From fatigue to anger: the hidden ‘faces’ of depression
Depression is often associated with a sad looking person sitting in the corner dressed in black, but Dr Renata Schoeman, a psychiatrist from Cape Town, says this is a general misconception about the disease.
“Depression is a constellation of symptoms present during a defined period and people can present differently as a result of gender, age and other defining characteristics,” Dr Schoeman explains. In a child, it might be through a failure to thrive, in a teenager through the onset of behavioural problems, while an adult may become very sensitive and irritable.
How is depression diagnosed?
There are currently two widely established systems for classifying mental disorders namely the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD).
Based on the DSM 5, the diagnosis of depression requires any five of the following symptoms (of which at least one of the first two) to be present for the same two week period in a patient’s life:
- Depressed mood
- Loss of interest or pleasure
- Changes in appetite/weight
- Changes in sleeping patterns
- Psychomotor agitation or retardation (e.g. restlessness or sluggishness)
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Impaired concentration or indecisiveness
- Death wishes or suicidality
These symptoms should additionally also cause significant impairment in interpersonal, social or occupational functioning and must not be attributed to medical conditions, substances or medication.
The five types of depression according to the DSM-5
- Disruptive mood dysregulation disorder
- Major depressive disorder
- Persistent depressive disorder (dysthymia)
- Premenstrual Dysphoric disorder
- Substance/medication-induced depressive disorder
Dr Schoeman says that depression can also be distinguished through three levels of severity: mild, moderate or severe. For depression to be severe, symptoms of psychosis or suicidality should be present.
“We also distinguish between unipolar and bipolar depression where the latter is part of another mood disorder, i.e. where episodes of hypomanic or manic symptoms are present. Treatment requires mood stabilizers and not necessarily antidepressants,” she explains.
Preventing and managing depression
Although depression is a clinical condition, there are ways to prevent and manage it to a certain extent. According to Dr Schoeman, you can lower your risk for depression through good self-care:
- Enough sleep
- Exercising at least five times per week for at least 30 min
- Following a healthy diet
- Avoiding substances (especially alcohol and codeine containing painkillers)
- Healthy social interactions with good friends
- Creating “me-time” for creativity, mindfulness etc.
- Managing your stress levels
If your symptoms still persist despite your efforts to manage them, it is better to get help either through support programmes or visiting a psychologist or doctor for a referral to a psychiatrist.