Depression is a serious mental illness, far different from regular sadness and it can interfere with one’s ability to carry out even minor activities. It affects 6.7% adults in any given year and it will be experienced at least once in a lifetime by 16.6%. On average, it strikes during late teens to mid-20s, but it can affect people of all ages.
There are several forms of depression: persistent depressive disorder, postpartum depression, psychotic depression and seasonal affective disorder. Persistent depressive disorder lasts for at least two years, with episodes of major depression intermingled with periods with periods when the symptoms are milder. Postpartum depression occurs during pregnancy or after delivery and is represented by feelings of extreme sadness, anxiety and exhaustion that prevent the new mothers to complete daily activities. Psychotic depression appears when, besides depression, the individual also has a form pf psychosis, such as delusions or hallucinations. In the case of seasonal affective disorder, depression occurs during winter months and generally lifts during spring and summer.
According to the Diagnostic and Statistical Manual of Mental Disorders, the two key symptoms of depression are the feeling of sadness (which can also manifest as emotional numbness) and the loss of interest or pleasure in activities which would normally be perceived as enjoyable. An individual has to have at least one of these main symptoms and another three or four additional symptoms in order to be diagnosed with depression. Some of the secondary symptoms include a feeling of worthlessness, changes in appetite, increased fatigue, difficulty in concentrating and making decisions, difficulty sleeping or sleeping too much, suicidal thoughts, hopelessness and helplessness.
Another lesser-known symptoms of depression are self-blame, rumination, anger and irritability. Self-blame is very common among depressed people and is one of the factors that help differentiating depression from sadness. Depressed people don’t assign blame to others in the same way they assign it to themselves, tending to be more critical about their own mistakes. They often blame themselves whenever something bad happens and also end up considering themselves to be a complete failure on the whole. Rumination may be an explanation for the problems with memory and concentration faced by depressed people, as it consumes most of their brain power.
These symptoms must last at least two weeks for one to be diagnosed with depression. It must also be established that the symptoms are not the result of other medical condition or due to direct effect of a drug or medication.
Current research suggest that depression is caused by a combination of biological, genetic, environmental and psychological factors; it can also be hormonally induced (post-partum depression) or triggered by certain medical conditions. Some sedatives are also linked to depression, according to the National Institute of Mental Health.
Biological factors: The areas of the brain which play a significant role in depression are the amygdala, the thalamus, and the hippocampus. The amygdala is associated with anger, pleasure, fear, sorrow and sexual arousal and its activity is higher when a person is depressed or even just sad. The thalamus is the part of the brain which receives most sensory information and some research suggest that problems with the thalamus may trigger bipolar disorder. The hippocampus’ main role is in processing long-term memory and it is also the part of the brain that registers fear; it is smaller in the case of some depressed people and continuous exposure to stress may weaken the growth of nerve cells in this part of the brain. Problems at the level of these parts of the brain may reduce its capacity to regulate mood and contribute to the apparition of depression.
Genetic factors: a person who is genetically vulnerable to depression can be affected more easily by any kind of minor stress. If one has a first-degree relative who suffered from depression the risk of developing it increases by 1.5% – 3%.
Environmental factors: chronic stress, early losses and emotional trauma have been shown to be causes of vulnerability to depression.
Medical problems: cancer, Parkinson’s disease, Alzheimer’s disease, hepatitis, HIV, erectile dysfunction in men, stroke and other endocrine disorders or certain immune system diseases have all been associated with depression and other mood disorders.
Treatment with antidepressants:
The brain chemistry may contribute to one’s depression and antidepressants can be prescribed in order to modify it. One commonly prescribed type of antidepressant is SSRIs (Selective serotonin reuptake inhibitors), which increases the serotonin levels in the brain. Serotonin is a neurotransmitter which plays a role in depression, as well as norepinephrine, dopamine, glutamine and others. Neurotransmitters are chemicals that pass on information from neuron to neuron. Brain cells usually produce enough levels of neurotransmitters for a proper functioning of senses, learning, movements and also moods. However, in case of some depressed people the process does not follow the expected course. Thus said, antidepressants have the role of increasing the concentration of neurotransmitters in the spaces between neurons.
The low level of the above mentioned neurotransmitters has serious consequences regarding the development of depression: the low level of serotonin is linked to a higher risk of suicide, norepinephrine triggers anxiety, problems in dopamine transmission are associated with psychosis and glutamate plays a role in bipolar disorder and schizophrenia.
Antidepressants can also help new neurons grow in certain parts of the brain, such as the hippocampus. This is a process that takes weeks and it may be an explanation for the reason why antidepressants sometimes take longer to have an effect.
The duration of treatment varies depending on the severity of the depression. Psychiatrists usually recommend taking medication for six or more months after the improvement of symptoms. In the case of people who are at high risk to have future depressive episodes, long-term maintenance may be suggested.
Other forms of treatment:
Psychotherapy – Different types of therapy include cognitive behavioral therapy, a form of therapy which helps a person recognize distorted thinking and then change behaviors, or interpersonal therapy, which focuses on the patient’s relationship with others. This form of treatment may be used alone in cases of mild depression and it can take the form of individual therapy or couple/family therapy. In numerous cases significant progress can be made in 10-15 sessions.
Electroconvulsive Therapy – this medical treatment is used only with patients who have not responded to any other form of treatment; it is usually used for those who suffer from severe major depression or bipolar disorder. It consists in brief electrical stimulation of the brain while the patient is under anesthesia.
The good news is that depression is one of the most treatable mental disorders, with 80-90% of people responding well to treatment; in order to know the adequate form of treatment, one must consult a clinical psychologist.