What is depression?
Depression is a mood disorder characterised by feelings of sadness, apathy, loss, irritability, and hopelessness. It is a common condition that can cause various emotional and physical issues and affect the capacity to function in daily life.
Depression affects women more than men, and it can develop at any age, although it is most common between 15 and 45 years old. The symptoms can vary depending on the person’s age: young people often show behavioural symptoms, whereas adults suffer more from somatic symptoms.
Specific individuals are more prone to suffer from depression. For example, perfectionism, excessive sense of responsibility, duty or respect, low self-compassion, low tolerance to failure, and rigid mindset are characteristics of susceptible people.
Another essential characteristic is the need for control and the low tolerance to uncertainty. People prone to depression desire to know what is going on at all times. They need a routine and struggle with improvising.
The causes of depression are varied and complicated, including multiple possible factors. Imbalanced biochemistry is important, as people with depression tend to show high levels of the hormone cortisol and the neurotransmitters serotonin, dopamine, and noradrenaline in the brain.
Some factors that can contribute to the development of depression are:
- Family: from one side, high levels of these substances can be inherited. On the other side, sharing the same environment with someone suffering from depression can affect children living in that same environment.
- Events: events such as emotional losses can change the biochemistry of the person and cause the disorder. It is possible that these changes trigger depression not immediately but later in time. Other factors that can trigger depression are losing a job or the perception of being unable to adapt to changes or solve problems.
- Other diseases:
- Chronic diseases: people with chronic illnesses, both mental and physical, have a higher risk to develop depression.
- Heart disease
- Endocrine disorders: such as diabetes, hyperthyroidism, Cushing syndrome, Addison disease, or hyperprolactinemia can increase the risk of depression.
- Panic attacks: individuals, especially men with a history of panic attacks, have a higher risk of developing depression.
- Migraine: migraines and depression are associated. People with depression are more likely to suffer from migraines, and people with migraines are more likely to suffer depression.
- Alcohol and tobacco consumption
Depression is characterised by low mood and apathy during periods longer than two weeks. The symptoms can include:
- Affective: sadness, anxiety, irritability, despair, guilt, incapacity to experience joy or suicidal thoughts.
- Cognitive: problems with attention, memory, and decision-making.
- Somatic: tiredness, changes in hunger and weight, insomnia, sexual dysfunction, stomach issues, agitation, etc.
Types of depression
Major depressive disorder
Major depressive disorder presents a variety of symptoms that interfere with the individual’s capacity to work, study, sleep, eat, or enjoy activities that are enjoyable in normal circumstances. People with this type of depression tend to suffer the condition once, but they can relapse after recovery.
Persistent depressive disorder (dysthymia)
Persistent depressive disorder is a state of chronic depression that shows the same physical and cognitive symptoms as major depressive disorder but is less acute and long-lasting. The symptoms persist in the long-term, for at least two years in adults or one year in children and adolescents.
Bipolar disorder, also known as manic-depressive disorder, is characterised by manic episodes and depressive episodes. During the depressive episode, the person affected can show some or all the symptoms of the major depressive disorder.
During the manic episode, the person can feel highly energised, hyperactive, and talkative. Sometimes this can impact the person’s thoughts, judgment, and social behaviour, and if not treated with medication, it can lead to a psychotic crisis. Sometimes bipolar disorder’s symptoms can be mistaken with schizophrenia, as in both cases, there can be paranoia, delusion, and psychosis.
As the NHS explains, “many people who have given birth will experience mild mood changes after having a baby, known as the “baby blues”. This is normal and usually only lasts for a few days”. In the case of peripartum depression, the mother can suffer deep sadness, insomnia, and irritability.
The causes of this depression are not clear, but it can be the stress and hormonal imbalance produced during pregnancy and after labour. The female hormones are high during pregnancy, but they drop after childbirth.
In some extreme cases, the mother can suffer post-partum psychosis, where the mother can experience hallucinations, delusions, and a manic mood.
The history of the patient is essential for getting a diagnosis. It is essential to know when the symptoms started and their duration, if there is an abuse of drugs and alcohol, and if they have had suicidal thoughts or tried to commit suicide in the past. It is also important to analyse the speaking patterns, thoughts patterns and possible problems with memory.
To diagnose depression, some of the symptoms should be present for at least two weeks before starting any treatment. One symptom should be a mood change, loss of interest in pleasurable activities, or the loss of capacity to enjoy.
The treatment for depression includes medication and psychotherapy. They can be used independently, or they can complement each other. When the condition is severe, there is another available treatment: electroconvulsive therapy (ECT).
In most cases, medication is needed. Antidepressants are used to correct the levels of neurochemicals in the brain, especially serotonin, a chemical that transmits information in the areas of the brain that control emotions, hunger, blood pressure, body temperature, or sleep hormones. The antidepressants act by increasing the levels of serotonin in the brain.
There are several types of antidepressants, and each of them increases serotonin levels in different ways. It can take between three to six weeks to have an effect, but each person is different, and it can happen that one specific tablet doesn’t have the desired effect in one patient. Hence, trying different tablets or doses might be necessary before finding the treatment that works for the individual.
The most common side effects of antidepressants can include insomnia, sexual dysfunction, nausea, weight gain, or nervousness.
Psychotherapy is a talk therapy that can be used on its own, especially in mild to moderate depression. Cognitive-behavioural therapy (CBT) is the type of therapy that has been proven most effective for depression.
CBT focuses on the present and reframing the thoughts of the person with depression, and his cognitive distortions. It helps the individual be aware of the type of distorted thoughts he is having, challenge them, and change them for others more accurate and realistic. Within CBT, an important technique for severe depression is called behavioural activation. You can read more about therapy for depression.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy is a medical therapy used when the patient can’t take medication, the medication taken is not helping enough, or when the risk of suicide is high.
The American Psychiatry Association explains that ECT involves a brief electrical stimulation of the brain while the patient is under anaesthesia. Patients usually receive ECT two to three times a week for a total of six to 12 sessions.
The person’s environment is vital to achieving recovery, and the compassion and empathy of the person’s loved ones is a key factor. Their patience is vital, as the patient lacks motivation and desire to perform any action, which can trigger people’s frustration. Suggesting and not commanding activities and recommending instead of imposing conversations are essential support that can make a difference.
- What is CBT?
- More information and resources for depression – Rethink
- Tips for coping with depression – NHS
- Self-care for depression – Mind
- Information for parents – Youngminds
- Self-help guide for mild depression – NHS
Other psychological issues
- What is behavioural activation: a treatment for depression
- How to stop ruminating thoughts: tools used by therapists
- Problem-solving methodology: the solution focus approach
- 8 strategies to overcome the negativity bias
- CBT techniques: tools for cognitive behavioural therapy
- What is a behavioural experiment and how to perform one?
- Cognitive defusion techniques and exercises