Depression: what it is and how it is treated

Depression is part of the mood disorders, usually the term 'depression' is used to indicate, in a generic way, any depressive condition. In fact, according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5^th edition), depressive disorders are different from each other and can be distinguished on the basis of symptoms or of the etiology (causes).

In the typology of depressive disorders divided by symptoms, we find:

• major depressive disorder (or major depression);
• persistent depressive disorder (dysthymia);
• other specified or unspecified depressive disorder.

In case depressive disorders are divided by cause, we refer to:

• premenstrual dysphoric disorder;
• depressive disorder associated with / due to another physical condition;
• iatrogenic depressive disorder, i.e. substance and / or drug induced.

Depression can present with a rather heterogeneous symptoms and with different levels of severity based on the specific disorder. Symptoms include:

• low mood;
• cognitive and / or motor dysfunction;
• exhaustion;
• loss of attention;
• absence / decrease of interest in leisure activities;
• sleep disorders;
• suicidal thoughts.

“These symptoms may be associated with further psychological symptoms, such as panic and anxiety attacks, complicating patient's clinical picture. It is also essential to point out that those suffering from depression are more inclined to use alcohol and drugs, often in vain attempt of self-medication,” explains Prof. Colombo.

“To date, specific causes of depressive disorders are unknown. The maggiority of experts believe that the disease has a multifactorial origin, in which the environment and genetic heredity play a key role,” continues the specialist.

They can occur at any age, more often during adolescence and between 20 and 30 years. There is a prevalence in the female population, but, even on this front, the reason is not scientifically known.

As for the diagnostic aspects, the key element is represented by the symptoms, both in terms of severity and duration.

For example, for major depression the fundamental condition is that at least 5 symptoms are present on a daily basis for 2 consecutive weeks.

On the other hand, in persistent depressive disorder at least 2 symptoms must have been present for at least 2 years without remission.

In addition to clinical criteria and identification of symptoms, diagnosis can be made using specific tests.

“In some realities, such as Center for Mood Disorders at the Ospedale San Raffaele-Turro, innovative therapeutic techniques from various fields are in the use, they include:

• pharmacological therapy;
• light therapy (LT);
• total sleep deprivation (TSD);
• TSD and LT in resistant depression (unipolar and bipolar);
• somatic therapies (transcranial magnetic stimulation, transcranial stimulation with direct current, electroconvulsive therapy),” concludes Prof. Colombo.