Did you know that depression is becoming more common and is affecting more people than ever before?
The impact of this illness on family, friends, and society is ever-increasing and it is important that we try to fully understand depression and find solutions to help people manage and overcome it.
What is Depression?
Depression is a disorder that can seriously affect the body, mood, and thoughts of a sufferer. It can be debilitating – permeating every aspect of life, disturbing a person’s ability to eat, sleep, think, and function. Depression is not the same as being a little sad or blue over a specific event. The feelings associated with depression are persistent and chronic, and a person suffering with depression cannot simply pull themselves out of the way that they are feeling.
Common Symptoms of Depression
Individuals who show some of the following symptoms of depression, chronically, may be clinically depressed:
- Persistent sad or “empty” mood
- A feeling of negativity, pessimism, or hopelessness
- Feelings of guilt, worthlessness, and helplessness
- Loss of interest or pleasure in activities that were once enjoyed
- Feelings of fatigue or being “slowed down”
- Trouble concentrating, staying focused, or making decisions
- Feelings of restlessness or irritability
- Loss of appetite and weight or increased appetite and weight gain
- Difficulty managing mood swings
- Avoidance of family members and friends
- Insomnia and/or oversleeping
- Thoughts of death or suicide
Not everyone who is depressed experiences every symptom. It is important to note that some people experience a few of the symptoms of depression, while others may experience all of them. Severity of the symptoms of depression will vary depending on the person and will also vary over time.
Types of Depression
There are different types of depression:
Major (Clinical) Depression is characterized by a combination of the above symptoms that are severe enough to impair the ability to work, study, sleep, eat, and enjoy life. Some people may experience an episode of Major Depression only once, but many experience several over the course of a lifetime.
Dysthymia is less severe than a Major Depressive episode. This form of Depression involves long-term, chronic manifestations of the above symptoms in way that does not completely disable the sufferer but still keeps them from functioning well or enjoying life.
Bipolar Disorder involves a cycle of mood changes from excessive highs to equally excessive lows. A person with Bipolar Disorder may experience a Manic phase during which they feel “on top of the world,” followed by a Major Depressive episode.
Other common forms of depression include mood disorder, postpartum depression, and cyclothymia.
What Causes Depression?
There are many possible causes of depression. It is important to note that there can be a combination of factors, and that some people might relate to these factors without ever developing depression.
People learn what they consider “normal” from the environment in which they are raised. If a person is raised around others with depression or a pessimistic attitude, they may adopt these outlooks as well. They may not have good examples of coping skills to model.
Stressful life events such as failing a class, moving far away from friends or family, or ending a serious relationship can bring on an episode of depression. While most people will experience sadness over such events, people with a tendency towards depression will react more strongly, especially in the absence of appropriate coping skills or a support system.
Other Medical Illnesses
The stress of being ill can increase the likelihood that someone will become depressed. Certain illnesses in particular appear to be linked to depression. These include under-active thyroid, heart attack, stroke, and cancer. In some cases it is possible that medications prescribed for certain illnesses put a person at a greater risk for depression.
Women are twice as likely as men to develop depression. Researchers are not certain as to why, and it could simply be that women are more likely to report being depressed. Women are also more likely to suffer from anxiety, which might also explain why they develop depression more often than men.
It is believed that an imbalance of neurotransmitters in the brain causes depression in some cases. Serotonin, norepinephrine, and dopamine are chemical messengers that operate within the brain to influence mood. If these get out of balance, a person can become more sensitive to the onset of depression.
Research shows that people with a family history of depression are more likely to develop depression themselves. This is especially true in the case of bipolar disorder. In fact, people with a family history of depression are 2 to 3 times more likely to develop depression than those with no genetic predisposition.
People who have unrealistically high standards for themselves or suffer from a persistent inability to be satisfied with outcomes due to perfectionism have been shown to be more likely to suffer from depression. When stressful situations present themselves, perfectionists have more difficulty coping, and this can increase the risk of depression in these situations.
Often times, poor coping skills compound these issues and intensify the problems individuals are experiencing. When people perceive a problem and focus on the issues surrounding that situation, the problem can seem to grow. Excessive worry can become debilitating and eventually turn into depression.
A growing body of research suggests that a link between depression and inflammation exists. About 20 years ago, researchers started noticing that the levels of cytokines and T-cells, (which help drive immune responses and secrete cytokines), were higher in blood samples from people diagnosed with depression.
Depression Risk Factors
There are many risk factors for major depression, and understanding all of them can help lead you to a proper diagnosis and treatment.
Depression risk factors fall into two basic categories – physical and psychological. We often hear about chemical imbalances in the brain as being the cause of depression. In general terms, this means that certain neurotransmitters that are responsible for mood stabilization – dopamine, serotonin, and GABA, to name a few -are not doing their job.
Psychologically, we might be prone to depression because of our coping mechanisms or attitudes. But what are the risk factors for depression? Why do some people experience full-blown depressive episodes while others seem more able to handle life stress and maintain a positive attitude?
The Genetic Link
One risk factor for depression is genetics. Your mood is controlled by chemical processes within the brain that determine how you handle life stress. The way your body performs these processes is affected by genetics. Our DNA is responsible for producing different proteins that are used in these chemical processes, and, if the DNA is sending the wrong messages, those chemical processes will make you more vulnerable to experiencing mood instability.
What does this mean?
It means that, if you have a family history of depression or other mood disorders, your risk of developing depression increases. While genetics aren’t the sole cause of depression, you can have a “genetic predisposition” to the disorder. In other words, your genetics make you more sensitive to long-term stress and, therefore, a major depressive episode. If one of your immediate family members has experienced a depressive episode, you have a greater chance of having bouts of depression.
The Psychological Link
While there are physical factors within the brain and our DNA that might leave us predisposed to depression, the picture would be incomplete if we didn’t look at psychological risk factors. Depression is, after all, most notably associated with its psychological effects—sadness, hopelessness, helplessness, and a chronic “blue mood.” The way we view and cope with life has a lot to do with whether or not we’ll develop depression.
Early childhood experiences, such as the death of a loved one or emotional abandonment by a parent or caregiver, can set us up for depression later in life. We learn our coping mechanisms as we grow, and, if we experience a traumatic event before we’ve matured enough to handle it emotionally, we’re much more likely to develop a negative outlook. If we didn’t feel safe expressing certain negative emotions as children or adolescents, we may carry those emotions with us into adulthood, and they might manifest as depression.
Our temperament and coping skills have a huge impact on how we handle life. Events are emotionally neutral, but the emotions we experience in response to those events depend in large part on how we handle stress – our attitude.
If we have a generally positive attitude, stressful or traumatic events might affect us, but we’re more likely to be able to handle any sadness or anger fairly well. On the other hand, if we view life with a negative attitude, we’re much more sensitive to depression in the face of stressful or traumatic events, and we’re more likely to see relatively insignificant events as stressful or traumatic. Those with certain temperaments (such as being easily agitated or tending to withdraw from relationships) are at greater risk for major depressive episodes, especially when faced with separation, loss, disappointment, or rejection.
The Illness Link
Depression can be linked to other physical health problems. Certain diseases tend to precipitate a depressed mood. Sometimes depression is directly linked to a medical condition such as thyroid imbalance or heart disease. In some cases, the depression might be due to the stress of coping with the illness. In other cases, the illness itself creates an imbalance of neurotransmitters.
It is important for anyone dealing with a major illness to investigate the possible link between their medical condition and a major depressive episode.
The Stress Link
Stress is most likely the biggest risk factor for depression. Making too many commitments, financial problems, separation or loss of a loved one, disagreements with our friends or partners – these all can cause stress, and stress triggers reactions (both physical and emotional) that can lead to depression in some cases.
When we’re under stress, the body reacts. We produce certain hormones and chemicals to prepare to deal with the stress. This is called the fight-or-flight response. We’re going to need to be ready to either take the stress head-on or run away from it.
Because of differences in each individual’s biology – mostly due to genetics – each of our bodies responds to stress differently. Some of us are more sensitive to stress, which can lead to our being easily upset or agitated. This heightened sensitivity is partially biological and partially emotional. If our bodies don’t produce the right brain chemicals in the right amounts when we’re under stress, we’re more likely to experience depression. On the other hand, if our coping skills or temperament make us less able to handle stress, we face the same problem.
Anyone facing long-term stress or traumatic events such as death, serious illness, separation from a loved one, abuse, or a major loss that threatens their security (such as the loss of a job) is at greater risk for major depression.
What does this mean?
With so many different risk factors, what can we do? Understanding the risk factors for depression helps doctors and therapists treat the disorder. Understanding physical risk factors enables medical professionals to know when medication might be a vital treatment option. Recognizing certain coping mechanisms, attitudes, and temperaments within an individual can lead a therapist to appropriate therapies.
Ultimately, it’s important to look at all sides of this disturbance. It’s also important to remember that, even if you are at a greater risk for depression due to any or all of these factors, there is help available. Life can feel better if you take the initiative and get the help you need.
How is Depression Diagnosed?
Because depression presents itself as both physical and emotional symptoms and is caused by genetic, environmental, behavioral and lifestyle factors, diagnosis can involve several different processes.
The doctor will perform a physical exam, blood tests, x-rays and ask some questions to determine if your depressive symptoms are caused by a health issue such as illness or medication. Many symptoms of depression are physical, including headaches, stomach discomfort, and chronic fatigue, so it’s important to figure out if there could be any actual health problems present. If you receive a clean bill of health, the physical problems you’re experiencing might be depression.
If no health problems are present, the doctor will ask some questions about how you’ve been feeling emotionally.
The doctor might ask:
- Have you been having feelings of hopelessness or sadness? If so, when and for how long?
- Have you experienced either a noticeable increase or decrease in appetite?
- Have you noticed a significant decrease in sex drive?
- Have you been experiencing an overwhelming need for more sleep than usual, or have you been experiencing bouts of insomnia?
- As far as you know, has anyone in your family ever been diagnosed with depression or some other form of emotional or mental disorder?
- Have you thought about suicide or attempted to commit suicide?
- Do you use drugs or alcohol to change the way you feel? If so, how much do you consume and how often?
The specific screening tools used to identify depression are:
You are given a checklist of symptoms and determine which ones you feel you’re experiencing and the degree to which you’re affected.
Observance by a clinician
Because it is difficult for those with depression to understand their symptoms, scales performed through the observance of a clinician can detect depression the patient might not be aware of.
Interviews with a therapist or doctor
This is the best of both worlds, as the patient gets to express their own feelings about what they’re experiencing. Then the doctor or therapist gets to guide the patient and observe their answers.
As of yet, there are not tests available that can detect a chemical imbalance to diagnose depression. While certain tests might be performed if the doctor suspects a physical problem as a possible cause of the depression, doctors will only perform lab tests to diagnose or treat depression in specific cases. Other tests might be needed to determine whether what you’re experiencing is depression or some other problem.
Further tests can include:
These tests will help the doctor to determine your temperament, organizational and planning skill levels, and your coping mechanisms through a series of questions, responses to pictures, and your performance of certain tasks.
In rare cases, a doctor might call for tests to look at the brain. These tests include EEGs and MRIs and can eliminate other neurological disorders as possible causes of your depression. There’s no need to worry; they’re completely painless.
These can help a doctor to determine if biological causes such as thyroid dysfunction could be the cause of depressive symptoms.
If you feel that you’re experiencing symptoms of depression, it’s important to tell your doctor. Once you’ve received proper diagnosis, you can begin finding help and getting on with your life without a cloud of depression hanging over you.
Depression Treatment Options
Various forms of help for depression are available. For some, modern day prescription drugs may be the answer. For others, medication may not be a viable option for a number of reasons, so seeking a particular therapy or a combination of therapies may help. The important thing is that you determine the treatment program or wellness plan that best suits you, and follow through on the treatment.
A basic run-down of some of the more popular treatment options and therapies are listed below. Though many people may find depression help on their own, please remember that some types of depression are more serious than others and may require regular guidance from a medical professional. The information in this article should not be considered a substitute for professional medical advice.
Psychotherapy, or “talk” therapy, means talking with a trained mental health professional to learn coping skills for dealing with depression. There are different types of mental health professionals including psychiatrists, psychologists, social workers, and licensed counselors, and there are different types of psychotherapy as well. Again, it is all about finding the right fit for the individual.
Based on the idea that depression is caused by our own internal thoughts, emotions, and behavioral response, these therapies use logical, adaptive coping techniques that are designed to control the thoughts that go through our head, as well as how we respond to them.
Interpersonal therapy, Cognitive-Behavioral therapy, and Psychodynamic therapy are some of the therapies that are regularly used to deal with depression. Interpersonal therapy focuses on the patient’s personal relationships and how these relate to their depression. Cognitive-Behavioral therapy, or CBT, helps the depressed patient change negative thinking patterns and behaviors associated with depression. Psychodynamic therapy seeks to resolve any conflicting feelings experienced by the patient. This last type of therapy is generally reserved until the patient’s depressive symptoms have improved.
Over the last few decades, prescription drugs like SSRIs and MAOIs have become the leading treatment option for depression in the United States, the UK, and Canada. Some medical professionals believe that these drugs are a simple, cost effective, and reliable solution.
Since the exact causes of depression are still being debated, it is not yet known whether these drugs cause more harm than good. They are, however, used by millions of adults, teens, and children each year.
There are three main types of antidepressants: selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs). SSRIs are the most popular antidepressants because of their relatively low incidence of negative side effects and their general effectiveness.
Selective serotonin reuptake inhibitors (SSRIs) have been around since the late 1980s, and the first SSRI to hit the scene was Prozac. Serotonin is a neurotransmitter that controls mood, and depression is often linked to noticeably low levels of serotonin in the system. SSRIs help by blocking reabsorbsion of serotonin by the neurons that release it, allowing more serotonin to be picked up by receptor sites that can use it to stabilize mood, thus warding off depression. Brand name SSRIs available today include:
While there are fewer side effects with SSRIs, there are still some negative side effects to be aware of, including nausea, insomnia, and sexual dysfunction (especially in men). In very rare cases, SSRIs can increase suicidal tendencies, especially in children and teens. It is always recommended that these medications be taken under a doctor’s supervision.
Before there were SSRIs, there were Tricyclic antidepressants (TCAs). These drugs increase levels of the neurotransmitter norepinephrine (which is responsible for mood and anxiety) and serotonin, blocking the neurons where these brain chemicals are produced from reabsorbing them. But because of their simultaneous effect on another neurotransmitter (acetylcholine), they also have a tendency to increase the likelihood of uncomfortable conditions, including constipation, vision problems, difficulty urinating, and dizziness. They can also cause an abnormal heartbeat. If SSRIs are ineffective, a doctor might prescribe a TCA. Otherwise, they are not generally the first choice in treating depression. Brand name TCAs include:
Monoamine oxidase inhibitors (MAOIs) block the chemical monoamine oxidase. This chemical is used to break down the monoamines norepinephrine and serotonin, decreasing their availability. MAOIs are especially effective in fighting anxiety related to depression, panic attacks, and atypical depression symptoms. Brand names of currently available MAOIs are:
There are several other antidepressants that have been released in the last few years. These antidepressants include:
These antidepressants are often called atypical antidepressants because they are not chemically related to the three major classes of prescription antidepressants: SSRIs, Tricyclics, and MAOIs. Wellbutrin affects levels of dopamine and norepinephrine in the brain. It works as a stimulant against depression, and it is also sometimes prescribed to diminish nicotine cravings for anyone quitting smoking. Effexor balances out levels of serotonin and norepinephrine in the brain to fight the symptoms of depression.
Mood Stabilizers and Antipsychotics
Mood stabilizers are used to treat mood swings related to bipolar disorder. In fact, because antidepressants can trigger mania related to bipolar disorder, mood stabilizers are often used instead of antidepressants. For those with major depressive disorder, mood stabilizers can be used in conjunction with an antidepressant to improve relief. The two main mood stabilizers are lithium and valproate, and brand names include:
Antipsychotics are used in very rare cases. Some individuals suffering from major depressive disorder have psychotic episodes during which they might hallucinate, hear voices, or experience extreme delusions. Antipsychotics can have serious side effects, and they’re a last defense against severe depressive symptoms. They often cause weight gain, drowsiness, upset stomach, fever, seizures, dangerous drops in white blood cell count, rapid heart rate, and movement disorders. For those who do suffer with psychotic episodes related to depression, though, these drugs are a necessity. Psychotic depression greatly increases the risk of suicide. Brand names include:
If you’re experiencing symptoms of any type of depressive disorder, speak with your doctor about which prescription medications are options for you. Make sure to let your doctor know if you experience any effects the medication might have once you’ve started taking it. There is always a period of adjustment, and dosages or medications may have to be switched several times to find the one that’s right for you.
Complementary and Alternative Medicine
Complementary and Alternative Medicine (CAM) is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Many CAM therapies are supported by scientific research, but, in all cases, there are key questions yet to be answered.
CAM modalities are based on aiding the individual to find balance so that an emotional or physical disorder doesn’t become a chronic issue and, if it does, healing can be done through a more natural, holistic approach.
The following complementary and alternative practices are currently used to manage depression (click on each to learn more):
- Art Therapy
- Breathing and relaxation exercises
- Chiropractic care
- Herbal medicine
- Light therapy
- Massage therapy
Remember, you are human and it is normal to experience some blue moods on occasion. But, if you find that you are feeling down on a regular basis, or you think it is possible you or someone you care about has depression, seeking the help of a professional is a good idea.