Depression (Major Depressive Disorder)

Overview
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.
Also called major depressive disorder or clinical depression, it affects how you feel, think and
behave and can lead to a variety of emotional and physical problems. You may have trouble
doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out"
of it. Depression may require long-term treatment. But don't get discouraged. Most people with
depression feel better with medication, psychotherapy or both.

Symptoms
Although depression may occur only once during your life, people typically have multiple
episodes. During these episodes, symptoms occur most of the day, nearly every day and may
include:

• Feelings of sadness, tearfulness, emptiness or hopelessness

• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches
• avoiding contact with friends and taking part in fewer social activities
• neglecting your hobbies and interests
• having difficulties in your home, work or family life
•

For many people with depression, symptoms usually are severe enough to cause noticeable
problems in day-to-day activities, such as work, school, social activities or relationships with
others. Some people may feel generally miserable or unhappy without really knowing why.

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Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly.
Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may
feel reluctant to seek help. Symptoms of depression may be different or less obvious in older
adults, such as:

• Memory difficulties or personality changes

• Physical aches or pain
• Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a
medical condition or medication
• Often wanting to stay at home, rather than going out to socialize or doing new things
• Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as
soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health
care professional, a faith leader, or someone else you trust such as the Saudi Aramco
designated wellness officer in your area of actions

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number
immediately.

Also consider these options if you're having suicidal thoughts:

• Call your doctor or mental health professional.

• Call a suicide hotline number — in Saudi, call the (TBD) at -000-000-0000
• Reach out to a close friend or loved one.
• Contact a spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure
someone stays with that person. Call 911 or your local emergency number immediately. Or, if
you think you can do so safely, take the person to the nearest hospital emergency room.

Causes
It's not known exactly what causes depression. As with many mental disorders, a variety of
factors may be involved, such as:

• Biological differences. People with depression appear to have physical changes in their
brains. The significance of these changes is still uncertain, but may eventually help
pinpoint causes.
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 • Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely
play a role in depression. Recent research indicates that changes in the function and
effect of these neurotransmitters and how they interact with neurocircuits involved in
maintaining mood stability may play a significant role in depression and its treatment.
• Hormones. Changes in the body's balance of hormones may be involved in causing or
triggering depression. Hormone changes can result with pregnancy and during the
weeks or months after delivery (postpartum) and from thyroid problems, menopause or
a number of other conditions.
• Inherited traits. Depression is more common in people whose blood relatives also have
this condition. Researchers are trying to find genes that may be involved in causing
depression.

Risk factors
Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women
than men are diagnosed with depression, but this may be due in part because women are more
likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

• Certain personality traits, such as low self-esteem and being too dependent, self-critical
or pessimistic
• Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a
loved one, a difficult relationship, or financial problems
• Blood relatives with a history of depression, bipolar disorder, alcoholism or su icide
• Being lesbian, gay, bisexual or transgender, or having variations in the development of
genital organs that aren't clearly male or female (intersex) in an unsupportive situation
• History of other mental health disorders, such as anxiety disorder, eating disorders or
post-traumatic stress disorder
• Abuse of alcohol or recreational drugs
• Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
• Certain medications, such as some high blood pressure medications or sleeping pills
(talk to your doctor before stopping any medication)

Complications
Depression is a serious disorder that can take a terrible toll on you and your family. Depression
often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that
affect every area of your life.

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Examples of complications associated with depression include:

• Excess weight or obesity, which can lead to heart disease and diabetes
• Pain or physical illness
• Alcohol or drug misuse
• Anxiety, panic disorder or social phobia
• Family conflicts, relationship difficulties, and work or school problems
• Social isolation
• Suicidal feelings, suicide attempts or suicide
• Self-mutilation, such as cutting
• Premature death from medical conditions

Prevention
There's no sure way to prevent depression. However, these strategies may help.

• Take steps to control stress, to increase your resilience and boost your self-esteem.
• Reach out to family and friends, especially in times of crisis, to help you weather rough
spells.
• Get treatment at the earliest sign of a problem to help prevent depression from
worsening.
• Consider getting long-term maintenance treatment to help prevent a relapse of
symptoms.

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 Beck's Depression Inventory

This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.

1.
0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can't snap out of it.
3 I am so sad and unhappy that I can't stand it.
2.
0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.
3.
0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.
4.
0 I get as much satisfaction out of things as I used to.
1 I don't enjoy things the way I used to.
2 I don't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
5.
0 I don't feel particularly guilty
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.
6.
0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
7.
0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
8.
0 I don't feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens

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 9.
0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10.
0 I don't cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can't cry even though I want to.
11.
0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.
12.
0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.
13.
0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than I used to.
3 I can't make decisions at all anymore.
14.
0 I don't feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance that make me look
unattractive
3 I believe that I look ugly.
15.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can't do any work at all.
16.
0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.
17.
0 I don't get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.

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18.
0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.
19.
0 I haven't lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.
20.
0 I am no more worried about my health than usual.
1 I am worried about physical problems like aches, pains, upset stomach, or constipation.
2 I am very worried about physical problems and it's hard to think of much else.
3 I am so worried about my physical problems that I cannot think of anything else.
21.
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
3 I have lost interest in sex completely.

INTERPRETING THE BECK DEPRESSION INVENTORY

Now that you have completed the questionnaire, add up the score for each of the twenty-one questions
by counting the number to the right of each question you marked. The highest possible total for the
whole test would be sixty-three. This would mean you circled number three on all twenty-one
questions. Since the lowest possible score for each question is zero, the lowest possible score for the test
would be zero. This would mean you circles zero on each question. You can evaluate your depression
according to the Table below.

Total Score____________________Levels of Depression

1-10____________________These ups and downs are considered normal

11-16___________________ Mild mood disturbance

17-20___________________Borderline clinical depression

21-30___________________Moderate depression

31-40___________________Severe depression

over 40__________________Extreme depression

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References:

https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

https://www.apa.org/depression-guideline/assessment/

http://www.med.navy.mil/sites/NMCP2/PatientServices/SleepClinicLab/Documents/Beck_Depressio
n_Inventory.pdf

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