Depression is a topic many people have an opinion on. Often-times, the opinions are not flattering. Many people believe that depression is simply feeling a little down. Others claim that all a depressed person has to do is to try a little harder in order to feel better. These opinions could not be further from truth. There are various types of depression and it is not simply a bad mood or a phase that one is going through. It is a mental illness, a problem and needs to be taken seriously.

Satiric comparisons of depression to physical illness are not there simply for laughs. They indeed are rather accurate in their depictions. A person suffering from this illness cannot get out of bed, because they do not have the required energy to do so. They may want to commit to some plans, but find themselves unable to do so. Depression interferes with a person’s daily functioning and affects their lives negatively. Luckily, the 21st century offers many treatments and ways to help people who suffer from depression. However, before talking about cures, let us talk about the very basics of this illness.

What is Depression?

When people hear the word depression, often-times, they imagine a singular illness. However, it can be used as an umbrella term for different types of this serious mood disorder. Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) recognizes several depressive disorders. The 5th edition in particular lists the following: disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, unspecified depressive disorder (American Psychiatric Association, 2013). However – as it has been stated above – when mentioning the word depression, most people commonly refer to major (also, known as clinical) depression. Therefore, this is the type that is going to be written about in this article.

It should also be noted that one’s culture plays a part on how seriously depression will be taken and what stigma shall be associated with it. Some cultures do not even have the concept of this illness. Rather, when one is depressed they refer to themselves as sick and in need of medical attention. This, if one takes all the symptoms into consideration, is not exactly an erroneous statement.







What are the Common Signs/Symptoms of Depression?

The first association with depression is sadness. However, it does not have to be so. Some people with this illness do not experience sadness, but other emotions. Oftentimes, it is feeling empty or numb. Although, it should be noted that symptoms can be both emotional and physical. The U.S. Department of Health and Human Services states that if signs of this mood disorder last for more than two weeks, there is a chance that one is suffering from depression (2015). However, some symptoms of this illness are more common than the other and can be experienced due to many other causes. Such causes can be grief or loss. Therefore, to be diagnosed with depression, one has to show at least five signs over a two week period (Borrill, 2000). So, what are the symptoms?

There are many signs of depression. They can include sad or hollow moods, pessimism, hopelessness, guilt, helplessness, feeling worthless, losing interest in activities that once brought joy, decreased energy, issues with memory, concentration, and making decisions, disrupted sleeping cycle, changes in appetite and/or sex-drive, thoughts of or attempts of suicide (U.S. Department, 2015). It is important to observe these symptoms once they appear. They could be because of a certain event that one is going through or they could be a sign of something more serious. The top warning signs are a depressed mood throughout most of the day and loss of interest in hobbies.

A mistake that many people might commit is to compare their symptoms to those of someone else. They may think that because their own signs are not as severe as another’s then they are most likely fine or coping better. However, this does not have to be so. Different people have different thresholds of how much they can handle and cope with. Someone might experience mild bouts of depression every other season, like in seasonal affective disorder. While, other people might have a more severe long-lasting depression. The crucial sign is: if it does not feel like something one can handle or if it lowers one’s quality of life, then it requires attention.

What Causes Depression?

Depression is a rather complex illness and there is not a singular leading cause that shall guarantee the onset of this mood disorder. However, there are several explanations as to why it might occur. WebMD lists the following causes: physical, sexual, emotional forms of abuse, certain types of medication, various conflicts, death or loss, genetics, major events (even positive ones), other personal problems, serious illnesses and substance abuse (2016). These are not the sole causes behind this illness and some people might have a completely different reason that shall lead to depression. For some, a combination of the stated-above causes may lead to being depressed. This is why it is important to monitor oneself and know one’s limits, resilience and emotional threshold. All these factors may help recognize the first signs of depression. However, a neurobiological explanation behind the cause of this mood disorder needs to be discussed as well.

Depression is not all, colloquially-spoken, in one’s head. It is because of a disrupted brain functioning. Scientists have noted that people who suffer from depression have a smaller hippocampus (part of the brain responsible for storing memory) than those who are healthy, which means lesser production of serotonin (WebMD, 2016). Serotonin is one of the feel-good hormones that are produced when one is in high spirits, as are oxytocin and dopamine. An average adult produces only five to ten mg of serotonin to please all those needy 40 million cells in the brain (Boyden, 2017). Any lesser amount shall result in an imbalance that will affect the human mind. However, some people are born with a smaller hippocampus (reasons to this are not known, yet). Thus, this makes them more prone to developing depression than other people are.







It should be noted that hippocampus and serotonin are not the only factors that cause disruptions. Harvard University states that the amygdala (responsible for emotions) and thalamus (plays part in sending sensory information to the appropriate parts of the brain) also play a large role in depression, as does norepinephrine and dopamine, to name the very few (2009). This illness is extremely complex; therefore, there are still many areas that require further studying and research. Causes behind depression are one of those areas that require further investigation.

What Treatments are Available?

To decide on treatment, all factors have to be considered. A person’s age, gender, severity of the illness, possible causes, other health issues and personal background has to be taken into account. There are many different treatments available for people with mild, moderate or severe depression. Many types of antidepressants are available as well as different types of one-on-one or group therapies and mindfulness trainings. However, if the depression is suspected to be mild, one can turn to self-help books or even something as simple as social support. Saisan, Smith and Segal (2017) state that exercising, receiving support, a healthy diet, getting enough sleep and reducing stress can make a whole difference to someone with mild or even moderate depression. However, for those who are suffering from a severe form of the illness hospitalization may be required in order to monitor the person and make sure they are safe. These people might also receive electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS).

Many people might associate ECT with typical Hollywood movie scenes where patients are strapped to a table against their will and given strong electrical currents as a form of punishment. However, that is not what happens in today’s hospitals as they are done with the patient’s consent. The purpose of ECT is to send currents of electricity to provoke a set of convulsions in the patient, like in an epileptic fit. While ECT is banned in some countries, others allow it to be practiced. It is recognized as a form of treatment and has been observed to cause some improvement in treating severe depression.

TMS is another form of treatment that can be used to cure depression. Nall (2016) states that it “involves using a magnet to target and stimulate certain areas of the brain” and can last from half an hour and up to a full hour. An electromagnetic coil is held up to the patient’s head and magnetic pulses are passed to the area of the brain that is responsible for mood regulation. It stimulates brain cells in a way that can reduce symptoms of depression.

Who Can Help You and How?

The question of who can help, once again, depends on the symptoms, severity and on the person themselves. What one may find helpful can be seen as completely useless to another person. However, it is, generally, a good idea to find support within the circle of friends or family or any other person one can trust and rely on. For some people, words of support, love and knowing that they have a support group is enough to feel better. Of course, if one seeks help in a form of intervention, then it is a good idea to find a qualified psychologist or a psychiatrist.







While both these professionals could help patients with overcoming depression, a psychiatrist’s education is a lot more medical than a psychologist’s. Thus, a psychiatrist would be more likely to prescribe antidepressant drugs. This is something a psychologist legally cannot do in some countries, at least not with the written permission of a psychiatrist.

Trained professionals shall asses a patient by asking them questions about their symptoms, their background information, past experiences and anything else that might paint a bigger picture of what their patient is currently going through. Some may hand out questionnaires to be filled out that shall test the severity of the illness. Based on all the information collected, a preferred treatment shall be chosen.

Many people do not wish to visit psychologists or psychiatrists for help, because of the stigma that it carries. However, it does not make a person lesser or superior to any other, just because they are getting professional help. Visiting either of these trained professionals is the same as visiting a general practitioner. There is simply nothing about depression that psychologists or psychiatrists have not heard before. This topic is extremely common and they have heard it all before during their studying and training. All information shall be confidential as it is illegal for psychologists and psychiatrists to share it with any other person (even their own spouse) unless the patient poses a threat to themselves or any other person.

Medication, CBT, or Both?

Many argue whether drugs, therapy or a combination of both is the correct way to treat depression. Truth is there is not a straightforward answer to that question. It really depends on the person as different people will respond differently to various treatments. Let us briefly discuss both options.

Antidepressants are important to treating depression. They may lift the symptoms and prevent the illness from returning. There are different types of this medication that can be separated into several groups. PubMed Health (2017) names the following groups of antidepressants: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), selective serotonin noradrenaline reuptake inhibitors (SSNRIs), alpha-2 blockers, monoamine oxidase (MAO) inhibitors, selective noradrenaline reuptake inhibitors, selective noradrenaline/dopamine reuptake inhibitors, melatonin receptor agonists and serotonin 5-HT2C receptor antagonists. The way antidepressants work is by increasing the amount of chemicals in one’s nerve cells that are necessary for healthy nerve connections. The medication is normally taken daily and the course is usually continued for up to nine months after the symptoms of depression disappear to prevent relapse (PubMed Health, 2017). Some people will have to use medication for much longer than others. It all depends on their personal progress and how quickly the symptoms disappear. However, the issue with antidepressants is that they cannot be prescribed just to anyone. Two people with different severity of depression cannot and should not receive the same drug. This is not the same as treating cold with Nurofen. Antidepressants are suitable only for those with severe depression as these patients will find them to be most effective. The more serious the condition, the more the medication helps.

Cognitive behavioural therapy (CBT) is another form of treatment that many scientists favour. It has gained so much popularity because it is one of the most effective forms of psychotherapy and has been known to alter brain structure (Folk & Folk, 2017; Porto, Oliveira, Mari, Volchan, Figueira & Ventura, 2009). CBT was developed in the 1960s and is a talk therapy that focuses on problem-solving and achieving milestones in order to reach a desired solution. Martin (2016) explains that the aim of this type of therapy is to change a person’s attitude and behaviour by targeting the cognitive processes (thoughts, images, beliefs, etc.) that one uses in order to cope with emotional issues. Normally, weekly sessions with a trained professional that last 50 or 60 minutes are taken. They focus on understanding a patient’s issues and developing new strategies for coping with them. What is especially useful about CBT is that the principles developed during therapy are something the patient can use during their lifetime. Whenever a familiar issue arises, one can use learnt CBT coping techniques to overcome their problems. Martin (2016) states that CBT combines psychotherapy and behavioural therapy; the former focuses on recognizing the importance one places in personal meanings on things and the latter – the correlation and causation between thoughts and behaviour. Thus, CBT is very personal and is often tailored to each person’s individual experiences, thought processes and temperament.

Lastly, what about a combination of both? Is it good to use both CBT and medication? Again, this depends on the individual and their severity of depression. For example, if both the treatments are used simultaneously for curing mild depression then, most likely, it will lead to more harm than good. However, if CBT and medication are used simultaneously to treat a person with a severe form of this illness, it might work rather well. As was stated earlier, the more severe the form is the more likely antidepressants shall successfully work. While, CBT had always been a favoured type of therapy chosen to approach various problems and treat them. This reputation is what makes it a preferable treatment for people who do not want to take medication for treating their depression. Therefore, it depends on the patient and the severity of their illness.







Real Life Examples

Unfortunately, depression can claim lives. World Health Organization (WHO) states that over 300 million people worldwide are affected by this illness and as many as 800,000 shall claim their life every year (2017). This is due to the fact that depression can and will control a person’s mind-set, causing them to believe no one shall care if they are gone tomorrow, not even their loved ones. Year 2017 was notorious for the amounts of deaths that occurred and some of these deaths were caused by suicide.

The two lost lives from that year that most can name are the ones of Chris Cornell followed shortly by the lead singer of Linkin Park – Chester Bennington. Both men had fought battles with depression and, in the end, lost to it. Chris Cornell had a history of drug abuse while Chester Bennington was a victim of sexual abuse in his childhood. Other examples of famous people committing suicide because of depression could be those of the band’s Nirvana’s Kurt Cobain and Robin Williams – comedian and the voice of Genie from Aladdin. It may sound strange to some that a comedian – a person who is a master of laughter shall take their own life. But this only displays the seriousness of this illness and the affect and power depression has over people.

Is it Totally Curable?

Depression cannot be seen, it does not have a visible red flag that one can spot and figure the rest out. Oftentimes, people who are depressed try their best to act in a way that shall not give away what is bothering them in fear of burdening someone else with their issues. This is why it is important to monitor patients even when they seem to be doing better or are cured of their illness. However, is depression fully curable? To answer that question it is important to discuss relapse.

After the symptoms of depression disappear, there is a chance of relapse – sudden return of the symptoms. Gotter (2017) states that this can happen to as many as 50% of patients and, usually, can happen after at least four months of being depression-free. If one relapses, it is important they return to their therapist and work on treating this illness again. This will not be seen as a failed attempt at treating depression, it is simply something that happens (especially if treatment is stopped abruptly). A good therapist will only appreciate if their patient returns to inform them of their relapse. Because the danger of relapse is this: if one relapses for the first time, they have a higher chance of relapsing for the second time. Hence, if one relapses for the second time, they have an even higher chance of relapsing for the third time. It is important to keep symptoms of depression as low as one possibly can. This is because, for now, there is no end-point of treatment and no specific cure that exists for depression (Marano, 2003). At this point, all that can be done is to eradicate the symptoms to the exact minimum. Patients should be taught how to, colloquially-spoken, self-help and keep their symptoms at bay just like they have been doing with the help of the therapist.

New Undergoing Research

Scientists do not stop researching the topic of depression. There is, indeed, a lot to research and understand in order to find a long-lasting solution. As was stated in the Causes section of this article, the reasons to developing depression are not really known. They are estimated, yes. It is known what is most likely to lead to developing this illness in individuals. But what happens when two people with the same background go through the same level of adversity and only one of them develops depression? It is necessary to delve deeper and focus on neurological causes, to study the brain in further detail. It is only once the causes are thoroughly researched that the next step of finding a cure that fully eradicates depression can be taken.

However, such step has been taken recently. Nield (2017) states that it has been found that there is a link between depression and the structure of white matter within the brain. It is reduced in people who are suffering from this illness; therefore, procession of thoughts and emotions is impaired. This discovery can help in developing new treatment. However, plenty more research needs to be done in order to understand depression.

References

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