Depression

1.    Preface

 

I chose to do a project about depression because in our modern society, depression plays a huge role in people’s lives. I find it such a horrible mental illness because it just ruins your life and sucks away your motivation to do anything. That is why I decided to learn more about it.

I also did this project to raise more awareness about what depression actually is, because many people are misinformed about this mental illness or simply do not understand it.

 

2.    Introduction of depression

 

Major depressive disorder is a common but serious mental illness that negatively affects how you feel, the way you think and how you act. It can lead to feelings of sadness and loss of interest in things you once enjoyed. Depression can also cause a variety of other physical and mental problems. Fortunately, it is treatable.

DSM-5, an acronym for “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition”, is a wide classification of officially recognized psychiatric disorders, published by the American Psychiatric Association. It's used by mental health professionals to ensure uniformity of a diagnosis.

There is a difference between ‘having depression’ and ‘feeling depressed’: it is like comparing a mental illness with feelings of sadness.

Feeling depressed is temporary: having depression is not. For example, the feelings you get from the death of a loved one, loss of a job or the ending of a relationship, does not necessarily mean that you have a depression.  

The symptoms mentioned below need to last more than 2 weeks to be diagnosed with depression.

The symptoms of depression can vary from mild to severe and include:

• Feeling sad or having a depressed mood.
• Loss of interest and pleasure in activities that you once enjoyed.
• Changes in appetite: weight loss or gain not related to dieting.
• Having trouble sleeping or sleeping too much.
• Loss of energy or increased tiredness.
• Increase in purposeless physical activity (like handwringing or pacing) or slowed movements and speech.
• Feeling worthless and guilty.
• Difficulty thinking, concentrating and making decisions.
• Thoughts of death or suicide.

 

3.    Causes and types of depression

3.1             Causes

It is proven that long term and continuing difficulties, like long-term unemployment and having an abusive relationship are more likely to cause depression than recent life problems. However, recent events or a combination of events can trigger depression if you are already at risk because of previous experiences or other factors. These factors include:

• Depression can run in families and people can be at an increased genetic risk.
• People with specific personality traits are more likely to experience depression. These traits include low self esteem, perfectionism, worrying a lot, being overwhelmed by stress easily etc.
• Serious medical illness. The stress and worry from coping with a serious medical illness can cause depression, especially when dealing with chronic pain or long-term management.
• Drug and alcohol use. This can both lead to depression or result from depression: people can get addicted to drugs/alcohol and get depression because of it, or people with depression use drugs/alcohol to try and reduce symptoms of depression (temporarily).
• Differences in certain chemicals in the brain can lead to symptoms of depression. Hormones can can play a role in this biochemistry. Learn more about this in paragraph 3.2.
• Environmental factors. Continuous exposure to abuse, neglect violence, or poverty can make people more vulnerable for depression.

However, everyone is different and it is usually a combination of factors that contribute to depression. It is important to remember that you can not always find the cause of depression or change difficult situations. It is most important to recognize signs and symptoms and to seek support.

 

3.2             Types

There are many different types of depression, including:

• Major depression disorder.

Major depression disorder, also known as classic depression and unipolar depression, is the most common type of depression, already described in chapter one. Symptoms can last weeks or even months and there is usually no obvious reason for major depression, just like other types of depression.

• Persistent depression.

Persistent depression is a type of depression that lasts for more than two years. It might not be as intense as major depression, but it can be just as difficult. The symptoms can become less intense for months before worsening again.

• Manic depression.

Manic depression, also known as bipolar disorder, consists of periods of mania or hypomania: periods in which you feel very happy, followed by periods of depression.

• Depressive psychosis.

Some people with manic depression go through periods where they are losing touch with reality; this is known as psychosis. This can involve hallucinations and delusions.

• Perinatal depression.

Perinatal depression, also known as postpartum depression, occurs during pregnancy or within four weeks of childbirth. However, postpartum depression is not the correct term to use here because it only applies to depression after giving birth.

• Seasonal depression.

Seasonal depression is depression that’s related to certain seasons, mostly winter. Symptoms often begin in fall, when days get shorter, and continue through winter. Once it’s spring, symptoms usually improve. This might be related to your body’s response to the increase in natural light.

• Situational depression.

Situational depression looks like major depression in most aspects, but it’s brought on by specific events or situations, like the death of a loved one or a serious illness. Of course, it’s normal to feel sad or anxious in situations like this, but situational depression happens when these feelings start to feel out of proportion with the event and interfere with your daily life.

• Atypical depression

Atypical depression is depression that temporarily goes away in response to a positive event. It can also be referred to as major depression with atypical features. So, the name doesn’t mean it’s not unusual or rare. It can be even more frustrating than major depression because you don’t “look” like you have depression to others.

 

4.    How can depression be treated?

 

Depression is the most treatable mental disorder. Around 85 percent of people with depression eventually respond well to their treatments and almost all of them find some kind of relief in the treatments. We can distinguish two types of help, professional help and self help as described below.

 

4.1             Professional help

 

After a diagnostic evaluation, including an interview, possibly a physical examination or a blood test, it is decided which treatment is the best for the patient. These treatments are:

Brain chemistry can contribute to depression and can be a factor in their treatment. Antidepressants can be prescribed to change their bran chemistry. They are not habit-forming, sedatives, “uppers” or tranquilizers, as many may think. Usually, antidepressants already produce improvement within the first week. Most people will have to try various doses or medications to find what works for them. Learn more about medication for depression in chapter 5.

Psychotherapy, also known as talk therapy, is a term for treating depression by talking with a psychiatrist, psychologist or other mental health provider. Psychiatrists are trained doctors, so they can prescribe medication, and they spend a lot of their time with patients managing their medication. Psychologists focus on psychotherapy and the treatment of emotional suffering in patients. Psychotherapy can be used alone for mild depression, but for moderate to severe depression, psychotherapy is often used with medications. There are many different kinds of psychotherapy, including CBT, IPT and psychodynamic therapy. CBT, cognitive behavioral therapy, is a time-limited therapy that helps assess and change negative thinking patterns connected to depression. IPT, interpersonal therapy, is a time-limited therapy that focuses on improving problems in personal relationships and other things that may be contributing to depression.

• Psychoeducation and Support Groups.

Psychoeducation teaches individuals about their illness, how it is treatable and how to recognize signs of a relapse. It is also for people who have a loved one with depression and want to understand it better.

Support groups are groups where people can share their experiences and coping strategies. They are for people with depression but also their family/friends. These groups can be led by mental health professionals or peer led.

• Brain Stimulation Therapies.

Brain stimulation therapies are treatments for patients with severe depression that have not responded to the other treatments. With brain stimulation therapies, the brain is directly touched or stimulated with electricity, magnets or implants.

There are different types, including electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS) and Vagus Nerve Stimulation (VNS). ECT is a short electrical stimulation of the brain. TMS creates magnetic fields to stimulate nerve cells in the brain. VNS uses a pulse generator in the upper left corner of the chest to stimulate the vagus nerve. The vagus nerve is one of the nerves that connect the brain to the body.

 

4.2             Self help

 

There are also things people can do themselves to help reduce the symptoms of depression, usually called self help or Complementary and Alternative Medicine (CAM). These include:

• Getting enough quality sleep
• Staying on a healthy diet.
• Avoiding alcohol or drugs.
• Keeping a journal.
• Looking after your hygiene.
• Trying meditation, mindfulness or yoga.
• Practicing other self care.

These alone can not treat your depression, but they will make you feel better.

 

5.   What happens to your body and brain when having depression?

 

While depression is seen as a mental disorder, it can also affect the body and the brain.

5.1             Effects of depression on the body

 

Depression has effects on most parts of the body, including:

• Risk of heart attack: depressed people are more likely to die from a heart attack.
• Weight fluctuations: depression can lead to overeating or loss of appetite.
• Constricted blood vessels: depression and stress can cause vessels to constrict.
• Increased pain sensitivity: depression can lead to headache or other aches/pains.
• Lower interest in sex: depression can cause loss of interest in many things, including sex.
• Overall weakened immune system: depression decreases your ability to fight off diseases, including common colds, but also serious illnesses.

But what happens to your brain when you have depression? Depression affects to parts of the brain: the hippocampus, amygdala, and prefrontal cortex.

The hippocampus is located near the center of the brain. It stores memories, and it regulates the production of the hormone cortisol. The body releases the hormone cortisol when the person is in physical and mental stress: like times of depression. But problems can form when huge amounts of cortisol are sent to the brain, because of chemical imbalance in the body or a stressful event. In a healthy brain, brain cells (neurons) are produced, in a part of the hippocampus called the dentate gyrus, during the person's whole life. However, when people have depression, this long-term exposure to increased cortisol levels can slow down the productions of new brain cells, which leads to the brain cells in the hippocampus shrinking. This can cause memory loss and other complications.

The amygdala is the part of the brain that eases emotional responses like pleasure and fear. When people have depression, the amygdala becomes bigger and more active because of constant exposure to high levels of cortisol. An enlarged and hyperactive amygdala, along with unusual activity in other parts of the brain, can lead to sleeping disorders and can disturb activity patterns. It can also lead to the body to releasing irregular amounts of hormones and other chemicals into the body, which leads to further complications.

The prefrontal cortex is located in the very front of the brain. It is used to regulate emotions, to make decisions, and to form memories. When the body produces a large amount of cortisol, the prefrontal cortex also shrinks.

 

5.2  Depression medication and the effect to the brain

 

Experts have found that balancing the amount of cortisol and other chemicals in the brain can help reverse the hippocampal shrinkage and treat the memory problems that it can cause. Correcting the chemical levels of the body can also help reduce the symptoms of depression. The chemicals in your brain that need to be balanced by medication are called neurotransmitters: the chemicals that affect your mood and emotions.

These medications, called anti-depressants, can also help by giving people a boost to get over their symptoms of depression. This is because this medication often allows them to do the things they enjoy again and make better choices for themselves, which leads to a better mood.

 

6.    History of depression: are more people depressed nowadays?

 

While no one can actually be credited for the discovery of depression, there are many thinkers who have contributed to the understanding of what depression really is.

The earliest written accounts of what is now known as depression, appeared in the second millennium B.C. in Mesopotami. Here, depression was seen as something spiritual: they believed it was caused by demonic possession.

The idea that depression was caused by demons and evil spirits existed in many cultures, such as the ancient Greeks, Romans, Babylonians, Chinese, and Egyptians. Only a few Greek and Roman doctors believed depression was a biological, psychological illness. They used to “cure” depression with gymnastics, massage, diet, music, baths, and a medication containing poppy extract and donkey's milk.

Hippocrates, a Greek physician that lived from 460 B.C – 370 B.C, thought that depression was caused by an imbalance in four body fluids, called humors: yellow bile, black bile, phlegm, and blood. However, Civero, a Roman philosopher that lived from 106 B.C – 43 B.C, believed it was caused by psychological causes, like rage, fear and grief.

During the Common Era, treatments were very primitive and barbaric. For example, Cornelius Celsus (25 BC-AD 50) recommended starvation, shackles, and beating. Others still thought depression was caused by demons and exorcisms, drowning and burning were popular treatments of the time.

A Persian doctor named Rhazes (AD 865-925) recommended treatments like baths and a very early form of behavior therapy which included positive rewards for appropriate behavior.

During the Renaissance, some doctors were revisiting the idea of mental illness having a natural cause, not a supernatural cause. A book called “Anatomy of Melancholy”, written in 1614 by Robert Burnton, explained that depression had both social and psychological causes.

During the 18th and 19th centuries, depression was seen as a weakness that could not be changed. People who had depression were often locked up or shunned. During the later part of the Age of Enlightenment, doctors began suggesting that aggression was the root depression. Treatments such as exercise, diet, music, and drugs were recommended, and doctors said that it was important to talk about your problems with your friends or doctor.

Since then, treatments began evolving to where they are now. It is also said that these days, more people have depression. But is that really true? Opinions vary. While it’s mostly said that people are just less afraid to admit it these days, others think it’s because of that the modern lifestyle is more stressful. Stressful because of social media, peer pressure, financial issues, work, education etc.  What are your opinions on this matter?

 

7.    Sources.

 

https://www.allpsychologyschools.com/psychology/psychology-vs-psychiatry/
https://www.beyondblue.org.au/the-facts/depression/what-causes-depression
https://www.healthline.com/health/depression/effects-brain#6
https://www.healthline.com/health/depression/effects-on-body#2
https://www.healthline.com/health/types-of-depression
https://www.healthyplace.com/blogs/mentalhealthforthedigitalgeneration/2017/10/the-difference-between-being-depressed-and-having-depression
https://www.nami.org/Learn-More/Mental-Health-Conditions/Depression/Treatment
https://www.mayoclinic.org/tests-procedures/psychotherapy/about/pac-20384616
https://www.mind.org.uk/information-support/types-of-mental-health-problems/depression/self-care/#.XZ4KM0ZKjIU
https://www.nami.org/Learn-More/Mental-Health-Conditions/Depression/Treatment
https://www.nami.org/Learn-More/Treatment/ECT,-TMS-and-Other-Brain-Stimulation-Therapies
https://www.psychiatry.org/patients-families/depression/what-is-depression
https://www.verywellmind.com/who-discovered-depression-1066770
https://www.webmd.com/depression/features/antidepressant-effects#1

 

Written in October 2019.