Depression

Symptoms Of Depression

Depression is a mental illness which starts with subtle signs like difficulty in focusing, poor recalling abilities, feeling low quite often and changes in appetite. Most of the people tend to ignore these signs, till it manifests as a clinical illness and can have serious and life changing health implications.

Here are the most common and early signs of depression. If you or anyone in your family is experiencing these signs, you may need to consult a therapist or a psychiatrist.

1. Getting irritated very often

Many people think that depression leads to just sadness. But some people with depression can get angry often, feel irritated over trivial issues and argue over small things. While these signs could be due to stress as well, if you notice an increased irritability in your behavior, do not ignore it. Take a moment to consider the possibility that you may be depressed.

2. Loss of interest

A common sign of depression is that you have a lack of interest in otherwise pleasurable activities like your favorite hobbies, meeting friends and in sex. People tend to avoid social gatherings, become more withdrawn and lose the inclinations towards achieving simple everyday goals.

3. Changes in appetite

One of the classical signs of depression is a dramatic change in appetite. This can reflect as eating too much or too little. If you have a weight gain or loss of more than 5% of your body weight in one month, it could be a warning sign of depression. Some people take up eating as a way to compensate for how they feel while others experience a loss of interest in food.

4. Being too pessimistic 

If you find yourself criticizing and cribbing about almost everything all the time and if you tend to hold a negative or demotivating opinion on everything, it could be a sign of depression.

5.  Sleep disturbances

Most of the people with depression first consult their doctor because of sleeping disturbances they’ve experienced. While having troubled sleep for a couple of nights is a normal phenomenon, persistent sleep difficulties or insomnia can be a symptom of depression. Many people with depression struggle to fall asleep, or stay asleep, despite feeling exhausted. Other people with depression sleep too much.

6. Having aches and pains

Your brain is designed in such a manner that when you are struggling with mental health issues, you tend to develop signs of physical illness too. Many people with depression experience unexplained body aches, muscle pains and headaches. But they attribute these to a physical health problem and pop painkillers instead.

7. Feeling tired all the time

Depression can make you feel fatigued and tired all the time and lower your energy levels. Most of the people attribute this to excessive workload or increasing age and do not address it in a timely manner. Remember that if small tasks tire you or take longer to complete, you may be depressed.

8. Feeling of guilt

Blaming yourself without a logical reasoning for all the events in your life is an unhealthy trait. If you blame yourself responsible for all personal, professional and childhood issues, you may be depressed. Many people with depression also feel worthless. Always pay close attention to your inner thought process. If you feel you are being excessively harsh, critical or illogical, it could be a sign of depression.

9. Difficulty in concentration

Many people with depression face forgetfulness and misplace things like their keys or paperwork very frequently. People with early signs of depression experience difficulty concentrating and focusing for example when giving or receiving direction or comprehending what they’re reading, and an inability to remember specific details.

Additional signs include:

• Low mood/sadness

• Crying spells

• Diminished interest in play and activities

• Problems with concentration

• Excessive tiredness/fatigue/weakness

• Behavior symptoms such as anger and aggression/agitation

• Self-accusation/self-criticism

• Work difficulty

• Expectation of punishment

• Decreased appetite

• Anorexia

• Decreased sleep/change in sleeping pattern

• Increased appetite, weight gain, and excessive sleep

• Past failure/sense of failure

• Anhedonia (inability to feel pleasure in normally pleasurable activities)

• Anxiety symptoms

• Irritability

• Hopelessness

• Physical symptoms/multiple complaints such as headache, abdominal pain, and chest pain

• Suicidal ideations/thoughts

• Psychotic features in the form of persecutory delusions

• Catatonia (inability to move normally or speak)

• Depersonalization

• Obsessive compulsive symptoms

• Guilt 

• Attempted suicide

• Recent deterioration in school performance

• Dissatisfaction

• Self dislike

• Indecisiveness

• Social withdrawal

• Loss of libido

• Body image changes

• Poor interaction

• Decreased interest in school

• Low self esteem

• Death wishes

• Worthlessness

• Loss of energy

Note: Depressive episodes can be categorized as mild, moderate, or severe depending on the number and severity of symptoms, as well as the impact on the individual’s functioning. Common signs and symptoms of depression in children and teenagers are similar to those of adults.

Causes Of Depression

The exact cause of depression is not yet known. Depression can occur spontaneously, without any obvious reason. Some experts think it could be due to imbalance in the brain chemicals, while some believe it could be due to a genetic defect. Some believe that a person’s environment and emotions play a crucial role in developing depression.

Hence, depression can be defined in ‘bio-psycho-social’ terms, meaning that it is a complex disorder most likely triggered by overlapping biological, psychological, and environmental factors. 

What happens in the brain?

Our brain is made up of millions of nerve cells, also known as neurons. These cells are responsible for relaying chemical signals back and forth from the brain to various parts of the body. The neurons interact with each other via chemical messengers known as neurotransmitters (in simple terms brain chemicals). These messages help the brain to have thoughts, emotions and sensations, which play a key role in your brain function and mental wellbeing.  

What happens during depression?

In depression, it is believed that there is an imbalance in the brain chemicals. There is either too much or too little of these neurotransmitters, which affect your ability to think, feel and emote. These neurotransmitters include dopamine, serotonin, and norepinephrine. Medications to manage depression often focus on altering the levels of these chemicals in the brain.

In some people with depression, brain scans show a smaller hippocampus, which plays a major role in long-term memory. Exposure to stress and other risk factors can impair the growth of nerve cells in the hippocampus and trigger depression.

Types Of Depression

1. Major depression

It is a condition that is characterized by a combination of symptoms along with a sad mood which interferes with your everyday routine. This includes the ability to sleep, eat, work, and other activities. Episodes of depression can occur once to several times in a lifetime and continue for more than two weeks.

2. Dysthymic disorder

In this, the person suffers from a low to moderate level of depression that may last for at least 2 years. Although the symptoms are not as severe as major depression, the condition is resistant to treatment. People with this type of depression may develop major depression.

3. Unspecified depression

As the name suggests, this type of depression includes people with symptoms of depression but not quite serious enough to be classified as major depression. 

4. Adjustment disorder with depression

This includes depression that occurs due to a major life stressor or crisis such as death of a family member, diagnosis of a critical condition, etc.

5. Bipolar depression (mania)

A disorder associated with episodes of mood swings ranging from depressive lows to manic highs. Manic episodes may include symptoms such as high energy, reduced need for sleep and loss of touch with reality. Depressive episodes may include symptoms such as low energy, low motivation, and loss of interest in daily activities. Mood episodes last days to months at a time and may also be associated with suicidal thoughts.

6. Seasonal affective disorder (SAD)

A mood disorder characterized by depression that occurs at the same time every year. Seasonal affective disorder occurs in climates where there is less sunlight at certain times of the year. Symptoms include fatigue, depression, hopelessness, and social withdrawal.

Risk Factors For Depression

Anyone can suffer from depression, even a person who appears to live in relatively ideal circumstances. However, there are many potential factors that can trigger or influence depression:

1. Family history and genetics

Genetic makeup and heredity are thought to be significant factors that influence depression. Some types of depression run in families, especially bipolar disorder. While studies suggest that there is a strong genetic component that increases the risk of getting depression, other factors are usually needed to trigger the symptoms.

2. Psychological and social factors 

• History of physical, emotional or sexual abuse

• Social isolation or loneliness

• Low socioeconomic status

• Stressful life events like loss of a loved one, divorce, loss of a job & financial issues

• Sometimes, even positive events like marriage, shifting places, graduation, or retirement can also cause depression as they alter the daily routine which can trigger feelings

3. Medical conditions

Physical health and certain medical conditions like ongoing or chronic physical pain or disease, sleep disorder, thyroid disorder, diabetes, liver disease, multiple sclerosis,  Addison's disease, Parkinson’s disease, and cancer can cause symptoms of depression.

4. Inflammation

Inflammation caused by diseases or stress may cause chemical changes in the brain that can trigger or worsen depression in certain people. It can also affect response to drug therapy. 

5. Traumatic brain injury (TBI)

TBIs or concussions following any injury to the head from falls, accidents, and workplace and sports-related injuries are thought to trigger depression.

6. Certain medications

Some medications that treat hypertension (high blood pressure), cancer, and seizures can cause depression. Even some psychiatric medicines such as certain sleeping aids and medications used to treat alcoholism and anxiety, can trigger depression. 

7. Personality

People who are easily overwhelmed, have trouble coping with stress or anxiety, have low self-esteem or who are generally pessimistic or self critical are more prone to depression.

8. History of other mental health conditions

Anxiety disorder, eating disorders or post-traumatic stress disorder, substance use disorders and learning disabilities are commonly associated with or can perpetuate depression. 

9. Lifestyle factors

• Recreational drugs and alcohol can also cause depression or make it worse.
• Working late till night and getting up late or spending less time outdoors can disrupt the circadian rhythm which may trigger depression. Along with disruption in circadian rhythm, reduced sunlight can also lead to a drop in serotonin and melatonin levels in the body, which can disrupt mood and sound sleep.

10. Poor diet

A poor or imbalanced diet with deficiency of vital vitamins and minerals are known to cause depression. Low levels of omega-3 fatty acids, Vitamin D and an imbalanced ratio of omega-6 to omega-3 fatty acids are associated with increased rates of depression. Also, high levels of sugar intake are thought to trigger depression.

Why are women at a higher risk than men?

According to the World Health Organization (WHO), the burden of depression is 50% higher for females than males. Depression is widely prevalent in women in India across all age groups. 

Psychosocial and social factors that contribute to the increased vulnerability of women to depression include:

• Stress

• Victimization

• Sex-specific socialization

• Coping style

• Disadvantaged social status

• Perceived stigma of mental illness

• Domestic violence

Women have the greatest risk for developing depressive disorders during their child-bearing years. This could be attributed to the hormone changes associated with menstrual cycles, pregnancy, and giving birth. The following types of depression can occur in females:

1. Premenstrual dysphoric disorder: Premenstrual dysphoric disorder is a severe form of premenstrual disorder which affects women in the days or weeks before having their menstrual periods.

2. Antenatal depression: It is also known as prenatal or perinatal depression. It affects women during pregnancy, and can lead to postpartum depression if not treated timely or properly.

3. Postpartum psychiatric disorders: They can be divided into three categories: postpartum blues, postpartum depression and postpartum psychosis.

Postpartum blues

Postpartum blues or so-called "baby blues" happen in many women in the days right after delivery. The mother can get overwhelmed and have sudden mood swings. She may feel impatient, irritable, restless, lonely, sad or may cry without any reason. Postpartum blues do not always require any treatment and may resolve in a few days to a week. Love and reassurance, support from the family in sharing childcare duties, and talking to other new mothers can be of great help.

Postpartum depression

Postpartum depression can start soon after childbirth or as a continuation of antenatal depression and needs to be treated.The global prevalence of postpartum depression has been estimated as 100‒150 per 1000 births.

A woman can have similar but stronger feelings as experienced in the baby blues. Symptoms of postpartum depression often can get worse and last for as long as one year. Postpartum depression can predispose to chronic or recurrent depression, which may affect the mother-infant relationship and child growth and development. Children of mothers with postpartum depression have greater cognitive, behavioral and interpersonal problems compared with the children of non-depressed mothers. Hence, timely treatment with medication and counseling is very important

Postpartum psychosis

Postpartum psychosis, which has a global prevalence ranging from 0.89 to 2.6 per 1000 births, is a severe disorder that begins postpartum. New mothers suffering from postpartum psychosis may feel agitated, angry and show strange behavior. They can also suffer from hallucinations, delusions, insomnia, and rarely have suicidal or homicidal thoughts as well. They require medical attention right away. 

Young Vs old: Who is more depressed?

The average age for onset of depression across the world varies from 24 to 35 years. In India, the average age of onset of depression is 31.9 years.

There is currently a trend of an increasingly younger age of depression onset. For example, 40% of depressed individuals have their first depressive episode prior to the age of 20, 50% have their first episode between 20 - 50 years of age and the remaining 10%, after 50 years of age.

Adolescent depression

Over the years, it is recognized that the age of onset of depression is decreasing and it is now increasingly being recognized in children and adolescents.

Factors associated with depression in children and adolescents are: 

• Stress at school

• Lower academic performance

• Failure in examination

• Stress in the family

• Change of house/residence

• Death of a family member

• Prolonged absence or death of a parent

• Serious illness

• End of a relationship

Diagnosis Of Depression

The diagnosis of depression is based on history and physical findings. No diagnostic laboratory tests are available to diagnose major depressive disorder. 

1. Psychiatric evaluation 

It is a comprehensive evaluation needed to diagnose emotional, behavioral, or developmental disorders. The evaluation may include description of behaviors (like how long does the changed behavior last, and what are the conditions in which the behaviors most often happen), and complete medical history, including description of the person's overall physical health, list of any other illnesses or conditions present, and any current ongoing treatments.

DSM 5 Guidelines**
These are the 9 symptoms listed in the DSM-5. Five must be present to make the diagnosis of major depressive disorder (one of the symptoms should be depressed mood or loss of interest or pleasure):

• Sleep disturbance

• Interest/pleasure reduction

• Guilt feelings or thoughts of worthlessness

• Energy changes/fatigue

• Concentration/attention impairment

• Appetite/weight changes

• Psychomotor disturbances

• Suicidal thoughts

• Depressed mood

2. Blood tests 

The diagnosis of depression is based on history and physical findings. No diagnostic laboratory tests are available to diagnose major depressive disorder. However, laboratory tests can help in the exclusion of any underlying medical conditions that can manifest as depression. These include:

• Complete blood cell (CBC) count

• Thyroid-stimulating hormone (TSH)

• Vitamin B-12

• Rapid plasma reagin (RPR)

• Toxic screening (to rule out active substance abuse)

• HIV test

• Electrolytes, including calcium, phosphate, and magnesium levels

• Blood urea nitrogen (BUN) and creatinine

• Liver function tests (LFTs)

• Blood alcohol level

• Blood and urine toxicology screen

• Arterial blood gas (ABG)

• Dexamethasone suppression test (Cushing disease, but also positive in depression)

• Cosyntropin (ACTH) stimulation test (Addison disease)  

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3. Imaging tests

Just like blood tests, imaging tests can help to rule out the other medical causes and conditions. These include:

• CT scan

• MRI of the brain

Specialist To Visit 

If you have some of these classic symptoms of depression and if your symptoms are severe and have lasted longer than a few weeks, you should seek help. The best place to start is with your doctor. 

Doctors/specialist you can visit include:

• General physician

• Psychiatrist

• Clinical psychologist

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Treatment Of Depression

Depression is among the most treatable of mental disorders. The treatment of depression involves both pharmacological (medical) and psychological approaches.

1. Medical therapy

The drugs used to treat depression are known as antidepressants. These drugs may produce some improvement within the first week or two of use yet full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute another antidepressant. In some situations, other psychotropic medications may be helpful. It is important to let your doctor know if a medication does not work or if you experience side effects.

Also, the possible reasons for no improvement in the symptoms post treatment include:

• Not taking the antidepressants for the recommended period because ideally, antidepressants might take 8 to 12 weeks to show any effect.
• Not taking the medications regularly.
• Taking the medicines in low doses (under dosing).
• Always discuss with your doctor prior to making any dose changes.
• Concurrent substance abuse which might contribute to the non responsiveness of depressive symptoms.
• Some underlying medical disorder which has been unaddressed.

Antidepressants can be classified into typical antidepressants and atypical antidepressants.

A) Typical antidepressants
These are further divided into:

1. Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are used as frontline drugs for the treatment of depression and anxiety. These drugs increase the level of serotonin and brain derived neurotrophic factor (BDNF). Examples of this class of drugs include: 

• Escitalopram

• Fluoxetine

• Sertraline

• Paroxetine

2. Serotonin and nor-adrenaline reuptake inhibitors (SNRIs)
As the name suggests, SNRIs are the drugs that aid in the treatment of depression by increasing the level of serotonin and noradrenaline in the body. The list of drugs that fall under this category include:

• Duloxetine

• Milnacipran

• Venlafaxine

3. Monoamine oxidase (MAO) inhibitors 
This type of antidepressant primarily increases the level of noradrenaline, thereby improving the symptoms of depression. However, these drugs also increase the level of serotonin in the body. Some of the commonly prescribed MAO inhibitors include: 

• Phenelzine 

• Isocarboxazid 

• Tranylcypromine

4. Tricyclic antidepressants (TCA)
This class of antidepressants work by increasing levels of the hormone noradrenaline in the body. These are outdated medications (not used currently). Examples of these drugs include: 

• Nortriptyline

• Amitriptyline

• Imipramine

Note: Selegiline, a newer MAOI that sticks on the skin as a patch, may cause fewer side effects than other MAOIs do.

B) Atypical antidepressants 
As this class of drugs do not have a specific action mechanism they are known as atypical antidepressants. Some of the common examples of these medications are: 

• Mirtazapine

• Agomelatine

• Bupropion

• Atomoxetine

Here are 8 things about antidepressants everyone needs to know.
Read To Know!

2. Psychotherapy

Also known as talk therapy or psychological therapy, it is a common approach used for treating depression by talking about your condition and related issues in the form of counseling sessions with a mental health professional.

• Cognitive behavioral therapy (CBT): This type of psychological therapy helps teach the patient coping skills to manage their difficult conditions. The therapy focuses on the cognitive component. This helps the patient to change their thinking about a particular situation and the behavioral component which further helps them to change their reactions to any situation.

• Interpersonal therapy (IPT): This is a time-limited approach that focuses on improving the symptoms of depression and treating mood disorders. In this, a therapist emphatically engages the patient to improve their communication with others and solve the problem.

3. Surgical and other interventions

• Electro-convulsive therapy (ECT): Also known as shock therapy, this mode of treatment is the best for acute depression. It is also useful for patients who do not respond to drug therapy, are psychotic, or are suicidal or dangerous to themselves. Onset of action may be more rapid than that of drug treatments, with benefit often seen within 1 week of commencing treatment. 
• Transcranial magnetic stimulation (TMS): It is usually reserved for those who haven't responded to antidepressants. During TMS, a treatment coil placed against your scalp, it sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression.
• Vagus nerve stimulation (VNS): This approach is also used in refractory cases. Like ECT, it uses electrical stimulation to relieve the symptoms of depression. The difference is that the device is surgically implanted in your body. VNS is FDA-approved for the long-term (not acute) depression of chronic depression that does not respond to at least two antidepressant trials. Its effects may take up to 9 months to appear and studies have shown that a meaningful response seems to occur only in about 1 in 3 people.

Complications Of Depression

Depression in elderly can lead to severe health complications which include:

• Excess disability

• Forgetfulness

• Increased symptoms from medical illness

• Suicidal thoughts

Alternative Therapies For Depression

Yoga

1. Setubandhasana (Bridge pose)

• Lying flat on your back with hands on your sides, bend your knees so that your feet are flat on the ground and as close to your buttocks as possible.
• Slowly raise your hips with your hands lying on the side and hold the pose for 5 breaths.

2. Marjariasana (Cat stretch)

• Lying on the floor face-down, get up on all fours with palms planted on the ground and knees bent so that you resemble a cat. Your back should be gently arched.
• Now breathe normally for 5 counts.
• This pose relaxes stomach and spine muscles.

3. Sukhasana (Easy pose)

• This one is to give you calmness in your mind and body.
• Sit cross legged in a comfortable place with your spine straight and palms on your knees like you would be sitting for meditation.
• Then breathe normally and focus on the breath entering and exiting your body.

4. Balasana (Child pose)

• For this pose, you have to sit on your heels with your knees bent.
• With your arms resting on your thighs, bend your torso towards the floor with your nose touching the floor.
• Bring your arms to your sides near your feet with your palms facing upward.
• Breathe deeply for 5 to 10 counts.

5. Savasana (Corpse pose)

• This one is the easiest and leads to deep relaxation.
• Just lie down on your back and leave your hands loose on your sides.
• Let your body relax and sink while taking deep breaths.

6. Paschimottanasana (Seated forward bend)

• Besides reducing depression and anxiety, this pose will help in digestion, stretching of back and leg muscles and promotes healthy kidneys and uterus.
• While sitting with your legs stretched out straight in front of you, bend your torso forward and downward with your nose touching your knees.
• Stretch out your hands parallel and above your legs to hold your feet with your palms.

Living With Depression

Here is a list of practical ways that will  help you cope with depression effectively:

1. Speak up

• To effectively fight depression, it is important for you to seek social help.

• Connect with your friends and family. Try to talk as much and share your problems.

• Talking about your worries will help to lessen the burden of your problem. 

2. Engage in activities that make you happy

• Depression wipes you off the energy and the zeal to engage yourself in activities that once were your passion. Not trying to pull yourself out of this state shall only worsen your depression.

• Engage yourself in activities that keep you happy to fight depression effectively.

• Stay active by opting for activities that relax and energize you.

3. Don’t be harsh on yourself

• Depression puts you at an increased risk of self-hate and embarrassment. It makes you think negatively and very critically over all issues.

• It is important that you remain compassionate towards your own self and not demean or discourage yourself from connecting with others.

• Research suggests that supporting others has been found to boost one’s mood and makes one feel happy.

• To overcome this condition, it is important for you to love your own self.

4. Get moving

• Depression tends to keep you  in bed or glued to your couch. The less you move around the more worse it may get.

• Go for a 20 minute walk everyday with a friend or alone. You could also pick a sport that interests you or any other physical activity that would keep you moving.

• Exercise has been found to increase the production of neurochemicals such as endorphins that elevate the mood and make you happy.

5. Get some sunshine

• Studies suggest that sunlight has a therapeutic effect on those suffering from depression. Sunlight has been found to boost depressed mood and serves as a therapy.

• Take short walks outdoors in the sunlight. Instead of opting to have coffee/ tea in a dark room, try doing the same in the sun.

• If you practice yoga, do it during the early morning hours and enjoy the benefits of sunlight as well.

6. Have mood enhancing foods

• While fighting depression, include foods that are rich in B complex, Vitamin C and omega-3 fatty acids.

• Omega-3 rich foods (rich in EPA and DHA) have been found to stabilize mood swings. Include foods such as fatty fish or fish oil supplements to your diet.

• Do not skip your meals. Make sure you eat after regular hours (2-3 hours).

• Minimize the intake of sugars and refined carbs such as bakery items, pasta and french fries as they may lead to energy crash.

7. Seek medical help

• In severe cases, when all the above mentioned practical tips fail to get results it is better that you seek help from a therapist.

• Medical help will help you combat the situation and keep your symptoms in check.

Depression and related conditions

Diabetes
Did you know depression occurrence is two to three times higher in people with diabetes mellitus?

The prevalence rates of depression could be up to three-times higher in patients with type 1 diabetes and twice as high in people with type 2 diabetes compared with the general population worldwide. The presence of depression and anxiety in diabetic patients is known to worsen the prognosis of diabetes, increase the non-compliance to the medical treatment, poor quality of life and mortality.

The common cause could be stress and inflammation, as both promote depression and type 2 diabetes, giving a feasible common link between them.

Heart disease
Depression is known to be associated with poorer outcomes of coronary heart disease (CHD). Depression can act as a risk factor for a poor prognosis after a heart attack or unstable angina (chest pain at rest due to reduced blood flow to the heart). It was also found that the risk of death in heart attack survivors with depression was three times that of those without depression.

It has been linked to low-grade inflammation, which is involved in the clogging of arteries and the rupture of cholesterol-filled plaque. 

Depression also boosts the production of stress hormones, which dull the response of the heart and arteries to demands for increased blood flow. It activates blood cell fragments known as platelets, making them more likely to clump and form clots in the bloodstream.

Depression and other mental disorders

Anxiety disorders
Comorbid anxiety is common in patients with depressive disorders. It complicates the clinical presentation of depressive disorders and can contribute to treatment resistance. Studies have shown that more than 70% of individuals with depressive disorders also have anxiety symptoms and 40 to 70% simultaneously met criteria for at least one type of anxiety disorder. The concurrent presence of anxiety symptoms or anxiety disorders often complicates the treatment of depressive disorders. 

Schizophrenia
Although technically, depression and schizophrenia are totally different, it is seen that depressed mood is commonly associated with first-episode schizophrenia. Schizophrenia is a chronic mental disorder that affects how a person thinks, feels, behaves, and interacts with his/her surroundings. Moreover, it is reported that these symptoms impair the everyday life of the patient as well as the quality of life which requires medical treatment as well as hospitalization, in some cases.

Eating disorders
Both depressive disorders and eating disorders are multidimensional and heterogeneous disorders. Research shows that 32-39% of people with anorexia nervosa, 36-50% of people with bulimia nervosa, and 33% of people with binge eating disorder are also diagnosed with major depressive disorder. They are much more common among women and girls, but men and boys account for about 5 to 15 percent of those with anorexia or bulimia and about 35 percent of those with binge eating disorder.

Substance abuse
It’s no secret that there is a strong connection between substance use and mental illness. A strong link of depression with substance use and impairment would suggest that depressed substance users may require enhanced treatment interventions. 

Phobias
Phobias are a form of anxiety disorder, wherein a patient will have an irrational, and all-encompassing fear of a person, place, thing, or a specific situation. Unfortunately, depression and anxiety are closely linked. Some of the common phobias include:

• Aviophobia/aerophobia (fear of flying)

• Emetophobia (fear of vomiting)

• Amaxophobia (fear of driving)