Depression Awareness Month
Understanding Depression: A Common Mental Health Issue
By: CDR Michaela Montecalvo, PA-C, CAQ-Psych and ENS William Hwang, PA-S

While global awareness of mental health is increasing, depression continues to be a prevalent issue and a significant concern for both healthcare professionals and the public. It is one of the leading causes of disability worldwide, affecting individuals across all ages and backgrounds. According to the World Health Organization, more than 280 million people are affected by depression each year. If left untreated, depression can have severe consequences, including suicide, strained relationships, and disruption of daily activities, making early diagnosis, prevention, and treatment crucial.

Depression is a mental health disorder, specifically categorized as a mood disorder. It leads to long-lasting feelings of sadness and a loss of interest in activities that once brought pleasure. This extends beyond simply feeling down or responding to challenging circumstances. It changes how someone thinks, feels, and behaves. The effects of depression can last for weeks, months, or even years, making it difficult to maintain relationships or even carry out everyday tasks. Several factors can raise the risk of developing depression, such as genetics, environmental factors, biological and psychological. Factors that contribute to an increased risk of developing or triggering depression include stressors, trauma, family history, sexuality, financial difficulties, and relationship problems. Chronic health conditions like diabetes, heart disease, and ongoing pain can also play a role in triggering depression. Moreover, substance abuse, certain medications, and being socially isolated are additional factors that can increase the risk.

Symptoms
Recognizing the early signs and symptoms of depression is critical for timely diagnosis. While some individuals may experience depression only once, it is more common for people to go through multiple episodes. These episodes often persist for at least two weeks, with 5 or more of the following symptoms present most of the day, every day. Depression is diagnosed clinically utilizing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) with the criteria. 
 
Common symptoms include:

•    Feelings of sadness, tearfulness, or hopelessness
•    Psychomotor agitation or retardation
•    Loss of interest or pleasure in most or all normal activities, hobbies, sports, etc.
•    Sleep disturbances (insomnia or hypersomnia)
•    Lack of energy or fatigue
•    Significant weight loss or gain
•    Feelings of worthlessness
•    Difficulty with thinking or concentration
•    Frequent recurrent thoughts of death, suicidal ideation, or plan

Common Screening Tools for Depression:
•    Patient Health Questionnaires (PHQ-2) and a more extensive PHQ-9 if results are positive. 
•    Beck Depression Inventory (BDI): 21-item questionnaire 
•    Geriatric Depression Scale (GDS) 
•    Edinburgh Postnatal Depression Scale (EPDS) 
 
Treatment Options:
Medications:
•    Antidepressants: These medications work by increasing the levels of certain neurotransmitters in the brain, such as serotonin and norepinephrine. Examples include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). 
Psychotherapy:
•    Cognitive Behavioral Therapy (CBT): This type of therapy focuses on identifying and changing negative thought patterns and behaviors that contribute to depression. 
•    Interpersonal Therapy (IPT): focuses on improving relationships and resolving interpersonal conflicts that may be contributing to depression.
•    Psychodynamic therapy: This therapy explores unconscious conflicts and early childhood experiences that may be underlying depression.
Other Treatments: (ECT, Light Therapy, and Lifestyle Changes)

Choosing The Right Treatment:
Healthcare providers frequently make the first contact with patients who have symptoms of depression. Early identification can be achieved by a simple mental health screening during provider visits, especially for individuals with known risk factors. The best treatment option for depression will vary depending on the individual's symptoms, severity of depression, and other health conditions. It is essential to consult with a healthcare professional to discuss treatment options and find the most appropriate, tailored treatment plan that aligns with recovery.

References 
Crockett, M. A., Núñez, D., Martínez, P., Borghero, F., Campos, S., Langer, Á. I., & Martínez, V. (2024). Interventions to Reduce Mental Health Stigma in Young People: A Systematic Review and Meta-Analysis. JAMA Network Open, 8(1), e2454730-e2454730. 
Samari, E., Teh, W. L., Roystonn, K., Devi, F., Cetty, L., Shahwan, S., & Subramaniam, M. (2022). Perceived mental illness stigma among family and friends of young people with depression and its role in help-seeking: a qualitative inquiry. BMC psychiatry, 22(1), 107.