This document provides an overview of depression including its definition, causes, symptoms, types, risk factors, and treatment. Depression is defined as a persistent feeling of sadness and loss of interest that affects how one feels, thinks, and behaves. It can be caused by genetic, biological, environmental, and psychological factors. Common symptoms include feelings of sadness, hopelessness, and lack of enjoyment. Types of depression include major depressive disorder, persistent depressive disorder, perinatal depression, psychotic depression, seasonal affective disorder, and bipolar disorder. Risk factors include personal or family history of depression and major life changes. Treatment involves medication, psychotherapy, or a combination of both.

1. Harish kumar.R
MSW 2 year
CUK

2. Harish kumar R
MSW 2 year
Central University of Karnataka, Kalburgi

3. Content
• Introduction
• Meaning of depression
• Definition of depression
• Causes of Depression?
• Symptoms of Depression?
• Types of depressions
• Treatment and Therapies for depression
• Beyond Treatment: Things You Can Do for depression
• Conclusion
• References

4. Introduction
• Depression is a mood disorder that causes a persistent feeling of sadness and loss
of interest. Also called major depressive disorder or clinical depression, it affects
how you feel, think and behave and can lead to a variety of emotional and physical
problems. You may have trouble doing normal day-to-day activities, and
sometimes you may feel as if life isn't worth living. More than just a bout of the
blues, depression isn't a weakness and you can't simply "snap out" of it.
Depression may require long-term treatment. But don't get discouraged. Most
people with depression feel better with medication, psychological counseling or
both.

5. What is depression?
• Depression is a mental health disorder. Specifically, it is a mood disorder
characterized by persistently low mood in which there is a feeling of sadness and
loss of interest.
• Depression is a persistent problem, not a passing one - the average length of a
depressive episode is 6-8 months.
• Depression is different from the fluctuations in mood that we all experience as a
part of a normal and healthy life. Temporary emotional responses to the challenges
of everyday life do not constitute depression.

6. Definition of depression
• Depression (major depressive disorder or clinical depression) is a common
but serious mood disorder. It causes severe symptoms that affect how you
feel, think, and handle daily activities, such as sleeping, eating, or working. To
be diagnosed with depression, the symptoms must be present for at least two
weeks.

7. Definition of depression (WHO)
• 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.
• According to the CDC, 7.6 percent of people over the age of 12 has depression in
any 2-week period.
• According to the World Health Organization (WHO), depression is the most
common illness worldwide and the leading cause of disability. They estimate that
350 million people are affected by depression, globally.

8. Tests and diagnosis of depression
• Diagnosis of depression starts with a consultation with a doctor or mental health
specialist (psychologist or psychiatrist).
• It is important to seek the help of a health professional to rule out different
causes of depression, ensure an accurate differential diagnosis, and secure safe and
effective treatment.
• As for most visits to the doctor, there may be a physical examination to check for
physical causes and coexisting conditions. Questions will also be asked - "taking a
history" - to establish the symptoms, their time course, and so on.
• Some questionnaires help doctors to assess the severity of depression. The
Hamilton depression rating scale, for example, has 21 questions, with resulting
scores describing the severity of the condition.

9. What Are the Main Causes of Depression?
• Abuse. Past physical, sexual, or emotional abuse can increase the vulnerability to
clinical depression later in life.
• Certain medications. Some drugs, such as isotretinoin (used to treat acne), the
antiviral drug interferon-alpha, and corticosteroids, can increase your risk of
depression.
• Conflict. Depression in someone who has the biological vulnerability to develop
depression may result from personal conflicts or disputes with family members or
friends.
• Death or a loss. Sadness or grief from the death or loss of a loved one, though
natural, may increase the risk of depression.

10. Cont.
• Genetics. A family history of depression may increase the risk. It's thought that depression
is a complex trait, meaning that there are probably many different genes that each exert
small effects, rather than a single gene that contributes to disease risk. The genetics of
depression, like most psychiatric disorders, are not as simple or straightforward as in purely
genetic diseases such as Huntington's chorea or cystic fibrosis.
• Major events. Even good events such as starting a new job, graduating, or getting married
can lead to depression. So can moving, losing a job or income, getting divorced, or retiring.
However, the syndrome of clinical depression is never just a "normal" response to
stressful life events.
• Other personal problems. Problems such as social isolation due to other mental illnesses or
being cast out of a family or social group can contribute to the risk of developing clinical
depression.
• Serious illnesses. Sometimes depression co-exists with a major illness or may be triggered
by another medical condition.
• Substance abuse. Nearly 30% of people with substance abuse problems also have major or
clinical depression.

11. What Are the Symptoms of Depression?
They include feeling several of the following for at least 2 weeks:
• Feeling sad, anxious, or empty
• Feeling hopeless or pessimistic
• Feeling guilty, worthless, or helpless
• Not enjoying things you used to enjoy
• Trouble with concentration, memory, or making decisions
• Sleeping too much or too little
• Gaining or losing weight
• Feeling restless or irritable
• Thoughts of suicide or death

12. Some forms of depression are slightly
different, or they may develop under unique
circumstances, such as:
• Persistent depressive disorder (also called dysthymia) is a depressed mood
that lasts for at least two years. A person diagnosed with persistent depressive
disorder may have episodes of major depression along with periods of less
severe symptoms, but symptoms must last for two years to be considered
persistent depressive disorder.

13. Perinatal depression
• Perinatal depression is much more serious than the “baby blues” (relatively mild
depressive and anxiety symptoms that typically clear within two weeks after delivery)
that many women experience after giving birth.
• Women with perinatal depression experience full-blown major depression during
pregnancy or after delivery (postpartum depression).
• The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal
depression may make it difficult for these new mothers to complete daily care
activities for themselves and/or for their babies.

14. Psychotic depression
• Psychotic depression occurs when a person has severe depression plus some
form of psychosis, such as having disturbing false fixed beliefs (delusions) or
hearing or seeing upsetting things that others cannot hear or see
(hallucinations).
• The psychotic symptoms typically have a depressive “theme,” such as
delusions of guilt, poverty, or illness.

15. Seasonal affective disorder
• Seasonal affective disorder is characterized by the onset
of depression during the winter months, when there is
less natural sunlight.
• This depression generally lifts during spring and summer.
Winter depression, typically accompanied by social
withdrawal, increased sleep, and weight gain, predictably
returns every year in seasonal affective disorder.

16. Bipolar disorder
• Bipolar disorder is different from depression, but it is included in this list is
because someone with bipolar disorder experiences episodes of extremely
low moods that meet the criteria for major depression (called “bipolar
depression”).
• But a person with bipolar disorder also experiences extreme high – euphoric
or irritable – moods called “mania” or a less severe form called “hypomania.”

17. Risk Factors
• Depression is one of the most common mental disorders in the U.S. Current research suggests
that depression is caused by a combination of genetic, biological, environmental, and
psychological factors.
• Depression can happen at any age, but often begins in adulthood. Depression is now
recognized as occurring in children and adolescents, although it sometimes presents with more
prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin
as high levels of anxiety in children.
• Personal or family history of depression
• Major life changes, trauma, or stress
• Certain physical illnesses and medications

18. Special Situations
Depression in Special Situations
• Learn all about depression in special situations, including depression in men and
how it’s different from depression in women. Find out about depression in older
adults and treatment-resistant depression.
Depression in Women
• Depression in women is increasingly common. Find out the symptoms of
depression in women and what medical treatment can do to manage these
depression symptoms.

19. Cont…
Depression in the Elderly
• Depression in seniors is often confused with signs of serious illnesses or grieving.
Learn the specific symptoms of depression in older adults and talk to your doctor.
Treatment-Resistant Depression
• Treatment-resistant depression should be taken very seriously. Find out who’s at
risk for treatment-resistant depression and how a doctor can help manage the
symptoms.
Antidepressant Withdrawal
• Why does someone have withdrawal symptoms after taking antidepressants and
how can it be overcome? WebMD explains.

20. Treatment and Therapies
• Depression, even the most severe cases, can be treated.
• The earlier that treatment can begin, the more effective it is.
• Depression is usually treated with medications, psychotherapy, or a
combination of the two.
• If these treatments do not reduce symptoms, electroconvulsive therapy
(ECT) and other brain stimulation therapies may be options to explore.

21. Medications
• A medication that has helped you or a close family member
in the past will often be considered.
• Antidepressants take time – usually 2 to 4 weeks – to work,
and often, symptoms such as sleep, appetite, and
concentration problems improve before mood lifts, so it is
important to give medication a chance before reaching a
conclusion about its effectiveness.
• Sometimes people taking antidepressants feel better and then
stop taking the medication on their own, and the depression
returns.
• usually after a course of 6 to 12 months, the doctor will help
slowly and safely decrease dose. Stopping them abruptly can
cause withdrawal symptoms.

22. Psychotherapies
• Several types of psychotherapy (also called “talk therapy” or, in a less
specific form, counseling) can help people with depression.
• Examples of evidence-based approaches specific to the treatment of
depression include cognitive-behavioral therapy (CBT), interpersonal
therapy (IPT), and problem-solving therapy. More

23. Brain Stimulation Therapies
• If medications do not reduce the symptoms of depression, electroconvulsive therapy
(ECT) may be an option to explore. Based on the latest research:
• ECT can provide relief for people with severe depression who have not been able to
feel better with other treatments.
• Electroconvulsive therapy can be an effective treatment for depression. In some severe
cases where a rapid response is necessary or medications cannot be used safely, ECT
can even be a first-line intervention.
• ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a
patient is put under brief anesthesia and given a muscle relaxant. Within one hour after
the treatment session, which takes only a few minutes, the patient is awake and alert.

24. Psychological treatments for depression
• Psychological treatments (also known as talking therapies) can help you change
your thinking patterns and improve your coping skills so you're better equipped to
deal with life's stresses and conflicts.
• As well as supporting your recovery, psychological therapies can also help you stay
well by identifying and changing unhelpful thoughts and behavior.
• There are several types of effective psychological treatments for depression, as
well as different delivery options.
• Some people prefer to work one on one with a professional, while others get
more out of a group environment. A growing number of online programs, or e-
therapies, are also available.

25. Cognitive behavior therapy (CBT)
• CBT is a structured psychological treatment which recognizes that the way we think
(cognition) and act (behavior) affects the way we feel. CBT is one of the most
effective treatments for depression, and has been found to be useful for a wide
range of ages, including children, adolescents, adults and older people.
• CBT involves working with a professional (therapist) to identify thought and
behavior patterns that are either making you more likely to become depressed, or
stopping you from getting better when you’re experiencing depression.
• It works to change your thoughts and behavior by teaching you to think rationally
about common difficulties, helping you to shift negative or unhelpful thought
patterns and reactions to a more realistic, positive and problem-solving approach.
• CBT is also well-suited to being delivered electronically (often called e-therapies)

26. Interpersonal therapy (IPT)
• IPT is a structured psychological therapy that focuses on problems in personal
relationships and the skills needed to deal with these.
• IPT is based on the idea that relationship problems can have a significant effect
on someone experiencing depression, and can even contribute to the cause.
• IPT helps you recognize patterns in your relationships that make you more
vulnerable to depression.
• Identifying these patterns means you can focus on improving relationships, coping
with grief and finding new ways to get along with others.

27. Behavior therapy
• While behaviour therapy is a major component of cognitive behaviour therapy
(CBT), unlike CBT it doesn’t attempt to change beliefs and attitudes.
• Instead it focuses on encouraging activities that are rewarding, pleasant or
satisfying, aiming to reverse the patterns of avoidance, withdrawal and inactivity
that make depression worse.

28. Mindfulness-based cognitive therapy
(MBCT)
• MBCT is generally delivered in groups and involves a type of meditation called
'mindfulness meditation‘
• . This teaches you to focus on the present moment – just noticing whatever you’re
experiencing, whether it's pleasant or unpleasant – without trying to change it.
• At first, this approach is used to focus on physical sensations (like breathing), but then
moves on to feelings and thoughts.
• MBCT can help to stop your mind wandering off into thoughts about the future or the
past, and avoid unpleasant thoughts and feelings.
• This is thought to be helpful in preventing depression from returning because it encourages
you to notice feelings of sadness and negative thinking patterns early on, before they
become fixed. As a result, you’re able to deal with warning signs earlier and more effectively.

29. Medical treatments for depression
• The main medical treatment for depression is antidepressant
medication.
• There's a lot of misinformation about antidepressant medication
and while there is no simple explanation as to how it works, it can
be very useful in the treatment of moderate to severe depression
and some anxiety disorders.
• If you're experiencing moderate to severe depression your doctor
may prescribe antidepressant medication, along with
psychological treatments.
• Antidepressants are sometimes prescribed when other treatments
have not been successful or when psychological treatments aren't
possible due to the severity of the condition or a lack of access to
the treatment.

30. Beyond Treatment: Things You Can Do

31. Here are other tips that may help you or a loved one during treatment for
depression:
• Try to be active and exercise.
• Set realistic goals for yourself.
• Try to spend time with other people and confide in a trusted friend or relative.
• Try not to isolate yourself, and let others help you.
• Expect your mood to improve gradually, not immediately.
• Postpone important decisions, such as getting married or divorced, or changing jobs until you feel
better. Discuss decisions with others who know you well and have a more objective view of your
situation.
• Continue to educate yourself about depression.

32. Family and friends
• The people close to you can play an important role in your recovery by providing
support, understanding and help, or just being there to listen. It can be hard to socialize
if you’re experiencing anxiety or depression, but spending time alone can make you feel
cut off from the world, which in turn makes it harder to recover.
• Try to get out and spend time with your family and friends, and keep saying ‘yes’ to
social invitations – even if it's the last thing you feel like doing. If you don’t feel like
talking and interacting, try an activity where you don’t have to make conversation, like
watching a movie or playing sport.
• Staying connected improves your wellbeing and confidence, and doing some physical
activity has the added bonus of helping you keep fit and bust stress.

33. Support groups & online forum
• Support groups for people with depression and anxiety can provide an opportunity
to connect with others, share experiences and find new ways to deal with challenges.
• Contact your local community health Centre or the mental health
association/foundation in your state or territory to find your nearest group, or try
searching online.
• Some people prefer to seek and offer support or share their stories via online
forums. You can visit the Australian Government's mindhealthconnect website to
find trusted communities, or join beyondblue's online community.

34. Other approaches to try
• While it's not uncommon for people with depression or anxiety to try to manage
their condition themselves, there's no substitute for the advice of a qualified health
professional. They can talk you through the treatment options and help you find an
approach you're comfortable with.
• If you're looking for ways to complement your treatment, there are a range of non-
medical or alternative approaches you can try. These vary in both effectiveness and
the level of evidence to support their use.
• Our Guide to what works series provides summaries of what the research and
scientific evidence says about each treatment. Each guide takes you through medical,
psychological and complementary and lifestyle interventions.

35. Maintaining healthy lifestyle
• Staying well is about finding a balance that works for
you, but there are some general principles that most
people find useful. These include reducing and
managing your stress levels, maintaining a healthy
lifestyle, cutting back on alcohol and drugs, and taking
action early if you start experiencing symptoms of
depression or anxiety. It's also important to deal with
any setbacks and keep trying.

37. Conclusion
• Living with a depressed person can be very difficult and stressful on family members
and friends. The pain of watching a loved one suffer from depression can bring
about feelings of helplessness and loss. Family or couples therapy may be beneficial
in bringing together all the individuals affected by depression and helping them learn
effective ways to cope. The support and involvement of family and friends can play
a crucial role in aiding someone who is depressed. Individuals in the “support
system” can encourage a depressed loved one to stick with treatment and practice
the coping techniques and problem-solving skills he or she is learning through
psychotherapy.

38. Reference
Abnormal psychology(6 edition)
By:Ronald. J.comer
Worth publishers, New York(2007)
Health & well being(1 edition)
By: Dr.Sandhya ojha, Dr.Shobhana joshi, & Dr. urmila Ranin Srivastava
A short textbook of psychiatry(7 edition)
By: Dr.Niraj Ahuja
Jaypee Brothers publishers,Jabalpur(2015)
en.wikipedia.org/../depression(mood)
www.nimh.nih.gov/..depression/
Depression toolkit.org