that identifies depression, although some investigations are often done to rule out other medical conditions that could be causing depression (such as thyroid gland disease, drug abuse, brain disease such as multiple sclerosis, Parkinson’s disease, stroke, etc.). A diagnosis of major depression requires that symptoms are severe enough to interfere with a person’s daily activities, and the ability to take care of oneself, maintain relationships, engage in work activities, and to support oneself. A diagnosis also requires that the symptoms have occurred on a daily basis for at least two weeks There are other forms of depression but with almost the same symptoms as major depression. Some of these include; Seasonal affective disorder (SAD) which is a form of major depression that varies with the seasons, manic depression in which one has periods of mania (feeling excessively elated, impulsive, irritable, or irrational) alternating periods of major depression Depression is manageable Depression is a treatable condition. However, many people are reluctant to accept a diagnosis of depression and pursue treatment. A person may worry about the social stigma of depression and may be embarrassed to discuss the need for treatment with family or friends. In addition, some people do not understand that physical problems such as aches and pains, fatigue, and difficulty sleeping can be caused by depression. Fortunately, early and successful treatment of depression shortens the duration of illness, reduces the likelihood of persistent symptoms, and reduces the likelihood of a relapse. The treatment of depression may include psychotherapy (counseling), drug therapy, or some combination of these therapies. Treatment is most successful in people who are open to being helped and willing to participate in treatment. Suicide is a tragic and preventable consequence of severe depression. If one has thoughts of self-hurt or someone tells you that they feel depressed and think of ending their lives, it should be taken as a serious life threatening emergency and medical care sought immediately. Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital iangashugi@gmail.com
