Depression is a common mental disorder characterized by sadness, loss of interest, and feelings of guilt or low self-worth. Symptoms include depressed mood, anxiety, poor concentration, changes in sleep and appetite, and thoughts of death. Doctors diagnose depression through screening tests and blood tests to rule out other medical conditions. Treatments include psychotherapy, antidepressant medications, and lifestyle changes like exercise and a healthy diet. Sticking with treatment and making lifestyle changes is important for recovery from depression.

1. Subhas Chandra Aryal [MSC MEDICAL MICROBIOLOGY}
GOLDENGATE INTERNATIONAL COLLEGE,KATHMANDU
subasaryal98@gmail.com, https://www.facebook.com/thesubhas.chandra
NALANG-3 KAMDI DHADING,NEPAL
Depression being biggest health issue
What is Depression?
Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure,
feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor
concentration. Depression is a state of low mood and aversion to activity that can affect a person's
thoughts,behavior, feelings and sense of well-being. Depression is an ancient disease that has affected

2. millions of people. As far back as the 4th century BCE, Hippocrates described the symptoms of
depression,callingit"melancholia."Ithastormentedthe likesof WinstonChurchill, Ernest Hemingway,
Abraham Lincon, and Mark Twain.
Symptoms
1. Depressed mood
2. Loss of interest
3. Anxiety/Irritability
4. Poor concentration
5. Low energy:
6. Sleep changes
7. Appetite or weight change
8. Slow moving or restless
9. aches and pains
10. Thoughts of death
Causes
1. Live events: Adversity in childhood, such as bereavement, neglect, mental abuse, physical
abuse, sexual abuse andunequal parental treatmentof siblingscancontribute to depression
in adulthood.
2. Medication: Certain medications are known to cause depressed mood in a significant
number of patients.
3. Several drugs of abuse can cause or exacerbate depression

3. 4. An anxiety disorder thatsometimesfollowstrauma,is commonly accompanied by depressed
mood.
5. Depressedmoodcanbe the resultof a numberof infectious diseases, nutritional deficiencies,
neurological conditions and physiological problems.
6. The historical legacies of racism and colonialism may create depressive conditions.
7. Trauma and Grief
8. Age
9. Changes and Stressful Events
10. The hormonal changes that women go through at different times of their lives may play a
role.
11. Central nervous system tumors
12. Multiple sclerosis
13. Stroke
14. Syphilis
15. Various cancers (pancreas, prostate, breast)
How doctors diagnose depression?

4. Screening tests: Doctor can usually tell if he/she has depression by asking specific questions
and doing a physical exam.Doctor may, however, ask for lab tests to rule out other diagnoses.
Doctor will likely do blood tests to check for medical conditions that may cause depressive
symptoms. He or she will use the blood tests to check for such things as anemia as well as thyroid,
other hormone, and calcium and vitamin D levels.Doctors also do different tests in finding the
associated diseases.
Treatment
1 Psychotherapy
2 Pharmaceutical drug treatment:Selective serotonin reuptake inhibitors (SSRIs), such as sertraline,
escitalopram , fluoxetine, paroxetine, and citalopram, are the primary medications considered, due to their
relatively mild side effects and broad effect on the symptoms of depression and anxiety, as well as
reduced risk in overdose, compared to their older tricyclic alternatives.
3 Medical devices :Electroconvulsive therapy, Deep brain stimulation, Repetitive transcranial
magnetic stimulation, Vagus nerve stimulation
4 Other treatments :Bright light therapy, Exercise, Meditation, Music therapy ,St John's wort, Sleep,
Smoking cessation, Total/partial sleep deprivation
The UK NationalInstitute for HealthandCare Excellence (NICE)2009 guidelinesindicate thatantidepressants
shouldnotbe routinelyusedforthe initial treatmentof milddepression,because the risk-benefitratiois
poor.The treatmentof depressionisbestmanagedbylifestyle choices, which includes, diet, sleep and
exercise. A recent meta-analysis also indicated that most antidepressants, besides fluoxetine, do not
seemtooffera clearadvantage for childrenandadolescentsinthe acute treatmentof majordepressive
disorder.

5. Here are some tips for patients:
1. Stick with it. Antidepressants may not take effect for four to six weeks. In some cases, a
medication may not work and you'll need to try another, or possibly a combination of
medicines. Therapy can take a while, too. But don't despair. If you give them time,
these treatments are very likely to help. When a depressed person gets the right
medicine, at the right dose, and takes it long enough, treatment succeeds about 70%
of the time.
2. Take your medicine as prescribed: Take your medicine at the same time every day.
3. Never stop taking your medicine without your doctor's OK.
4. Make lifestyle changes. Eat healthy foods, high in fruits and vegetables and low in sugars
and fats. Avoid alcohol and illicit drugs. Make sure to get a good night's sleep. Do
regular exercise and have a regular visit with friends and relatives.
5. Reduce stress at home and at work..
6. Be honest. Opening up to a therapist isn't easy. But if you're not truthful, therapy is
less likely to help. If you have doubts about therapy or your therapist's approach,
don't hide them. Instead, talk about them openly with your therapist.
7. Be open to new ideas.
8. Don't give up. You may feel hopeless right now. You may feel like you're never going
to get better. But feeling that way is a symptom of your condition. If you give yourself
some time and allow your treatment to take effect, you will feel better again.