Depression

What is depression

Worldwide, about 320 million people live with depression. About 1 in 6 people develop a form of clinical depression at some point in their life.

In practice, depression can look like this:

• energy: unexplained tiredness, lack of initiative
• sleep: insomnia or, on the contrary, excessive sleep
• thinking: difficulty concentrating, even small decisions feel exhausting, rumination
• the ability to feel pleasure: things that used to bring joy no longer have any effect
• the body: changes in appetite, unexplained pain, digestive problems

With the right treatment plan, many patients feel much better.

Specific forms of depression

Functional depression is the form many people manage to hide, sometimes even from themselves. The person goes to work, meets their responsibilities and seems “fine” to those around them, but is deeply exhausted, without pleasure and empty inside. It is common among professionals, entrepreneurs and parents with heavy responsibilities; the lack of dramatic symptoms often makes them believe that “it isn’t that bad”. It is just as real and just as treatable as any other form.

Postnatal depression appears in the first months after giving birth. It is different from the “baby blues” (the normal sadness of the first days after birth, which passes on its own within 1–2 weeks). Postnatal depression persists, gets worse and needs specialist assessment. Assessment is urgent if thoughts of self-harm or of harming the baby appear.

Perimenopausal depression appears in women around the age of 45–55 and is linked to the hormonal changes of this period. It often presents with vasomotor symptoms (hot flushes, sweats) and sleep problems, alongside the classic depressive symptoms. It is often mistaken for “just the menopause”.

Seasonal depression appears cyclically, usually in autumn and winter, when the days get shorter. It is associated with excessive tiredness, sleepiness and increased appetite. It responds to treatment.

Depression with melancholic features is a severe form, with deep sadness, a complete loss of pleasure, intense feelings of guilt, early-morning waking and significant weight loss. It can sometimes be a psychiatric emergency.

Atypical depression has distinct features: the person may have moments of improvement in response to pleasant events, as well as increased appetite and sleep, and hypersensitivity to rejection. It is sometimes mistaken for “just tiredness” or for personality problems.

The difference between depression and “a hard time”

We all go through difficult periods. Losses, failures and major changes all bring sadness, tiredness and a lack of motivation. The difference that matters for diagnosis:

Ordinary sadness	Clinical depression
Appears in response to a specific event	Often appears without a proportionate reason
Has periods of relief, when you feel better	Is almost constant
You can still enjoy some things	Nothing brings pleasure any more
Passes gradually, over weeks or months	Persists constantly for more than 2 weeks or comes back cyclically
Sleep and appetite stay mostly normal	Affects sleep, appetite, energy
You still feel like yourself	Often brings the feeling that “you are not yourself any more”

For a diagnosis, the symptoms must be present for at least 2 weeks and affect everyday life.

Factors that contribute to depression

Depression is rarely caused by a single factor. Usually several elements contribute:

• Genetic predisposition: a family history increases the risk, but does not determine it
• Life events: losses, trauma, major changes, chronic stress
• Medical factors: certain conditions (thyroid, neurological, autoimmune) can cause depressive symptoms
• Hormonal changes: after giving birth or in perimenopause
• Substance use: alcohol, drugs and certain medicines can cause or worsen depression
• Lifestyle: chronic sleep deprivation, social isolation, lack of physical activity, an unbalanced diet

For a correct diagnosis, the assessment often includes ruling out medical causes that can mimic depression.

When to see a specialist

A psychiatric assessment is worthwhile if:

• you have felt sad, empty or irritable every day for more than 2 weeks
• you have lost interest in activities you used to enjoy
• your sleep is disturbed (insomnia or excessive sleep)
• you feel constantly exhausted, without a medical cause
• you have difficulty concentrating or making decisions
• you feel useless or guilty, or have dark thoughts about yourself
• you have thoughts about death or about “no longer being here”
• you have turned to alcohol or other substances to cope
• you have an ongoing sense of “I’m functioning, but I’m not myself any more”

Important: if you have concrete thoughts of self-harm or suicide, assessment is urgent. In a suicidal crisis, call 112 or the Romanian Green Anti-Suicide Line, 0800 801 200 (free; Friday–Sunday, 19:00–07:00), or go to the nearest psychiatric emergency department.

See also: “I function, but I am not myself any more”: the distress that does not show from the outside

The first step

If you recognise yourself in what you’ve read, book a conversation with one of our specialists. Together, we’ll look at what’s going on and what your options are.

Services: Psychiatry · Psychotherapy · Counselling
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This information is for educational purposes and does not replace a specialist consultation.