Depression

    One of the most common mental health disorders, with one of the highest prevalence rates is Depression. According to the World Health Organization (WHO), more than 264 million people globally suffer from this disorder (World Health Organization, 2020). Despite its high prevalence, most of society still remains ignorant and oblivious to its symptoms and detrimental effects on the human body. It is therefore imperative for us to further educate ourselves on the array of symptoms as well as consequences of depression. 

   
    Depression to many is a singular term referring to the main type of depression called Major Depressive Disorder (MDD). It is, however, an umbrella term that references several other conditions related to depression.
They are: 

• Major Depressive Disorder (MDD) 
  
• Persistent Depressive Disorder (PDD) 
  
• Premenstrual Dysphoric Disorder 
  
• Peripartum Depression (Postpartum Depression) 
  
• Seasonal Depression (Seasonal Affective Disorder)
  

    The two main types of depression are Major Depressive Disorder (MDD) and Persistent Depressive Disorder (PDD). While normal depressions are common and expected in people who have experienced painful but common life events and losses. MDD is however characterized by the client being in a major depressive disorder and have never had a manic, hypomanic, or mixed episode. PDD on the other hand, is characterized by a persistently depressed mood most of the day, for more days than not, for at least 2 years (1 year for children and adolescents). While periods of normal moods may occur briefly, they are usually intermittent and last for only a few days to a maximum of 2 months. However, the chronicity of this disorder has proven to be far more damaging than MDD (Hooley et al., 2017).  

Symptoms of Depression:

    According to the American Psychiatric Association (APA), common symptoms include (American Psychiatric Association, 2020): 

• Feeling sad or having a depressed mood 
  
• Loss of interest or pleasure in activities once enjoyed 
  
• Thoughts of death or suicide 
  
• Loss of energy or increased fatigue 
  
• Feeling worthless or guilty 
  
• Trouble sleeping or sleeping too much 
  
• Increased in purposeless physical activity (eg. inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others) 
  
• Feeling worthless or guilty 
  
• Difficulty thinking, concentrating or making decisions
  

Misconceptions on Depression: 

    As humans, we experience adverse and tragic life events such as the death of a loved one, loss of a job or the ending of a relationship. These common familial and economic losses are painful and difficult experiences we all have to endure. During such events, it is normal for feelings of sadness, grief or bereavement to occur. These “depressive” feelings however differ from having depression. While grief and painful feelings come in waves, often intermixed with positive memories of the loved ones we’ve lost. In MDD, mood or pleasure are decreased for most of two weeks. 
    While self-esteem is usually maintained during periods of grief, in depression, feelings of worthlessness and self-loathing are common. Furthermore, in grief, thoughts of death stem from the fantasizing of “joining” the deceased loved one. Whereas, in depression thoughts of suicide are due to the inability to cope with the pain of depression and feelings of worthlessness. 
    It is however important to note that grief and depression can co-occur. Grief may also serve as a trigger for some, which may lead to depression (American Psychiatric Association, 2020). 

Depression in Youths: 
    What many of us fail to realise is that our youths are extremely vulnerable to depression. With adolescence being a unique and formative time, youths are extremely susceptible to emotional, physical and social changes. According to the World Health Organization, exposure to poverty, abuse or violence, can make youths vulnerable to mental health problems
    One of the most common disorders to emerge during adolescence are emotional disorders such as depression. Globally, depression is one of the leading causes of illness and disability among adolescents, with suicide being the third leading cause of death in 15 to 19-year-olds. Sadly, in 2016, an estimated 62,000 youths died as a result of self-harm (World Health Organization, 2020). 
    Our youths are the pillars of our future, it is therefore essential that we double our efforts in securing their mental health.

What are some things I can do to cope with depression? (Adapted from article by Bushman, 2017)
    Even if you’re on antidepressant medications, positive coping skills are frequently recommended by scientific research and medication prescribers, such as psychiatrists, as crucial parts of treatment. It is recommended that you follow most, if not all, of the subsequent coping techniques once a day when experiencing depression. You likely won’t feel motivated to do any of them at first, since depression often drains your motivation. This is normal, and it’s alright to feel unmotivated until you are halfway through these activities. These can be summarised with the acronym: MY PEERS.

1. Meaning: Find small ways to help others.
   

Personal meaning can be found by serving something on a bigger scale than yourself. Service doesn’t have to be large-scale to count - small activities you could try include:

• Helping your family out with household chores
  
• Helping someone who’s lost with finding their direction
  
• Helping someone struggling with a heavy load to carry their items
  

1. Your goals: Find achievable goals that give you a sense of accomplishment.
   

Many people find goals hard to achieve because they’re set to be too unreasonable or unworkable. A goal is achievable if it’s:

• Realistic for you (not for someone else)
  
• Manageable (i.e. not overwhelming)
  
• Something you can control (i.e. doesn’t depend on others)
  
• Measurable (i.e. you know whether or not it is done or in progress)
  

If something goes wrong with your goal, reflect on what you can learn from the experience (a growth mindset). Don’t judge yourself harshly (fixed mindset). 

1. Pleasant events: Schedule pleasant events or activities.
   

Wholeheartedly engaging (see point 4) in a healthy hobby or ‘vacation’ for just 30 minutes a day can give you something to look forward to each day. Taking time to notice what went well each day, rather than just what went wrong, can also improve your outlook on life. Keeping a gratitude journal of all these moments can be a great help in the times you feel depressed. 

1. Engagement: Stay in the present.
   

Practise mindfulness. Do your best to engage fully in activities, and do not entertain thoughts of self-judgement. Notice any harsh thoughts, let them pass and bring yourself gently back to the present. 

1. Exercise: and eat healthy.
   

Doing moderate exercise for about 30 minutes, at least 5 times a week, can dramatically lift your mood. When engaged in moderate exercise, it should be hard to sing from your diaphragm. There’s no need to participate in trendy diets, but moderate your intake of carbs, junk food, and energy drinks (including caffeine-containing beverages like coffee!). Pay attention to how your nutrition influences your mood.

1. Relationships: Focus on people who uplift you.
   

Spend more time with others that encourage you and influence you positively, as opposed to people who are negative influences. While it’s alright to have some alone time, find a balance and don’t isolate yourself from others. This makes it harder for depression to linger.

1. Sleep regularly: Try to keep a regular sleep schedule.
   

Strike a balance with just enough sleep each night, rather than pulling an all-nighter and then sleeping in excessively the next day. Also, don’t try to solve problems late at night when your brain is half-asleep.

No matter what medication you’re taking, doing several of these activities every day - especially when you don’t feel like doing them - is crucial to treating depression. These skills may take time and practice, but they’re well worth it in the long run.

What can Family Members and Friends Do? 
    As family members and friends of those suffering from depression, we are often confronted with the thought of “how can I make this better?” and “I wish there was something I could do.” Understanding and support for our loved ones are thus what we as family members and friends can provide (Mayo Clinic, 2018).
According to the Mayo Clinic, family and friends can: 

Learn the symptoms of depression:
    More often than not, those suffering from depression fail to recognise their need for treatment. It is thus up to family members and friends to recognise the tell tale signs of depression. It is important to note that symptoms vary from person to person. However, common symptoms include prolonged feelings of sadness, tearfulness, emptiness or hopelessness. As well as a loss of interest or pleasure in most or all normal activities. 

Encourage treatment: 
    Most people with depression might feel a sense of shame with regards to their disorder. They often believe that depression can be overcomed with their willpower alone. It is therefore imperative that we as family and friends show our support and suggest professional help. By expressing our willingness to help, patients might be more open to treatment, greatly reducing treatment gaps. 

Identify warning signs of worsening depression: 
    As everyone’s experience with depression differs, we need to consider these issues

• What are the typical signs and symptoms of depression in your relative or friend? 
  
• What behaviours or language do you observe when depression is worse? 
  
• What behaviours or language do you observe when he or she is doing well? 
  
• What circumstances trigger episodes or more severe depression? 
  
• What activities are most helpful when depression worsens? 
  

Understand suicde risk: 
    Given that people with depression are often at an increased risk of suicide, we should always remain alert for warning signs of suicide. If signs of suicidal behaviour do occur, we should take it seriously and act immediately. 

• Talk to the person about your concern 
  
• Seek help 
  
• Call a suicide hotline number 
  
• Make sure the person is in a safe environment 
  
• Call 911 or your local emergency number immediately if the person is in danger of self-harm or suicide.
  

Provide support and be willing to listen 

Recovery is not always an easy road. As family and friends, we should always try to provide positive reinforcement and offer assistance. Being patient and helping to create a low-stress environment is crucial. Lastly, other than learning more about depression, we should also be mindful of our own mental well-being. 

Depression is thus a real and pressing problem society has to acknowledge. It is vital that we continue to shed light on the realities and dangers of depression. 


Bibliography
American Psychiatric Association. (2020, October). Depression. American Psychiatric Association. https://www.psychiatry.org/patients-families/depression/what-is-depression
Bushman, B. (2017, May 15). 7 ways to overcome depression without medication. Intermountain Healthcare. https://intermountainhealthcare.org/blogs/topics/live-well/2017/05/7-ways-to-overcome-depression-without-medication/ 
Hooley, J. M., Butcher, J. N., Nock, M. K., & Mineka, S. (2017). Abnormal Psychology. Pearson.
Mayo Clinic. (2018, November 28). Depression: Supporting a family member or friend. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20045943
World Health Organization. (2020, January 30). Depression. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/depression
World Health Organization. (2020, September 28). Adolescent Mental Health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health