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Depression: symptoms, causes and treatment

By Cristiano Antonino On Feb 14, 2023

Depression is a term used to indicate the presence of a sad, empty or irritable mood, accompanied by physical, physiological and cognitive changes that significantly affect the individual’s ability to function

The depressive episode does not coincide with the diagnosis of Major Depressive Disorder (or Major Depression), because many people can have mood swings, more or less marked, up to full-blown bipolar disorder, of which depression may be only one symptom, although it is usually the most unwelcome to the subject, who seeks help in these phases.

Depression is a widespread disorder in the general population and therefore very well known

It appears, in fact, that 10% to 15% of the population suffers from it, with a higher frequency among women.

Major depression is associated with high mortality.

Up to 15% of individuals with major depression die by suicide.

Nevertheless, most depressed individuals do not go so far as to have suicidal ideations or particularly severe symptoms, but complain of symptoms that are often not even easily associated with depression itself (chronic fatigue, physical discomfort, apathy, asthenia, decreased desire, irritability, etc.).

Depression is twice as common in adolescent and adult females as in adolescent and adult males.

In children, males and females are equally affected.

Depressive disorder can begin at any age, with an average age of onset around 25 years.

Some have isolated episodes of major depression followed by many years without symptoms, while others have clusters of episodes, and still others have increasingly frequent episodes with increasing age.

Depression symptoms

The symptoms of depression are varied and to facilitate their identification can be grouped into:

Cognitive symptoms of depression
A reduced ability to concentrate or make even small decisions, where there may be distractibility or memory difficulties.
A very strong tendency to blame oneself, devalue oneself, feel unworthy. Ruminations on small past mistakes are commonplace and neutral or trivial everyday events are interpreted as evidence of personal faults or shortcomings.

Affective symptoms of depression:

Generally, those suffering from major depression show a depressed mood, a marked sadness almost on a daily basis, such that the mood and thoughts are always negative.

There seems to be a real pain of living, which leads to no longer being able to enjoy anything.

In fact, the loss of pleasure in pursuing hobbies or activities that were previously actively sought after is an ever-present feature of depressive disorders.

There may be social withdrawal, abandonment of pleasurable occupations or decreased sexual desire.

Volitional/motivational symptoms of depression:

Marked fatigability, whereby the person feels exhausted and tired even in the absence of motor activity.

The smallest tasks seem to require considerable effort and efficiency in performing them may be reduced (e.g. an individual may complain that eating breakfast is tiring and takes twice as long as usual).

Behavioural symptoms of depression:

An increased or decreased appetite.

Usually there is weight loss and slimming down, some individuals with major depression report having to force themselves to eat.

Others may eat more and strongly crave particular foods (e.g. sweets or other carbohydrates), as if seeking comfort in food.

An increase or decrease in sleep.

Some people may wake up early, have frequent nocturnal awakenings or struggle to fall asleep, without feeling rested in the morning; others get to sleep too much (hypersomnia).

Sometimes disturbed sleep is the reason why the individual requires treatment.

A marked motor slowdown that may manifest itself as slowness in doing things, slower speech, slowed thoughts and body movements, or, conversely, a marked agitation in which there is an inability to sit up, walk back and forth, wring one’s hands, pull or rub one’s skin, clothes or other objects.

Physical symptoms of depression:

Headaches, palpitations or tachycardia, muscle, bone, joint and abdominal pain.

People may feel dizzy or empty-headed.

Sometimes there may be constipation or diarrhoea.

It may also happen that the person only manifests the above-mentioned physical symptoms of depression without there being any perception of a drop in mood on the part of the individual.

In fact, when such somatic complaints are not due to traumatic conditions (accidents), pathologies, metabolic alterations or muscular strain, and the doctor has ruled out any organic cause, it may be a condition known as ‘masked depression’, the diagnostic confirmation of which may come from the fact that the subject responds positively to antidepressant drugs or has a family member who suffers or has suffered from major depression.

It should be borne in mind that the symptoms of depression can sometimes be subtle, to the point that no one is aware of the problem, sometimes not even the subject himself, who tends to attribute them to normal tiredness, stress, nervousness or problems at work, at home or in a relationship.

In fact, it is quite frequent that the depressed person does not want to recognise his or her own internal state, which leads him or her to see ‘everything black’, to be intolerant, irritable, pessimistic, nervous, distant, etc., and believes that it is only the consequence of external factors that should be changed (work, couple, money, children, etc.).

All the symptoms of depression that we have described above can manifest themselves either acutely (with very acute and sudden phases of depression, which perhaps tend to disappear on their own or with therapy) or constantly, albeit in a mild form, with some sudden moments of worsening.

In this case we speak of dysthymia.

Depression causes

In general, the causes of depression can be summarised in three factors:

Biological factors. These refer to alterations in neurotransmitters, hormones and the immune system. For example, alterations in the regulation of neurotransmitters such as norepinephrine and serotonin, altering the transmission of nerve impulses can affect the subject’s initiative, sleep, brooding and interactions with others.
Psychological and social factors. At the psychosocial level, stressful life events have been well recognised as precipitating depressive episodes. These may include bereavement, interpersonal and family conflicts, physical illness, life changes, being a victim of crime, marital and child separation. Among these events we can also find changes in working conditions or the start of a new type of job, the illness of a loved one, serious family conflicts, changes in friendships, changes of city, etc. These events may be more impactful in people who have had adverse childhood experiences and therefore lack the skills to deal with them effectively.
Genetic and physiological factors. First-degree relatives of individuals with major depression have a two to four times greater risk of developing the disorder than the general population. It is the predisposition to develop the disorder that is genetically inherited, not the disorder itself.

Depression treatment

Psychotherapy for depression

Cognitive behavioural therapy has proven to be very effective for the treatment of depression.

On the one hand, an attempt is made to change negative thoughts that may support depression.

For example, sufferers tend to be hypercritical of themselves, they tend to blame themselves beyond all evidence, and they tend to notice negative events more in everyday situations.

Cognitive behavioural therapy helps the person to develop a more balanced and rational way of thinking.

On the other hand, for the treatment of depression, people are helped to build better coping skills to deal with everyday difficulties, which probably led the person to be depressed.

Thus, for example, the person can be taught more effective ways of communicating or strategies for solving problems in which he or she is involved.

Treatment of depression, therefore, invites the person to gradually resume activities that have been abandoned, perhaps starting with the more pleasant ones, to develop more functional behaviour to solve their problems, to think in a more balanced and rational way.

Cognitive behavioural therapy differs greatly from other types of psychotherapy: it is centred on the present, on the symptoms of depression, and tends to produce workable solutions to the problems presented.

Drugs for depression

Antidepressants are widely used nowadays and have become among the most widely used drugs in medicine, but unfortunately the results are often modest and/or temporary.

Without effective psychotherapy to help the person acquire functional strategies for resolving acute depressive episodes and preventing relapses, it is highly likely that the person will experience recurring relapses.

Several classes of antidepressant drugs are used in the pharmacological treatment of depression: tricyclics and tetracyclics (e.g. desipramine, nortriptyline, maprotiline, chlorimipramine, imipramine, amitriptyline, nortriptyline); noradrenalin-serotonin multisystem agonists (e.g. venlafaxine, trazodone); substituted benzamides (e.g. amisulpiride) noradrenergic system agonists (e.g. mianserin, mirtazapine, reboxetine); serotonin reuptake inhibitors – SSRIs – (e.g. fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram, buspirone); methyl group donors (S-adenosyl-L-methionine).

All classes of drugs have been shown to be effective in treating

In resistant forms, combinations with mood stabilisers (e.g. lithium, valproate, carbamazepine, oxcarbamazepine, gabapentin) and in some cases with thyroid hormones can be used.

A new molecule, agomelatine (Tymanax, Valdoxan), which acts on melatonin and seems to have moderate efficacy on depressive symptoms, with fewer side effects than the other above-mentioned drugs, has been introduced on the market a few years ago.

The use of antipsychotics in combination with antidepressants is justified in cases where the depressive picture presents with psychotic symptoms.