Depression

Depression is a disorder in which the person presents a constant sadness that affects their daily life and is associated with other symptoms such as insomnia, irritability, and anxiety.

Author:	Doctor Anny Palencia
Reviewed by:	Ana Codallo, CTO
Last Updated on Aug 18, 2023

Even though in the course of life, all people can experience sadness to a greater or lesser degree, what is different from clinical depression is that the latter lasts over time, and the person loses control over it. Depression is also called Major Depressive Disorder.

Is Depression Curable?

Clinical depression cannot be cured but can remain asymptomatic for a long time, with adequate treatment and periodic medical control.

Symptoms of Depression

The symptoms that accompany depression are:

• Depressed mood, off most of the day.
• The patient feels tired, without strength, and sees everything with pessimism.
• Feelings of guilt, anxiety and increased irritability.
• Difficulty concentrating; lack of interest in anything.
• Sleep disorders, which can be insomnia or difficulty falling asleep.
• Loss of courage for life, even to the point of attempting to go against himself/herself.
• Overeating or losing appetite resulting in weight gain or loss in the long run.
• Physical symptoms may also include headaches, back pain, abdominal cramps, and digestive problems.

Pain plays a vital role in depression since it tends to be associated with the pain of loss or a feeling of hopelessness, although studies also report a decrease in pain tolerance when there is depression, that is, that everything hurts more.

What Is the ICD 10 Code for Depression?

The ICD / ICD 10 code for Depression is "F33.0" (Major Depressive Disorder, Recurrent, Mild).

Depression in Children

In children, you must know how to differentiate sadness as a momentary emotion from a depressive problem; consider that depression is a sadness that lasts for a long time and, in turn, interferes with their daily habits, losing interest in their social, family, and school activities.

Depression in Adolescents

Teenagers are prone to frequent mood swings, irritability, and sadness. That is why it is essential to observe them and consider that there may be a depression problem if:

• The sadness lasts more than two continuous weeks
• Withdraws from family and group of friends
• Begins to use drugs or alcohol
• Decreases school performance

It is crucial to consult a doctor if several of these symptoms occur, to determine if depression is diagnosed and indicate the appropriate treatment early.

Causes of Depression

The cause of depression is still being studied, but there are some theories that, when combined, can explain it:

• Brain structure: There seem to be physical differences between the brain of a person with depression and one who does not.
• Brain chemistry: Neurotransmitters can alter a person's mood. In depression, there is an abnormal function of the neurotransmitters.
• Hormones: Hormonal changes can predispose to depression, such as in pregnancy, adolescence, and menopause.
• Genetics: The genes for depression have not yet been found, but it has been seen that there is a greater propensity for depression if this problem exists in the family.

Some factors can predispose an episode of sadness to be prolonged over time and become clinical depression. If we know those factors, we can be attentive and ask for help at the right time. These factors are:

• Death or loss: It is usual for death to generate mourning or sadness, but when the loss entails overwhelming stress, this can trigger depression with severe symptoms.
• Conflict: Problems with family or friends can also trigger depression in some people.
• Abuse: Sexual abuse, child abuse, or any abuse can trigger depression.
• Specific events: Any event that generates stress, such as marriage, divorce, a new job, job loss, retirement, moving, or having a baby, can lead to depression.

Types of Depression

There are several types of depression, from the sadness that occurs due to something eventual to that which develops for no apparent reason. What makes it a problem is the extended duration of that sadness and how it affects other spheres of life.

Clinical depression has several forms of presentation. These are:

Types of Depression: Major Depression or Major Depressive Disorder

This condition is when you have five or more symptoms of depression, including a depressed mood with a lack of interest in daily activities.

It can be associated with agitation, mania, or melancholy.

Types of Depression: Persistent Depressive Disorder

It refers to depression lasting for two years or more. It separately encompasses two entities we described: persistent low-grade depression or dysthymia and chronic major depression.

Types of Depression: Bipolar Disorder

Also known as manic depression, since bipolar disorder occurs at the extremes of its pathology with an increase in energy, known as a "high" phase and a low or depressive phase; it is in the latter where the patient can present the same symptoms of major depression.

Types of Depression: Peripartum or Postpartum Depression

Symptoms begin during pregnancy or after delivery.

Types of Depression: Other Depressive Disorders

Other depressive disorders are:

Disruptive Mood Dysregulation Disorder

Disruptive mood dysregulation disorder occurs in children and adolescents when they present a state of extreme irritability, and the outbursts are more intense than a child can typically have.

Premenstrual Dysphoric Disorder

It is when a woman presents mood disorders before the menstrual period but more intensely and severely than in the typical premenstrual syndrome.

Substance-Induced Mood Disorder

It is when depressive symptoms appear in people who consume drugs or drink alcohol. It is also the case when someone has just given up alcohol or drugs.

What Illnesses Occur Along With Depression?

It is common for depression to occur along with other medical or mental health problems, such as obsessive-compulsive disorder, phobias, or eating disorders, such as bulimia or anorexia.

In any case, you should consult your doctor if you have any doubts about it.

Depression and Suicide

Suicide is always the result of depression, so don't hesitate to call your local suicide hotline or mental health professional if you or someone close to you talks about taking your/their own life.

Diagnosis of Depression

Ideally, a mental health specialist, called a psychiatrist, should evaluate the diagnosis of clinical depression.

First, a general medical evaluation is needed. The assessment includes a complete physical examination to see the general condition and if there are any other previous medical problems.

In the same way, it is essential to carry out paraclinical examinations such as routine laboratory tests (complete blood count, glycemia, urea, creatinine, lipid profile) or any other that is pertinent according to the findings of the physical examination or the history.

Other laboratory tests include monitoring electrolytes, liver and kidney function, and toxicology tests. This is very important since the liver and kidneys eliminate most antidepressant drugs, so they must be at normal levels before medication.

After the general evaluation, the psychiatric assessment includes interrogating the patient's thoughts, feelings, and behavior.

A guide approved by the American Psychiatric Association includes the criteria for the diagnosis of depression. This is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Other diagnostic tests may include:

• Computed axial tomography or magnetic resonance imaging at the skull level to rule out the presence of a tumor.
• Electroencephalogram to record the electrical activity of the brain.
• Electrocardiogram to rule out any heart problems.

Depression Treatment

Treatment for depression consists of several steps, which depend on the degree of depression and must be individualized on a case-by-case basis.

Depression Treatment: Medications

First, we have the drugs. Antidepressants are the first line of treatment but should ideally be used in conjunction with psychotherapy.

There are many types of antidepressants, and several can be tried until the ideal one is found. There is also the possibility of using a combination of several.

The antidepressants most used today are the so-called selective serotonin reuptake inhibitors (SSRIs) which work by regulating the chemical serotonin (fluoxetine, fluvoxamine, paroxetine, sertraline) and the serotonin and norepinephrine reuptake inhibitors (IRNS) that are not selective for serotonin. Among these are desvenlafaxine, duloxetine, venlafaxine, among others.

There are other antidepressants whose mechanism of action seems related to regulating dopamine and norepinephrine, such as bupropion. Others raise serotonin and norepinephrine levels, but by a different mechanism than serotonin and norepinephrine reuptake inhibitors (SNRIs) do, such is the case with mirtazapine.

Other older antidepressants are also available, although with more significant side effects. These are the tricyclic antidepressants (TCA) which include amitriptyline, amoxapine, desipramine, doxepin, imipramine. On the other hand, we have monoamine oxidase inhibitors (MAOIs) among which are phenelzine and tranylcypromine.

Other medications that the physician may also prescribe are antipsychotics, anxiolytics, or mood stabilizers.

Treatment of Depression: Psychotherapy

It consists of regular consultations with a mental health professional to discuss the problem and seek feasible solutions.

In cases where depression is mild or moderate, psychotherapy alone can be helpful, but most often, a combination with medication is more effective. The forms of psychotherapy used during treatment are cognitive therapies and behavioral therapies. These therapies can last long, so choosing a therapist with whom the person is comfortable is essential.

Treatment of Depression: Inpatient Treatment

If the depression becomes severe, that treatment on an outpatient basis is not possible or is dangerous. Hospitalization in a health center or nursing home is recommended.

Depression Treatment: Other Treatments

When antidepressant medications do not work or are contraindicated, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or vagal nerve stimulation (VNS) may be helpful.

Complications of Depression

Depression is a health problem that affects several spheres of life, such as sleep and sexual energy.

Insomnia plays an essential role in the development of depression since it affects daily life due to the inability to sleep, which can worsen the depressive picture. Although the opposite case, called hypersomnia, where the person is more sleepy than average, can also affect it since the patient is just as tired as if they had not slept at all.

Sexuality can be affected in two ways, both by depression itself, which seems to decrease sexual drive, and by medications for the treatment of depression, which can reduce libido and sexual functioning or potency.

Studies have shown that antidepressants decrease sexual desire and response by interfering with the chemicals responsible for it.

Likewise, there are certain chronic diseases where the patient can also be diagnosed with depression, especially if there is a personal or family history. For example, patients with heart attacks could suffer from depression up to 65% of the time, those with Parkinson's disease and multiple sclerosis up to 40%, and cancer and diabetes patients up to 25%.

For the diagnosis and treatment of depression, recognizing that a person has depression is always an obstacle, because if they do not realize it, it is challenging for them to seek help.

50% of people with depression do not receive treatment, and more than 10% of people with depression commit suicide. That is why it is essential that when depression is suspected to immediately visit a health center or ask for professional help.

Dr. Brenda W J H Penninx: KOL #1 for Depression

According to KOL's technology, Dr. Brenda W J H Penninx is the top ranking Key Opinion Leader (worldwide) for Depression. You can see Dr. Brenda W J H Penninx's KOL resume and other concepts they rank #1 for.

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