Depression
Summary/Definition
Depression is a condition accompanied by deterioration of mood and general mental function, including the structure and course of thoughts, their content, motivation, desire, sleep and physical activity. The causes of depression can include genetic, neurobiological, psychosocial and somatic factors. In psychiatry, a depressive state is understood not only as a temporary decrease in mood, but also as a state in which thoughts become gloomy, the speed of the thought process slows down, excessive drowsiness occurs and an increase in appetite is noted. If the depressive state becomes so severe that everyday life becomes difficult, it can be diagnosed as a major depressive disorder. Despite the fact that the exact causes of depression have not been established, it is known that its development is associated with various biochemical, genetic and environmental factors.
| Depression | |
| Psychological causes | Low self-esteem, dependent personality, perfectionism |
| Social causes | Shocking events (robbery, rape, etc.), negative events (divorce, bereavement, etc.) |
| Biological causes | Hormonal disorders (thyroid hormones, etc.), disorders of neurotransmitter synthesis (norepinephrine, serotonin, etc.) |
| Physical causes | Thyroid diseases (hypothyroidism, etc.), endocrine diseases (diabetes, etc.), stroke, tumors, etc. |
Symptoms
In addition to mood deterioration, depression is accompanied by various clinical signs, covering cognitive, psychomotor and physical aspects.
Depressive state in children and adolescents is characterized by persistent symptoms, including general sadness, apathy, boredom and irritability. In elderly patients suffering from depression, complaints of mood changes are less pronounced, but the number of physical symptoms increases markedly. In the case of postpartum depression, symptoms of fatigue, apathy, loss of enthusiasm, irritability and anxiety may appear. Menopausal depression is accompanied by such manifestations as depressive mood, anxiety, sharp fluctuations in emotional state, sleep disorders and cognitive decline, as well as a variety of physical disorders. The most basic symptom of depression is negative changes in mood. Common cognitive symptoms include impaired concentration and attention, negative thinking, and feelings of guilt. Some patients may experience such manifestations of irritability as anxiety, nervousness and outbursts of anger. Disorders of physical functions, for example, eating disorders or sexual dysfunction, may indicate a severe form of depression.
Diagnostics
The severity of symptoms of depression is easy to determine with the help of special questionnaires for self-diagnosis. One of these tools is the scale of the Center for Epidemiological Studies of Depression (CES-D) and the patient’s Health Status questionnaire-9 (PHQ-9).
<Table 1. CES-D scale: Scale of the Center for Epidemiological Studies of Depression>
*Extremely rarely or never (less than 1 time per week)
*Sometimes (1-2 times a week)
*A significant part of the time (3-4 times a week)
*Almost all the time (5-7 times a week)
| For the past week … | Extremely rarely or never | Sometimes | A significant part of the time | Almost all the time |
| Less than 1 day | 1-2 days | 3-4 days | 5-7 days | |
| I’m nervous about something that didn’t bother me before | 0 | 1 | 2 | 3 |
| I don’t enjoy eating, I have a bad appetite | 0 | 1 | 2 | 3 |
| Despite the help of friends and family members, I can’t get rid of the feeling of longing | 0 | 1 | 2 | 3 |
| It seems to me that I am no worse than others | 3 | 2 | 1 | 0 |
| It’s hard for me to concentrate on what I have to do | 0 | 1 | 2 | 3 |
| I feel depressed | 0 | 1 | 2 | 3 |
| Everything I do requires extra effort from me | 0 | 1 | 2 | 3 |
| I hope for a good future | 3 | 2 | 1 | 0 |
| It seems to me that my life has turned out badly | 0 | 1 | 2 | 3 |
| I am experiencing anxiety, fears | 0 | 1 | 2 | 3 |
| I have a bad night’s sleep | 0 | 1 | 2 | 3 |
| I feel like a happy person | 3 | 2 | 1 | 0 |
| It seems that I have started talking less | 0 | 1 | 2 | 3 |
| I’m worried about feeling lonely | 0 | 1 | 2 | 3 |
| People around me are unfriendly to me | 0 | 1 | 2 | 3 |
| Life gives me pleasure | 3 | 2 | 1 | 0 |
| I can easily cry | 0 | 1 | 2 | 3 |
| I feel sad, depressed | 0 | 1 | 2 | 3 |
| It seems to me that people don’t like me | 0 | 1 | 2 | 3 |
| I don’t have the strength and desire to start doing anything | 0 | 1 | 2 | 3 |
<Survey Instructions> This questionnaire contains information that may be relevant to your daily life. After carefully reviewing the questions presented below, please indicate with the “O” symbol the number that best reflects your feelings and actions over the past week, including today. Be sure to choose one of the answer options without missing a single question, and answer honestly without thinking too long.
<Table 2 Korean version of Depression screening test>
*Please indicate the symbol (V) next to the corresponding digit, how often during the last two weeks you have been bothered by the following problems.
| Questions | Not once | Several days | More than a week | Almost every day | |
| 1. You didn’t want to do work or spend your free time in any way | 0 | 1 | 2 | 3 | |
| 2. You were in a bad mood, you were depressed or felt a sense of hopelessness | 0 | 1 | 2 | 3 | |
| 3. You had difficulty falling asleep, you had intermittent sleep, or you slept too much | 0 | 1 | 2 | 3 | |
| 4. Were you tired, or did you have little strength | 0 | 1 | 2 | 3 | |
| 5. Did you have a bad appetite or did you overeat | 0 | 1 | 2 | 3 | |
| 6. You thought badly of yourself: you considered yourself a loser (loser), or you were disappointed in yourself, or you thought that you had let your family down | 0 | 1 | 2 | 3 | |
| 7. You had difficulty concentrating on everyday tasks such as reading the newspaper or watching television | 0 | 1 | 2 | 3 | |
| 8. Did you move or speak so slowly that others noticed it? Or, on the contrary, you were so fussy or excited that you moved much more than usual | 0 | 1 | 2 | 3 | |
| 9. Have you had thoughts that it would be better for you to die, or to do yourself some harm | 0 | 1 | 2 | 3 | |
| * Numeric values reflect scores. | Total score | ||||
Treatment and course of the disease
If you have serious symptoms of depression or you face problems in everyday life due to symptoms associated with depression, it is recommended to contact a medical institution for a diagnosis of depression.
Treatment provided in medical institutions includes both drug and non-drug therapy. If depression is considered as a medical condition, medication is prescribed. Correction of the biological factors underlying depression can be performed by restoring the balance of neurotransmitters such as serotonin, norepinephrine and dopamine in the body.
Non-drug treatment includes consultation with a mental health specialist and transcranial magnetic stimulation. With mild depression, symptoms can be improved with the help of psychotherapy alone, but with severe depression, combined treatment may be required, including both psychotherapy and medication. Various types of psychotherapy may also be useful, for example, cognitive behavioral therapy and interpersonal therapy. Among the non-drug treatment methods, a recently developed method should be mentioned, such as rhythmic transcranial magnetic stimulation (rTMS), which is a non-invasive treatment method that affects the brain through an electromagnetic field, and has proven its effectiveness in the treatment of depression.
