Depressive disorders are characterized by sadness that is severe or persistent enough to interfere with functioning and, frequently, by decreased interest or pleasure in activities. The precise cause is unknown but probably includes a heritable component, changes in neurotransmitter levels, alterations in neuroendocrine function, and psychosocial factors. Treatment usually involves drug therapy, psychotherapy, or both and sometimes electroconvulsive therapy or rapid transcranial magnetic stimulation.
What is depression?
Depression is a term used to indicate the presence of a sad, empty or irritable mood. This is accompanied by physical, physiological and cognitive changes that significantly affect the person’s ability to function. The depressive episode does not coincide with the diagnosis of major depression. This is because many people can have mood swings, more or less marked, up to the point of real bipolar disorder. Depression can therefore be only a symptom, even if it is usually the most unpleasant one for the subject, who asks for help in these phases.
Depressive disorder is widespread among the general population and therefore very well known. In fact, it seems that 10% to 15% of the population suffers from it, with a higher frequency among women. Major depression is associated with high mortality. Up to 15% of individuals with severe depression die by suicide.
However, most depressed subjects do not have suicidal ideation or particularly serious symptoms. Instead, they complain of symptoms that are often not even easily associated with depression itself, such as chronic fatigue, physical discomfort, apathy, asthenia, decreased desire, irritability, etc..
Common Signs and Symptoms of Depression
The symptoms of major depression are varied, multiple and can present themselves in very different ways. In general, the typical aspects of this disorder are low mood and loss of interest in normal daily activities. The main symptoms of depression are:
- ✅ Persistent low mood or sadness;
- ✅ Loss of interest or pleasure in usual activities;
- ✅ Fatigue or lack of energy;
- ✅ Feelings of worthlessness or excessive guilt;
- ✅ Difficulty concentrating or making decisions;
- ✅ Changes in appetite (weight loss or gain);
- ✅ Sleep disturbances (insomnia or oversleeping);
- ✅ Psychomotor agitation or slowing
- ✅ Thoughts of death or suicide;
- ✅ Irritability or frustration;
- ✅ Social withdrawal or isolation;
- ✅ Decreased motivation or productivity.
1. Depressed mood
Among the affective symptoms, the central one in major depression is deep sadness, present almost always throughout the day and insensitive to any positive events. Pathological sadness is different from common sadness. Non-pathological sadness is in fact situational, linked to some moments, and does not pervade the entire life of the people.
On the other hand, those suffering from major depression complain of profound daily sadness and a sense of desperation that does not change even in the face of pleasant and joyful events.
2. Negative thoughts
Major depression, in addition to affecting the area of emotions and mood, has important applications on the content of thoughts that are negative and catastrophic. Depressed patients tend to have a low opinion of themselves and their abilities. They also show negative expectations and thoughts towards others and the people around them and negative expectations regarding their own future.
Typically, the negative content of thoughts worsens as the mood worsens, leading to the presence of delusional ideations or suicidal ideations or actions.
3. Cognitive function disorders
In addition to alterations in the content of thought, those suffering from major depression may show difficulties in cognitive processes. Rumination is very common in depressed patients, that is, the tendency to continually think about one’s symptoms, one’s condition, and negative contents regarding one’s future. Furthermore, patients may complain of difficulties in concentration, memory and decision making.
4. Behavioral Symptoms of Depression
Among the most obvious behavioral symptoms we find the reduction of daily activities. The loss of pleasure in doing anything, the loss of interest combined with the feeling of chronic tiredness lead the subject to gradually reduce all daily activities, to reduce social contacts, thus closing himself off from the world and life.
The progressive and constant reduction of daily activities leads to perceived disability and reality. Other behavioral aspects typical of major depression are the progressive disappearance of actions aimed at one’s well-being and personal care.
Those who suffer from this disorder generally find it painful to take care of their physical appearance and personal hygiene. Furthermore, there is a progressive and gradual abandonment of all social activities, with worsening feelings of loneliness and uselessness, resulting in a worsening of the clinical picture.
5. Physical Symptoms of Depression
Major depression also manifests itself on a somatic level. Some patients can somatize sadness by manifesting more somatic symptoms, such as chronic fatigue, widespread pain, gastrointestinal problems. In some cases patients can deny the mood disorder by worrying only about the physical symptoms, to the point of manifesting real hypochondriac delusions.
In addition to somatic manifestations, a depressive disorder can manifest itself through an alteration of the sleep-wake rhythm, an increase or decrease in night-time sleep, changes in eating habits, a reduction in sexual desire and other problems related to the sexual sphere. In cases of very profound disorder, we can observe a general slowing down of the patient’s motor skills.
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Call: (469)-868-6250Causes of Depression
In general, the causes of depression can be summarized in three factors:
🧠 1. Biological factors
These refer to alterations in neurotransmitters, hormones and the immune system. For example, alterations in the regulation of neurotransmitters such as norepinephrine and serotonin, by altering the transmission of nerve impulses, can affect the person’s initiative, sleep, rumination and interactions with others.
🌀 2. Psychological and social factors
At the psychosocial level, stressful life events have been well recognized as precipitating factors for depressive episodes. These may include:
- ✅ Loss of a loved one;
- ✅ Divorce or relationship breakdown;
- ✅ Job loss or financial difficulties;
- ✅ Serious illness or chronic health problems;
- ✅ Childhood trauma or abuse;
- ✅ Loneliness or lack of social support;
- ✅ Academic or work-related stress;
- ✅ Relocation or significant life transitions.
We may also find changes in working conditions or starting a new type of job, the illness of a loved one, serious family conflicts, changes in friendships, changes in cities, etc. These events may have a greater impact on people who have had adverse childhood experiences and therefore lack the skills to deal with them effectively.
🧬 3. Genetic and physiological factors
First-degree relatives of individuals with major depression have a two to four times greater risk of developing the disorder than the general population. What is genetically inherited is the predisposition to develop the disorder, not the disorder itself.
Diagnosis of major depression
According to the experts, at least 5 of the following symptoms are required to diagnose major depression:
- ✅ Persistent low mood or sadness;
- ✅ Marked loss of interest or pleasure in most activities;
- ✅ Significant weight loss or gain without dieting;
- ✅ Insomnia or hypersomnia;
- ✅ Psychomotor agitation or retardation;
- ✅ Fatigue or loss of energy;
- ✅ Feelings of worthlessness or excessive guilt;
- ✅ Diminished ability to think or concentrate;
- ✅ Recurrent thoughts of death or suicide.
🌟 At least one of the above symptoms must be a depressed mood or loss of interest in doing anything.
Depression Treatment
Depression treatment focuses on reducing symptoms and improving quality of life through personalized care. It often involves a combination of therapy, medication, and lifestyle changes.
💬 Psychotherapy for depression
Cognitive behavioral therapy (CBT) has been shown to be the most effective method, according to hundreds of scientific studies, for the treatment of depression.
🧠 Cognitive interventions
Low mood affects thought processes, causing the person to see everything in black, as if looking at himself, others and the future through dark glasses.
On the one hand, doctors try to help the patient identify and modify the negative automatic thoughts that can sustain depression. For example, people who suffer from it tend to be hypercritical towards themselves. Or they tend to accuse themselves beyond all evidence. Or they notice negative events in everyday situations more.
Therapy helps the person develop a more balanced and rational way of thinking. As a result, negative emotions are reduced and the mood improves.
🔄 Interventions on rumination
Various studies have shown that depressed patients tend to spend a lot of time brooding. In fact, their thoughts are too often oriented towards the past, on failures or setbacks, on losses, on grief, on mistakes. They think and rethink what happened, blaming themselves, wondering why, trying to understand the reasons or continuing to search for solutions.
Rumination activity, however, tends to keep the mind focused on painful events, increasing suffering. It does not allow one to shift attention to the present and the future, accepting what may have happened in the past. In essence, it fuels and maintains the depressive state.
In cognitive-behavioral therapy, we therefore intervene on the beliefs regarding the rumination process itself, to then try to transmit strategies to reduce this dysfunctional mental activity to a minimum.
🏃 Behavioral interventions
On the other hand, for the treatment of depression, people are helped to build better skills to deal with daily difficulties. These in fact probably led the person to be depressed. Thus, for example, the person can be taught more effective communication methods or strategies for solving problems in which he or she finds himself or herself involved.
The treatment of depression also involves a gradual resumption of activities that have been abandoned. Perhaps starting with those that the subject once considered more pleasant. The therapist will then invite the patient to actively plan his future days, inserting small pleasant or rewarding activities.
Cognitive behavioral therapy is therefore very different from other types of psychotherapy: it focuses on the present, on the symptoms of depression, and tends to produce effective solutions to the problems presented.
🧘 Mindfulness interventions
Mindfulness meditation has been shown to be very effective especially in preventing depressive relapses. It is therefore a recommended activity, to be integrated into therapies, but not in the acute phase. It cannot replace psychotherapy and/or pharmacological therapies when a depressive episode is underway, but it can be indicated as a strategy in intercritical periods. Clearly, since it is a real discipline, it requires a group learning path and above all continuous daily practice.
💊 Drugs for depression
Nowadays, antidepressant drugs are widely used and have become among the most widely used drugs in medicine, but unfortunately the results are often modest and/or temporary. If we do not intervene with a valid psychotherapy that helps the person to acquire functional strategies for solving acute depressive episodes and preventing relapses, it is highly probable that the person will encounter recurrent relapses. Various classes of antidepressant drugs are used in the pharmacological treatment of depression:
- ☑️ Selective serotonin reuptake inhibitors (SSRIs);
- ☑️ Serotonin-norepinephrine reuptake inhibitors (SNRIs);
- ☑️ Tricyclic antidepressants (TCAs);
- ☑️ Monoamine oxidase inhibitors (MAOIs);
- ☑️ Atypical antidepressants.
All classes of drugs have been shown to be effective in the treatment, although in the initial forms SSRIs are the most used due to their reduced side effect profile.
🏥 Hospitalization for depression
Hospitalization for depression can occur in hospital wards and is always indicated in the most serious cases, or when the disorder appears resistant to outpatient treatment. During a hospital stay, clinical monitoring and the daily presence of psychiatrists and other mental health professionals allow for the planning of an intensive therapeutic-rehabilitative intervention.
Freqently asked questions (FAQs) depression
What is depression and how does it affect people?
Depression is a mood disorder marked by persistent sadness, low energy, and loss of interest in daily activities. It affects how a person feels, thinks, and handles everyday tasks like sleeping, eating, or working.
What are the common symptoms of major depression?
Symptoms include persistent low mood, fatigue, sleep issues, feelings of worthlessness or guilt, appetite changes, lack of interest in activities, and suicidal thoughts in severe cases.
What causes depression?
Depression may result from a combination of biological, psychological, and genetic factors. Neurotransmitter imbalances, stressful life events, hormonal shifts, and inherited traits all play a role.
How is major depression diagnosed?
Diagnosis requires at least five specific symptoms lasting two weeks or more. These include low mood, lack of interest, fatigue, and changes in sleep or appetite. A mental health professional must make the diagnosis.
What are the main treatment options for depression?
Treatment typically includes psychotherapy (especially CBT), antidepressant medication, lifestyle adjustments, and, in some cases, hospitalization or brain stimulation therapies like rTMS or ECT.
Is Cognitive Behavioral Therapy (CBT) effective for depression?
Yes. CBT is one of the most effective evidence-based treatments for depression. It helps patients reframe negative thoughts, develop healthier behaviors, and improve emotional regulation.
Are medications necessary for treating depression?
Not always. Some people respond well to therapy alone. However, medications such as SSRIs or SNRIs may be needed in moderate to severe cases or when therapy alone isn’t enough.
Can depression be treated without hospitalization?
Yes. Most people are treated as outpatients. Hospitalization is typically reserved for severe cases where safety is a concern or when outpatient treatments have failed.
What role does mindfulness play in managing depression?
Mindfulness practices, such as meditation, can help prevent depressive relapse by increasing awareness and reducing rumination. It’s most effective as a complement to therapy, not a replacement.
Is depression curable?
Depression is highly treatable. Many individuals recover fully with a combination of therapy, medication, and lifestyle support. Early treatment increases the chances of long-term recovery.