Depression explained – causes, symptoms and treatment

Depression occurs worldwide in all age groups and among people of all social backgrounds, both men and women. Depression usually first appears between the ages of 20 and 25. Estimates of the prevalence of depression vary widely, but in most countries, between 8 and 121% of people experience depression during their lifetime.

World Health Organization has classified depression as one of the world's most disabling diseases - major depression causes the same level of disability as terminal cancer. Depression is the disease with the highest burden of disease in middle- and high-income countries.

One study found that up to 651% of people with depression consider the illness to be a serious disability. Despite this, many people with depression do not receive any treatment.

What is depression?

Lundbeck Estonia writes on its website that “Depression is a serious illness characterized by symptoms such as sadness, inability to feel joy and pleasure, decreased energy, difficulty concentrating, and suicidal thoughts.”

So depression is not just sadness. Depression affects people in different ways, but it is more than just a temporary low mood and depression. 

Due to chemical changes in the brain, patients with depression experience prolonged sadness and anxiety, unexplained pain, and poor sleep quality and/or a lack of interest and energy. Symptoms of depression can last for weeks, months, or years. In the most severe cases, depression can lead to suicidal thoughts and self-harm. 

Living with depression can be challenging, but with the right treatment and support, it is possible to find new coping strategies and restore quality of life and joy in everyday activities.

What causes depression?

Depression The causes can be very different. To understand the cause of depression, it is worth analyzing the sources of stress in your life. Any source of stress can lead to depression. This could be the death of a loved one, a major change, such as moving, a chronic illness, or the birth of a child. It is also worth thinking about your family history and perhaps the cause of depression is hereditary. You could also notice whether your moods follow a certain pattern. If your moods regularly fluctuate up and down, you may have seasonal depression or bipolar disorder. Possible causes of depression could therefore be, for example:

• psychological or emotional causes (long-term stress, psychotrauma)
• Sad events and accidents in the past (loss of loved ones, physical and sexual violence)
• changes in the chemical balance of the brain (as a side effect of medications, as a result of constant alcohol or drug use, in cases of illness, hormonal changes, lack of daylight)
• personal loss (prolonged grief)
• environment (winter depression, loneliness)
• disease and medications (chronic diseases)
• heredity
• hormonal changes in women (pregnancy, childbirth, menopause), which can be accompanied by both pregnancy and postpartum depression
• personality (excessive emotional sensitivity, negative thinking, passive behavior, excessive perfectionism)

Depression is a complex illness and usually does not have one specific cause, but rather a combination of factors. If possible, you can also consult a psychologist who can help you understand what is causing the depression. 

Development of depression due to the influence of a close relationship

Close relationships can also be a major source of depression. For example, something in another person's behavior or words can rekindle years of trauma that has nothing to do with that person. Close relationships can also cause long-term stress, which can lead to the development of depression. For example, the need to constantly care for someone, fighting, intimate partner violence etc. If the possible cause of depression remains ignored and unresolved, the emotional and physical signs and symptoms of depression can persist long-term.

If you've assessed your level of happiness and found enough reason to worry, it's also worth reviewing your close relationships. 

• Does your spouse treat you with kindness and respect? If your spouse criticizes or belittles you frequently, you may suffer from feelings of inferiority and depression. In a healthy relationship, both partners encourage and respect each other. For example, if your spouse makes fun of your work and doesn't discuss decisions that affect both of you, you are more likely to become depressed in your relationship.
• Think about whether you can remain yourself around your spouse. Ask yourself, does your partner love and appreciate you for who you are, or do you have to pretend to be someone else around them? A relationship that robs you of your identity can be a cause of depression.
  If your spouse expects you to watch the same shows, listen to the same music, and share the same opinions as them, it's time to evaluate whether this relationship is still good for you.
• How often do you do something new with your spouse? Do you and your spouse regularly go to new places, try new things, and have new experiences together? A stagnant relationship that lacks growth can make you unhappy. One sign of a stagnant relationship is that you have nothing to talk about anymore.
• Look to the future. Compare your goals with your partner's and see if they are in line with each other. If they are not in line or if you are unable to discuss future plans together at all, there is a high chance that this relationship will make you unhappy.
  For example, if you want to have children or get married, but your partner doesn't want to, you are at risk of becoming depressed.
• Control your sex drive. Think back a few months and assess whether you or your partner's interest in sex has decreased. A decreased desire for sex is a symptom of depression and can have a major impact on your relationship. Some medications for depression can also reduce your desire for sex.
• Talk to your spouse about your doubts and hesitations. If you are worried about some aspect of your relationship, bring it up with your partner. Talk about your feelings and ask if they are willing to help you work through it. An honest conversation can either reassure you or, conversely, make it clear that you need to seek professional help. Avoid blaming or otherwise getting defensive. Remember that they may not see the problem the same way you do or recognize that you are unhappy.
  Be constructive. Focus on finding a solution together, instead of throwing all sorts of relationship problems at your partner.
• Watch for signs of an unhealthy relationship. If there are signs of codependency in your relationship (codependency) and/or abuse, it can make you depressed without you even realizing it. It is important to recognize codependency and abuse in a relationship.
  • Codependency is basically a one-sided relationship, where one partner constantly gives at the expense of themselves in order to satisfy the other.
  • Abuse in a relationship doesn't just have to be physical. Emotional abuse is also abuse. Signs include one spouse constantly criticizing or belittling the other. Not respecting privacy, being jealous, or constantly snooping.
  • If you notice signs of codependency or abuse in a relationship, be sure to consult a psychologist immediately.
  • If you are in an abusive relationship and fear for your safety, seek help immediately. For more information, visit the Victim Support page. help.ee.
• Make time for couples therapyIf you and your spouse are both ready to work through your problems together, attend couples therapy together. A psychologist can help you work through your problems together.
• Know when it's time to end a relationship. If you are in an unhealthy relationship and there are no signs of improvement, it may be time to end it.
  Ending a relationship, either permanently or temporarily, is a very extreme solution. Unless it is an abusive relationship, such a decision should not be made until after couples counseling. In order to make a decision about the future of the relationship, you should go to couples therapy at least 6-8 times. Couples therapy is usually once a month, so this would mean 6-8 months of effort to resolve the problems.

Signs and symptoms of depression

Depression is a common mental health condition characterized by various symptoms that can affect a person's thinking, feelings, and daily functioning.

Do I have depression, stress, anxiety or an anxiety disorder?

Differentiating between these conditions can be difficult, as depression, stress, and anxiety disorders share many overlapping symptoms. However, each has its own characteristics. When differentiating between depression, stress, depression, and anxiety disorders, it is worth analyzing the duration, intensity, causes, and need for treatment:

• Depression and stress are usually temporary, while depression and anxiety disorders are long-term conditions.
• Depression and anxiety disorders are usually more intense and interfere with daily life more than depression or stress.
• Depression and stress are often linked to specific events or situations, while depression and anxiety disorders can occur without a clear external cause.
• Depression and stress often go away on their own or with lifestyle changes, while depression and anxiety disorders usually require professional help.

Understanding and distinguishing the symptoms of depression, stress, and anxiety disorders is important for both prevention and seeking timely help. While depression and stress are normal reactions to life's challenges, depression and anxiety disorders may require professional intervention. It is important to monitor the duration and intensity of symptoms and, if in doubt, seek professional help.

Smiling depression

Even the symptoms of severe depression can go unnoticed by an outside observer. “Smiling depression” is not an official term for psychologists, but there is increasing awareness of this condition. In “smiling depression,” a person appears to be smiling and cheerful, even though they are actually suffering from symptoms of depression.

Severe or profound depression

Heavy with depression The patient usually experiences intense sadness or anxiety, has a severe decrease in self-esteem or feelings of worthlessness and guilt, and in particularly severe cases, there is a real risk of suicide. 

In severe depression, the symptoms are more intense and more frequent. The symptoms are severe enough to significantly interfere with daily life, potentially leading to significant impairment in work or school performance, social isolation, and difficulty functioning in various ways.

Bipolar depression

Bipolar disorder During bipolar disorder, there are periods of mania and depression. While during mania, the mood is excessively elevated, there is excessive energy and a flood of ideas, during the period of bipolar depression the person feels unhappy and depressed, with no hope that anything will get better in the future.

Chronic or long-term depression

Chronic depression is a long-term form of depression. It is characterized by a longer duration and persistent symptoms. The main symptoms of chronic depression are persistent low mood, decreased energy, low self-esteem, difficulty concentrating, sleep and appetite disturbances, and a feeling of hopelessness. 

Seasonal depression

Seasonal depression is related to seasonal changes, especially the lack of daylight in the fall and winter. Symptoms of seasonal depression can include sadness, feelings of hopelessness, fatigue, decreased energy levels, changes in appetite, weight gain, etc. 

Scientists have differing opinions about the causes of seasonal depression. It is believed that melatonin levels increase in the body during the winter, which prepares the body for hibernation. It is also believed that during the winter period, the regulation of serotonin, the so-called happiness hormone, is more difficult and vitamin D levels decrease.

Depression during pregnancy

Depression during pregnancy The estimated prevalence is 7-20%, but it is also believed that depression during pregnancy may be underdiagnosed. Symptoms of depression during pregnancy may include:

• depression, 
• loss of interest and joy in life, 
• decrease in energy,
• each activity may require more effort than usual, 
• decreased attention and concentration, 
• decreased self-esteem and self-confidence, 
• feelings of guilt and worthlessness, 
• a despondent and pessimistic attitude towards the future, 
• thoughts or actions of self-harm or suicide, 
• disturbed sleep, 
• change in appetite,
• excessive worry about childbirth or parenthood. 
• loss of interest in your pregnancy, baby, or yourself
• feeling emotionally detached, 
• more easily irritable,
• more difficult to establish contact with other people.

Postpartum depression

Postpartum depression According to studies, at least 101% of new mothers and 51% of new fathers experience this during the first year of their child's life.

Postpartum so-called baby blues is a very common phenomenon, manifesting itself as mood swings, crying, sadness, irritability, and sleep disturbances. About 70-80% of all new mothers experience negative feelings or mood swings after giving birth.

Symptoms of depression are stronger, more severe, and last longer than a few weeks. Postpartum depression can make it difficult to properly care for your baby, which can affect the development of a bond and, through it, the baby's well-being.

Signs of postpartum depression that should prompt you to seek professional help include:

• Lack of energy and interest
• Guilt
• Feeling worthless
• Neglecting oneself
• Inability to enjoy life
• Lack of interest in your baby
• Negative feelings towards the baby or fear of hurting him/her
• High anxiety levels
• Difficulty concentrating
• Irritability
• Insomnia or significantly increased need for sleep
• Loss of appetite

About the symptoms of postpartum depression and ways to help You can also read more from the Health Insurance Fund's information sheet.

Depression diagnosis and tests

If you suspect you may be depressed, it is important to notice how you are feeling, be kind and understanding to yourself. Acknowledging your emotions is a sign of courage and self-awareness, and seeking help and taking care of your well-being is an expression of self-love. Remember that depression is treatable, and it is possible to alleviate the symptoms of depression and significantly improve your quality of life.

To diagnose depression, you can contact your family doctor or mental health nurse. A psychologist or psychiatrist can also perform a thorough assessment. There is a fee for seeing a psychologist and the waiting list can be several months long. So what can you do yourself? The first thing to do is to assess whether there is reason to suspect depression. There are several options for this. One possible self-assessment questionnaire is on the peaasi.ee website. If possible, write down your feelings and behavior, this will help identify patterns. There is also a lot of information about the symptoms and treatment options for depression, along with the possibility of testing. depression notebook. 

Depression treatment

Depression treatment depends on the severity of the illness and the patient's preferences. Mild depression can be relieved with general support and psychotherapy. Specialist help can also be helpful. recommendations on how to overcome depression. Moderate and severe depression is treated with medication, psychotherapy, or a combination of both. Sometimes electroconvulsive therapy and light therapy are also used in the treatment of depression. If necessary, a sick leave may be taken for a period recommended by the doctor to support the treatment of depression.

Depression is a serious illness, and it is important to seek professional help if you are experiencing symptoms of depression. It is also important to maintain a healthy lifestyle. On regular sleep, on the move and on a healthy diet has a positive impact on our well-being and physical and mental health. Supporting relationships and the opportunity to engage in enjoyable activities and hobbies also have an important impact.

Psychotherapy 

Psychotherapy is often very effective in treating depression because talking provides an opportunity to create change in your feelings, thoughts, and behavior and find solutions. 

The importance of psychotherapy in the treatment of depression:

• Provides a supportive environment for expressing your feelings and thoughts.
• Helps identify and change negative thought patterns.
• Helps develop problem-solving skills.
• Increases awareness of your emotions and behavior, helps you understand the causes of depression, and supports improving your sense of self.
• Helps find healthy ways to cope with stress and effective methods for resolving conflicts.
• Supports the development of a healthy lifestyle.
• Helps prevent relapses and spot early signs of depression.

Depression medications

In the treatment of depression often used antidepressants, which affect the functioning of the human brain and help restore mental balance, reduce anxiety and restlessness, increase the will to act, and improve mood, sleep, and appetite.

Things to remember about antidepressants:

• The treatment effect usually appears within a week or two. 
• The use of antidepressants does not cause drug dependence.
• Every medication has side effects, and so do antidepressants – these will be explained to you by the doctor who prescribed your depression medication. Remember that most side effects are short-term.
• The choice of medication is individual. Never give your medication to someone else or take medication prescribed for someone else.
• Treatment with an antidepressant is usually long-term and lasts at least several months.

Natural treatment for depression

One of the best-known folk remedies for anxiety and depression is valerian, which is a relatively mild natural remedy and has been shown to have a calming effect. In addition, there are a number of other natural herbs that have been found to have a positive effect in the treatment of depression in smaller studies. Some studies have shown that such the potential of natural remedies in alleviating symptoms of depression, but the expected therapeutic effect and interaction with other substances may be unclear. Common natural treatments for depression include saffron, omega-3 fatty acids, L-tryptophan, St. John's wort, etc. 

It is worth remembering that the studies conducted do not always have a strong scientific background and until we have high-quality and comprehensive research results, we should remain cautious, especially regarding dosing and toxicity. It is important to consult a doctor before trying it to avoid interactions with other medications.

Aromatherapy is also sometimes recommended, and although there is no evidence-based scientific basis for its use in treating depression, it is unlikely to be harmful to a person and, depending on the person, can be a pleasant and supportive experience.

It is important to always consult your doctor or a qualified healthcare professional before using herbs or supplements, especially if you are already taking medication or have a medical condition. Natural remedies are not a substitute for professional medical care for severe depression, so they should not be the only treatment for depression.

How to help or live with a depressed person?

A supportive loved one can help by offering a listening ear, encouraging seeking professional help, and being there every day, even when the situation seems difficult. Through small steps and constant understanding, a safe environment can be created that helps you cope with depression and move towards healing.

The main thing is to bring together the main recommendations to follow if a loved one has depression:

• Listen to him. He may often say the same things over and over again, but that's what he needs. Don't rush to give advice unless he asks for it. If there is a specific problem that is causing his depression, try to help him find a solution.
• Be patient with him. He may be irritable, withdrawn, uninterested, withdrawn, and ungrateful at times. Don't take it personally, as it is due to the illness.
• Spend time with him, encourage him to do at least some daily activities. Accept that he wants to be alone sometimes.
• A person suffering from depression often finds it difficult to believe that their situation will improve. Give them hope that they will get better.
• Make sure he eats and drinks enough.
• Help him stay away from alcohol and drugs.
• Encourage him to seek and accept professional help.
• Don't ignore suicidal thoughts. If they have suicidal thoughts or have harmed themselves, encourage them to talk to their doctor. If they are at risk of suicide, don't leave them alone and call for help.

Summary

The causes of depression are diverse, encompassing biological, psychological, and environmental factors. It is important to understand that the manifestation of depression is individual for each person - the signs of depression and their intensity can vary significantly. Therefore, the treatment of depression is always personalized, depending on the individual's situation, symptoms, and needs. Possible treatments range from psychotherapy and depression medications to lifestyle changes and natural approaches. 

The most important message is to remember that depression is a treatable condition, and the first and most important step on the path to recovery is to seek help. If you suspect that you or someone you love is depressed, do not hesitate to seek professional help – timely and professional help can significantly improve your quality of life and speed up recovery.