Depression: the symptoms and when to seek help

Depression or depressive disorder is the overall name for a variety of conditions that are characterized by chronic sadness, emptiness or hopelessness coupled with physical symptoms that significantly impair the ability to function in everyday life. The severity, duration and onset of the depression varies in every individual.  

To understand and successfully treat depression, it is also important to know that there are various types of depression and to become familiar with the various symptoms. The following article will help you sort out the issue and of course understand when it is important to seek help.

When is it depression? 

Everyone experiences periods of sadness or dejection - it is a natural part of life. Everyone copes with changes in life that require adjustment, mental resilience and occasionally seeking assistance from support such as family, friends and the community. If you are experiencing fatigue, a lack of strength or restlessness as well as an emptiness that cannot be filled, all of which impair your everyday function, then you may be experiencing depression.  

Depression may be characterized by a sense of sadness, but it goes much farther than that. The quality and severity of depression differs from sadness, and the intensity in which it is experienced is strong.  

Depression causes the individual to experience the world and himself through gloomy and pessimistic glasses. This feeling is frequently accompanied by attention difficulties, hesitancy in making decisions, poor self-esteem and irrational and unjustified feelings of guilt. The emotional suffering is occasionally overwhelming to the point that the feelings of despair and helplessness to change may give rise to thoughts of death and even suicide.  

The body is also affected by depression, manifested as fatigue, changes in appetite and weight, sleep disturbances and various pain including abdominal pain, headaches or muscle pain, passivity and slowdown in activity. Depression occasionally manifests in increased risk of contracting physical illnesses. 

Incidence of depression 

In the general population, the incidence of depressive disorders is an average of 8.3%, and is more common among women and different cultures have different methods of diagnosis. 

Symptoms of depression 

A diagnosis of depression is made when at least 5 of the 9 possible symptoms occur - with at least one being from among the first two symptoms appearing in the list below. Another diagnostic criterion is that the symptoms appear for most of the day for a period of at least two weeks. 

• Poor mood most of the day, almost all day. Sense of irritability, concern and emptiness. 
• Loss of interest or lack of enjoyment from previously loved hobbies and activities. 
• Changes in appetite, as manifested in frequent or diminished eating or alternatively - non-deliberate significant weight gain or loss, without a diet. 
• Sleep disorders, insomnia or sleep. 
• Restlessness or inability to be at rest, or alternatively - a significant slowdown in activity. 
• Fatigue and listlessness. 
• Lack of esteem or increased feelings of guilt. 
• Difficulty thinking or focusing, forgetfulness, difficulty in making decisions, even simple and minor ones. 
• Thoughts about death, suicidal ideation or suicide attempts. 

If you or someone close to you is experiencing similar feelings as those mentioned here, for a period of over two weeks, and that is affecting their function and sparking concern that this is not just passing dismay, professional help must be sought. There is no need to wait until the situation worsens and deal with it alone - seeking help early increases the chances of recovery. Contact the family physician in the HMO, emotional first aid, or HMO mental health services.

Types of depressive disorders 

Depression does not always look the same. Discussions of depression generally address serious depressive disorder (major depressive disorder), which is essentially what we described here. Major depressive disorder may occur as a single episode or as recurring episodes (Major Depressive Disorder, Single and Recurrent Episodes) as well as bear certain characteristics, such as: 

• Anxious depression: characterized more by anxiety and restlessness. 
• Melancholic depression: characterized by irritability, loss of enjoyment and interest while also including physical symptoms. 
• Depression with psychotic features: characterized by delusions, such as: “I am guilty of the September 11 attacks on the Twin Towers”, “I have no esophagus, I cannot eat”, “My whole family is dead (despite all of them being next to him), etc. 
• Perinatal depression: may occur during pregnancy or in the weeks and months following childbirth. 
• Seasonal depression: occurs during seasonal changes, known also as “winter depression”, and manifests as increased appetite, desire to sleep, general slowdown and withdrawal. 

Furthermore, under the chapter that discusses depression in the psychiatric diagnostic manual, the DSM-5, there are several other depressive disorders, including: 

• Persistent Depressive Disorder (dysthymia): a disorder with symptoms of depression, generally of lower intensity and with less impairment of function, which lasts for at least two years.  
• Disruptive Mood Dysregulation Disorder: diagnosed during childhood and adolescence, characterized by irritability, anger, frequent outbursts of rage that are not appropriate for age and situation.  
• Premenstrual dysphoric disorder: characterized by symptoms such as irritability, stress, poor mood, fluctuating mood, anxiety, irritability, declining interest, attention deficit, sleep disorders, fatigue and physical symptoms. All of these occur for at least two monthly menstrual cycles, between ovulation and menstruation, and then disappear for 7 days - until the next ovulation. 
• Substance/medication-induced depressive disorder: Disorder may occur as part of the side effects of proper use (medical prescription) of substances or medications, or after abuse of these substances, or during the course of withdrawal. 
• Depressive disorder due to another medical condition: may be caused by a physical disorder, such as hypothyroidism. During diagnosis, it is therefore important to undergo physical examinations to rule out any other physical problem. 

People who experience significant loss or a traumatic life experience may frequently and normally experience sadness, anger, frustration, etc. It should be noted that similar feelings may also occur in light of events that are seemingly good and positive, such as childbirth (postpartum depression has, of course, specific features), relocation, job promotion or even winning the lottery. In other words, the burden and intensity of the weight of the event constitutes, even if the event is perceived as being positive, may result in significant emotional overflow. When this emotional overflow leads to emotional distress and impaired function in several areas of life, then depression, or more accurately, a depressive disorder may be involved. 

In a period of mourning following the loss of a close relative, symptoms whose intensity and duration mimic depression may occur, but they are due to the loss itself and its repercussions. For example, difficulty in falling asleep due to thoughts about the deceased, guilt for possibly spending more time with the deceased, etc. If this situation lasts for a long time and at high intensity, a diagnosis of ‘complicated grief’ may be made. In any case, the recommendation is to seek consultation and receive treatment if there is significant distress. 

This is an excellent opportunity to explain that in psychiatric disorders, patients commonly find it difficult to see beyond their ‘tunnel vision’.  In other words, people suffering from depression find it difficult to see better options and methods, something that may be coined “fan vision”. Hopelessness and difficulty in believing that the situation can be different and that help as well as recovery are achievable are the main difficulties. For these reasons, family, social and professional support are critical. It is also important to know that the success rates in treating depression are extremely high. Although coping still exists, the right professional help can help one restore their breathing and feel better.