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Iqra Mazhar

Depression In Children!

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Saad Ullah Siddiqui

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Do Supplements And Herbs Cure Depression?

Introduction

As predicted earlier by the World Health Organization (WHO), major depressive disorders now account for a major illness in the world<a href="#accordion">[1]</a>, especially since the emergence of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a>. As the pandemic rapidly swept across the globe, it induced a considerable degree of fear, worry and concern in populations at large. Additionally, social isolation and loneliness worsened mental health worldwide.&nbsp; 
&nbsp;

Major depressive disorder is a major contributor to the incidences of suicide and ischemic heart disease. Moreover, it is the second leading cause of years lived with disability (YLDs) worldwide<a href="#accordion">[2]</a>. <a href="https://www.merisehat.pk/disease/depression">Depression</a> not only affects day-to-day activities but also decreases the quality of life and well-being of people. The mood disorder can present with mild to potentially debilitating and life-threatening symptoms.&nbsp;

&nbsp;

Over the years, the increase in the prevalence of psychiatric disorders, depression, anxiety, and insomnia has led to a search for more effective treatments. For this reason, people look to manage depression with more natural remedies. Hence, treatment (often self-treatment) with supplements and herbs continues to gain popularity. But natural does not always mean safe or effective.&nbsp; 
&nbsp;

Herbal formulas are commonly prescribed for the treatment of mental illnesses. More people are now turning to herbal medications because of the various side effects, high prices, and increased relapse rates associated with prescription medications. Over the past decade, several studies have been conducted on the mechanism of action of supplements and herbal medications for treating depression, anxiety, and insomnia.&nbsp;

&nbsp;

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Understanding the role of natural remedies  in treating depression

Below are some supplements and herbs that are most widely used for the treatment of depression:&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Omega-3 fatty acids&nbsp;</h5>
	</li>
</ul>

Omega-3 fatty acids are essential fats that help with treating depression. A randomized control trial conducted on pregnant women in 2020 concluded that omega-3 fatty acids significantly improve symptoms of depression and postpartum depression<a href="#accordion">[3]</a>. Supplements containing the two omega-3 fatty acids eicosatetraenoic acid (ECA) and docosahexaenoic acid (DHA) are most effective. Omega-3 supplements containing 60% or more eicosapentaenoic acid (EPA) show an overall positive effect on treating depressing symptoms<a href="#accordion">[4]</a>. While there is a lack of research to support the argument, the supplement is a well-tolerated and considered healthy addition to your diet that may help treat the mood disorder.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>NAC (N-acetylcysteine)&nbsp;</h5>
	</li>
</ul>

NAC is a precursor of glutathione, an important antioxidant in your body. It is essential for protecting cells against oxidative damage and regulating inflammation<a href="#accordion">[5]</a>. Studies have shown that people with depression are more likely to have higher levels of inflammatory markers. Thus, taking NAC may reduce inflammation and relieve the symptoms of depression. Doses of 2 to 2.4 grams in a day are thought to help treat mental health conditions. 
&nbsp;

<ul>
	<li>
	<h5>Vitamin D&nbsp;</h5>
	</li>
</ul>

Vitamin D is an essential nutrient for the body. However, many people, especially in Pakistan don&rsquo;t have sufficient vitamin D. Studies have further shown that people with depression are deficient in vitamin D. Similarly, people with vitamin D deficiency have more severe depressive symptoms<a href="#accordion">[6]</a>. Vitamin D helps curb depression by reducing inflammation and regulating mood. A randomized control study highlighted that vitamin D supplements are beneficial for people with clinical depression<a href="#accordion">[7]</a>. Another study found that 300,000 IU of adjunctive vitamin D significantly improved the severity of illness and overall quality of life in people with clinical depression<a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li>
	<h5>B vitamins&nbsp;</h5>
	</li>
</ul>

B vitamins play an essential role in the regulation of mood. These vitamins include folate, B12 and B6, and are needed to produce serotonin or the &ldquo;happy hormone&rdquo;. Studies have shown that a deficiency in vitamin B12 and folate increases the risk of depression. Whereas, supplementing vitamin B12 may help reduce depressive symptoms. According to a study published in 2020, low vitamin B12 levels are associated with a high risk of developing depression<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Zinc&nbsp;</h5>
	</li>
</ul>

Zinc is an essential mineral for brain health and a deficiency in the mineral may increase the risk of depression and the severity of symptoms. Studies have further shown that zinc when used alongside antidepressant medications may reduce depressive symptoms.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Magnesium&nbsp;</h5>
	</li>
</ul>

Magnesium is an important mineral that may help with the symptoms of depression. A randomised study concluded that 248 mg of magnesium per day for 6 weeks can significantly reduce the symptoms of depression<a href="#accordion">[10]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Creatine&nbsp;</h5>
	</li>
</ul>

Creatine is an organic compound that is essential for maintaining brain energy, which has shown to be involved in the development of depression. Some studies have shown that supplementing creatine can help with the symptoms of clinical depression.&nbsp; 
&nbsp;

<ul>
	<li>Rhodiola Rosea&nbsp;</li>
</ul>

Rhodiola Rosea is a popular herb that has several health benefits when taken in the form of a supplement. In addition to helping the body cope with stressful situations, the herb is known to reduce symptoms of depression. The herb when used in combination with saffron can significantly reduce depression and anxiety symptoms of mild to moderate depression<a href="#accordion">[11].</a>&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Saffron&nbsp;</h5>
	</li>
</ul>

Saffron is a spice that is commonly used in Asian foods. The spice is packed with antioxidants that have been shown to improve the symptoms of depression. While the exact mechanism behind it is unknown, studies have shown that saffron increases levels of the &ldquo;happy hormone&rdquo; in the brain 
.

<ul>
	<li>
	<h5>Ginseng&nbsp;</h5>
	</li>
</ul>

The ginseng plant has been used by the Chinese for thousands of years to help reduce the effects of stress, and improve mental clarity and energy. Derived from the plant, ginseng supplements have properties that help with low energy and motivation levels in people with depression. However, currently, there are not many studies to support the benefits of ginseng for depression&nbsp;&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Chamomile&nbsp;</h5>
	</li>
</ul>

Studies have shown that chamomile is useful in the management of depression and anxiety. The herb provides significant relief from depressive symptoms. However, there is a need for further studies to support the benefits of chamomile to treat depressive symptoms.&nbsp;

&nbsp;

Key Points

<ul>
	<li>While herbal and natural supplements may work for some people, they are not a substitute for conventional treatments. Especially, for people who also struggle with thoughts of self-harm or suicide.&nbsp;</li>
	<li>Depression is a treatable illness, and you may try different herbs and supplements, but they may have potential side effects.&nbsp;</li>
	<li>These herbs and supplements can also interact with other drugs, reducing their potency.&nbsp;</li>
	<li>If you struggle with depression or have thoughts of suicide or self-harm, seek professional help immediately.&nbsp;</li>
</ul>

&nbsp;

[1].Depressive disorder (depression). World Health Organization. Accessed May 18, 2023

[2].Ferrari, A.J., Charlson, F.J., Norman, R.E., Patten, S.B., Freedman, G., Murray, C.J., Vos, T. and Whiteford, H.A., 2013. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS medicine, 10(11), p.e1001547.

[3].Zhang, M.M., Zou, Y., Li, S.M., Wang, L., Sun, Y.H., Shi, L., Lu, L., Bao, Y.P. and Li, S.X., 2020. The efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trials. Translational psychiatry, 10(1), pp.1-9.

[4].Liao, Y., Xie, B., Zhang, H., He, Q., Guo, L., Subramanieapillai, M., Fan, B., Lu, C. and McIntyre, R.S., 2019. Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational psychiatry, 9(1), pp.1-9.

[5].Šalamon, Š., Kramar, B., Marolt, T.P., Poljšak, B. and Milisav, I., 2019. Medical and dietary uses of N-acetylcysteine. Antioxidants, 8(5), p.111.

[6].Menon, V., Kar, S.K., Suthar, N. and Nebhinani, N., 2020. Vitamin D and depression: a critical appraisal of the evidence and future directions. Indian journal of psychological medicine, 42(1), pp.11-21.

[7].Vellekkatt, F. and Menon, V., 2019. Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials. Journal of postgraduate medicine, 65(2), p.74.

[8].Vellekkatt, F., Menon, V., Rajappa, M. and Sahoo, J., 2020. Effect of adjunctive single dose parenteral vitamin D supplementation in major depressive disorder with concurrent vitamin D deficiency: a double-blind randomized placebo-controlled trial. Journal of Psychiatric Research, 129, pp.250-256.

[9].Sangle, P., Sandhu, O., Aftab, Z., Anthony, A.T. and Khan, S., 2020. Vitamin B12 supplementation: preventing onset and improving prognosis of depression. Cureus, 12(10).

[10].Tarleton, E.K., Littenberg, B., MacLean, C.D., Kennedy, A.G. and Daley, C., 2017. Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. PloS one, 12(6), p.e0180067.

[11].Bangratz, M., Abdellah, S.A., Berlin, A., Blondeau, C., Guilbot, A., Dubourdeaux, M. and Lemoine, P., 2018. A preliminary assessment of a combination of rhodiola and saffron in the management of mild–moderate depression. Neuropsychiatric disease and treatment, 14, p.1821.

Staff Writer

Humza Khizer

Baby Blues (Postpartum Depression): Is There A New Treatment?

Overview

The entire process of pregnancy is very rewarding, but what happens after you have delivered the baby? Your body that has gone through so many constant changes over the 9 months, reverses them all to get you back to normal. This process often leads to postpartum <a href="https://www.merisehat.pk/disease/depression">depression</a>.

About 11% of women in the United States suffer from postpartum depression (PPD).<a href="#accordion">[4]</a>&nbsp;PPD affects not just the life of the mother but also the infant. If left untreated, it can get worse and affect your spouse or other people close to you. So far, the treatment used for PPD has been very generic; similar to that of major depressive episode (MDE) consisting of conventional antidepressants like SSRIs, benzodiazepines, and tricyclic antidepressants. FDA has recently approved the first-ever drug targeted toward treating postpartum depression. 
&nbsp;

Understanding The Latest Treatment For Postpartum Depression

Postpartum depression is best explained as a worsened form of postpartum blues or baby blues. Baby blues are experienced a few days after delivery. Some new moms, however, experience a much more severe case of baby blues that can be classified as postpartum depression and it can go on for over a year.<a href="#accordion">[8]</a>&nbsp;PPD is characterized by:

<ul>
	<li>Feeling depressed and low</li>
	<li>Sleeping too little or too much</li>
	<li>Feeling tired all the time</li>
	<li>Doubting yourself as a mother</li>
	<li>Thinking that you do not want the baby</li>
	<li>Excessive crying</li>
	<li>Loss of appetite</li>
	<li>Anxiety and panic attacks&nbsp;</li>
	<li>Thoughts of harming yourself or the baby</li>
	<li>Unable to think clearly or make the right decisions</li>
	<li>Increased anger and irritability</li>
	<li>Overall reduced interest in everything</li>
</ul>

If you or anyone that you know are facing any of these symptoms, immediately contact your physician and get yourself screened through the Edinburg Postnatal Depression Scale (EPDS). It is one of the most common and quickest screening tools with high accuracy and allows your physician to assess the situation better through the score.&nbsp; 
&nbsp;

A lot of factors contribute to postpartum depression.The biggest factor that is not only responsible for PPD but also for the baby blues is the drastic change in hormones. During pregnancy, your estrogen and progesterone levels are very high. As soon as the baby is delivered, these levels are dropped drastically.

Since estrogen is directly linked to increasing serotonin levels in our brain&nbsp;and progesterone is known for stimulating dopamine release, the decrease in the production of these hormones coupled with some underlying mental issues or previous history of depression or anxiety becomes the most common and the biggest cause of PPD.<a href="#accordion">[2][3][7]</a> 
&nbsp;

While screening of postpartum depression can be done by several tools that are used for Major Depressive Episodes (MDE), the most universally acceptable tool targeted especially for PPD is Edinburgh Postnatal Depression Scale or EDPS. EDPS is a 10-item questionnaire with a response score of 0 to 3. If the total score is over 12, then there is a need for further in-depth assessment of the situation and severity of the condition.&nbsp;

PPD is best diagnosed by your medical practitioner through regular visits. Your doctor asks a series of questions every few days to assess your mental health and well-being. Another way to differentiate PPD from baby blues is to ensure that the patient has at least 3-5 of the symptoms that make up PPD. The generalized diagnostic criteria used for PPD are similar to the one used for Major Depressive Episode (MDE). Immediate attention is recommended to avoid any worsening of the symptoms and from transitioning of PPD to postpartum psychosis. 
&nbsp;

So far, the treatment of postpartum depression is similar to that of conventional major depressive disorder. Special attention is paid to the excretion of the drug and the concentration of the drug removed from the body through breast milk.

The following antidepressants are commonly used to treat postpartum depression due to their low levels of excretion in breast milk, making it safe for use if you are a breastfeeding mother:

<ul>
</ul>

<ul>
	<li>Fluoxetine</li>
	<li>Paroxetine</li>
	<li>Sertraline</li>
	<li>Bupropion</li>
	<li>Amitriptyline</li>
	<li>Doxepin</li>
	<li>Desipramine</li>
	<li>Tranylcypromine</li>
	<li>Trimipramine</li>
	<li>Desipramine</li>
	<li>Paroxetine</li>
	<li>Escitalopram</li>
</ul>

These antidepressants come with some common side effects that include nausea, vomiting, dizziness, sexual issues, diarrhea, blurry vision, weight gain, increased perspiration, etc.<a href="#accordion">[6]</a> 
&nbsp;

Brexanolone (under the brand name of Zulresso) got approved by the FDA as the first drug targeted toward PPD. Brexanolone is approved with a Risk Evaluation and Mitigation Strategy (REMS) which means that it is currently a controlled medicine available through a restricted distribution channel to carefully assess the conditions of the patients throughout the treatment. The program is currently known as Zulresso REMS Program.<a href="#accordion">[5]</a>&nbsp;Currently, to get Brexanolone administered to you for treating your PPD, you are required to enroll in the Zulresso REMS program.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Mechanism Of Action</h5>
	</li>
</ul>

Brexanolone is a synthetic form of allopregnanolone. Allopregnanolone is a neurosteroid. Neuroactive steroids are a group of substances that change a receptor&rsquo;s response to a stimulus by binding to them.<a href="#accordion">[4]</a>&nbsp;Allopregnanolone is best understood as a metabolite of progesterone, which is a GABA-A receptor agonist. This means that progesterone is responsible for increasing GABA functions.

The exact mechanism of the drug and of allopregnanolone is still unknown. Their enhancement of the functions of GABA (Gamma-aminobutyric acid) means that it will inhibit neuronal excitability by blocking messages that are sent to our nervous system with the help of certain stimuli. This not only aids in dealing with depressive triggers but also helps with anxiety.<a href="#accordion">[1]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Dosage And Administration</h5>
	</li>
</ul>

Zulresso is administered intravenously. The dosage is determined by your doctor based on your weight and other factors. The drug is administered over a period of 2.5 days or 60 hours and requires constant monitoring due to the risk of unconsciousness.<a href="#accordion">[5]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Adverse Effects</h5>
	</li>
</ul>

Since the drug is relatively new, there are a limited number of side effects reported so far. They include:

<ul>
	<li>Dry mouth</li>
	<li>Dizziness</li>
	<li>Flushed skin</li>
	<li>Losing consciousness</li>
</ul>

<h5 dir="ltr">Important!</h5>

FDA has advised to stop the treatment of Zulresso if more serious side effects occur that may include the worsening of PPD and suicidal thoughts especially in women under the age of 25. 
&nbsp;

Current research suggests that brexanolone may interact with other CNS depressants like opioids and benzodiazepines and increase the severity of the adverse effects with regard to sedation. Alcohol consumption is also not advised due to similar reasons.

During the clinical trials, patients who were taking antidepressants also showed a more severe case of sedation as compared to the ones who did not or were a part of the placebo studies. 
&nbsp;

Conclusion

Considering the rapid onset of action with brexanolone especially when compared to the long-term treatments offered by conventional antidepressants, it is believed that brexanolone can take over the go-to therapy for PPD. However, a much more convenient way of administration would be through oral pills instead of I/V. There are still many concerns left that can only be answered through long-term data in a lesser restricted environment as opposed to a clinical trial setting.&nbsp; 
&nbsp;

<ul>
</ul>

<ul>
	<li>Current antidepressant therapies employed for PPD are based on&nbsp;long-term treatment.</li>
	<li>Brexanolone&rsquo;s onset of action is fast and has shown significant improvement in women of all ages suffering from PPD.</li>
	<li>Some women under the age of 25 were observed to experience severe side effects that even led to the worsening of their PPD.</li>
	<li>The drug is still under strict observation with the help of the REMS program.</li>
	<li>Administration coupled with the duration over which it has to be administered can make it difficult to commercialize as compared to drugs that are available in the form of oral pills.&nbsp;</li>
</ul>

[1] Allen B, Vespa PM. Antiseizure medications in critical care: An update. Curr Opin Crit Care. 2019;25(2):117-125

[2] ATP Science, 2021. HOW DOES PROGESTERONE CREATE A DOPAMINERGIC RESPONSE?. [Online] .

[3] Debra Fulghum Bruce, P., 2020. Postpartum Depression. [Online].

[4] Fala, L., 2019. Approved by the FDA Specifically for Postpartum Depression in Adults. [Online]

[5] Federal Drug Administration, 2019. FDA approves first treatment for post-partum depression. [Online]

[6] Fields, L., 2021. Which Antidepressants Treat Postpartum Depression?. [Online]

[7] Matthew Hoffman, M., 2021. Estrogen and Women's Emotions. [Online]

[8] Mayo Clinic, 2022. Postpartum depression. [Online]

Umna Salah

Are My Mental Health Symptoms Linked With HIV?

It is normal to feel depressed and sad when you have HIV, and if over time you feel the sadness is becoming worse, talk to your healthcare provider. You might require <a href="https://www.merisehat.pk/disease/depression">treatment for depression</a>.

&nbsp;

Understanding Mental Health Issues In HIV Patients

The symptoms of depression last for more than two weeks and include the following:&nbsp;

<ul>
	<li>Feeling anxious, sad, hopeless, and irritable</li>
	<li>Loss of weight or weight gain</li>
	<li>Insomnia or sleeping more than usual</li>
	<li>Difficulty in sitting still</li>
	<li>Slow-paced movement and walking</li>
	<li>Loss of interest in things you once enjoyed</li>
	<li>Tiredness</li>
	<li>Worthlessness and guilt</li>
	<li>Having a hard time concentrating</li>
	<li>Suicidal thoughts</li>
</ul>

&nbsp;

There are multiple mental health aspects that you deal with when you have HIV. Some of them are the challenges you face that are associated with HIV and its diagnosis. Moreover, suggestions on how to cope with them can also be irritating.

 
You may experience all or some of the following symptoms:

&nbsp;

<h5>1. Denial</h5>

When you are diagnosed with HIV, it can become very hard to admit the diagnosis for some people. They usually end up denying it and believe that the test results are wrong. This is a very natural and normal first reaction, but not dealing with it can be dangerous. You may end up failing at taking precautions for HIV or even starting your medication on time. So it is important to talk to your physician right away and begin the treatment, in addition to the support you need.

&nbsp;

<h5>2. Anger&nbsp;</h5>

Anger is the most common feeling when you are diagnosed with HIV. A lot of people get upset because they don&rsquo;t know how they got infected by the virus. Most of these feelings can lead to feeling overwhelmed and helpless. However, you can deal with the situation in the following ways:

<ul>
	<li>Talk to your healthcare provider about the treatment of depression, for example, therapy or medications.</li>
	<li>You should also start with HIV treatment if you haven&rsquo;t already and that will be a positive step towards treatment. Moreover, it will also help with depression.</li>
	<li>Joining a support group is also a good option because spending time with other people in a similar situation can help your feel at ease. If you don&rsquo;t want to do that, you can talk to your family and friends who are supportive.</li>
	<li>Avoid being in contact with people who make your condition worse.</li>
</ul>

&nbsp;

<h5>3. Sadness And Depression</h5>

It is completely normal to feel sad when you have HIV, and if the depression or sadness does not go away with time, you can talk to your healthcare provider. You might require treatment for depression. 
&nbsp;

<h5>4. Fear And Anxiety</h5>

When you don&rsquo;t know what to expect after being diagnosed with HIV, fear and anxiety may take a toll on your mental health. Furthermore, you may also fear telling people because you are unsure how they will treat you.&nbsp;

The fear of having the disease can make you anxious and disrupt your sleep. Moreover, anxiety can also make you feel agitated and nervous. You may also be afraid of telling people because you may fear how they will treat you after knowing that you have HIV.

You can manage the fear and anxiety in the following ways:

<ul>
	<li>Talk to a psychiatrist about the possible treatment for anxiety if the feelings are chronic and do not lessen with time, or get worse.</li>
	<li>Educate yourself about HIV.</li>
	<li>Start antiretroviral treatment or ART for HIV. When you take the required action to control your HIV, you will also protect yourself and your partners. Moreover, this can also help in lessening your fears about the future.</li>
	<li>Talk to your healthcare provider and family.</li>
	<li>Sign up for a support group.</li>
	<li>Volunteer at services that has people dealing with the same situation. This can help you in empowering yourself and can also lessen your fear.</li>
</ul>

&nbsp;

The medications that are used in the treatment of HIV and AIDS can affect your brain. When HIV infects the brain alone, it can create problems in thinking and movement. The symptoms of HIV-associated neurocognitive disorders are the following:

<ul>
	<li>Confusion</li>
	<li>Forgetfulness</li>
	<li>Sudden change in mood and behavior</li>
	<li>Weakness in the muscles</li>
	<li>Difficulty in paying attention</li>
	<li>Clumsiness</li>
</ul>

&nbsp;

<h5 dir="ltr">Important!</h5>

Tell your healthcare provider if you think you have HAND.

<ul>
	<li>Don&rsquo;t be scared to tell your healthcare provider if you feel something is wrong.</li>
	<li>Whenever you feel the symptoms are unusual, note them down and keep this information to show your doctor the next time you visit them.</li>
	<li>Building maximum support is helpful, which includes your friends, family, and healthcare providers. Although the treatment of HAND is possible, it does take some time for the symptoms to resolve or completely go away.</li>
</ul>

&nbsp;

<ul>
</ul>

<ul>
	<li>Depression and HIV are linked. Always inform your doctor if you have depression, or if you think you do. They will help you in planning the right treatment.&nbsp;</li>
	<li>Don&rsquo;t give up if one treatment does not work.&nbsp;</li>
	<li>Your healthcare provider can help you in formulating a plan which works best for you. For example,&nbsp;talk therapy, cognitive behavioural therapy, support groups, medications (including anti-depressants), and techniques to reduce stress.</li>
	<li>Remember, healing takes time.&nbsp;</li>
</ul>

&nbsp;

[1] Nanni, M.G., Caruso, R., Mitchell, A.J., Meggiolaro, E. and Grassi, L., 2015. Depression in HIV infected patients: a review. Current psychiatry reports, 17(1), pp.1-11.

[2] Tran, B.X., Ho, R., Ho, C.S., Latkin, C.A., Phan, H.T., Ha, G.H., Vu, G.T., Ying, J. and Zhang, M.W., 2019. Depression among patients with HIV/AIDS: research development and effective interventions (GAPRESEARCH). International journal of environmental research and public health, 16(10), p.1772.

[3] Bhatia, M.S. and Munjal, S., 2014. Prevalence of depression in people living with HIV/AIDS undergoing ART and factors associated with it. Journal of clinical and diagnostic research: JCDR, 8(10), p.WC01.

[4] Gonzalez, J.S., Batchelder, A.W., Psaros, C. and Safren, S.A., 2011. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. Journal of acquired immune deficiency syndromes (1999), 58(2).

Madeeha Syed

The Impact Of Stress On Weight Gain/Loss And Mental Health

In today&#39;s fast-paced and demanding world, <a href="https://merisehat.pk/disease/stress">stress </a>has become an inevitable part of our lives. Whether it&#39;s due to work pressure, relationship issues, financial concerns, or any other life challenge, stress affects us all at some point. Not only does stress take a toll on our mental well-being, but it can also have a profound impact on our physical health, particularly when it comes to weight gain or loss. 
&nbsp;

&quot;I always tell my clients to have fun when working out with me,&quot; says 33-year-old Ahsan Shah, a fitness trainer and consultant based out of Karachi with over 15 years of experience in managing fitness and weight loss with clients in both Karachi and Dubai. &quot;If they&#39;re not having fun and are stressed out, it will impact not only their motivation but also their cortisol levels,&quot; he says. &quot;This affects everything: whether they will be consistent in pursuing a healthy exercise and diet regimen and most importantly, how their body will respond to it.&quot;&nbsp;

&nbsp;

Weight gain and Stress

<h5>Weight Gain And Stress</h5>

Stress can significantly contribute to weight gain for various reasons. One of the main factors is the hormonal response triggered by stress. When we are under stress, our body releases cortisol, often referred to as the &quot;stress hormone.&quot; Cortisol plays a crucial role in regulating metabolism, blood sugar levels, and energy balance. However, prolonged or chronic stress can lead to consistently elevated cortisol levels, which can disrupt these processes.

Increased cortisol levels can cause an increase in appetite, particularly for foods that are high in sugar, fat, and calories. This can lead to overeating and indulging in unhealthy food choices as a way to cope with stress. Additionally, cortisol can promote the accumulation of fat, especially around the abdominal area, which is associated with an increased risk of various health problems, including cardiovascular diseases and<a href="https://merisehat.pk/disease/diabetes-type-1-and-2"> type 2 diabetes</a>.

Furthermore, stress can disrupt sleep patterns. Lack of sleep or poor-quality sleep is linked to weight gain as it affects hunger-regulating hormones, such as leptin and ghrelin. When we don&#39;t get enough sleep, ghrelin levels increase, stimulating hunger, while leptin levels decrease, reducing feelings of fullness. This imbalance can lead to excessive calorie intake and weight gain over time. 
&nbsp;

<h5>Weight Loss And Stress</h5>

On the other hand, stress can also lead to weight loss in some individuals. During stressful periods, some people may experience a loss of appetite or have difficulty eating due to digestive disturbances. This can result in inadequate nutrition and unintentional weight loss. Moreover, stress can increase metabolic rate and energy expenditure, causing some individuals to burn more calories than they consume, leading to weight loss. 
&nbsp;

<h5>Mental Health And Stress</h5>

The impact of stress on mental health is widely recognized. Chronic stress can contribute to the development or exacerbation of mental health conditions such as anxiety and depression. These conditions can have a profound effect on a person&#39;s overall well-being and can further contribute to weight gain or loss.

Stress and mental health are closely intertwined. For some individuals, stress can trigger emotional eating or binge eating episodes as a coping mechanism to alleviate negative emotions. This can create a vicious cycle where stress leads to unhealthy eating habits, resulting in weight gain, and in turn, worsening mental health symptoms.

Conversely, stress can also lead to loss of appetite, decreased interest in food, or even disordered eating patterns. In severe cases, chronic stress can contribute to the development of eating disorders like anorexia nervosa or bulimia nervosa, which can have serious consequences on both physical and mental health. 
&nbsp;

<h5>Managing Stress And Promoting Well-being</h5>

To mitigate the negative effects of stress on weight and mental health, it is crucial to implement effective stress management strategies. Here are some recommendations: 
&nbsp;

<ul>
	<li>Regular Exercise: Engaging in physical activity can help reduce stress levels, promote weight management, and enhance overall well-being. Exercise releases endorphins, the body&#39;s natural mood elevators, which can counteract the negative impact of stress hormones. 
	&nbsp;</li>
	<li>Balanced Diet: Adopting a balanced diet rich in whole foods, fruits, vegetables, lean proteins, and healthy fats can support both physical and mental health. Avoid using food as a coping mechanism for stress and opt for healthier stress-relief strategies. 
	&nbsp;</li>
	<li>Adequate Sleep: Prioritize good sleep hygiene and aim for seven to eight hours of quality sleep each night. Establishing a consistent sleep routine can improve stress resilience, aid in weight management, and enhance mental clarity. 
	&nbsp;</li>
	<li>Stress Reduction Techniques: Explore stress reduction techniques such as meditation, deep breathing exercises, yoga, or mindfulness practices. These techniques can help calm the mind, reduce cortisol levels, and promote relaxation. 
	&nbsp;</li>
	<li>Seek Support: Don&#39;t hesitate to reach out for support from friends, family, or mental health professionals. Talking about your stressors and emotions can provide relief and help you develop healthier coping mechanisms. 
	&nbsp;</li>
</ul>

bottom Line

Stress can have a significant impact on both weight management and mental health. It is important to recognize the interplay between stress, weight gain/loss, and mental well-being. By implementing effective stress management strategies and seeking support when needed, individuals can better navigate the challenges of stress and promote their overall health and well-being.

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

In Sickness And In Health

&ldquo;What did I even achieve?&rdquo;

&ldquo;Why can&rsquo;t I be how I want to be?&rdquo;

&ldquo;Is this it?&rdquo;

And a million other questions may arise when you are not feeling your best. 
&nbsp;

Depressive disorders, mood disorders, in fact the entirety of mental health, is a lesser understood subject. It&rsquo;s bad enough that mental health continues to be a taboo, at times shunned by the most educated even, but it&rsquo;s sadder that society has somehow categorised who should be &ldquo;allowed&rdquo; to have <a href="https://www.merisehat.pk/article/mental-health">mental health</a> problems. This scrutiny is done on the basis of gender, race, socioeconomic status and even profession. No matter how organised this categorisation sounds, it is incorrect, unfair and devastating. 
&nbsp;

Mental health is your psychological well-being that not only affects your personal, career and professional life, but also your health. Depression or any other mental health illness, can either directly affect your appetite and cause weakness, or bring your immune system down to an extent that it gets susceptible to harmful organisms. 
&nbsp;

Moreover, it is seen that symptoms, such as those in anxiety in particular, can alter the physiological processes of the autonomic nervous system i.e. respiration and heart rate. Thus, increasing the risk of certain malicious diseases.&nbsp; 
&nbsp;

Healthcare practitioners, including the nursing staff, paramedics, and all those involved in patient care are part of an extremely noble, but immensely stressful profession. Whether they are sick or healthy, patient care is an obligation they cannot ignore. Moreover, providing hope to patients who believe they will never recover is a major part of the job description. But do you ever think how scary it can be for healthcare professionals to provide this hope, regardless of their own fears?&nbsp; &nbsp; &nbsp;&nbsp;

&nbsp;

Understanding Mental Health Issues Faced By The Medical Community

According to the World Health Organization (WHO), in 2015, almost 4.4% of the global population was diagnosed with depression, which is around 320 million people<a href="#accordion">[1]</a>. Studies prove that except for the United States of America, where there are an equal number of depressed doctors as the general population, other countries report a greater incidence of depression among doctors and other related health professionals than the rest of the population.&nbsp; 
&nbsp;

Current statistics report the prevalence of depression as 27% in medical students, 29% in registrars and up to 60% in practicing doctors<a href="#accordion">[1]</a>.&nbsp;Furthermore, a study conducted using Beck&rsquo;s Depression Inventory, revealed that 30% of the primary healthcare workers in a public setup were moderate to severely depressed<a href="#accordion">[1]</a>. In China, where health workers&rsquo; mental health wasn&rsquo;t taken into consideration until the 21st Century, the prevalence of depressive symptoms varies between 31.7% to 65.3%<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

There are no set criteria that enables only a certain population to be exclusive to mental health disorders. It can happen to almost anyone, but there are sure factors that have been proved to put healthcare workers at a greater risk than others. These risk factors include: 
&nbsp;

<ul>
	<li>Working longer hours</li>
	<li>Extensive workload</li>
	<li>Ever-growing intensity and complexity of the job description</li>
	<li>Relentless contact with patient&rsquo;s ill health and emergencies</li>
	<li>Higher responsibilities</li>
	<li>Post-traumatic stress due to the severity of the patient&rsquo;s condition</li>
	<li>Feelings of guilt, failure, shame and low self-esteem due to fear of failure, or actually failing to execute a task&nbsp;</li>
	<li>Discrimination in their licensing procedures specifically</li>
</ul>

&nbsp;

One term to understand while discussing the mental health of healthcare workers is &lsquo;burnout&rsquo;. According to the International Classification of Diseases (11th edition), or ICD-11, burnout is a phenomenon seen in workplaces where excessive pressure from the office surroundings can drain a person to an extent that they can&rsquo;t function properly anymore.&nbsp; 
&nbsp;

Burnout is characterised by three aspects:

1. Being unnecessarily exhausted.

2. Having negativity related to the workplace, in this case around patients.

3. Major reduction in efficiency. 
&nbsp;

Further research reports that a reason exclusive to low- and middle-income countries is the unfair ratio of physicians to the general population. This increases the workload which in turn raises the risk of burnout in healthcare providers. Thus, ultimately affecting patient care. Many cross-sectional studies signify that burnt-out medical practitioners were twice as likely to make errors, and had a 17% risk of being sued for malpractice<a href="#accordion">[3]</a>. This reduced efficacy can in turn aggravate burnout, as well as instill a factor of guilt for not being efficient enough. 
&nbsp;

According to a study carried out in the US, in 2017, almost 44% of physicians showed at least one symptom of burnout while the number was 54% in 2014<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

Moral injury is defined as the psychological distress which results from the actions, or the restricted ability of the practitioner, that may violate their moral or ethical code. A fine example is a doctor having to decide between saving one patient over the other, purely on practical grounds. This may put profound emotional and psychological stress. Although the moral injury is not a disease itself, it may shake a healthcare practitioner&rsquo;s core and lead to feelings of self-doubt, unnecessary yet strong guilt and ambiguity in their actions. For example, paramedics hold themselves accountable for not being able to do enough on-site, regardless of correctly analyzing the severity of the condition<a href="#accordion">[3]</a>.

&nbsp;

An unjust stereotype that prevails in our society is that a person who works in the healthcare industry is not allowed to be compromised medically themselves. This puts unnecessary pressure on the healthcare workers as it is idealised that their efficiency is subject to their own health. Due to the unfair perception set, medical workers not only feel frustrated, but they use alternative ways for instant gratification which in turn makes matters even worse for them.&nbsp; 
&nbsp;

Studies prove that alcohol misuse in healthcare providers was 49%, five times higher than the general population (9%)<a href="#accordion">[1]</a>. Furthermore, a survey conducted in the United States in 2016 revealed that although 50% of the female doctors acknowledged that while they met the criteria for a disturbed mental state, they did not consider starting appropriate treatment as they wanted to deal with it independently<a href="#accordion">[1]</a>. Or, because they believed the diagnosis was shameful or embarrassing 
.&nbsp;

Therefore, there is a dire need of changing perceptions<a href="#accordion">[1]</a>.

&nbsp;

The treatment is as complicated as diagnosing mental health disorders in healthcare professionals. The relevance lies with the fact that professionals who have dedicated their lives to serving patients find it hard to fit in the role of a patient themselves. Nevertheless, it is important to ensure appropriate treatment. The treatment plan includes a pharmacological and psychological approach. Antidepressants are the first-line medications. The most widely used antidepressants are selective serotonin re-uptake Inhibitors (SSRIs). These are usually initiated for 9-12 months in the beginning, irrespective of the reason.&nbsp; 
&nbsp;

Studies also prove that medical practitioners have a higher suicide rate than the general population. Hence, encouraging treatment plans is of utmost importance. The psychological approach includes cognitive behavioural therapy (CBT) and support groups to normalise the conception of being unwell. Moreover, exercises like adopting new hobbies, restricting alcohol intake, and taking up healthy challenges might be helpful in the process<a href="#accordion">[1]</a>.

&nbsp;

<h4>"Worried? Anxious? Head on over to the<a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank"> sehat scan</a> to check your stress level!" </h4>

The mental health of doctors or other healthcare professionals was already a neglected topic, but after the pandemic things took a turn for the worse. Numerous studies have recently been dedicated exclusively to the impact of COVID-19 on the mental health of healthcare providers.&nbsp; 
&nbsp;

As of 30th July, COVID-19 has caused more than 6.4 million global deaths<a href="#accordion">[4]</a>. The sudden patient influx, presence of unorthodox symptoms, and their management, along with the unpredictability of COVID-19 have further increased the burden on healthcare practitioners. A meta-analysis conducted across 65 studies, involving 97,333 health care workers from 21 countries, identified a high prevalence of moderate depression (21.7%), anxiety (22.1%), and PTSD (21.5%) during the COVID-19 pandemic<a href="#accordion">[3]</a>. Another survey reported trauma-related stress, with a prevalence ranging from 7.4% to 35%, particularly among women, nurses, frontline workers and workers who experienced physical symptoms<a href="#accordion">[3]</a>. In fact, nurses have shown a higher incidence of depression and PTSD than physicians<a href="#accordion">[3]</a>.

&nbsp;

Doctors are mere humans; as fragile or strong as any other person alive. Just because their job involves treating illnesses, doesn&rsquo;t mean that they are not bound to get ill themselves. The stereotype built for healthcare professionals restricts them to get diagnosed, and if they do, prevents them from getting treatment efficiently. 
&nbsp;

The statistics collected have been recent and alarming, yet not much attention has been paid to the situation. This needs to change not only for the sake of humanity but also for the stagnant progress of our healthcare industry. Having our medical workers burnt out does not only put patient care at risk but also aggravates their mental health itself. 
&nbsp;

<ul>
	<li>Mental health is your psychological well-being that not only affects your personal, career and professional life but also your health.</li>
	<li>&nbsp;Healthcare practitioners, including nursing staff, paramedics and all those involved in patient care are an integral part of the health system.</li>
	<li>Data proposed by the World Health Organization (WHO) in 2015 shows that almost 4.4% of the world&rsquo;s population is diagnosed with depression, which is around 320 million people.</li>
	<li>Prevalence of depression was found to be 27% in medical students, 29% in registrars and up to 60% in practicing doctors.</li>
	<li>Risk factors that make healthcare practitioners vulnerable to mental disorders are working longer hours, extensive workload, ever-growing intensity and complexity of the job description, relentless contact with patient&rsquo;s ill health and emergencies, higher responsibilities, post-traumatic stress due to the severity of patient presentation, feelings of guilt, failure, shame and low self-esteem due to fear of failure.&nbsp;</li>
	<li>According to ICD-11, burnout is a phenomenon seen in workplaces where excessive pressure from the office surroundings can drain a person to an extent that they can&rsquo;t function properly anymore.</li>
	<li>Burnout is characterised by being unnecessarily exhausted, having negative thoughts related to the workplace, and major reductions in efficiency.</li>
	<li>In 2017 almost 44% of US physicians showed at least one symptom of burnout, while the number was 54% in the year 2014.</li>
	<li>Many cross-sectional studies signify that burnt-out medical practitioners were twice as likely to make errors, and had a 17% risk of being sued for malpractice.</li>
	<li>Moral injury is defined as the psychological distress that results from actions, or the restricted ability of the practitioner, that may violate their moral or ethical code.</li>
	<li>A survey conducted in the United States in 2016 revealed that although 50% of the female doctors acknowledged the fact that they had met the criteria for a disturbed mental state, they did not consider starting appropriate treatment.</li>
	<li>&nbsp;The treatment plan for depression includes pharmacological and psychological approaches, in which antidepressants are the first-line medications.</li>
	<li>However, any medication should be started only after being officially prescribed by a certified healthcare practitioner.</li>
	<li>Studies also prove that medical practitioners have a higher suicide rate than the general population.</li>
	<li>Summarising 65 studies, involving 97,333 healthcare workers in 21 countries, a high prevalence of moderate depression (21.7%), anxiety (22.1%), and PTSD (21.5%) was present among them during the COVID-19 pandemic.</li>
</ul>

[1] Ignacio Mora-Magaña, Sherman A. Lee, Isaac Maldonado-Castellanos, Carlos Jiménez-Gutierrez, José Mendez-Venegas, Azareel Maya-Del-Moral, Margarita D. Rosas-Munive, Amanda A. Mathis, Mary C. Jobe. (2022) Coronaphobia among healthcare professionals in Mexico: A psychometric analysis. Death Studies 46:2, pages 280-289.

[2] Gong, Yanhong et al. “Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: a cross-sectional study.” PloS one vol. 9,7 e103242. 22 Jul. 2014, doi:10.1371/journal.pone.0103242

[3] Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority.

[4] Coronavirus cases: Worldometer.

Arbaz Ansari

The Intricate Relationship Between Weight Gain/ Loss And Depression

The relationship between weight gain/loss and depression is a multifaceted and intricate interplay that has garnered significant attention in recent years. While it is well-known that depression can impact appetite and eating patterns, the connection extends beyond simple cause-and-effect. In this article, we delve into the complex relationship between weight and depression, exploring the factors involved, potential mechanisms, and the importance of addressing both aspects in achieving holistic well-being. 
&nbsp;

&quot;I wish someone told me there was more to life than just eating food,&quot; says 39-year-old Nariman Khan, a mindfulness meditation instructor based out of Islamabad. &quot;I had always been chubby but my weight ballooned in my 20s. I tried all kinds of crazy diets and would always end up with a tub of ice cream at midnight, binge eating until I finally felt full.&quot;&nbsp;

And as a result, Nariman would pack on more pounds, suffer from severe self-esteem issues, and avoided meeting people and going out. &quot;It took me years to realise I needed to love myself in order to really feel full,&quot; she adds. &quot;And once I did, I could do what was good for me, insteading of approaching weight loss as a form of punishment, it became self care. Our mental health is very closely linked to our weight gain or loss. It goes both ways.&quot;&nbsp;

&nbsp;

Bidirectional Impact between Weight and Depression

The Bidirectional Influence: Weight gain/loss and <a href="https://merisehat.pk/disease/depression">depression </a>often interact in a bidirectional manner, with one influencing the other and vice versa. On one hand, individuals experiencing depression may find solace in comfort eating, leading to weight gain. Depression can also cause a lack of motivation or energy, resulting in a sedentary lifestyle and further weight gain. On the other hand, weight gain itself can trigger feelings of low self-esteem, body dissatisfaction, and contribute to the development or exacerbation of depressive symptoms. Similarly, weight loss due to depression may stem from loss of appetite, decreased interest in food, or changes in metabolism. 
&nbsp;

Psychological Factors: Psychological factors play a vital role in the relationship between weight and depression. Negative body image, low self-esteem, and distorted perceptions of one&#39;s physical appearance can contribute to both weight gain and depressive symptoms. Society&#39;s emphasis on thinness as an ideal, coupled with social pressures and stigma, can exacerbate these psychological factors and create a vicious cycle. Additionally, emotional eating as a coping mechanism for managing <a href="https://merisehat.pk/disease/stress">stress</a>, sadness, or other negative emotions is common, further influencing weight gain and emotional well-being. 
&nbsp;

Biological Mechanisms: Biological mechanisms, such as hormonal imbalances and neurotransmitter dysregulation, also contribute to the relationship between weight and depression. Stress-related hormones, such as cortisol, can impact appetite, food cravings, and fat distribution in the body. Furthermore, neurotransmitters like serotonin, which are implicated in mood regulation, appetite control, and satiety, can influence both weight and depressive symptoms. Imbalances in these biological factors can create a complex feedback loop, perpetuating weight gain/loss and depressive states. 
&nbsp;

Treatment Approaches: Addressing the relationship between weight gain/loss and depression requires a comprehensive approach. Effective treatment involves targeting both mental health and physical well-being simultaneously. Integrated treatment strategies may include:

<ol>
	<li style="list-style-type:decimal">Psychotherapy: Cognitive-behavioral therapy (CBT) and other evidence-based approaches can help individuals develop healthier coping mechanisms, manage emotions, and improve body image.</li>
	<li style="list-style-type:decimal">Medication: Antidepressant medications may be prescribed to manage depressive symptoms, with consideration given to potential effects on weight.</li>
	<li style="list-style-type:decimal">Lifestyle Changes: Encouraging regular physical activity, adopting a balanced and nutritious diet, and promoting healthy sleep patterns are crucial in addressing both weight and depression.</li>
	<li style="list-style-type:decimal">Support Networks: Building a strong support system, including friends, family, or support groups, can provide emotional support and practical assistance throughout the recovery process.</li>
	<li style="list-style-type:decimal">Professional Guidance: Collaborating with a multidisciplinary team comprising mental health professionals, nutritionists, and physicians can ensure a holistic approach tailored to the individual&#39;s needs. 
	&nbsp;</li>
</ol>

The relationship between weight gain/loss and depression is a complex interplay involving psychological, biological, and social factors. Recognizing and addressing this intricate connection is vital for comprehensive well-being. By integrating mental health support, lifestyle changes, and a holistic treatment approach, individuals can work towards achieving both physical and emotional wellness. Through increased awareness and a compassionate understanding of this relationship, we can foster a more inclusive and supportive environment that prioritizes the overall health of individuals struggling with weight and depression.

Depression In Teenagers

If you&rsquo;re a teenager or a parent to one, I&rsquo;d like you to do this small exercise. Repeat after me:

&ldquo;Depression is a real illness.&rdquo;

&ldquo;Depression is not sadness.&rdquo;

&ldquo;Depression can happen to anyone, regardless of their age or gender.&rdquo;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
&nbsp;

Good job!

With so many myths and misconceptions afloat about mental health and depression in particular, we must shed our biases and approach the topic with a clear mind.

This article will help you determine symptoms of depression, identify possible triggers, and where to seek help in case you or a loved one is experiencing this mental disorder. 
&nbsp;

Globally, one in seven 10-19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group<a href="#accordion">[1]</a>. Depression is among the most common mental disorders and affects 1.1% of 10-14 year-olds and 2.8% of 15-19-year-olds<a href="#accordion">[1]</a>.

It is often confused with persistent depressive disorder (dysthymia), mood dysregulation disorder, premenstrual depressive disorder, and adjustment&nbsp;disorder.

According to the DSM-5, a person must exhibit low mood, loss of interest in usual activities, feelings of sadness, and a change from their previous level of functioning for at least two weeks to be diagnosed with major depression<a href="#accordion">[2]</a>. 
&nbsp;

These symptoms must be accompanied by at least five other common symptoms of depression, such as<a href="#accordion">[2]</a>:

<ul>
	<li>Difficulty sleeping (insomnia) or sleeping too much (hypersomnia)</li>
	<li>Feeling worthless and hopeless</li>
	<li>Feeling guilty</li>
	<li>Gaining or losing weight with a change in appetite</li>
	<li>Unusually slow or agitated movements</li>
	<li>Fatigue</li>
	<li>Inability to focus or concentrate at home or school</li>
	<li>Thinking about death or suicide attempts 
	&nbsp;</li>
</ul>

These symptoms should:

<ul>
	<li>Cause significant distress</li>
	<li>Interfere with daily life</li>
	<li>Not be due to an underlying medical condition or a result of substance abuse 
	&nbsp;</li>
</ul>

Depression can be mild and short-lived or severe and long-lasting. There may be just a single episode or there may be multiple episodes. 
&nbsp;

Understanding Depression in Teenagers

You may belong to a perfect family with fun and supportive parents, loving siblings, and a pet or two. You may also be a high-achiever at school, part of the student body, and excellent in extra-curricular activities. An outsider might say, &lsquo;Hey! This kid has got it all. Nothing&rsquo;s wrong in their life&rsquo;. You may even repeatedly hear people asking you to be grateful for each day. But all that &lsquo;perfection&rsquo; does not mean, you cannot be depressed.

Unfortunately, a lot of young depressed people are good at masking. They go about doing their routine tasks without letting anyone know how they&rsquo;re feeling. Some of them even fail to recognize they&rsquo;re depressed themselves. Especially if they&rsquo;ve been taught to think that they have no reason to be sad or depressed. Or they&rsquo;re just not sad enough to qualify as depressed. 
&nbsp;

Others do not report their symptoms because they think these issues are related to daily stress that they can sort out and don&rsquo;t require professional help. Moreover, there is a reluctance to discuss personal issues with another person and a stigma associated with antidepressant medications or psychotherapy that makes children and young adults deny their condition. 
&nbsp;

While unexplained anxiety, distraction, and a sudden and apparent lack of interest in personal hygiene are strong indicators of silent depression, other symptoms can include<a href="#accordion">[3][4]</a>:

<ul>
	<li>Lack of energy waking up or rapidly getting tired during the day even when rested</li>
	<li>Apathy</li>
	<li>Overworking to divert thoughts</li>
	<li>Restlessness</li>
	<li>Body pain, including headaches, low back pain, and stomachaches, without an obvious cause</li>
	<li>Avoid meeting or communicating with friends or loved ones</li>
	<li>Loneliness</li>
	<li>Persistent and intense mood swings, including nervousness, irritability, anger even over small matters, crying without reason</li>
	<li>Exaggerated self-criticism</li>
	<li>Pessimism</li>
	<li>Fixation on past failures</li>
	<li>Low self-esteem</li>
	<li>Trouble making decisions</li>
	<li>Frequent absences from school and poor school performance</li>
	<li>Consuming excessive amounts of prescription medication or other drugs to subdue symptoms</li>
	<li>Constantly expecting adverse situations to occur or negative self-talk (e.g., &ldquo;I feel unhappy/sad&rdquo; or &ldquo;I want to kill myself&rdquo;)</li>
	<li>Indulging in risky, rebellious, and even criminal behavior (e.g., shoplifting) 
	&nbsp;</li>
</ul>

If you&rsquo;re here, you&rsquo;re probably wondering if you are depressed.

You don&rsquo;t slack, you don&rsquo;t cry when a pet dies, and most importantly, you socialize. But then you&rsquo;re overwhelmed with hopelessness, you suddenly feel frustrated with schoolwork, you quit pursuing your favorite hobby, you think about running away from home, you start feeling ugly, and you find your addiction to your smartphone and the internet an escape from the real world.

If you&rsquo;ve been an overachiever all your life, you may now be extremely sensitive to criticism. If you&rsquo;re a boy, you may be turning aggressive or violent. 
&nbsp;

As a teenager, it&rsquo;s possible you feel excessively or inappropriately worthless or guilty due to the following:

<ul>
	<li>Perceived failures at school</li>
	<li>Social status (compared to your peers)</li>
	<li>Bullying by peers</li>
	<li>Lack of social support 
	&nbsp;</li>
</ul>

It&rsquo;s also possible that your depression is an outcome of struggling with:

<ul>
	<li>Environmental stress, including family problems</li>
	<li>PTSD, including the loss of a loved one</li>
	<li>Obsessive-compulsive disorder (OCD)</li>
	<li>Family history of depression</li>
	<li>Eating disorders</li>
	<li>ADHD</li>
	<li>Learning disorder</li>
	<li>Bipolar disorder</li>
	<li>Chronic illness</li>
	<li>Physical disabilities</li>
	<li>Drug abuse 
	&nbsp;</li>
</ul>

<h5>Adult Intervention</h5>

18-24 years olds form one of the most vulnerable groups at risk of death by suicide. This is why the United States Preventive Service Task Force advises screening for anxiety in individuals aged 8-18 years and for major depressive disorder in individuals aged 12-18 years<a href="#accordion">[6]</a>. 
&nbsp;

Here&rsquo;s how parents and teachers can help support a child through depression:

<ul>
	<li>Spend Time With Them</li>
</ul>

While they may not specifically be asking for it, you must give them time so they feel comfortable communicating their concerns. If they&rsquo;re hesitating, you can initiate an honest, open discussion by letting them know the changes you&rsquo;ve observed and asking them to share what they&rsquo;re going through.

Your focus should be on listening closely. Connect on their comfort level. Set a time to talk each day, face-to-face and without distractions. Suicidal thoughts, especially, are often a cry for help. 
&nbsp;

<ul>
	<li>Give Them Breathing Space</li>
</ul>

There&rsquo;s no need to school them all the time. Let them make mistakes. Let them enjoy activities they like and experience life as they want. Guide them, yes. But don&rsquo;t make decisions on their behalf, overprotect them, or force them to follow your career trajectory. It will crush their confidence.

Note: This doesn&rsquo;t overlook the fact that you need to set boundaries to combat unhealthy behaviors, like staying up late or eating junk food. 
&nbsp;

<ul>
	<li>Support Them</li>
</ul>

Children need support both at home and at school, especially if they&rsquo;re being bullied or being preyed on by sexual predators. Don&rsquo;t shame or punish them for being a victim. Don&rsquo;t judge them for their choices. Acknowledge their feelings. Be patient and understanding. 
&nbsp;

<ul>
	<li>Take Them Seriously</li>
</ul>

Children who threaten to kill themselves, act violently, abuse drugs, or continually express that no one cares about them, should be taken seriously. If they claim nothing is wrong but can&rsquo;t explain their depressed behavior, trust your gut. Seek help from a mental health professional immediately! 
&nbsp;

<ul>
	<li>Limit Social Media Use</li>
</ul>

Teenagers who spend more time on social media have a higher risk of depression than those who don&rsquo;t[5]. Online interaction increases their fear of missing out &ndash; seeing others enjoying themselves and feeling excluded. They compare their own lives to what they see online.

Also, scrolling through media on the phone leads to a sedentary lifestyle, which negatively affects mental health. It also interferes with sleep, eventually affecting their mood. 
&nbsp;

Invite friends over or encourage them to go out with friends to overcome social isolation. Involve them in after-school clubs or sports, volunteering for a cause, or whatever activity interests them. Set an example by turning off your phone as well. 
&nbsp;

<ul>
	<li>Involve Them In Treatment Options</li>
</ul>

There is no universal treatment that works effectively for every individual. If you&rsquo;re going to a therapist, make sure that choosing the specialist is not just your decision. If your child is feeling uncomfortable in the presence of that psychiatrist or psychologist, they won&rsquo;t be motivated at all to attend these sessions. It&rsquo;s important to find someone your child connects with and is comfortable with.

It&rsquo;s the same with medications. They come with their own set of side effects like increasing the risk of suicidal thinking in some teenagers, especially if they have previously attempted suicide. Make sure you keep reminding them that they&rsquo;re valued and accepted throughout the treatment. 
&nbsp;

Important!

<ul>
	<li>Remember to prioritize your own mental and physical health.</li>
	<li>As a parent or guardian, you also have the added responsibility of ensuring that other family members, especially other children, don&rsquo;t feel ignored.</li>
	<li>DO NOT blame yourself or another family member for the teenager&rsquo;s depression. 
	&nbsp;</li>
</ul>

While severe depression may require hospitalization, remember that your condition can be managed through psychotherapy and medications. If family conflict is affecting your mental health, then family therapy is also recommended. 
 
&nbsp;

During COVID-19, the implementation of curfews limiting social interaction had a major impact on the mental health of adolescents worldwide. The closure of schools and colleges was a significant factor. On one hand, children who had access to various resources in their educational setups were deprived of them. On the other hand, children living in abusive households had no escape and experienced higher levels of loneliness and increased anxiety.

Moreover, with therapies suspended, especially in the case of children with special needs, the disruption in daily routine led to a relapse of their mental conditions. 
&nbsp;

The period, however, reinforced the idea that teen users have got the option to benefit from both remote learning and remote healthcare via technology. Not only were they able to connect with their teachers and peers over Google Classroom and Zoom, virtual reality applications promised a greater degree of control for doctors to customize and reproduce treatment parameters as per the individual&rsquo;s needs, making it less scary and more private and accommodating, something which is not feasible in a traditional hospital environment<a href="#accordion">[7][8]</a>.&nbsp; 
&nbsp;

It is important to remember that it is not possible to always be optimistic and anyone expecting it from you &ndash; yourself included &ndash; is being unrealistic. Depression is real and not something to be ignored. Take the first step and put yourself first. Don&rsquo;t be afraid to ask for help. You&rsquo;ve got this! 
&nbsp;

[1] Mental health of adolescents. World Health Organization.

[2] Schimelpfening N. What you need to know about the DSM-5 updates on depression. Verywell Mind.

[3] Carr A. Spotting teen depression. GoodTherapy.org Therapy Blog.

[4] Griffith Dr. Can you be depressed and not know it? Silent depression explained: Dr. TMS therapy. TMS Treatment.

[5] Melinda Smith MA. Parent’s Guide to Teen Depression. HelpGuide.org.

[6] Teen depression: Causes, symptoms, heredity, and treatments. WebMD.

[7] Anacabana. Mental health in adolescents and VR’s contribution to their well-being&nbsp;. Amelia Virtual Care.

Shermeen Zuberi

Exploring The Connection: Is There A Link Between Watching Pornography And Depression?

The consumption of pornography has grown exponentially in recent years, thanks in large part to the internet&#39;s accessibility. Alongside this trend, concerns have emerged about the potential impact of pornography on mental health, particularly its relationship with depression. In this article, we examine existing research to shed light on whether a link exists between watching pornography and depression. 
&nbsp;

Watching Pornography and Depression

<ul>
	<li>The Prevalence Of Pornography: In today&#39;s digital age, explicit content is readily accessible to nearly anyone with an internet connection. As a result, pornography consumption has become more common, prompting discussions about its potential consequences. 
	&nbsp;</li>
	<li>Varied Patterns Of Consumption: Individuals&#39; patterns of pornography consumption can vary widely, from occasional viewing to frequent and prolonged exposure. 
	&nbsp;</li>
</ul>

<ul>
	<li>Defining Depression: Depression is a multifaceted mental health disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest in previously enjoyed activities. It can affect a person&#39;s daily life, relationships, and overall well-being. 
	&nbsp;</li>
	<li>Depression Triggers: Depression can be triggered by a multitude of factors, including genetics, life events, trauma, and underlying neurochemical imbalances. 
	&nbsp;</li>
</ul>

<ul>
	<li>Mixed Findings: Existing research on the link between pornography consumption and depression yields mixed findings. Some studies suggest a potential correlation, while others do not establish a direct causative relationship. 
	&nbsp;</li>
	<li>Co-Occurrence Vs&nbsp;Causation: It is important to distinguish between the co-occurrence of pornography consumption and depression and the idea that one causes the other. Correlation does not necessarily imply causation. 
	&nbsp;</li>
</ul>

<ul>
	<li>Psychological Factors: Some individuals may use pornography as a coping mechanism for stress or emotional issues, potentially contributing to feelings of guilt or shame, which can exacerbate depression. 
	&nbsp;</li>
	<li>Relationship Impact: Excessive pornography consumption can strain relationships, leading to feelings of isolation and potentially contributing to depressive symptoms. 
	&nbsp;</li>
</ul>

<ul>
	<li>Healthy Consumption: Like many forms of entertainment, moderation is key. Engaging in pornography consumption in a balanced and mindful manner may reduce the risk of negative mental health outcomes. 
	&nbsp;</li>
	<li>Self-Reflection And Boundaries: Being self-aware about one&#39;s pornography consumption and setting personal boundaries can help individuals make informed choices about how they engage with explicit content. 
	&nbsp;</li>
</ul>

Treatment Options: If an individual experiences depression or believes their pornography consumption is impacting their mental health, seeking professional help is essential. Therapists and counselors can provide guidance and support tailored to the individual&#39;s needs. 
&nbsp;

Bottom Line

The question of whether there is a direct link between watching pornography and depression is a complex and ongoing debate. While some studies suggest correlations, it is crucial to remember that individual experiences and vulnerabilities vary significantly. Rather than vilifying pornography, a more constructive approach may involve fostering self-awareness, setting boundaries, and seeking professional help when needed. As we continue to explore this intricate relationship, it is essential to approach the issue with an open and non-judgmental mindset, recognizing the multifaceted nature of both pornography consumption and mental health. 
&nbsp;

Rukhsana Rizwan

This article or video has been viewed by many visitors, and is popular.

The Abyss Within: Navigating Existential Depression And Finding The Light

&ldquo;What if, every little action that we take is completely meaningless and we are just speckles of dust in the universe?&rdquo;

I think about this every single day. All the restrictions that human society has put on its self for better functioning, what if all of this means nothing at all?

Life, at times, resembles a labyrinthine funhouse of questions. Who am I? What&#39;s the purpose of my existence? Why does any of this matter? Welcome to the puzzling realm of existential depression, where the pursuit of meaning takes the spotlight, and despair lurks in the shadows. Let&#39;s dive into the psychological maze of existential depression, share some whimsical anecdotes, and illuminate the path towards hope. 
&nbsp;

Navigational Strategies

Existential depression, much like a whimsical trip down the rabbit hole, commences with a tumble into the profound world of questioning. It&#39;s that state of mind where we grapple with the stark reality that life doesn&#39;t come with an instruction manual. Picture yourself in a tea party conversation with a Cheshire Cat-like philosopher who ponders, &quot;What is the meaning of meaning?&quot; 
&nbsp;

<h5>The Odyssey Of The Soul</h5>

Joseph Campbell once remarked, &quot;The cave you fear to enter holds the treasure you seek.&quot; In the depths of existential depression, we embark on a hero&#39;s journey, confronting inner demons and grappling with existential dragons. Just as Frodo bore the One Ring to Mount Doom, we shoulder the burden of seeking our purpose in an indifferent universe.

However, most people are led to believe in a bigger goal or a deeper meaning behind every action they take but when you are experiencing existential depression, it all feels useless. You tend to wonder if all ideologies and principles are man-made just to keep our sanity afloat. 
&nbsp;

<h5>Quirky Guides: Existential Philosophers</h5>

Meet our peculiar guides for this journey - the existential philosophers. Sartre, with his ever-present pipe and a &quot;No Exit&quot; sign, reminds us of the intricate nature of human freedom. Camus, the absurdist, insists that we must imagine Sisyphus happy, even as he ceaselessly pushes his boulder. These philosophers become our quirky companions through the maze of existential introspection. 
&nbsp;

<h5>The Eeyore Effect</h5>

Ever encountered someone exhibiting the &quot;Eeyore Effect&quot;? Existential depression often leaves us feeling like Eeyore, the melancholic donkey from Winnie the Pooh, sighing, &quot;What&#39;s the point?&quot; Yet, even Eeyore found hope through his friends. Connection and support can be a lifeline when you&#39;re adrift in the abyss. 
&nbsp;

<h5>Embracing The Cosmic Absurdity</h5>

Embracing the absurdity of existence can be truly liberating. Visualize a conversation between Salvador Dal&iacute; and a rubber duck - as nonsensical as life itself! Amidst the surreal landscapes of existential depression, absurdity can be a life jacket, keeping you buoyant in the sea of despair.

In addition to that, the best way to go is to just let things happen without overthinking it. The moment you start questioning your existence is when you realize that very little matters in this world and your actions along with you will be forgotten so might as well make the best of the little time that we have here in this world. 
&nbsp;

<h5>Seeking Meaning In The Cosmic Chaos</h5>

Existential depression resembles a puzzle without a clear picture on the box. However, like a cosmic detective, we gather clues from our experiences, relationships, and passions. Each piece unveils a fragment of meaning, guiding us toward a deeper understanding of our existence.

Seeking meaning is a very complicated aspect because we all have different thought processes and different things that we deem important enough to live and strive for. You need to find your motivator and the factor that keeps you going. This can definitely be a short-term motivator but everyone requires an ultimate life goal to keep them going. 
&nbsp;

<h5>Navigating The Existential Storm</h5>

Existential depression may feel like a turbulent sea, but mindfulness serves as your anchor. Picture yourself on a boat, serenely riding the waves. Mindfulness teaches us to observe our thoughts and feelings without judgment, helping us find tranquillity amidst the existential tempest. 
&nbsp;

<h5>A Glimpse Of Hope</h5>

In the midst of existential gloom, a glimmer of hope often emerges, akin to stumbling upon a hidden treasure chest in a dark forest. Through therapy, creative endeavours, and cultivating gratitude, we unearth this hope and use it to light our path forward. 
&nbsp;

Existential depression, with all its intricacies, is an intrinsic facet of the human experience. It&#39;s a journey through the whimsical carnival of our minds, where we wrestle with life&#39;s profound questions. Embrace the absurd, connect with your inner hero, and remember that even in the darkest depths, there&#39;s always a flicker of hope. Let&#39;s enjoy this cosmic carousel ride together, and who knows what wonders we might discover along the way?

Depressed? Your Blood Sugar Might Be The Culprit

This common mental disorder that can be effectively treated, is often dreaded because it increases the risk of complications when living with chronic conditions such as diabetes<a href="#accordion">[1]</a>. 
&nbsp;

Understanding of the Diabetes Related To Depression

Both diabetes and depression usually entail a family history of any of these conditions besides hypertension, coronary artery disease, obesity, and inactivity.

But diabetes and depression comorbidity is like a vicious cycle. The risk of a diabetic patient being diagnosed with depression is three times higher than non-diabetic individuals. However, it&rsquo;s important to note that diabetes itself doesn&rsquo;t cause depression. The pressure of dealing with it daily is what causes depression<a href="#accordion">[4]</a>.

Moreover, a diabetic person developing other diabetes-related health problems is at greater risk of developing depression. According to research, damage due to diabetes, such as blocked blood vessels in the brain, may trigger or worsen symptoms of depression<a href="#accordion">[2]</a>.

And vice versa, people who suffer from depression are more likely to develop type 2 diabetes than the general population<a href="#accordion">[3]</a>. When a person with depression is mentally, emotionally, and physically drained, they struggle to manage diabetes. They make harmful lifestyle choices, like less exercise and unhealthy eating, which are risk factors for diabetes.

Poor blood sugar control feeds into the depression cycle, affecting the individual&rsquo;s mental health drastically. This is why it&rsquo;s recommended to screen people for diabetes if they report a history of depression<a href="#accordion">[2]</a>.

Moreover, it&rsquo;s important to have regular mental health screenings during routine checkups for women and those with a family history of depression. This is because women are twice as likely as men to experience depression, especially if they have diabetes, because of hormonal changes during the menstrual cycle, miscarriage, pregnancy, post-partum, and menopause. Whereas, almost 40% of people have depression if their first-degree relative (children, siblings, parents) has it<a href="#accordion">[7]</a> <a href="#accordion">[8]</a>.

These factors are compounded by other external stressors, like single parenthood, home and/or work responsibilities, caring for aging parents, etc.

&nbsp;

A depressed person is unable to find pleasure in daily activities. While feeling low is normal or acceptable, depression is not normal under any circumstances. It can affect anyone at any point in their lives.

According to research, nearly 17.2% of people with diabetes develop depression as well but it goes undiagnosed and, consequently, untreated[5]. This is usually because of the stigma attached to mental health issues.

It&rsquo;s important to understand that depression is not a sign of personal weakness or something that will go away on its own. On the contrary, it&rsquo;s a very serious medical condition that needs proper treatment for the person to recover. 
&nbsp;

Note: The condition should never be taken lightly as it can lead to suicide. Contact a healthcare professional ASAP if you or a loved one is feeling depressed. Early diagnosis not just helps effectively treat it, but also prevents the possibility of recurrences.&nbsp; 
&nbsp;

Symptoms range from mild to severe, including<a href="#accordion">[6]</a>:

<ul>
	<li>Persistent sad or anxious mood</li>
	<li>Having body aches, like cramps and headaches, without an obvious cause</li>
	<li>Loss of interest in once pleasurable activities</li>
	<li>Not managing diabetes properly, including not checking blood sugar, not taking medication, ignoring other health issues, missing medical appointments due to lack of energy or motivation </li>
	<li>Loneliness and withdrawal from others</li>
	<li>Unable to sleep or sleeping too much</li>
	<li>Feeling down for a longer time</li>
	<li>Feeling tired often, even when rested, which leads to avoiding exercising</li>
	<li>Not eating enough or overeating</li>
	<li>Finding it difficult to concentrate or make decisions</li>
	<li>Restlessness or moving/speaking too slowly</li>
	<li>Hopelessness </li>
	<li>Irritability </li>
	<li>Self-criticism </li>
	<li>Lose more time from work</li>
	<li>Feeling guilty and fixating on past failures</li>
	<li>Feeling ashamed of diabetes, which leads to avoiding injecting in public or not injecting at all</li>
	<li>Suicidal or self-destructive thoughts 
	&nbsp;</li>
</ul>

In children, it may present as clinginess, refusal to go to school, and a decline in school performance. In teenagers, symptoms may include anger, a feeling of being misunderstood, possible use of recreational drugs, avoidance of social activities, and being extremely sensitive.

When depression is left untreated in individuals with type 1 diabetes, it also translates to higher HbA1c and an increased risk of severe hypoglycemia and diabetic ketoacidosis. Consequently, it means increased healthcare costs. 
&nbsp;

Note: If these symptoms persist for two or more weeks and begin affecting daily life, including school, work, relationships, and especially diabetes management, seek professional help. 
&nbsp;

Living with diabetes is possible. Nevertheless, it is a challenging task. Whether it&rsquo;s type 1 or type 2 diabetes, it necessitates significant lifestyle changes.

For one, it&rsquo;s essential to keep track of insulin and blood glucose levels. Further, it involves changing the diet, like avoiding alcohol and sugary beverages and eating only specific kinds of food.

This may cause a person to feel sad or empty inside. Other symptoms may include insomnia, anxiety, digestive issues, mood swings and irritability, lethargy, racing heart, and eating disorders.

An individual who feels as if their efforts are not working will experience excessive despair and distress. Or they may think that their diabetes is controlling them, changing their day-to-day routine, and not the other way around. Added responsibilities like frequent doctor visits due to injuries or diabetes-related health problems can be hard to remember not to say expensive.

When this starts to feel like a burden and leaves little energy to do other important tasks, they stop checking their insulin and blood sugar levels and go back to their unhealthy habits.

Prolonged stress is dangerous as it causes blood sugar to rise or fall unpredictably. It can also make it difficult to monitor blood sugar, thereby, affecting overall well-being. 
&nbsp;

Note: Diabetic distress is not the same as depression because it can be linked to diabetes-related causal factors. Around 33-50% of people with diabetes experience diabetes distress at some point. Talk therapy, yoga, meditation, and support groups can help reduce stress and improve diabetes management<a href="#accordion">[9]</a>. 
&nbsp;

The good news is both depression and diabetes can be treated simultaneously. Having both of these conditions doesn&rsquo;t make anyone less treatable. Rather, effectively managing one condition will automatically improve the other[4]. Antidepressant medication, psychotherapy, stress management, or a combination of all these are commonly used to treat depression depending on the severity, pattern, and persistence of symptoms. 
&nbsp;

<h5>Do</h5>

<ul>
	<li>Reach out and get support instead of self-isolating</li>
	<li>Move your body; engage in regular light-moderate physical activity</li>
	<li>Socialize </li>
	<li>Focus on the present moment; try mindful breathing exercises</li>
	<li>Get enough sleep</li>
	<li>Manage stress</li>
	<li>Prioritize healthy eating, including reducing the intake of refined carbs and increasing the intake of fiber and protein</li>
	<li>Talk to health professionals, such as an endocrinologist, a dietitian, a psychologist, and a psychiatrist 
	&nbsp;</li>
</ul>

An adult can support a child by:

<ul>
	<li>Spending time with them and finding out what&rsquo;s happening</li>
	<li>Encouraging positive habits, like maintaining a healthy weight</li>
	<li>Providing stress-free environments 
	&nbsp;</li>
</ul>

[1] Depressive disorder (depression). World Health Organization.

[2] Jovinally J. Diabetes and depression. Healthline. January 27, 2022.

[3] Singh K. Diabetes and depression. November 9, 2022.

[4] Diabetes and depression: Coping with the two conditions. Mayo Clinic. August 16, 2022.

[5] Kendra Cherry Mse. Is there a link between diabetes and depression? Verywell Mind. November 15, 2022.

[6] BridgetChapple. Depression and diabetes. Diabetes UK.

[7] Are you experiencing depression? Are You Experiencing Depression? | ADA.

[8] What is depression? Psychiatry.org - What Is Depression?

[9] Diabetes and mental health. Mental Health America.

Disclaimer: Information presented in this article may be triggering for some people.

A common misconception is that children cannot get depressed and are emotionally or cognitively immature. However, depression in children is more common than people think, with studies showing that around 1-2% of children have it<a href="#accordion">[7]</a>.

In the US, it is estimated that 3.2 million adolescents aged 12-17 years have experienced at least one major depressive episode<a href="#accordion">[1]</a>.

Childhood depression is associated with poor school performance, impaired social relationships, and a recurrence of depressive episodes or depressive disorder as children grow up. It can also lead to suicide. 
&nbsp;

Understanding  childhood depression

This classification system, as defined by the DSM-5, is based on several factors, such as the number, type, and severity of symptoms and how much they disrupt the child&#39;s daily activities: 
&nbsp;

Mild (Low-Grade) &ndash; Chronic low-grade depression is a symptom of persistent depressive disorder. It is characterized by symptoms that are less intense and more subtle:

<ul>
	<li>Fatigue</li>
	<li>Restlessness</li>
	<li>Appetite or weight changes</li>
	<li>Sleep problems</li>
	<li>Lack of pleasure</li>
	<li>Trouble concentrating and making decisions</li>
	<li>Feeling of worthlessness, hopelessness, or guilt</li>
	<li>Reduced motivation</li>
	<li>Sadness and frequent crying</li>
	<li>Thoughts of suicide 
	&nbsp;</li>
</ul>

Moderate &ndash; Not listed as a diagnosis in DSM-5. It is typically characterized by decreased interest in activities and a persistent low mood. Other symptoms include:

<ul>
	<li>Change in appetite</li>
	<li>Despair</li>
	<li>Difficulty sleeping</li>
	<li>Fatigue</li>
	<li>Increased irritability</li>
	<li>Avoiding social activities</li>
	<li>Decreased productivity</li>
	<li>Difficulty concentrating</li>
	<li>Excessive worry</li>
	<li>Hopelessness</li>
	<li>Low self-esteem</li>
	<li>Lack of motivation 
	&nbsp;</li>
</ul>

Severe (Major Depressive Disorder Or Clinical Depression) &ndash; Key signs include:

<ul>
	<li>Psychosis</li>
	<li>Suicidal thoughts and behaviors</li>
	<li>Melancholia</li>
	<li>Sleep disturbance</li>
	<li>Poor concentration or memory</li>
	<li>Appetite changes</li>
	<li>Gastrointestinal issues</li>
	<li>Chronic pain</li>
	<li>High level of fatigue</li>
	<li>Noticeable psychomotor changes (e.g., having trouble picking up a coin, speech impairment) 
	&nbsp;</li>
</ul>

Mild depression can occur when the child is stressed and may resolve with time. It may not require any treatment. Moderate depression, on the other hand, which has more symptoms that are more severe or lasts longer than mild depression, requires at least one form of treatment. Severe depression needs to be treated.

The symptoms of depression in children can vary and may be mistaken for typical emotional and psychological changes. However, it is important to be aware of the signs and seek help if you suspect that your child may be struggling with depression. 
&nbsp;

The primary symptoms of depression in children include sadness, a feeling of hopelessness, and mood changes. Some children may also exhibit &quot;masked&quot; depression characterized by acting out or angry behavior. 
&nbsp;

Here are some common symptoms of depression in children:

<ul>
	<li>Mood Changes, such as anger, irritability, or hostility that have persisted for longer than two weeks (without any noticeable break)&nbsp;</li>
	<li>Anhedonia or loss of interest in activities they used to enjoy</li>
	<li>Changes In Appetite, eating a lot more or less than usual</li>
	<li>Changes In Weight</li>
	<li>Changes In Sleep Patterns, either excessive sleep or sleeplessness</li>
	<li>Fatigue and low energy</li>
	<li>Difficulty Concentrating</li>
	<li>Feelings Of Worthlessness or guilt</li>
	<li>Thoughts Of Hopelessness, like everything in life is going wrong</li>
	<li>Frequent Physical Complaints, such as headaches, stomach aches, dizziness, nausea, heart palpitations, and abdominal cramps, which don&rsquo;t respond to treatment</li>
	<li>Behavioral Problems at school</li>
	<li>Loss Of Interest in school</li>
	<li>Poor Academic Performance</li>
	<li>Social Withdrawal and less interaction with friends and family</li>
	<li>Spike In Crying episodes or &ldquo;moping around&rdquo; and withdrawing from friends and family</li>
	<li>Being More Sensitive to rejection</li>
	<li>Self-Injury</li>
	<li>Lack Of Confidence</li>
	<li>Feelings Of Insecurity or low self-esteem</li>
	<li>Self-Critical</li>
	<li>Being Indecisive</li>
	<li>Feel Numb or unable to feel emotions</li>
	<li>Apathy</li>
	<li>Difficulty Communicating or maintaining relationships</li>
	<li>Delusional Thinking and visual or auditory hallucinations</li>
	<li>Thoughts Of Death or suicide 
	&nbsp;</li>
</ul>

Note: It&#39;s important to remember that not all children with depression will show all of these symptoms. If you are concerned about your child&#39;s mental health, it&#39;s best to talk to a mental health professional for an accurate evaluation and proper treatment. 
&nbsp;

Are these normal mood swings or is your child showing symptoms of depression? Let&rsquo;s find out! 
&nbsp;

<h5>Normal Behavior</h5>

<ul>
	<li>Mood change that is out of proportion to the event or circumstances</li>
	<li>Strong reaction to apparently minor events</li>
	<li>Decreased interest in spending time with family</li>
	<li>Being tired on school mornings or sleeping late on weekends</li>
	<li>Low grades in the same class or when shifting from middle grade to high school</li>
	<li>Change in taste for specific foods</li>
	<li>Change in preferred activities 
	&nbsp;</li>
</ul>

<h5>Depression</h5>

<ul>
	<li>Persistent irritability or negative mood</li>
	<li>Verbally or physically aggressive behavior</li>
	<li>Decreased interest in socializing with friends</li>
	<li>Refusing to get out of bed or sleeping all the time</li>
	<li>Sudden decline in academic performance</li>
	<li>Change in eating pattern</li>
	<li>Decreased activity overall</li>
	<li>Self-injury</li>
	<li>Statements like they&rsquo;re better off dead 
	&nbsp;</li>
</ul>

Note: Seek professional help immediately if your child exhibits these symptoms! 
&nbsp;

There could be several reasons for a child to experience depression. Some common causes include:

<ul>
	<li>Genetics And Biology: Depression can run in families and may be related to changes in brain chemistry.</li>
	<li>Trauma Or Abuse: Children who have experienced trauma or abuse may be more prone to depression.</li>
	<li>Life Events: Children may become depressed due to stressful life events, such as the death of a loved one, moving, or family problems.</li>
	<li>Chronic Illness: Children with chronic illnesses, like diabetes, may experience depression because of their condition and its impact on their daily life.</li>
	<li>Substance Abuse: Substance abuse can contribute to a child&#39;s depression. 
	&nbsp;</li>
</ul>

Note: Seek a professional evaluation to determine the cause of your child&#39;s depression and to develop a treatment plan. 
&nbsp;

The US Preventive Service Task Force recommends screening for anxiety in children aged 8-18 years and for major depressive disorder in adolescents aged 12-18 years<a href="#accordion">[2]</a>.

If the symptoms of depression last for at least two weeks, it is important to schedule a visit with a doctor to rule out any physical causes and ensure they receive proper care<a href="#accordion">[2]</a>.

The pediatrician will eventually refer the child to a mental health professional for a detailed evaluation. Screening scales and structured interviews, such as the preschool feelings checklist, mood feeling questionnaire, and Children&rsquo;s Depression Inventory 2 (CDI 2), are commonly used to screen and assess depression in children<a href="#accordion">[7]</a>.

Information from other sources, such as teachers, classmates, and parents, provides valuable insights into the child&#39;s behavior and helps establish a clear understanding of their mental state.

Early treatment is crucial, so don&#39;t hesitate to take action if you have concerns about your child&#39;s well-being.

Sometimes, these screening sessions help uncover other mental health conditions, like ADHD, conduct disorder, and OCD, that may be contributing to depression. 
&nbsp;

Treatment for childhood depression may involve a combination of medications and psychotherapy. Some common treatments include: 
&nbsp;

<ol>
	<li>Antidepressant Medications: Certain antidepressant medications, such as selective serotonin reuptake inhibitors, effectively treat depression in children and adolescents<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Cognitive Behavioral Therapy (CBT): CBT is a type of psychotherapy that helps children change negative thought patterns and behaviors. CBT is effective in treating depression in children and adolescents. 
	&nbsp;</li>
	<li>Family Therapy: Family therapy can help families understand and support the child during treatment. It can also address any family conflicts or issues that may be contributing to the child&#39;s depression. 
	&nbsp;</li>
	<li>Interpersonal Therapy: The focus is on the child&#39;s communication skills. It helps the child improve their relationships and manage stress more efficiently. 
	&nbsp;</li>
</ol>

Note: For some teens, depression can be so severe and debilitating that hospitalization is necessary. 
&nbsp;

Depression can be caused by certain life events or by a biological cause. As a parent, it&rsquo;s not always possible to shield the child from the difficulties of life. However, it is possible to help them avoid triggers and lead a healthy lifestyle along with the correct treatment so that they can manage depression:

<ul>
	<li>Make sure the child exercises daily, especially practicing relaxation or mindfulness techniques.</li>
	<li>Provide a safe environment at home and school so they know their loved ones support them.</li>
	<li>Ensure they get the recommended amount of sleep every night according to their age.</li>
	<li>Have them follow a healthy eating plan.</li>
	<li>Help them develop a social life without over-scheduling their time.</li>
	<li>Teach them how to manage their emotions and cope with setbacks and failures.</li>
	<li>Discuss your mental health with them and make health a priority at home.</li>
	<li>Listen to your child actively instead of dismissing or not paying attention.</li>
	<li>Frequent conflict affects relationships negatively; pick something that you and your child enjoy doing together and you bond over that.</li>
	<li>Supervise what your adolescent is doing and where they are, so they don&rsquo;t indulge in risky behaviors like substance abuse or self-harm. 
	&nbsp;</li>
</ul>

Depression in children is a serious mental health issue that can have long-lasting effects on their emotional and psychological well-being. It is important to recognize the symptoms of depression in children and seek appropriate treatment, such as therapy and medication. With proper support and care, many children with depression can recover and lead healthy and happy lives. 
&nbsp;

Key Takeaways

<ul>
	<li>Depression in children is more common than people think, with studies showing that around 1-2% of children have it.</li>
	<li>Childhood depression is associated with poor school performance, impaired social relationships, and a recurrence of depressive episodes or depressive disorder as children grow up. In the worst-case scenario, the result may be suicide.</li>
	<li>Early detection and treatment of depression in children are crucial as untreated depression can have long-term effects on their mental and physical health and affect their overall quality of life.</li>
</ul>