Depression or Clinical Depression

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Depression is defined as when someone is feeling sad and unhappy persistently for weeks and months. When feelings of sadness, loss of interest and gloomy symptoms continue for months and start to interfere with daily life, then it is called depression. It is medically referred as clinical depression.

However, occasional feelings of sadness or grief are normal and not referred as clinical depression. Everyone experiences feelings of sadness due to some painful situation or disturbing incident in life. It is therefore, called as situational depression. In situational depression, the feeling of sadness fades away with time and the person often recovers itself.

Depression is a mental or mood disorder. It’s a real illness having real symptoms although some people mistakenly do not consider depression as a real illness. Many people tend to intermix normal sadness with clinical depression. However, these two are quite different.

World Health Organization (WHO) recognizes depression as one of the major cause of disability affecting all age people.

Fortunately, effective treatment is available for depression, most people feel much better with psychological counseling, medication or both.

Generally, healthy people suggest the depression patients to look at the positives of the life and try to be happy. They try to assess the patient’s condition from their own circumstances and perspective. Normal people cannot completely understand the reasons of consistent sadness in depression patient. Patient who are suffering with depression do not get better from thinking positive.

Covid 19 Pakistan

In Pakistan, Covid-19 pandemic restrictions, associated fear and economic distress have been causing a great deal of anxiety and depression among the general public. People should stay positive and follow all relevant precautions to ensure covid-19 prevention and associated complications.

In this leaflet, clinical depression is referred as depression

Symptoms of depression could vary from person to person. Symptoms persist for weeks or even months and interfere with the social life, family life and work. Symptoms can be broadly divided as psychological, physical and social.

Psychological Symptoms

  • Feeling helpless or hopeless
  • Sadness or constant low mood
  • Feeling tearful
  • Having low self-esteem
  • Feeling guilty
  • Being intolerant to others Feeling irritable
  • Having no interest in things
  • Having no motivation
  • Not enjoying life
  • Being worried or feeling anxious
  • Having thoughts of harming or suicidal thoughts
  • Agitation
  • Poor concentration or lack of focus
  • Taking out anger even on small matters

Physical Symptoms

  • Speaking slowly or moving slowly than usual
  • Increase in purposeless physical activity such as, pacing or hand-wringing. Sometimes, there is slowing down of movements
  • Changes in weight or appetite
  • Unexplained pains and aches
  • Low sex drive
  • Lack of energy
  • Disturbed sleeping pattern

Social Symptoms

  • Not performing well at work
  • Avoiding talking to friends or family
  • Neglecting your own interests or hobbies
  • Having trouble in your home

Severity of Depression

There are three severity levels of depression

  1. Mild Depression: when it has some impact on the daily life.
  2. Moderate Depression: when it has significant impact on the daily life
  3. Severe Depression: This degree of depression makes it almost impossible to get through the daily life and some people may also show psychotic symptoms

The exact cause of feeling depressed is not known.

Depression can effect anyone; men, women even children. It is not always entirely due to hardships or difficulties in life, even people who appear to live in ideal conditions may suffer with depression. However, following are some of the main causes of depression

  • Hormonal: Changes in hormonal balance in the body due to pregnancy, thyroid problems, menopause or various other conditions could lead to depression
  • Genetics: Depression could also run in families. It is common in people whose blood relatives also have depression.
  • Personality: Depression is more common among people who stress over little things, who think negatively and have low self-esteem
  • Brain Chemistry: According to recent researches, neurotransmitters are natural brain chemicals which play role in depression.
  • Environmental Effect: Depression could also occur due to various environmental factors such as, poverty, abuse, neglect, violence and much more.

Apart from all these causes, an episode of depression could trigger due to any distressing event in life such as serious illness like cancer, any relationship problem or financial difficulties.

Depression in Women

Women are more likely to develop depression than men. Particularly in countries like Pakistan, women are said to have depression in at least some phase of their lives. Particularly common times for women to become depressed is after child birth, which is termed as postnatal or postpartum depression. During postpartum depression, the physical, hormonal changes and the new responsibility of caring for a newborn can be heavy or overwhelming which causes depression. Some women also feel depressed at the time of their menopause.

There are no specific tests required to diagnose depression.

Doctor usually discusses the condition in detail by talking to the patient and diagnose depression based on clinic assessment. Patients are usually referred to psychologist for counseling, psychiatrist for medication or a health counselor depending on the degree of depression.

Depression is very treatable disease, around 80-90% patients feel better after treatment.

Generally, depression treatment requires family support, psychological counselling and medicines to ensure success of the treatment.

Mother consoling her sad daughter

The earlier the treatment begins, the more benefit it will provide. Most of the times, people experience improvement in their condition after being treated with talk therapy (psychological counselling), anti-depressants medications or even both.

Before starting the treatment, complete diagnostic evaluation is carried out by doctors, which includes physical examination, some laboratory test and an interview. This is to rule out other conditions that may also cause depression like thyroid problems.


Antidepressant drugs are medicines that are prescribed to people who suffer with depression. They produce some improvement in the first few weeks after their use. Full benefits of antidepressant medicines could be seen after use of several weeks or months.

Antidepressant medicines work by correcting certain chemical imbalances in the brain. The chemicals they are working to balance are known as neurotransmitters. When the chemicals in the brain are not in balance, this can cause changes in behavior and mood.

Most psychiatrists suggests that patients should continue taking antidepressant medicines for a couple of months even after their symptoms have been improved. This long term treatment is suggested in order to decrease the risk of future episodes of depression for certain people who are at risk.


Psychotherapy is also known as talk therapy or psychological counselling. It is mostly used alone for treating mild depression. For moderate and severe depression, it is used along with medication. Behavioral therapy is also useful in treating depression. Treatment can take a couple of weeks or months, depending on the severity of depression. In many cases, improvement in the symptoms is seen in almost 10-15 sessions of psychotherapy.

Electroconvulsive Therapy (ECT)

It is a medical treatment which is used for patients having a major depressive disorder, not responding to other drugs. In ECT brain is stimulated with electrical therapy while patient is placed under anesthesia.

With proper diagnosis and treatment, depression could be effectively treated. Moreover, regular exercise, getting enough sleep, eating healthy food and avoiding alcohol could also help reducing the symptoms of depression. Patients who have depression of any sort, the first and the most important step is to see your family psychiatrist or physician.

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