What Is Depression?

Depression or in medical terms called major depressive disorder is a mood disorder that can affect the mindset, feelings, and how to deal with daily activities. When experiencing depression, someone will feel sad, hopeless, worthless, lose interest in things that he once liked, or blame themselves. This happens all day and lasts for at least 2 weeks. Depression is different from temporary feelings of unhappiness. But because of wrong understanding and common sense of sadness, this disease is often considered trivial. In fact, depression is a serious disease that can encourage sufferers to commit suicide.

In its classification, in addition to major depressive disorders, there are several other forms of depression that are slightly different in terms of time, possible causes, or other accompanying symptoms, namely:

• Disruptive mood dysregulation disorder . Often referred to as bipolar disorder in children, because this disorder occurs in children (less than 18 years) with symptoms of rapid anger and often extreme acts out of control.
• Persistent depressive disorder . Mild but chronic form of depression. Chronic because the symptoms of depression can last for 2 years.
• Premenstrual dysphoric disorder . Symptoms of mood changes, irritability, and depressive symptoms that occur during the last week before menstruation and decrease during menstruation, then disappear after menstruation.
• Perinatal depression. A more serious form of baby blues experienced by women after childbirth. Perinatal depression can occur during pregnancy or after childbirth. This situation makes it difficult for mothers to carry out activities for themselves or for their children.
• Depression is accompanied by symptoms of psychosis.
• Bipolar disorder.

In 2015 the WHO estimated there were more than 300 million people worldwide experiencing depression, where women were more often compared to men, and more than 750 thousand people died from suicide. While in Indonesia alone, an estimated 3.7% of the population is depressed. To prevent suicide, depression must be addressed immediately with appropriate support and treatment.


Symptoms of Depression

Symptoms of depression can be very broad and complicated, not just sad feelings that can occur from time to time. Depressive symptoms can also be experienced differently by each person, but in general someone who is depressed will experience feelings of sadness, hopelessness, and loss of interest in various things.

Symptoms of depression can be seen from two aspects, namely psychological and physical. The following are symptoms of depression that are reviewed from each aspect:
Psychological aspects.

• Always burdened with guilt.
• Feeling hopeless, inferior and worthless.
• Always feeling anxious and worrying excessively.
• Bad or sad mood on an ongoing basis.
• Angry or sensitive, and easy to cry.
• Difficulty concentrating, thinking, and making decisions.
• Not interested and not motivated by everything.
• The idea arises of self-harm or suicidal ideas.

Physical aspects.

• Always feel tired and lose energy.
• Changes in the menstrual cycle in women.
• Constipation .
• Movement of the body and speech are slower than usual.
• There is no sexual desire.
• Sleep disturbance .
• Changes in body weight and appetite.

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Not all of these symptoms are experienced by people with depression. Some experience it entirely, but there are also those who only experience some symptoms. To declare someone experiencing depression, these symptoms must last throughout the day for at least 2 weeks and cause disruption to social aspects such as work, school, and relationships with friends and family.

These symptoms are often not realized by the patient, but it seems clear to people around him. Therefore, to declare someone experiencing depression, doctors need a psychiatric examination, one of them is a questionnaire to determine the diagnosis of depression. In addition, a thorough physical examination and investigation is needed, such as laboratory tests to detect other physical disorders that may be related to the condition of his depression.


Causes of Depression

Depression can occur at any age, but depression usually starts at adulthood. The specific causes of depression are still unknown, presumably this condition occurs due to a combination of genetic, biological, psychological, and environmental factors.

There are several facts that genetic factors are thought to influence the incidence of depression:

• Nearly 50% of people who have twins who suffer from depression also have a tendency to experience depression.
• Someone who has a nuclear family has experienced depression, three times more prone to depression than those who don't.

But surely the location of the gene abnormality cannot yet be determined.

Although depression can develop without being preceded by a trigger factor, some of the conditions below are thought to increase a person's risk for depression. Among others are:

• Experiencing a traumatic event . Some examples of events or circumstances that can trigger depression include torture or abuse, death of a person, problems in relationships (marriage, friendship, family, love, and coworkers), and economic difficulties.
• Have certain diseases . Sometimes depression arises as a reaction to an illness that is being suffered, such as a head injury and interference with thyroid hormones. Some chronic and life-threatening diseases can also trigger depression. Examples are HIV / AIDS , coronary heart disease, diabetes , or cancer.
• Have a certain personality . Feeling inferior, too hard at self-assessment, pessimistic, or too dependent on others, can increase a person's risk for depression.
• Alcohol and drug dependence . Many people try to escape from problems by consuming alcoholic beverages or using drugs. Even though the two things just just can trigger depression or aggravate depression.
• Certain drugs . Some drugs can increase a person's risk of depression. Examples are sleeping pills and medications for hypertension .

Treatment of Depression

Depression will be more easily cured if handled faster. Handling by a doctor usually includes psychotherapy, medication, or a combination of both.

Psychotherapy

Some psychotherapy techniques that are used to treat depression include:

• Cognitive behavior therapy (CBT). This therapy is applied to people who are held hostage by certain mindsets that harm them. CBT will help him to break away from negative thoughts and feelings, and replace them with positive responses. CBT can also help patients to recognize conditions that make depression worse, so patients can change their behavior to deal with it. Usually CBT is done 6-8 sessions for 10-12 weeks.
• Problem-solving problem (PST) . PST can improve the ability of sufferers to face experiences that make them depressed, especially those with depression who are more mature. Patients will be asked to identify problems and get realistic solutions through a gradual process.
• Interpersonal therapy (IPT). The basic principle of IPT is to overcome problems that arise when dealing with other people, which can lead to or exacerbate depression.
• Psychodynamic therapy. This therapy encourages the patient to explore the various feelings and emotions that are in him, which he sometimes does not realize. The aim of psychodynamic therapy is to help the patient understand that what he feels and how he behaves, is influenced by the existence of a problem that has not been resolved, in his subconscious mind.

Antidepressants

Antidepressants are medicines to treat symptoms of depression. There are various kinds of antidepressant drugs, with varying degrees of success and impact on each person. Therefore, patients may try several types of antidepressants until they find the appropriate medication.

Usually, antidepressant drugs take several weeks or months to work and begin to eliminate symptoms that people with depression feel. After the drug starts working, the drug consumption will be continued for 6 months to 1 year, and stopped after the depressive symptoms are completely gone. Keep in mind that antidepressant drugs should not be stopped alone without doctor's advice, even though they feel they have improved, because they are at risk of relapse and can cause withdrawal symptoms, such as:

• Heartburn
• Fever, headache, rheumatic aches, and nausea.
• Anxious.
• Dizzy.
• A dream that feels like reality.
• Sensation like electrocution in the body.

To avoid drug withdrawal symptoms, when stopping consumption of antidepressants, the doctor will reduce the dose of the drug slowly, before finally being stopped.

Nearly half of people taking antidepressants experience side effects from the drug, especially at the beginning of use. Therefore, during treatment with antidepressants, intensive monitoring of doctors is needed. And keep in mind once again, do not stop using antidepressants alone without advice from your doctor, even if side effects arise, such as:

• Dry mouth.
• Constipation.
• Dizzy and dizzy especially during the day.
• Visual impairment.
• Disorders of urination.
• Impaired sexual activity.
• Insomnia and anxiety.
• Easily offended.

Doctors have ways to deal with the side effects of antidepressants, for example reducing the dose of the drug, giving additional drugs to help reduce side effects, or changing antidepressants. Examples of antidepressant drugs are fluoxetin , venlafaxine, and amitriptyline .

Electric Shock Therapy

Electroconvulsive therapy (ECT) is very effective for treating depression in patients who do not respond to drugs, experience symptoms of psychosis, and patients with suicide attempts. However, the security of ECT is still a debate, especially in the elderly.

Prevention of Depression

Depression in general cannot be prevented. But with a good and healthy lifestyle, the severity and risk of recurrence of depression can be reduced. Some activities that can help a person with depression in preventing his condition from worsening include:

• Maintain social interaction. Depressed people tend to withdraw from the environment and the people around them. This condition can worsen depression. Therefore, maintaining social interaction with the closest people or meeting new people can prevent depression from developing or reappearing.
• Sports . Regular exercise is not only beneficial for maintaining fitness. Exercise can also help relieve depression, anxiety, and keep emotions stable. It is recommended to exercise for 30 minutes, 3-5 times a week.
• Maintain health. Poor health in people with depression will greatly affect the development of depression experienced. To prevent depression from worsening, sufferers must maintain good health. It is advisable to get enough sleep, exercise regularly, and maintain a good and healthy diet.
• Do not consume alcoholic beverages. Alcohol is a drink that can change moods. Someone who is at risk for depression must protect themselves from alcoholic beverages so as not to worsen the mood.
• Planning life. Planning a life, both short and long term, can help a person prepare mentally. Although there will still be unexpected events, with good planning, stress levels due to unexpected events can be suppressed.

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