Depression

Depression and You: A Turbulent Relationship

Depression isn’t as stigmatized as now as it was in the past. People are now waking up to the fact that depression is a real, indiscriminate, and sometimes debilitating condition that affects many people across the globe. The fact that it’s not just simply as a case of being sad. Hundreds of foundations and associations like Hope for Depression Research Foundation (HDRF), the Brain & Behavior Research (BBR) Foundation, the Anxiety and Depression Association of America (ADAA), and so much more have sprung up over the years. All of these foundations are dedicated to funding research in hopes of being able to learn more about depression (and similar mood disorders) and find medication to help more people who have it.

But what is depression? There are a ton of statistics that are thrown around and stuff, and I know people are pretty sad when they’re depressed. But what causes it? Why do people get depressed? Why can’t they get over it and just be happy? Is medication necessary? Why would anyone even think to kill themselves?

I’ll answer all of those and some more after the jump.

As always, if there is a conclusion or actionable steps, they will be found at the end of the article. 🙂


What Is Depression?

adult, alone, anxious
“I used the rest of the milk in the damn fridge and put the empty carton back in… I’m ready to make cereal now, but when I touched the milk carton… I knew my worst fear had been realized…”

Sadness and grief are apart of being human. You will sometimes experience things that evoke those feelings in you, like the loss of a loved one or the loss of a job. But under normal circumstances, these feelings tend to go away on their own in a short period of time without much intervention needed.

According to the National Institute of Mental Health (NIH), “depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities”.  You may not feel like doing any of the things you used to do anymore. You may have difficulty getting out of bed during the day or trouble going to sleep at night. You may overeat or undereat. You may call out of work more than normal and have difficulty managing your job when you do show up.

Depression is not just a day or two of the blues; it’s more than that. It is a persistent and overwhelming feeling of sadness that involves a loss of interest. If left untreated depression can lead to some pretty nasty consequences. At its worst, depression can lead to suicide; and at the moment, close to 800,000 people die every year because of it.

It is estimated that about 16 million adults in the US have had a major depressive episode in 2016, and about 350 million people worldwide. In my previous article that spoke of common mental illnesses among college students, we found out that about 1 in 5 students have depression. Additionally, in adolescents aged 12-17, there were 3.1 million children with at least one incident of a major depressive episode and 2.2 million that also had a severe depression-related impairment.

And unfortunately, while depression can be effectively treated, it cannot be cured. It is a condition with a high chance of recurrence, so instead the goal is remission. Which can very vaguely be defined as a positive state of being that takes into consideration the 3 foundations of wellness: symptoms, functional status, and pathophysiologic (in this case, the processes associated with depression) changes.

What Causes Depression?

Unfortunately, no one is exactly sure what causes depression. According to PsychCentral, “it is generally believed that all mental disorders — including clinical depression — are caused by a complex interaction and combination of biological, psychological, and social factors.” They went on to add that, “this theory is called the bio-psycho-social model of causation and is the most generally accepted theory among mental health professionals and researchers of the cause of disorders such as depression.”  As such, it is said that there are a number of factors that could be at play.

Hormones– A substance in you that sends signals to other parts of your body on what it should be doing, like growing more hair or telling you to go to sleep. The hypothalamus, in particular, regulates mood among other things. So, when your hormones become unbalanced, it can lead to depression. You can see this happen when women go through menopause or when they are pregnant. Or even when someone has an under or overactive thyroid.

A transparent skull model in a corridor
Typically, what you’ll see is in a patient who is depressed is that there are fewer lit areas of the brain as compared to a person who isn’t.

 

 

Biological differences– A study that the University of Edinburgh conducted suggests that depression physically changes the structure of the brain. According to Science Daily, in regard to the alterations to the white brain matter founds that, “a quality of the matter — known as white matter integrity — was reduced in people who reported symptoms indicative of depression. The same changes were not seen in people who were unaffected.” This is worrying because white matter is, “a key component of the brain’s wiring and its disruption has been linked to problems with emotion processing and thinking skills”.

Inherited traits & genes– This is a bit difficult to figure out because what we know singularly as “depression” may be made up of several different things with similar symptoms.  Also, there may be genetic differences between men and women. However, there is still some breakthrough research happening that will help to guide scientists to the answer.  Furthermore, there are some theories that vulnerability to depression may be inherited from first-degree family (like a parent or sibling).

Gut bacteria– According to this article on Forbes, scientists are starting to near a conclusion on the effect that gut bacteria have on the brain. Though we colloquially use the word “gut” to mean your stomach, it’s actually the small and large intestine. (Where do you think the term “bubble guts” comes from? ?) Within there are trillions of bacteria that make up its microbiome. A lot of these bacteria do wonderful and amazing things for your body, but scientists are also starting to believe that it may also affect your mood. Stress can affect and change the gut bacteria and in turn, put you at risk for depression later in your life.

Usually, people list a chemical imbalance in brain chemistry is one of the possible causes. And by people I mean, the people who advertise medication on TV, people online who are trying to demystify depression and its causes, and teachers and researchers alike. However, there have been a lot of articles in recent years that assert that it’s a really old theory that hasn’t been proven to be true. So, for now, until we get a bit more clarification on this, I’m going to leave it out.

Risk Factors

Here are some other risk factors that could possibly result in or manifest as a result of having depression:

Sex– As per Psych Central, ” It is estimated that one out of every four women and one out of every 10 men experience some type of depression during their lifetime. While women suffer from depression more often and attempt suicide more frequently, men are more successful in their suicide attempts. Women also suffer from unique forms of depression related to their unique biology and life experiences.”

Drug Abuse– Abuse of alcohol or other drugs can worsen or create depression in people.

Medication– There are tons of medications out there that can spur feelings of depression in people, like sedatives, high blood pressure medication, sleeping pills, stimulants (like Adderall), anticonvulsants, pain meds, and so much more. (This, however, should not be the reason you do not take your medication. Your doctor will monitor your symptoms as they show up and make adjustments as needed after weighing your options.)

Serious or Chronic Illness– Chronic illnesses like diabetes, cancer, HIV/AIDS, hyperthyroidism, multiple sclerosis (MS), or stroke can trigger depression in some people.

Stress, Grief, and Trauma– There are many serious and negative life events that can trigger depression in some people; in those are vulnerable, yes, but also in those who are not. The inability to cope with a prevalent problem, a long-term period of abuse or a particularly shocking even like death are something things that can trigger depression in people.

Low Self-Esteem– Certain personality traits can contribute to manifesting depression like low self-esteem, being too pessimistic, or too self-critical.

Different Kinds of Depression

Depression isn’t just one big monolith that doesn’t have any caveats for other more specific situations. There are a lot of avenues in which depression manifests; and while the overall symptoms can be generally the same, there are small but significant symptoms that make or break the different kinds of depression that there are.

While reading this, please resist making a diagnosis on yourself as that can be counterproductive and potentially dangerous. If you feel you may fall into one of these categories, please seek someone who can give you professional advice.

(Note: Please be aware that this is not an exhaustive list and there are some that I have left out. )

Major Depression (MDD)

Greyscale Photography of Woman Wearing Long-sleeved Top

Major Depressive Disorder, or clinical depression, is a severe disorder that affects mood, behavior, and physical functions. It is one of the most types of depression and the one that you might think of when you hear the word “depression”. You tend to feel depressed most days out of the week with a loss of interest in doing anything among other things. To be diagnosed with a major depressive disorder, you must meet the criteria in the DSM-V and present with 5 or more symptoms. (Symptoms can be found here.)

Persistent Depressive Disorder (Dysthymia)

Persistent depressive disorder (PDD) is similar to major depressive disorder. Formerly known as dysthymia (a low-grade persistent depression) and chronic major depression, PDD is a form of depression that last two years or longer. If you have persistent depressive disorder, you will have experienced prolonged periods of a low mood with an occasional bout of major depression. (Symptoms can be found here.)

Infant lying in a teal blanket being cradled by a woman with reddish brown hair

Postpartum Depression

After a woman gives birth to a child, her body releases many necessary chemicals and she is flooded with many different emotions. Pregnancy and childbirth are a beautifully traumatic (read: a tough experience for mind and body) event for one person to go through. So, it’s within reason that sometimes, women experience “baby blues”, a mild bout of anxiety and depression that clears up after a week or two after childbirth. However, there are instances where it goes well beyond that timeframe with the same or increased intensity. That is known as postpartum depression.

There is no exact cause for “baby blues” or postpartum depression, but doctors suspect that it’s due to the quick drop in hormones after delivery. This results in chemical changes in her brain that can cause mood swings. On top of everything else that comes with a new baby (mainly sleep deprivation), depression can manifest in some women. This is especially worrying because there have been cases of women hurting themselves or their baby due to it. Fortunately, there are more precautions taken to watch over and educate women who have recently given birth. (Symptoms can be found here.)

Psychotic Depression

This is a less common form of depression and can be a bit off-putting for the sufferer. It occurs in some 20% of people who have particularly severe forms of depression. Those who deal with this usually don’t start with any episodes of psychosis, though. Typically a few bouts of major depression will pass before it appears, gradually becoming more prominent with each depressive episode. You may be inclined to call this schizoaffective disorder or schizophrenia (two different things, by the way), but it is neither.

Psychotic depression primarily involves auditory or visual hallucinations or disturbing delusions that tend to have a “theme”. For instance, they could revolve around guilt, shame, or illness. These hallucinations and delusions seem incredibly real to the person experiencing it. There are many medications and therapies used to help patients with psychotic depression. However, the prognosis for this disorder is poorer than other forms of depression. (Symptoms can be found here.)

Seasonal Affective Disorder

You may have experienced this on a much milder scale. Whenever it’s cloudy or raining outside, the mood may feel more somber, eliciting a feeling of sadness in you. As opposed to the bright and happy feeling you get when the sun is out. Seasonal affective disorder, appropriately “acronymized” as SAD, is a disorder characterized by depression during the winter months and feeling fine in the summer months. Though, there are people whom the opposite problem affects.

SAD affects everyone but is more commonly found in women, those with a relative with SAD, people who live far from the equator, and those who are between 15-55 years of age. Typically those with seasonal affective disorder will withdraw from people, sleep more, and gain weight due to increased cravings for carbohydrates. (Symptoms can be found here.)

Bipolar Disorder

Bipolar depression is different from “unipolar” depression (basically, depression without “highs”). However, it is often included due to the bipolar depression that accompanies it. Bipolar disorder is characterized by mood swings that range from depressive lows to “manic” highs and it affects about 60 million people worldwide. There are four sub-categories within this larger one. They are bipolar I disorder, bipolar II disorder, cyclothymic disorder, and “other specified and unspecified bipolar and related disorders”.

People around you (and you, yourself) might feel like you’re an emotional rollercoaster and aren’t quite sure what to expect next. Those who have bipolar disorder experience really high highs (elated, energized, impulsive and promiscuous behavior, reckless spending, fast thoughts) and low lows (depressed, hopeless, too much or too little sleep, forgetfulness, slow). Sometimes a mood can have a little bit of both mixed in, known as an episode with mixed features. (Symptoms can be found here.)

Premenstrual Dysphoric Disorder
“Yeah… That’s… That’s, uh– hahaha– pretty damn accurate.”

 

Premenstrual dysphoric disorder is a relatively new addition to the DSM-V. If you’re a woman, there’s a good chance that you’ve experienced some sort of symptom associated with your period.  From breast tenderness to cramps to backaches and fatigue, periods are sometimes an exhausting time of the month for women. (I know it used to be for me before I gave birth.) Premenstrual dysphoric disorder is a severe, sometimes disabling extension to premenstrual syndrome (PMS). It typically shows up about a week before your period and lasts until maybe half-way through.

PMDD affects women in a way similar to those with a typical kind of depression and can be just as disabling. It leaves you feeling down in the dumps, contemplating things that don’t even make sense. It is severe and debilitating and keeps you from doing the things that you normally do. We, again, aren’t sure why this happens. However, studies have linked PMDD to lowered amounts of serotonin in the brain (a chemical that certain brain cells use to control mood). (Symptoms can be found here.)

How Can I Tell If I or Someone I Know Is Depressed?

Depression manifests in a number of ways as you’ve seen, so a good place to start is with your GP. They can screen you for the typical symptoms that accompany depression and give you a referral if necessary to see a specialist (a therapist, psychologist or psychiatrist).

If you want to know the signs of depression before you plan an unnecessary trip to your doctor, here are some common symptoms that come with depression:

Not everyone who had depression experiences all of these symptoms. The key is the persistence and severity of your problems. Especially if they have a tendency to interfere with your productivity or what have you throughout the day. If you think you have had 5 or more of these symptoms consistently and for most of the week for the past 2 weeks, definitely think about seeing a doctor.

Treatments for Depression

Even though as many people worldwide deal with depression as they do, much fewer (less than half and in some countries less than 10%) actually have their depression treated. “Barriers to effective care include a lack of resources, lack of trained health-care providers, and social stigma associated with mental disorders,” WHO says. “Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.”

Obviously, the safest course of action is to discuss these options with your doctor to see if it is a good fit for you.

Image result for treatment
“For Christ… As if this damn cuff wasn’t tight enough, here you come trying to amputate my fucking arm with your hand.”
Natural treatments

There are some natural treatments that can help to alleviate depression. I’ve spoken at length about some of them like having a good diet, integrating exercise into your life, meditation, expressing gratitude and socializing. Having a schedule is also something that I’ve found that helps people with depression and anxiety. This helps because it eases the burden of trying to figure out how to spend your time. You spend less time thinking about what to do and more time doing it.

Some people may suggest supplements like St. John’s Wort, but other than vitamin D which you can find in a multivitamin, I do not suggest supplements unless directed by your doctor. They are not regulated by the FDA and may not give you the result you’re looking for or, at worst, give you additional problems to deal with. It would just be easier and safer to be prescribed anything at the hands of your doctor.

Medication

I know sometimes people are a bit iffy on taking medications willy-nilly for one reason or another. Truth is that it’s OK to take legally prescribed medication if you need it. Sure, medications have side effects, but so do a lot of things in life that aren’t medication. The most important thing is making sure that calculated risks are taken, and your doctor will do that when taking your medical history before prescribing medication to you. As long as you follow your doctor’s instructions precisely, you can lower your chance of an adverse reaction. And even if there is, there are ways to correct it with minimal damage to you.

More often than not when people are experiencing a severe form of depression, they are given medication to help to lessen or get rid of the symptoms that you may be struggling with. Things like insomnia and decreased energy or concentration, are all things that can be alleviated by medication.  Which, in turn, can help you to comply with the treatment plan that your doctor has laid out for you. Remember, the number one key to success with remission is patient compliance.

Therapy

There are several forms of therapy. But we’ve only spoken about two, a counselor and psychologist; and they both use techniques like CBT, DBT, or IPT. There are way more people out there that can help you to deal with your depression. A notable role is a psychiatrist. A psychiatrist is a medical doctor who can prescribe medication to a patient. They spend a lot of time with their patients diagnosing and correcting mental illness. However, their main focus is the administration of medication in a healthcare team.

There are other types of therapy that don’t “involve people” per se, like electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). I’ll briefly explain them here, but here is a link to a more in-depth article. My explanations below will also be from NAMI.

Electroconvulsive therapy (ECT) is NOT about strapping your loved one down into Frankenstein’s stretcher and pulling the lever to have a huge volt of lightning strike your brain. These are very controlled and short electrical impulses that are sent to your brain. ECT does have some side effects like memory loss, however.

Repetitive Transcranial Magnetic Stimulation (rTMS) sort of sounds like a super-secret government project, but I can guarantee you that it’s not. rTMS is a relatively new type of brain stimulation that uses a magnet instead of electrical impulses to activate the brain. However, it is not as effective as a maintenance treatment.

Resources

This article is getting really long (again, lol), so I’ll just leave a few links here that you can check out on your own time. Each link has a bevy of resources within that can help you in your time of need.

https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition – This is for helping people learn to deal with their mental illness.
https://psychcentral.com/lib/telephone-hotlines-and-help-lines/ – This is a website with various hotlines and helplines in times of emergencies.
https://www.everydayhealth.com/depression/guide/resources/ – This link contains coping advice, organizations, and the financial aspects surrounding mental illness.

Conclusion

As you can see, depression isn’t a one size fit all kind of deal. There are tons of nuanced things that are involved and can make or break the treatment for a person. It is imperative that anyone who feels as though they are suffering from depression go an see a healthcare professional. Or if you feel like someone you know or love is going through it, try your best to explain to them that seeing a doctor is so important; especially in the early stages.

There is no shame in admitting that you have depression. There is no shame in getting help. If you can afford the care, please get it. Despite the current atmosphere on the subject, it is getting better with time, advocacy, and attention brought to it. Right now, if you are dealing with this, you just need to work on getting the help you deserve.


I hope this article was helpful in teaching you about the many different aspects of depression. I think people have this idea that depression is just being really sad in the corner, but it can always be way more than that. And those differences are what makes everyone’s type of depression unique.

Also, sometimes it’s a bit hard trying to make issues like this entertaining because of the seriousness of it. Hopefully, you can appreciate the light-hearted jokes in some of the pictures’ captions. Anywaysssssss~

Peace and peace,

Althia.

 

Hi, I'm Althia! I love psychology have a particular obsession with promoting mental health. That being said, I have one specific goal that I want to achieve. I want to help millennials to finess mental illness and inspire personal growth one motivational & informational post at a time.

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