Depression is a mental illness characterized by feelings of sadness, guilt, apathy, irritability, difficulty concentrating, loss of interest in activities that you previously enjoyed, and lack of energy. This disease has a great impact on society due to its high rate of involvement worldwide (approximately 350 million people according to the WHO).

The predominant symptomatology is of an affective type, followed by cognitive and physical symptoms. Symptoms vary depending on the person and type of disease, severity, frequency, and duration.

Depression triggers a global repercussion of the daily life of people who suffer it, prevailing in the first-place personal affection, and continuing with social and work or school problems. Various studies have observed that this disease can trigger around 1 million deaths per year from suicide.

Depression is usually associated with other psychopathological diseases, few of which appear with a single clinical picture. For example, depressive disorders may appear associated with general manifestations of anxiety or eating disorder.

The onset of the disease can occur at any age, although its highest prevalence of cases appears between 15-44 years, so education, functioning, and personal relationships at a young age are of great importance. The symptoms of depression can vary according to age, in young people, it is more common to find fundamentally behavioral symptoms, while in older adults the symptoms tend to be somatic.

Depression is a chronic, recurring illness that requires long-term treatment. Its prevalence in the general population is between 8 and 12%. It is estimated that by the year 2030 it will occupy the first place in the measurement of disease burden according to disability-adjusted life years.

Know Your Risk

Risk factors for Depression

Depression is a complex illness in which the probability of developing depends on multiple risk factors that can sometimes interact with each other and cause a cumulative effect. The burden of each of them in relation to the circumstances and the moment of life in which it is triggered is unknown.

The circumstances that can increase the probability of suffering this disease are: personal and social factors; family and genetic factors.

Personal and Social Factors

The prevalence and incidence of mental illness are higher in women than in men, the burden of depression is 50% higher in the female gender in adolescence.

Young people are a group with a greater probability of suffering from mental illness, since changes in physical, psychological, sociocultural and cognitive state develop in the adolescent stage, which leads them to establish coping strategies to achieve a sense of identity, autonomy, personal and social success.

Given the changes on a personal level at that stage of youth, certain people take a successful role in society while others are discriminated against and may be candidates for harassment and humiliation. This sensation is a risk factor for causing a psychiatric illness disorder.

The consumption of drugs such as tobacco and alcohol is detrimental to mental illness, significantly enhancing the probability of suffering from depression. Social circumstances such as unemployment and low socioeconomic status are other of the most frequent factors related to depression.

Chronic diseases such as heart disease, diabetes, hypo or hyperthyroidism, Chusing's syndrome, Addison's disease, and hyperprolactinemia amenorrhea also increase the probability of suffering depression in later adulthood.

Lastly, marital status (single, divorced, or widowed), chronic stress, and exposure to adversities in life, help trigger a depressive disorder.

Family and Genetic Factors

A history of depression in parents is considered an important risk factor. Thus, children of mothers with depression are three to four times more likely to have a mood disorder. However, the load of the genetic factor and the environmental factor for its evolution is not clearly known.

The context of a family plays a fundamental role when it comes to suffering from depression. Conflicts between the couple or emotional difficulties between a parent and the child, physical, psychological or sexual abuse, conflicting divorce or separation from the parents, the loss or death of a family member or friend are factors associated with the disease.

According to recent genetic studies, the presence of a polymorphism of the gene that encodes the serotonin transporter would produce a decrease in the transport of that neurotransmitter, thus influencing the possibility of suffering from depression. Therefore, selective serotonin reuptake inhibitors are used in the treatment of this disease, in order to modify the levels that are altered in these people.

Diagnosis of Depression

Psychiatric illnesses are often underdiagnosed in young people, especially due to low visits to the doctor, the inadequacy of the current criteria to identify depressive manifestations, the lack of professional training, and their great stigmatization in society, thus causing a great public health problem.

It is estimated that only half of the patients with major depression are correctly detected and diagnosed, and of these, not all receive adequate treatment.

It should be noted that depressive disorder is often associated with another illness such as drug abuse, anxiety, eating disorder, or other physical illnesses.

The criteria of the American Psychiatric Association (DSM-IVTR) to diagnose depression are:

A. Presence of at least five of the following symptoms for at least two weeks and representing a previous change in functioning (symptoms should include depressed mood or loss of interest or pleasure):

Depressed mood most of the day, almost every day, indicated by the subjective story or by observation of others.
Anhedonia or decreased ability to enjoy or show interest and/or pleasure in regular activities for most of the day.
Decreased or increased weight without dieting or appetite almost every day
Insomnia or drowsiness almost every day
Slowness or psychomotor agitation almost every day
Fatigue or loss of energy almost every day
Feelings of worthlessness or excessive or inappropriate guilt almost every day
Less ability to think or concentrate, or indecision almost every day
Recurring thoughts of death or suicidal thoughts

B. There should be no signs or criteria of mixed affective disorders (manic and depressive), schizophrenic disorders, or schizoaffective disorders.

C. Symptoms have a negative impact on the patient's social, work, or other vital areas.

D. The symptoms are not explained by the consumption of toxic substances or medications, nor by an organic pathology.

E. Not explained by a grief reaction to the loss of someone important to the patient.

The severity of depression is categorized based on the following parameters:

Mild depression manifests with few or no symptoms, apart from those required to reach the diagnosis, and they cause only a minor deterioration in work performance or in habitual social activities or relationships with others.

Moderate depression refers to the symptomatology between mild depression and severe depression.

Severe depression can appear without psychotic characteristics when the patient presents various symptoms other than those required for the diagnosis and that interfere with work performance, habitual social activities, or relationships with others. But severe depression can appear associated with psychotic symptoms, with delusions and hallucinations.

Treatment of Depression

Depression must be treated in a comprehensive way and encompassing all psychotherapeutic, psychosocial, and pharmacological interventions to achieve the well-being and functional capacity of the individual. For this, the following techniques should be included: psychoeducation, individual and family support, coordination with other professionals, attention to comorbidities, and regular monitoring of mental and physical state.

The choice of treatment will depend on the clinic and other factors such as previous history, availability of treatments, patient preference, and the ability to support and contain the environment.

In recent years, scientific research has increased to develop different models that serve people with this mental illness. Among the diversity of models, the most suitable for this objective is the stepped model.

Stepped Model

Severe or/and resistant depression:

Pharmacological Strategies
Psychological Interventions
Combined Treatment
Electroshock Therapy

Moderate Depression: Psychological interventions, Combined treatment, Antidepressants

Mild Depression: Evaluation, support, psychoeducation Psychological interventions, and / or Antidepressants.

Suicide Risk for Depression

Source: Suicide Prevention | Akron Children's Hospital

Depression affects the growth and development of the individual, in adolescents, major depressive disorder is the main cause of suicidal behavior, which is frequently associated with a psychiatric disorder, often unrecognized or untreated: more than 90 percent of the adolescents who die by suicide suffered an associated psychiatric disorder (mood and/or drug abuse) at the time of their death.

Currently, scientific research recognizes depression and anxiety disorders as two mental health conditions that increase the risk of suicidal behavior

In the year 2019, suicide was placed as the second cause of death in the group of 15 to 29 years of age, and its prevalence is expected to increase due to the increase in risk factors such as poverty, violence, and drug abuse. feelings of loss and diverse cultural and social environments.

Faced with this serious public health problem, early diagnosis should be reinforced to act urgently and refer to specialized care for early and comprehensive care and to avoid deaths. If this phenomenon is not properly channeled by 2020, it is estimated that one and a half million suicides will occur annually.

Preventing suicidal acts is possible through actions that favor the identification of risk factors, including depression, as well as the adequate and timely clinical management of children and young people at risk, since it is precisely during the first decades of life when beginning most psychiatric disorders.

Sources

1.       World Health Organization. The Global Burden of Disease: 2004 Update (WHO, 2008).
2.       Alarcón R. Culture, cultural factors and psychiatric diagnosis: review and projections. World Psychiatry 2009; 8: 131-9.
3.       Rush AJ. Problems associated with the diagnosis of depression. J Clin Psychiatry 1990; (51): Suppl: 15-22.
4.       Angst J. A regular review of the long term follow up of depression. BMJ 1997; 315: 1143-6.
5.       Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, De Graaf R, Vollebergh W, et al. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res 2003; 12: 3-21

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