According to the World Health Organization (WHO) in 2020, depression is among the top three severe illnesses affecting the world and requires high attention. Depression can lead to functional impairment in one’s life and significant burdens on families, societies, and economies. Statistics show that about two-thirds of individuals with depression have attempted suicide, and approximately 15% of depressed individuals eventually die by suicide. Among those who died by suicide, a staggering 87% had been diagnosed with depression during their lifetime. Furthermore, the suicide rate in the population is on the rise, indicating a continuous increase in individuals with depression [1].
Depression is more common than diabetes or hypertension, yet it remains an easily overlooked mental illness!
What is depression? What is the definition of depression?
Depression is a psychological disorder characterized by a predominant mood of sadness, and it falls under the category of mood disorders. A common manifestation of depression is the experience of prolonged and persistent negative emotions. These negative emotions can extend to affect various aspects of an individual’s life, such as interpersonal relationships, cognition, physiological functioning, thoughts, and behaviors, causing a widespread imbalance.
Why is depression easily overlooked?
The main reason is that individuals with depression often do not recognize that they are suffering from depression, even when they are on the verge of collapse. Despite their struggles, they continue to maintain their daily functioning, making it difficult for friends and family to notice.
Many people hold misconceptions and attitudes about individuals with depression, such as believing that only those lacking strong willpower develop depression, that depression is solely caused by stress, or that psychiatric medications control the brain, leading to severe side effects and lifelong addiction. Moreover, inappropriate statements like those made by the former entertainer Wu Zongxian, who claimed that “depression is caused by not being content with what you have,” contribute to misunderstandings and discrimination. These misconceptions and biases contribute to the delay in seeking medical treatment for individuals with depression.
Causes of Depression
Depression is not caused by a single factor and can be divided into three main dimensions: “biological, psychological, and social.”
Biological Factors
Due to the current state of neuroscience research, theories about depression often focus on the insufficient functioning of neurotransmitters in the brain that regulate emotions, such as serotonin, norepinephrine, or dopamine. A deficit in these neurotransmitters can lead to the occurrence of depressive emotions. More detailed understanding of the physiological mechanisms underlying depression requires further exploration by researchers. Additionally, studies suggest that depression can have a genetic component and may be more likely to occur in individuals with a family history of the disorder.
Psychological Factors (The Primary Cause)
The psychological dimension is quite extensive and encompasses various aspects such as personality traits, negative thought patterns, pessimistic tendencies, anxiety, self-dissatisfaction, life stressors, broken relationships, family conflicts, major traumas, financial problems, job-related stress, significant losses, and severe illnesses. All of these factors can potentially trigger depression.
Social Factors
This aspect refers to the individual’s social environment, including their family, workplace, economic status, and broader societal context. Adequate social support can help individuals with depression navigate difficult times, preventing the worsening of the condition. Conversely, inadequate social support, negative attitudes towards depression, stigmatization of seeking mental health treatment, and societal labeling can indirectly affect patients’ willingness to seek help and exacerbate or prolong depression.
Depression is often the result of a combination of factors, so healthcare professionals need to carefully examine each dimension in order to provide effective assistance to patients.
What are the symptoms of a depressive episode? 9 major prodromes of depression
Currently, the commonly used diagnostic guidelines for depression in the medical field are DSM and ICD.
- The Diagnostic and Statistical Manual of Mental Disorders (DSM)
- International Statistical Classification of Diseases and Related Health Problems (ICD)
Symptoms related to depression outlined in the DSM guidelines include:
- Persistent feelings of sadness or emptiness most of the time.
- Loss of interest or pleasure in most activities.
- Significant weight loss or gain (more than 5% change in a month) or noticeable decrease or increase in appetite.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation, restlessness, or slowed speech and movements.
- Fatigue or loss of energy almost every day.
- Feelings of worthlessness or excessive guilt, low self-esteem, self-blame, and sadness.
- Diminished ability to think or concentrate, indecisiveness.
- Recurrent thoughts of death, suicidal ideation, or suicide plans.
If the symptoms persist for more than two weeks and significantly impact the quality of life, one should be cautious as it could be indicative of depression.
Both DSM and ICD are designed for mental health professionals. If they are used by individuals lacking clinical training, there is a possibility of inappropriate interpretation of their content. Therefore, seeking assistance from specialized doctors as soon as possible is essential to obtain a correct diagnosis and receive proper treatment.
What to do if there are signs of depression? How can depression be prevented?
After researching literature, four health components have been found to contribute to the improvement of depressive symptoms, which I’d like to introduce to you.
Fish Oil Omega-3 Fatty Acids
Epidemiological investigations have shown that countries with higher fish consumption tend to have a lower prevalence of depression compared to those with lower fish consumption. Furthermore, individuals with depression often exhibit a deficiency in Omega-3 fatty acids. The Omega-3s found in deep-sea fish oil are essential components for brain and nerve cells, which cannot be synthesized by the body and need to be supplemented through dietary intake. Supplementation of Omega-3s has been found to improve symptoms in individuals with depression. Clinical guidelines for using fish oil in the treatment of depression recommend high-concentration products (>80% Omega-3), with EPA being particularly effective against depression[2] [3] [4] [5].
St. John’s Wort
St. John’s Wort is a plant native to Europe, Western Asia, and North Africa, and is often used as a method for treating depression in Europe. Taking St. John’s Wort can increase serotonin levels in the body. According to the National Institutes of Health in the United States, St. John’s Wort can help alleviate mild depression. A comprehensive review published in 2008, which integrated 29 studies, found that this plant, like antidepressant medications, can effectively treat mild to moderate depression. However, it’s important to note that St. John’s Wort can interact with various medications, so medical consultation is essential before using this herb [6] [7].
Saffron
Saffron is a food spice commonly used in dishes like Spanish seafood paella. The chemical compounds in saffron can affect mood. A comprehensive analysis study showed that consuming saffron stigma (the styles or distal ends of the flower’s pistil) can effectively treat mild to moderate depression. Clinical trials conducted so far have also found that saffron supplements can significantly improve symptoms of major depressive disorder in adults. Pregnant women should avoid excessive consumption, as it may lead to miscarriage [8] [9] [10].
S-Adenosylmethionine (SAM-e)
S-Adenosylmethionine (SAM-e) helps promote the synthesis of mood-regulating chemicals to treat depression. Healthy brains naturally produce the required amount of SAM-e, but depression inhibits SAM-e production. Moreover, individuals with depression who undergo treatment with antidepressant medications show an increase in SAM-e concentrations in their bodies. Supplementing SAM-e can increase serotonin, dopamine, and phospholipid levels in the body, improving the binding of serotonin and dopamine to receptors. Therefore, it can aid individuals with depression[11] [12].
How to determine if you have depression? Self-assessment for depression
To gain a preliminary understanding of your current mental and physical state:
| Items/Frequency and Scoring Criteria | 0： less than 1 day in a week |
1： 1-2 days in a week |
2： 3-4 days in a week |
3： 5-7 days in a week |
| I often feel like crying | ||||
| I feel in a bad mood | ||||
| I find myself getting angry more easily than before | ||||
| I have trouble sleeping | ||||
| I don’t feel like eating | ||||
| I feel a tightness or discomfort in my chest (heart area or chest) | ||||
| I feel uneasy, uncomfortable (not at ease) | ||||
| I feel physically fatigued, weak, and powerless (lacking physical energy and strength) | ||||
| I feel annoyed | ||||
| I have poor memory | ||||
| I can’t concentrate when doing things | ||||
| I find myself slower in thinking or doing things than usual | ||||
| I have less confidence than before | ||||
| I tend to think more negatively | ||||
| I feel hopeless, or even have thoughts of dying | ||||
| I’ve lost interest in everything | ||||
| I feel physically uncomfortable (such as headaches, dizziness, palpitations, or stomach discomfort, etc.) | ||||
| I feel worthless |
Scoring Explanation
0-8 points:
Within the normal range.
9-14 points:
Give yourself more attention, try to understand the reasons for mood changes, and take appropriate actions.
15-18 points:
Mild depression. It’s recommended to talk to family members or friends and express your emotions.
19-28 points:
Moderate depression. It’s recommended to seek psychological counseling or professional assistance from relevant organizations.
29 points or above:
Severe depression. It’s recommended to seek immediate professional medical guidance, counseling, or psychiatric treatment.
Treatment Methods for Depression
The treatment of depression primarily involves two aspects: “physiological” and “psychological” approaches.
Physiological Treatment
Mainly Involves Medication and Electroconvulsive Therapy
- Medication Treatment:
Antidepressant medications are used, sometimes in combination with sleep aids or anti-anxiety medications, to assist patients with insomnia and anxiety symptoms. During this period, antidepressants typically take about 2 to 3 weeks to show effectiveness. Around 6 to 8 weeks of treatment, depressive symptoms will significantly improve, entering a recovery phase. Once the symptoms alleviate, there is no longer a need for sleep aids or anti-anxiety medications, and a single antidepressant can be continued. Following that, medication is maintained for 3 to 6 months to prevent relapse of depression. The attending physician will gradually reduce the dosage until discontinuation. It’s important to note that the side effects of medication often appear before the therapeutic effects, and some cases might discontinue medication prematurely, delaying treatment. - Electroconvulsive Therapy (ECT):
ECT is utilized for severe depression by inducing seizures to improve the condition. The detailed physiological mechanisms underlying the effectiveness of ECT are not entirely clear. In current medical understanding, ECT is believed to enhance the release of neurotransmitters regulating emotions in the brain (such as serotonin, norepinephrine, or dopamine), leading to an improvement in depressive symptoms.
Psychological Treatment
Psychological therapy addresses patients’ psychological and cognitive aspects. It primarily involves providing support, encouragement, affirmation, active listening, empathy, and reconfirmation to individuals with depression. Additionally, when necessary, patients are taught to change distorted cognitions, develop new thought patterns, and correct distorted beliefs that contribute to their depressive emotions.
How to Help Individuals Recover from Depression?
Depression is a treatable condition that can lead to a return to normal life and functioning. While about half of those with depression can gradually improve and recover on their own over time (typically taking six months to a year), the other half may experience worsened symptoms, deteriorated functioning, and even an increased risk of suicide. Furthermore, the relapse rate of depression can be as high as 50%.
In addition to self-care, individuals with depression also require the support and patience of their family and friends. Through love and patience, it’s important to provide companionship, reduce isolation, adopt positive attitudes, and encourage positive thought patterns to help individuals overcome depression. When listening to the individual, avoid being dismissive, critical, or judgmental, allowing them to express their feelings and alleviate their stress.
The most crucial aspect is actively seeking medical attention. Seeking professional help can shorten the duration of the illness, manage symptoms, prevent worsening, and reduce the risk of suicide. Maintaining positive thinking and emotional health is essential to bid farewell to depression and regain a normal life and mental well-being.
