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Depression, which can be part of a major depressive disorder, is an alteration of a person’s mental state, through the persistence of low mood and low self esteem. This is usually accompanied by a diminished enthusiasm and interest in enjoyable activities.

Unlike sadness or grief, which are temporary and usually triggered by a specific traumatic or emotionally challenging life event, depression in persistent and debilitating.

Depression is characterized by persistent and recurrent mood impairment associated with feelings of guilt and low self confidence that are typically experienced for several weeks.

Who gets it

Factors that may increase the susceptibility for depression include:

*Sex (more common in females, in part due to the occurrence of depressive episodes after childbirth)

*Age – Risk of depression tends to increase with age and can be insidious. In the elderly, depression can often be persistent and harder to treat with first line treatment.

* Genetic predisposition (it may not play a decisive role, but may cause a tendency towards depression if the individual is exposed to highly stressful situations)

* Economic factors (individuals with low income are more likely to be affected by depressive episodes)

* Urban environment (depression is slightly more common in cities compared to rural areas)

* Exposure to high levels of stress or the occurrence of emotionally traumatic events in one's life

What it feels like?

Depression is generally characterized by a persistent low mood with several other symptoms. Each affected individual can describe his or her feelings and symptoms differently, however, typical depressive symptoms include:

* Persistent sadness

* A diminished mental focus and productivity

* A loss of energy and motivation to perform daily tasks

* Feelings of guilt

* Loss of interest and desire to engage in enjoyable activities

* Persistent negative thoughts and low self esteem

* Poor sleep

* Reduced appetite

*Suicidal thoughts

*Hallucination if severe

When to seek professional help?

The decision whether to seek professional help for depression should be taken by the affected individual or by his or her family based on the following suggested factors:

* The duration of depression symptoms. If the symptoms are recurrent and are experienced on a regular basis for several weeks, it is recommended to seek mental health assessment. Early interventions, with antidepressant drugs, or with psychotherapy sessions, dramatically increase the chances of a successful recovery and can reduce the risk of depression in the future.

* The severity of symptoms. It depends on the degree to which depression affects one's quality of life. In severe cases, when an individual has thoughts of suicide, reduced appetite, or depression interferes significantly with one's career and family life, mental health evaluation is required for an accurate diagnosis and treatment.

* Experiencing episodes of sadness or grief following a traumatic event are normal psychological responses and are not considered signs of a mental health problem. Most individuals are able to overcome these feelings on their own and recover without professional help. If symptoms persist 6 months after the traumatic event, professional help should be sought.

What treatments are available?

*Psychotherapy is aimed at addressing the abnormal patterns and negative thoughts that may have led to the occurrence of depression through regular sessions conducted by a qualified therapist. In mild depression, psychotherapy successfully relieves depression without the use of medications.

* Antidepressants are a class of medications that are widely used for depression, but they may also be prescribed by a psychiatrist for anxiety disorders or other mental health problems. Selective serotonin reuptake inhibitors (SSRIs) are the newer generation of antidepressants, and they work by increasing the levels of the neurotransmitter serotonin in brain cell synapses, which may facilitate depression relief or increase the effectiveness of psychotherapy. Antidepressants from older generations are also approved for depression and prescribed in certain cases, but SSRIs are the first choice because they cause less side effects. Under specialist care, severe depression can be treated with combinations of antidepressants. Treatment resistant depression may also be managed with augmentation strategies. This would require close monitoring and regular reviews

A combination of psychotherapy and medication may be recommended in some cases, but usually psychotherapy alone is tried first, especially when the diagnosis is made early and the symptoms are mild.

Depression is often misdiagnosed. If identified and treated early with appropriate expertise, normal functioning can be restored, even if the depression is severe.