What is Depression: Types, Causes, and Management?

Depression, a profound emotional conflict that impairs the very essence of life, impacts a vast number of people worldwide. Depression is more than just feeling melancholy; it is a pervasive gloom that consumes the mind and heart. This article will shed light on the nature of depression and its various forms.

What is Depression?

Depression is a severe mental disorder defined by intense feelings of sorrow and hopelessness and a loss of interest or enjoyment in activities. It extends beyond the normal ups and downs of life, persists for extended periods, and has a significant influence on daily functioning and well-being. It is as if a thick fog spreads a shadow over one’s consciousness, distorting one’s thoughts, feelings, and perceptions.

Depression and depressive disorder are terms often used interchangeably, but it’s important to understand the distinction between them.

Depression: Depression is a broad term used to describe a common mental health condition characterized by persistent feelings of sadness, hopelessness, or a loss of interest or pleasure in daily activities. It is a normal emotional response to life’s challenges, losses, or setbacks. Situational depression, such as grief or a major life event, may be temporary and resolve over time without clinical intervention.

Depressive Disorder: Depressive disorder, on the other hand, refers to a clinical diagnosis made by a healthcare professional. It encompasses various specific mental health conditions characterized by persistent depressive symptoms that significantly interfere with daily functioning and well-being. Examples of depressive disorders include major depressive disorder (MDD), persistent depressive disorder (PDD), and other specified and unspecified depressive disorders outlined in diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In summary, depression is a general term used to describe feelings of sadness or low mood, whereas depressive disorder refers to clinically diagnosable mental health conditions characterized by persistent depressive symptoms. The diagnosis of a depressive disorder is made by a healthcare professional based on the severity, duration, and impact of the symptoms on an individual’s life.

Symptoms of Depression

Symptoms of depressive disorder can vary from person to person, and the severity and duration of symptoms can also differ. Here are common symptoms associated with depressive disorder:

1. Persistent Sadness: Feeling sad, empty, or hopeless most of the day, nearly every day.
2. Loss of Interest or Pleasure: Losing interest or pleasure in activities that were once enjoyable, including hobbies, socializing, or intimate relationships.
3. Changes in Appetite or Weight: Significant weight loss or gain, or changes in appetite, either increased or decreased.
4. Sleep Disturbances: Experiencing insomnia (difficulty sleeping) or hypersomnia (excessive sleepiness) almost every day.
5. Fatigue or Loss of Energy: Feeling tired, lacking energy, or experiencing a general sense of weakness or sluggishness.
6. Feelings of Guilt or Worthlessness: Having excessive or inappropriate feelings of guilt, worthlessness, or self-blame, often over minor matters.
7. Difficulty Concentrating: Struggling with concentration, memory, and making decisions.
8. Restlessness or Slowed Movements: Feeling restless, agitated, or physically slowed down.
9. Recurrent Thoughts of Death or Suicidal Ideation: Having persistent thoughts of death, suicidal thoughts, or engaging in self-harming behaviours.
10. Physical Symptoms: Experiencing unexplained physical symptoms such as headaches, stomachaches, or other chronic pain and sexual dysfunction that is not due to a medical condition.

It is important to note that experiencing some of these symptoms does not automatically indicate a depressive disorder. A diagnosis should be made by a qualified healthcare professional based on a comprehensive evaluation of symptoms, duration, and impact on daily functioning.

Types of Depressive Disorder

Depression can manifest in various forms, each with its own unique features and patterns. Here, we will explore some of the most common types of depression:

1. Major Depressive Disorder (MDD): Also known as clinical depression, MDD is the most common form of depression. It involves expe16riencing intense depressive symptoms that last for at least two weeks or longer. Individuals may struggle with a persistent feeling of sadness, loss of interest in activities, changes in appetite and sleep patterns, low energy, difficulty concentrating, and thoughts of self-harm.
2. Persistent Depressive Disorder (PDD): PDD, previously known as dysthymia, is a chronic form of depression. It involves experiencing depressive symptoms for a longer duration, lasting for at least two years or more. While the symptoms may be less severe than MDD, they can still impact daily life and lead to a constant state of sadness and low mood.
3. Postpartum Depression: Postpartum depression occurs in some individuals after giving birth. Hormonal changes, combined with the challenges of caring for a newborn, can trigger feelings of extreme sadness, anxiety, and exhaustion. It is essential for individuals experiencing postpartum depression to seek support and professional help to ensure the well-being of both the parent and the child.
4. Seasonal Affective Disorder (SAD): SAD is a type of depression that follows a seasonal pattern. It typically occurs during the fall and winter months when daylight is reduced. Individuals with Seasonal affective disorder may experience symptoms such as low mood, lethargy, increased need for sleep, and cravings for carbohydrates. As the seasons change and sunlight increases, these symptoms tend to improve.
5. Bipolar Disorder (BD): While not solely a depressive disorder, bipolar disorder involves cycling between periods of extreme highs (mania or hypomania) and depressive episodes. During the depressive phase, individuals may experience similar symptoms to those with MDD. However, the presence of manic or hypomanic episodes distinguishes bipolar disorder from unipolar depression.
6. Atypical depression: It is a subtype of depression characterized by mood reactivity, which means that positive events can temporarily improve the individual’s mood. It also includes symptoms such as increased appetite, weight gain, excessive sleep, and a sensation of heaviness in the limbs. Unlike typical depression, individuals with atypical depression may have heightened sensitivity to rejection.
7. Psychotic Depression: This type of depression involves severe depressive symptoms accompanied by psychosis, such as hallucinations (seeing or hearing things that aren’t real) or delusions (strongly held false beliefs). Psychotic depression requires immediate attention and intervention due to the increased risk of self-harm or harm to others.
8. The Unique Forms of Depression in Women: When it comes to depression, women face a higher risk compared to men. However, there are two specific types of depression that are influenced by reproductive hormones and primarily affect women: perinatal depression and premenstrual dysphoric disorder (PMDD).
   • Perinatal Depression: This encompasses major and minor depressive episodes that occur during pregnancy while postpartum depression occurs after the birth of the baby. Treatment for perinatal depression typically involves a combination of counselling and medication.
   • Premenstrual Dysphoric Disorder (PMDD): On the other hand, PMDD is a severe form of premenstrual syndrome (PMS) that is characterized by intense depressive symptoms. These symptoms usually arise shortly after ovulation and subside with the onset of menstruation. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) are commonly prescribed to alleviate PMDD symptoms. It is crucial to recognize and understand these unique forms of depression in women, as they require specific attention and tailored management approaches
   • Perinatal Depression: This encompasses major and minor depressive episodes that occur during pregnancy while postpartum depression occurs after the birth of the baby. Treatment for perinatal depression typically involves a combination of counselling and medication.
   • Premenstrual Dysphoric Disorder (PMDD): On the other hand, PMDD is a severe form of premenstrual syndrome (PMS) that is characterized by intense depressive symptoms. These symptoms usually arise shortly after ovulation and subside with the onset of menstruation. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) are commonly prescribed to alleviate PMDD symptoms. It is crucial to recognize and understand these unique forms of depression in women, as they require specific attention and tailored management approaches

Causes of Depressive Disorder

The depressive disorder does not have a single cause. It emerges from a combination of various factors that intertwine and contribute to its development. Here, we will explore some of the key causes:

• Biological Factors: Our brain chemistry plays a significant role in depressive disorder. Imbalances in neurotransmitters, such as serotonin and dopamine, can disrupt the delicate equilibrium that regulates our moods. These imbalances affect the brain’s ability to transmit signals and process emotions, contributing to the emergence of depressive symptoms.
• Genetic Predisposition: Genetics also play a part in depressive disorder. Individuals with a family history of depression may be more susceptible to developing the condition themselves. While genetics alone do not determine one’s fate, they can increase the vulnerability to depressive episodes when combined with other factors.
• Environmental Influences: Life experiences and the environment in which we live can shape our mental well-being. Adverse life events, such as trauma, loss of a loved one, abuse, or chronic stress, can trigger depressive symptoms. These experiences create emotional upheaval, disrupt coping mechanisms, and contribute to the emergence of depressive disorder.
• Psychological Factors: Our thoughts, beliefs, and perceptions about ourselves and the world around us also impact the development of depressive disorder. Negative thinking patterns, self-criticism, low self-esteem, and a pessimistic worldview can fuel the onset and perpetuation of depressive symptoms. These psychological factors influence how we interpret and respond to life events.
• Social and Cultural Influences: The social and cultural context in which we live plays a role in depressive disorder. Factors such as isolation, lack of social support, societal pressure, discrimination, and stigma surrounding mental health can exacerbate depressive symptoms. Feeling disconnected from others and society can deepen the sense of despair and loneliness.

Depressive disorder is a complex condition influenced by a web of biological, genetic, environmental, psychological, and social factors. It is important to remember that everyone’s journey is unique, and the causes of depressive disorder can vary from person to person. By understanding these causes and their interplay, we can foster empathy and compassion, helping individuals navigate the shadows of depression with support and understanding.

The Prevalence of Depressive Disorders across the Globe

Depressive disorders cast a pervasive shadow over the lives of individuals worldwide, transcending borders, cultures, and languages. Understanding the prevalence of these disorders can illuminate the scope of their impact and emphasize the urgent need for support and intervention. In this we will delve into the prevalence of depressive disorders in India and other countries, acknowledging the universal nature of this silent battle.

1. The Burden in India: In India, the burden of depressive disorders weighs heavily on the population, affecting countless lives. The World Health Organization (WHO) estimates that over 5 crore (50 million) people in India struggle with depression, making it a significant public health concern. The cultural and societal dynamics in India can contribute to the challenges faced by individuals, including stigmatization, limited access to mental health resources, and social pressures that can exacerbate depressive symptoms.
2. Global Perspectives: Depressive disorders extend beyond the borders of India, affecting people in various countries around the world. Let us explore the prevalence of depressive disorders in a few different regions:
   • United States:  In the United States, depressive disorders are alarmingly common. According to the National Institute of Mental Health (NIMH), over 17 million adults experienced at least one major depressive episode in 2019. Depression rates have been steadily increasing, particularly among adolescents and young adults.
   • United Kingdom:  In the United Kingdom, depression is a prevalent mental health condition. The National Health Service (NHS) reports that approximately 1 in 4 adults experience a mental health problem each year, with depression being one of the most common. The impact of depression is far-reaching, affecting individuals, families, and communities.
   • Australia: In Australia, depressive disorders have a significant impact on the population’s mental well-being. The Australian Bureau of Statistics (ABS) reports that approximately 1 million adults experienced depression in a 12-month period. The prevalence of depression highlights the need for accessible and effective mental health services.
   • China: In China, depressive disorders present a substantial burden. A study published in JAMA Network Open estimated that over 27 million adults in China experienced a major depressive episode in 2017. The study emphasized the need for increased awareness, prevention, and treatment efforts to address this prevalent mental health condition.

Depressive disorders transcend geographical boundaries, impacting individuals in India, the United States, the United Kingdom, Australia, China, and numerous other countries. The prevalence of depressive disorders underscores the urgent need for enhanced support, awareness, and accessible mental health resources globally. By acknowledging the universal nature of this struggle, we can work towards a world where individuals battling depressive disorders find solace, understanding, and the help they need to navigate the shadows and embrace hope.

Medical Treatment for Depressive Disorder

When the weight of depressive disorder feels insurmountable, medical treatment can serve as a guiding light, offering hope and support. In conjunction with other therapeutic approaches, such as therapy and self-care, medical interventions play a vital role in managing depressive disorder. In this emotionally charged exploration, we will delve into the medical treatments available for depressive disorder, showcasing the transformative power of these interventions.

• Selective Serotonin Reuptake Inhibitors (SSRIs): One of the most commonly prescribed medications for depressive disorder is selective serotonin reuptake inhibitors (SSRIs). These medications, such as fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), work by increasing the levels of serotonin, a neurotransmitter associated with mood regulation, in the brain. By restoring the balance of serotonin, SSRIs can alleviate depressive symptoms and improve overall well-being.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another class of medications used in the treatment of depressive disorder. Examples of SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta). SNRIs work by increasing the levels of both serotonin and norepinephrine, another neurotransmitter involved in mood regulation. By targeting these two neurotransmitters, SNRIs help alleviate depressive symptoms and restore emotional balance.
• Tricyclic Antidepressants (TCAs): Tricyclic antidepressants (TCAs), such as amitriptyline and nortriptyline, are older antidepressant medications that are still used in certain cases. They work by affecting the levels of various neurotransmitters, including serotonin and norepinephrine. While effective, TCAs often come with more potential side effects compared to newer antidepressant classes, so they are generally prescribed when other treatments have not been successful.
• Monoamine Oxidase Inhibitors (MAOIs): Monoamine oxidase inhibitors (MAOIs) are another class of antidepressant medications that work by inhibiting the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin and norepinephrine. MAOIs, such as phenelzine (Nardil) and tranylcypromine (Parnate), are typically reserved for cases where other treatments have not been effective or in specific situations. They require dietary restrictions and careful monitoring due to potential interactions with certain foods and medications.
• Brain stimulation therapy:Brain stimulation therapy is a treatment approach used to help individuals with severe depression or depression with psychosis when other treatments, such as medication and psychotherapy, have not been effective or well-tolerated. These therapies involve directly targeting specific areas of the brain or the nervous system to modulate brain activity and alleviate symptoms.
  • Electroconvulsive Therapy (ECT): ECT is one of the oldest and most effective forms of brain stimulation therapy. During the procedure, an electric current is passed through the brain intentionally inducing a brief seizure. This can lead to changes in brain chemistry and may help relieve severe depression. ECT is generally safe and well-tolerated and is often used when rapid and significant improvement is needed.
  • Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive brain stimulation technique that uses magnetic fields to stimulate nerve cells in the brain. It is typically administered to the prefrontal cortex, an area associated with mood regulation. TMS is performed as an outpatient procedure and does not require anaesthesia. It is considered a safer alternative to ECT and may be effective for some people with depression.
  • Vagus Nerve Stimulation (VNS): VNS involves implanting a small device, similar to a pacemaker, in the chest that stimulates the vagus nerve, which connects the brain to various organs in the body. The electrical signals from the device can influence brain activity and help regulate mood. VNS is often used when other treatments have been ineffective. It’s important to note that brain stimulation therapies are usually reserved for severe cases of depression or those with depression that have not responded well to other treatments. The specific type of brain stimulation therapy recommended will depend on the individual’s condition and their response to other interventions. These treatments are typically carried out by specialized healthcare professionals in controlled and monitored settings to ensure safety and efficacy.
  • Electroconvulsive Therapy (ECT): ECT is one of the oldest and most effective forms of brain stimulation therapy. During the procedure, an electric current is passed through the brain intentionally inducing a brief seizure. This can lead to changes in brain chemistry and may help relieve severe depression. ECT is generally safe and well-tolerated and is often used when rapid and significant improvement is needed.
  • Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive brain stimulation technique that uses magnetic fields to stimulate nerve cells in the brain. It is typically administered to the prefrontal cortex, an area associated with mood regulation. TMS is performed as an outpatient procedure and does not require anaesthesia. It is considered a safer alternative to ECT and may be effective for some people with depression.
  • Vagus Nerve Stimulation (VNS): VNS involves implanting a small device, similar to a pacemaker, in the chest that stimulates the vagus nerve, which connects the brain to various organs in the body. The electrical signals from the device can influence brain activity and help regulate mood. VNS is often used when other treatments have been ineffective. It’s important to note that brain stimulation therapies are usually reserved for severe cases of depression or those with depression that have not responded well to other treatments. The specific type of brain stimulation therapy recommended will depend on the individual’s condition and their response to other interventions. These treatments are typically carried out by specialized healthcare professionals in controlled and monitored settings to ensure safety and efficacy.

Other Medications and Adjunctive Treatments

In addition to the aforementioned classes of antidepressant medications, other medications may be used as adjunctive treatments for depressive disorder. For example, atypical antipsychotics, such as aripiprazole (Abilify) or quetiapine (Seroquel), may be prescribed alongside antidepressants in certain cases. Additionally, mood stabilizers, such as lithium or lamotrigine, can be beneficial for individuals with comorbid depressive and bipolar disorders.

Medical treatment for depressive disorder offers a beacon of hope for individuals navigating the depths of despair. From SSRIs and SNRIs to TCAs and MAOIs, these medications target neurotransmitter imbalances and help alleviate depressive symptoms. It is important to work closely with a qualified healthcare professional to determine the most appropriate medication and dosage based on individual needs. Together with therapy, self-care, and a supportive network, medical treatment can be a cornerstone of the journey toward healing and recovery.

Psychological Treatment for Depressive Disorder

In the depths of depressive disorder, psychological treatment serves as a guiding light, offering solace and transformation. Through therapeutic interventions, individuals can explore their thoughts, emotions, and behaviours, unravelling the intricate web of depression. In this emotionally charged exploration, we will delve into the psychological treatments available for depressive disorder, illuminating the path to healing and resilience.

• Cognitive-Behavioral Therapy (CBT): Cognitive-behavioural therapy (CBT) stands as a cornerstone in the treatment of depressive disorder. It aims to identify and modify negative thinking patterns and behaviours that contribute to depressive symptoms. Through a collaborative process, individuals work with a trained therapist to challenge self-defeating thoughts, develop healthier coping strategies, and cultivate a more positive outlook. CBT empowers individuals to regain control over their lives and reshape their perceptions of themselves and the world.
• Interpersonal Therapy (IPT): Interpersonal therapy (IPT) focuses on the connections between depressive symptoms and interpersonal relationships. It recognizes that the quality of relationships significantly impacts emotional well-being. By addressing interpersonal conflicts, improving communication skills, and fostering healthier relationships, individuals can experience relief from depressive symptoms. IPT offers a safe space to explore and navigate the complex dynamics of personal connections, ultimately promoting emotional growth and resilience.
• Psychodynamic Therapy: Psychodynamic therapy delves into the unconscious mind, exploring the deep-seated emotions and unresolved conflicts that contribute to depressive symptoms. Through a supportive and empathetic therapeutic relationship, individuals gain insight into their unconscious processes and gain a deeper understanding of themselves. Psychodynamic therapy provides a space for healing past wounds, processing unresolved emotions, and fostering personal growth, leading to lasting change.
• Mindfulness-Based Therapies: Mindfulness-based therapies, such as mindfulness-based cognitive therapy (MBCT) and dialectical behaviour therapy (DBT), harness the power of present-moment awareness and self-compassion. These therapies guide individuals to observe their thoughts and emotions without judgment, cultivating acceptance and self-care. By developing mindfulness skills, individuals can break free from the grip of depressive rumination and develop resilience in the face of adversity.
• Group Therapy and Support Groups: Group therapy and support groups offer a powerful avenue for healing within a supportive community. These therapeutic settings provide a safe space to share experiences, receive validation, and gain insights from others facing similar challenges. Group therapy fosters connection, reduces feelings of isolation, and encourages individuals to learn from each other’s journeys. Support groups offer a sense of belonging and serve as a reminder that no one is alone in their struggle against depressive disorder.

Psychological treatment holds the key to illuminating the mind and liberating individuals from the depths of depressive disorder. Whether through CBT, IPT, psychodynamic therapy, mindfulness-based approaches, or the power of group therapy, individuals can embark on a transformative journey of self-discovery and healing. By engaging in these therapeutic interventions and working collaboratively with trained professionals, individuals can find solace, resilience, and the strength to navigate the shadows of depression toward a brighter tomorrow.

Management Tips for Depressive Disorders

When grappling with the weight of depressive disorders, finding solace ineffective management strategies can offer a glimmer of hope and empowerment. While the journey may seem daunting, there are guiding lights that can illuminate the path toward healing and resilience. In this emotionally charged exploration, we will delve into practical tips for managing depressive disorders, offering support and inspiration along the way.

• Building a Supportive Network: Surrounding yourself with a supportive network is crucial for managing depressive disorders. Seek out understanding and compassionate individuals who can provide a listening ear, empathy, and encouragement. Open up to trusted friends, family, or support groups who can help you navigate the challenges, share your triumphs, and remind you that you are not alone on this journey.
• Prioritizing Self-Care: Self-care is a powerful tool in managing depressive disorders. Make self-care a priority in your daily life. Engage in activities that bring you joy, relaxation, and a sense of fulfilment. Take time to nurture your physical, emotional, and spiritual well-being. Practice self-compassion, embracing the importance of self-love and self-nurturing in your healing journey.
• Embracing Healthy Lifestyle Habits: Adopting healthy lifestyle habits can have a positive impact on your mental well-being. Engage in regular exercise, which releases endorphins and boosts your mood. Maintain a balanced diet that nourishes your body and brain. Prioritize sufficient sleep, as restorative rest plays a crucial role in emotional well-being. Avoid excessive alcohol or substance use, as they can exacerbate depressive symptoms.
• Developing Stress Reduction Techniques: Stress can intensify depressive symptoms, so it’s important to develop effective stress reduction techniques. Explore relaxation practices such as deep breathing exercises, meditation, or mindfulness. Engage in activities that bring you peace and calm, such as journaling, listening to soothing music, or spending time in nature. Find what works for you and integrate these techniques into your daily routine.
• Seeking Professional Help: Do not hesitate to seek professional help when managing depressive disorders. Reach out to qualified healthcare professionals who can provide guidance, support, and evidence-based treatments. Therapy, such as cognitive-behavioural therapy (CBT) or interpersonal therapy (IPT), can equip you with coping strategies, self-awareness, and a safe space for exploration. Medications, when prescribed by a healthcare professional, may also be beneficial in managing depressive symptoms.

Managing depressive disorders requires a multi-faceted approach, but with the right tools and support, you can find your way out of the darkness. Building a support network, prioritizing self-care, embracing healthy habits, developing stress reduction techniques, and seeking professional help form the foundation of effective management. Remember, every step forward is an act of courage and strength. You have the power to navigate the shadows, embrace your resilience, and discover the light within.

Helping a Loved One with Depressive Disorder

Supporting a loved one with depressive disorder requires understanding, patience, and empathy. Encouraging open communication, offering a listening ear, and avoiding judgment can create a safe space for them to express their emotions. It is crucial to educate oneself about depression, seek professional advice, and assist in accessing appropriate resources and treatment options.

Overcoming Stigma: Raising Awareness and Encouraging Support

Despite the prevalence of depressive disorder, stigma and misconceptions still surround mental health conditions. Raising awareness and promoting open dialogue about depression is vital in fostering understanding and empathy. By challenging stigma, we can create a society that encourages support, compassion, and acceptance for individuals living with depressive disorder.

Promoting Mental Health: Preventing Depressive Disorder

Prevention plays a crucial role in promoting mental health and well-being. Building resilience, developing healthy coping mechanisms, and maintaining a balanced lifestyle can help reduce the risk of depressive disorder. Encouraging open conversations about mental health, providing education, and implementing supportive policies in schools and workplaces can contribute to a mentally healthier society

Conclusion

Depressive disorder, commonly known as depression, is a significant mental health condition that affects countless individuals worldwide. By understanding the causes, types, symptoms, and treatment options for depressive disorder, we can work towards creating a more compassionate and supportive environment for those experiencing it. Remember, seeking help is a sign of strength, and with appropriate treatment and support, individuals with depressive disorder can embark on a path towards recovery and improved quality of life.

References

1. Anxiety and Depression Association of America. Tips for managing your depression. https://adaa.org/tips
2. Harvard Health Publishing. (2019). Exercise and depression: Endorphins, stress relief, and more. https://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt
3. Mayo Clinic. (2021). Depression and anxiety: Exercise eases symptoms https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495
4. National Institute of Mental Health. (2020). Depression. https://www.nimh.nih.gov/health/topics/depression/index.shtml
5. National Sleep Foundation. How to sleep better with depression. https://www.sleepfoundation.org/mental-health/depression-and-sleep
6. Reach Out. Developing coping strategies. https://au.reachout.com/articles/developing-coping-strategies
7. Substance Abuse and Mental Health Services Administration. (2016). Seeking help for mental illness. https://store.samhsa.gov/product/Seeking-Help-for-Mental-Illness/PEP16-01-01-003
8. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
9. National Institute of Mental Health (NIMH) – Depression: https://www.nimh.nih.gov/health/topics/depression/index.shtml
10. Mayo Clinic – Depression: https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
11. World Health Organization (WHO) – Depression: https://www.who.int/health-topics/depression#tab=tab_1
12. Wikipedia- https://en.wikipedia.org