Here are the many ways depression can strike


While anyone can experience depression, women are more likely to develop this condition than men. — Filepic

Major depressive disorder (MDD) is a severe, common illness that affects how you feel, how you think and how you act.

Anyone can be affected by depression – even those who seem to live in relatively ideal circumstances.

The first signs of depression typically appear from the late teens to mid-20s, but they can occur at any time.

It is more common for women to experience depression than men.

According to some studies, one-third of women will experience a major depressive episode in their lifetime.

The probability of the patient’s close relatives (e.g. parents, children and siblings) also having depression is approximately 40%.

It is, however, treatable.

Symptoms of depression can range from mild to severe and include:

  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g. 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
  • Thoughts of death or suicide
  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite – weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much.

Types of depression

Depression can be classified into different types.

The symptoms of these conditions can vary from mild (but still disabling) to very severe, so knowing their specific symptoms is helpful.

> Major depression

There are many names for major depression, including MDD, clinical depression, unipolar depression, or simply “depression”.

There are various levels of depression, from mild to severe, melancholy to psychotic.

> Psychotic depression

Depressive disorders can sometimes cause people to lose touch with reality and experience psychosis.

In addition, they may feel paranoid, believing that everyone is against them or that things are bad around them because of them.

> Melancholia

Symptoms of this form of depression include the inability to move rapidly, among other physical symptoms.

Also, they are more likely to have a depressed mood, characterised by a complete loss of enjoyment in almost everything.

> Antenatal and postnatal depression

Depression is more prevalent among women during pregnancy (antenatal or prenatal period) and after childbirth (postnatal period).

In addition to pregnancy and the first year after the baby’s birth, you may also come across the term “perinatal”.

There are many factors that can cause depression at this time, and the causes can be complex.

> Premenstrual dysphoric disorder (PMDD)

A week before menstruation begins, PMDD can cause depression, irritability, food cravings and tension.

The symptoms appear before menstruation begins, then decrease or disappear when it begins.

As a result of the symptoms, there may be significant distress, as well as difficulties with social interactions and daily functioning.

In order to be diagnosed with PMDD, the symptoms must have occurred during most menstrual cycles in the past year, and must have negatively impacted work or social functioning.

Approximately 1.8% to 5.8% of menstruating women suffer from PMDD every year.

It is possible to treat PMDD with antidepressants, birth control pills or nutritional supplements.

Changing your diet and lifestyle, such as reducing caffeine and alcohol consumption, getting enough sleep, exercising and practising relaxation techniques, can make a big difference.

> Bipolar disorder

Historically, bipolar disorder has been referred to as manic depression because the individual experiences periods of depression, followed by periods of mania.

An individual with mania feels great, has lots of energy, has racing thoughts, doesn’t need much sleep, talks quickly, has difficulty focusing on tasks, and feels frustrated and irritable.

There is more to this than a fleeting experience.

There are times when the person loses touch with reality and has psychotic episodes.

A person with mania can be difficult to diagnose unless they have had an episode.

In some cases, bipolar disorder is misdiagnosed as depression, alcoholism or substance abuse.

You should tell your doctor or treating health professional if you’re experiencing abnormal highs and lows.

> Persistent depressive disorder

Persistent depressive disorder (formerly known as dysthymic disorder) is characterised by a persistent depressed mood for the majority of the day, for at least two years in a row.

It is common for persistent depressive disorder to develop during childhood, adolescence or early adulthood.

The mood must last at least one year in children and adolescents who are irritable or depressed.

Other symptoms include:

  • Poor appetite or overeating
  • Insomnia or hypersomnia
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness

Individuals who experience these symptoms every day may not seek help, simply assuming that “it has always been this way”.

These symptoms cause significant distress or difficulty in work, social activities, or other important areas of functioning.

> Seasonal affective disorder (SAD)

SAD is a mood disorder that occurs during certain times of the year.

It’s unclear what causes the disorder, but it may be related to seasonal changes in light exposure.

In Malaysia, SAD is rare.

It is more prevalent in countries with shorter days and longer dark periods, such as those in the northern hemisphere with cold climates.

In most cases, it’s diagnosed after a couple of years of experiencing the same symptoms during winter.

People with SAD are more likely to lack energy, sleep excessively, overeat, gain weight and crave carbohydrates.

> Cyclothymic disorder

This is a milder form of bipolar disorder.

There are periods of hypomania (mild to moderate levels of mania) and periods of depression, with very short periods of normality (no more than two months) between.

These symptoms have a shorter duration, aren’t as severe and aren’t as regular as bipolar disorder or major depression.

> Disruptive mood dysregulation disorder

Disruptive mood dysregulation disorder affects children and youth ages six to 18.

The disorder is characterised by chronic irritability and frequent temper outbursts.

There are many ways in which temper outbursts can be expressed, including verbally or physically.

Outbursts such as these are significantly out of proportion to the situation and are not consistent with the child’s developmental stage.

To be diagnosed with disruptive mood dysregulation disorder, the symptoms must be present for at least one year in at least two settings (e.g. at home, at school and/or with peers), and the condition must begin before the age of 10.

The prevalence of disruptive mood dysregulation disorder is much higher in males than in females.

Treatment for depression

There are many ways to treat depression.

It is estimated that 80% to 90% of people with depression respond well to treatment.

The symptoms of almost all patients are relieved to some degree.

Before diagnosing or treating a patient, a health professional should conduct a thorough diagnostic evaluation, including a physical examination.

A blood test may be performed in some cases to determine whether the depression is caused by a thyroid problem or vitamin deficiency.

Here are the methods to manage depression:

> Self-help and coping

Get enough quality sleep on a regular basis.

Daily exercise helps create positive feeling and improves mood, especially if done outdoors in a green environment.

Even a stroll by the river or a mindful walk in the park is thought to be beneficial.

> Medication

Several factors may contribute to depression, including brain chemistry.

This is why antidepressants are prescribed to help modify brain chemistry.

No sedatives, “uppers” or tranquilisers are present in these medications, nor are they habit-forming.

> Psychotherapy

For mild depression, talk therapy is sometimes used alone.

For moderate to severe depression, psychotherapy is often used with antidepressants.

In many cases, significant improvement can be made in 10 to 15 sessions.

> Electroconvulsive therapy (ECT)

Patients with severe major depression who have not responded to other treatments are most likely to be prescribed ECT.

ECT has been used since the 1940s, but research over the years has led to significant improvements and its recognition as a mainstream therapy, rather than a “last resort”.

> Hormonal optimisation

If anxiety or depression are related to hormonal conditions such as polycystic ovarian syndrome (PCOS), menstrual cycles, postpartum depression or menopause, then screening for these disorders may allow early intervention.

Balancing the hormones may be warranted.

> Nutritional psychiatry

It is important to consider nutrition with regards to depression.

A 2017 study found that the symptoms of people with moderate-to-severe depression improved when they received nutritional counselling sessions and ate a more healthful diet for at least 12 weeks.

Macronutrients (carbohydrates, proteins and fats) are essential body-building blocks, but it is the micronutrients (vitamins, minerals, amino acids and essential fatty acids) that are required by the body to make the neurotransmitters (e.g. serotonin or dopamine) and hormones responsible for a balanced mood.

Eat a healthy diet and avoid alcohol.

Always get professional guidance from your doctor – preferably one knowledgeable in nutritional medicine – for more advice.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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