Depression: Symptoms, Causes and Treatment That Works

It is much more than feeling sad. Depression can make a person who used to enjoy life feel empty and exhausted for weeks. In many families it is dismissed as laziness, weak faith or “some tension”, and the person suffers in silence, often turning up at the doctor with headaches, body aches or stomach problems instead. Depression is a common medical illness, it is not a weakness, and it is treatable.

What is depression?

Depression is a mood illness in which low mood, loss of interest and other symptoms last most of the day, nearly every day, for at least two weeks and affect daily life. It differs from normal sadness after a loss or a bad day, which usually eases with time and support.

Depression symptoms

Emotional:

• Persistent sadness, emptiness or hopelessness
• Loss of interest or pleasure in things you used to enjoy
• Irritability, anger or tearfulness
• Guilt, worthlessness or very low self-esteem
• Difficulty concentrating, remembering or making decisions

Physical:

• Constant tiredness and low energy
• Sleeping too little or too much
• Loss of appetite and weight, or overeating
• Headaches, body aches, chest or stomach discomfort with no clear cause
• Slowed movement or restlessness

In many people in Pakistan the physical complaints come first, and the low mood is not mentioned. If tests keep coming back normal, depression may be the reason.

What causes depression?

• Long-term stress: money worries, job loss, exam pressure, family conflict, loneliness
• Loss or grief, a difficult past, or abuse
• Family history
• Medical illness, such as an underactive thyroid, vitamin D deficiency, vitamin B12 deficiency, anaemia, diabetes or chronic pain
• Hormonal changes, such as after childbirth, during menopause or with the menstrual cycle
• Alcohol, drug misuse and some medicines
• Poor sleep, see insomnia, and long-term anxiety

Treatment that works

Most people improve with treatment, and the earlier it starts the better.

• Talk therapy: cognitive behavioural therapy (CBT) and similar therapies help you change negative thinking patterns and rebuild activity.
• Antidepressant medicines for moderate to severe depression, often combined with therapy. Common choices are SSRIs such as sertraline, escitalopram, fluoxetine and paroxetine, and others such as mirtazapine, duloxetine and vortioxetine. Your doctor selects one based on your symptoms, other illnesses and side effects.
• Lifestyle support for all levels of depression.

Things worth knowing about antidepressants:

• They take 2 to 6 weeks to work, so be patient, and keep taking them as prescribed in that time.
• They are not addictive or “nasha”, and do not change your personality.
• Early side effects such as nausea, headache or restlessness often fade within a couple of weeks.
• Take them for at least 6 to 12 months after you feel well, as your doctor advises, to avoid relapse.
• Never stop suddenly, because it can cause withdrawal symptoms. Your doctor will reduce the dose gradually.
• In teenagers and young adults, doctors watch closely in the first weeks, and families should report any new worsening of mood or thoughts of self-harm straight away.
• Avoid alcohol while taking them.

What you can do for yourself

• Keep a simple daily routine: wake, eat and sleep at regular times.
• Take a brisk walk daily, ideally in morning sunlight. Exercise is a proven mild to moderate treatment on its own.
• Do one small, enjoyable or useful activity each day, even if you do not feel like it.
• Stay in touch with family and friends. Isolation makes depression worse.
• Find comfort in prayer, reflection or time in nature, if these help you.
• Avoid alcohol, and cut down on caffeine and late-night screen use.
• Break big tasks into small steps.

If someone you love is depressed

Listen without judging. Avoid saying “just be strong” or “think positive”. Offer to go with them to the doctor, help them keep appointments and take their medicines, and keep checking in. Take any talk of not wanting to live seriously, and never dismiss it.

When to get help

• Low mood or loss of interest lasting more than two weeks
• Difficulty working, studying or looking after yourself or your family
• Sleep or appetite changes with constant tiredness
• Using alcohol or sleeping pills to cope

If you are having thoughts of ending your life or harming yourself, please tell someone close to you right now, or go to the nearest hospital emergency department. You do not have to go through this alone, and help works.

Key takeaways

• Depression is a medical illness with emotional and physical symptoms, not a sign of weakness or weak faith.
• Persistent low mood, loss of interest and tiredness for two weeks or more need attention.
• Therapy, antidepressants, exercise and support all help, and most people recover.
• Antidepressants are not addictive, take weeks to work and should not be stopped suddenly.

Related medicines on Medimart

These are commonly prescribed by doctors for depression:

• Sertraline: an SSRI for depression and anxiety
• Escitalopram: an SSRI widely used for depression
• Fluoxetine: an SSRI antidepressant
• Paroxetine: an SSRI antidepressant
• Mirtazapine: helpful when sleep and appetite are poor
• Vortioxetine: a newer antidepressant

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse depression medicines on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor or mental health professional. If you think you may be depressed, please speak to one.