What is depression? Symptoms - Lean on Me

<strong>What</strong> <strong>is</strong> <strong>depression</strong>?
Depression <strong>is</strong> much more serious than the normal short ep<strong>is</strong>odes of unhappiness that we all experience from time to
time. People are considered to be depressed if they experience long-lasting feelings of sadness and hopelessness, have
unexplained aches and pains, suffer from poor sleep, anxiety, and/or lack of interest and energy. 1,2 These feelings can be
so severe that they interfere with their everyday life. 2
<strong>Symptoms</strong>
Depression affects different people in different ways – not everyone has the same symptoms. The symptoms of <strong>depression</strong>
impact upon patients both mentally and physically, typically preventing sufferers from leading normal lives. <strong>Symptoms</strong>
may be chronic or recurrent and in severe cases can lead to suicide. <strong>Symptoms</strong> may include any, or a combination of, the
following experienced for more than two weeks: 1,3,4,5
Main symptoms
Low/sad, irritable or indifferent mood
Loss of interest and enjoyment in daily life
Lack of energy
Physical symptoms
Fatigue and reduced activity
D<strong>is</strong>turbed sleep or excessive sleep
Changes in appetite and weight
Loss of sex drive
Unexplained aches and pains, e.g., headache,
Other symptoms
Poor concentration or reduced attention
Difficulty in making dec<strong>is</strong>ions
Tearfulness
Restlessness, agitation or anxiety
Low self-confidence and self-esteem
Feelings of guilt
Inability to cope with life as before
Avoiding other people
Bleak view of the future
Morbid thoughts, ideas of self-harm
backache
Changes to the menstrual cycle
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Prevalence
Depression <strong>is</strong> very common, affecting about 151 million people worldwide and one in five people in Ireland. 6 The prevalence
of <strong>depression</strong> <strong>is</strong> 50% higher for women than men, but women are also more likely to be treated for the condition as they
are more likely to seek professional help. 7,8 The gender difference in treatment rates tends to d<strong>is</strong>appear in the elderly,
although the elderly continue to be at high r<strong>is</strong>k of <strong>depression</strong>. 4
Although <strong>depression</strong> <strong>is</strong> common, it <strong>is</strong> often underestimated and m<strong>is</strong>understood by the public. Stigma creates a strong
barrier both to diagnos<strong>is</strong> and treatment and may perpetuate feelings of <strong>is</strong>olation by those experiencing <strong>depression</strong>
resulting in patients failing to seek help because of fear and shame about their d<strong>is</strong>ease. 4,8
People with personal experience of <strong>depression</strong> 9
Ever experienced personally
All adults
Youth/teens
15
31
Youth/teens
29
38
39
33
Unemployed
20
23
Unemployed
22
30
38
37
Older people/aging
9
24
Older people/aging
11
10
2
9
Men
13
11
Men
8
11
13
9
Women
14
17
Women
7
9
13
5
Parents
3
9
Parents
5
3
-
- 2
Full time workers
0
-
7
2008
2009
2010
Full time workers
0 4
3
- 1
2008
2009
2010

Social and economic consequences
As the incidence of <strong>depression</strong> r<strong>is</strong>es, it <strong>is</strong> on the verge of becoming globally one of the most debilitating d<strong>is</strong>eases th<strong>is</strong>
century. Major <strong>depression</strong> <strong>is</strong> now a leading cause of d<strong>is</strong>ability worldwide with a lifetime prevalence of 16% in the western
world and the most common mental d<strong>is</strong>order leading to suicide. 4,6,10 It <strong>is</strong> predicted that <strong>depression</strong> at its present rate of
growth, will be the leading cause of burden of global d<strong>is</strong>ease (a measure combining years of life lost due to premature
death and years of life lost due to time lived in states of less than full health) by 2030. 6,11 In addition to the severe clinical
symptoms that <strong>depression</strong> imposes on the individual, the economic costs to society are extensive:
People suffering from <strong>depression</strong> use 50-75% more healthcare resources than people who are not depressed. 12
Hospital adm<strong>is</strong>sions and healthcare services make up the bulk of the healthcare costs, while the cost of medication
forms a relatively small part. 13
The indirect costs of <strong>depression</strong> are 23 times larger than the cost to the health service, due to lost employment and
productivity. 14
Depression accounts for 33% of the total cost of brain d<strong>is</strong>orders in Europe, making it the most costly. 15
Onset and cause
Depression occurs in persons of all ages, genders, and backgrounds. The neurological causes of <strong>depression</strong> are still
not yet fully understood but it <strong>is</strong> believed that there may be a physiological element to <strong>depression</strong>. 1 The levels of certain
chemical messengers (neurotransmitters) in the brain, including serotonin, may play a key role in the development of
<strong>depression</strong>. 16
Depression can occur independently, or can be triggered by stressful or emotional situations where initial normal anxiety
and worry pers<strong>is</strong>ts and develops into prolonged <strong>depression</strong>.
D<strong>is</strong>eases that impair quality of life including heart d<strong>is</strong>ease, stroke, cancer, diabetes, HIV/AIDS and Parkinson’s d<strong>is</strong>ease
may also lead to <strong>depression</strong>. 2 A WHO study showed that people with pers<strong>is</strong>tent pain were over four times more likely to
have <strong>depression</strong> than those without pain. 17 Many hormonal factors may contribute to the increased rate of <strong>depression</strong> in
women, such as menstrual cycle changes, pregnancy, m<strong>is</strong>carriage, postpartum period, pre-menopause, and menopause. 2
There <strong>is</strong> some evidence of genetic links for <strong>depression</strong> 2,3 although <strong>depression</strong> <strong>is</strong> also present in people with no family
h<strong>is</strong>tory of the d<strong>is</strong>ease.

Treatment
Most cases of <strong>depression</strong> are treated in the primary care setting by general practitioners. 4 Despite it being a common and
debilitating mental d<strong>is</strong>order, <strong>depression</strong> <strong>is</strong> clinically under-recogn<strong>is</strong>ed and undertreated – 30-50% of cases of <strong>depression</strong>
are not detected in medical settings. 18
Treatment often involves a combination of different therapies such as medication, psychological therapies, social support,
and self-help techniques. An individual’s treatment will depend on the severity of their symptoms. Th<strong>is</strong> combined approach
treats the person as a whole, and marks the beginning of the journey back to wellness.
For further information
For further information about anxiety and <strong>depression</strong>, please v<strong>is</strong>it:
Aware at www.aware.ie
References
1. National Institute for Health and Clinical Excellence. 2009. Depression: the treatment and management of <strong>depression</strong> in adults (update). http://guidance.nice.org.uk/CG90.
2. National Institute for Mental Health. 2007. Depression. http://www.nimh.nih.gov/publicat/<strong>depression</strong>.cfm#ptdep3.
3. Burcusa and Iacono. 2007. R<strong>is</strong>k for Recurrence in Depression. Clin Psychol Rev; 27(8): 959–985.
4. The World Health Report. 2001. Mental Health: New Understanding, New Hope. World Health Organization. http://www.who.int/whr/2001/en/index.html.
5. The Royal College of Psychiatr<strong>is</strong>ts. 2010. Depression. http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/<strong>depression</strong>/<strong>depression</strong>.aspx.
6. World Health Organization. 2008. The global burden of d<strong>is</strong>ease: 2004 update.
7. World Health Organization. Gender D<strong>is</strong>parities in Mental Health. http://www.who.int/mental_health/media/en/242.pdf.
8. World Health Organization. 2002. Mental health: responding to the call for action. http://apps.who.int/gb/archive/pdf_files/WHA55/ea5518.pdf.
9. Lundbeck (Ireland). 2010. Mind Yourself - Lundbeck Mental Health Barometer 2010.
10. Kessler et al. 2003.The Epidemiology of Major Depressive D<strong>is</strong>order: Results From the National Comorbidity Survey Replication (NCS-R). JAMA; 289(23): 3095–3105.
11. World Health Organization. Global burden of d<strong>is</strong>ease. http://www.who.int/topics/global_burden_of_d<strong>is</strong>ease/en/.
12. Simon et al. 2000. Recovery from <strong>depression</strong>, work productivity, and health care costs among primary care patients. Gen Hosp Psychiatry; 22(3): 153–162.
13. Berto P et al. 2000. Depression: cost of-illness studies in the international literature, a review. J Ment Health Policy Econ; 3(1): 3–10.
14. Thomas and Morr<strong>is</strong>. 2003. Cost of <strong>depression</strong> among adults in England in 2000. Br J Psych; 183: 514–519.
15. Sobocki et al. 2006. Cost of Depression in Europe. J Ment Health Policy Econ; 9(2): 87–98.
16. The Royal College of Psychiatr<strong>is</strong>ts. 2010. Antidepressants. http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/<strong>depression</strong>/antidepressants.aspx.
17. Gureje et al. 1998. Pers<strong>is</strong>tent pain and well-being: a World Health Organ<strong>is</strong>ation study in primary care. JAMA; 280(2): 147–151.
18. Anderson et al. 2008. Evidence-based guidelines for treating depressive d<strong>is</strong>orders with antidepressants: A rev<strong>is</strong>ion of the 2000 Brit<strong>is</strong>h Association for Psychopharmacology
guidelines. Psychopharmacol; 22; 343.