Understanding Depression

You don’t feel pleasure anymore, you're tired, you feel sad and you cannot motivate yourself to do something.

For a lot of people these symptoms are recognizable, you feel down. Depressive periods are normal, particularly when a person faces tough personal issues, unemployment or relationship problems. However, if the depression continues for several weeks it may be a sign of a more prolonged and serious illness.

Several factors may contribute to depression. Studies show that both 'biological' and environmental factors play a role in depression. Hereditary factors play an important role in the onset of depression, although even 10 years on from the Human Genome Project, the exact genetic causes are still unknown. Science often talks about the ]importance of certain chemicals in the brain like serotonin, growth factors such as BDNF or an imbalance of brain activity between the right and left frontal cortex. On the other hand it is also known that severe emotional or traumatic experiences or emotional neglect over a person's history may increase the risk of depression. Below you will find more details on what depression is, its symptoms as well as possible causes.


What is Depression?

Depression is one of the most widespread mental illnesses and is distinguished from "normal" sadness by the nature and duration of symptoms. For it to be called a 'disorder' at least 5 out of 9 total symptoms would be present for more than two weeks which would include at least sadness and / or loss of interest or pleasure. It is said that women are two times more likely to have depression than men. Although it is more prevalent in women, the duration and recurrence rate is equal in men and women. According to the World Health Organization, around 350 million people suffer depression worldwide. Around 1 in 7 people will experience depression in their lifetime.

Not all depressive episodes or negative feelings are a mental disorder. It is normal for our emotions to fluctuate and to experience short-term periods of sadness from time to time. Depression, on the other hand, can be more difficult to overcome. It also has nothing to do with personal weakness or defects. It is a serious mental illness which people of all ages suffer. More than half of people with depression experience difficulties functioning socially. This may be reflected by increased absenteeism from school or work, fewer social contacts, poorer relationships with partners or family. In many cases depression leads to temporary or permanent inability to work.

Clinical Depression

Clinical depression is a mood disorder that is characterized by a loss of life pleasure or a heavily depressed mood. When depression is not treated in the right way it may worsen and can be life-threatening.

Clinical depression must meet certain criteria as defined in the DSM-IV, the diagnostic manual for psychological disorders.


Symptoms of Depression

Psychological Symptoms

  • Depressed mood: sadness, depression, hopelessness, sometimes mood is worse in the morning
  • Tiredness, loss of energy, initiative and strength
  • Feeling: fear is often a characteristic feeling of depression although sometimes emotions are flat and the person is not able to feel anything: no sadness, joy, fear or happiness.
  • Thoughts of guilt, self-blame, worthlessness and loss of self-respect

Behavioral symptoms

  • Social withdrawal, loss of interest in surrounding
  • Loss of willingness to have fun and participate in activities
  • Physical agitation or even inhibited behavior
  • Reduced productivity
  • Suicidal thoughts / tendencies
  • Emotional episodes, excessive crying

Psychotic symptoms:

In 10 to 15% of cases of depression there are psychotic features whereby the person has an altered perspective of reality. This manifests itself as a psychotic depression and the person usually experiences delusions (incorrect thoughts). Often the content of those delusions are in accordance with the depressed mood: the themes are dominated by personal shortcomings, failures, guilt, death, penalty or nihilism.


What are the types of Depression?

There are different types of depression. A unipolar depression is characterized by someone feeling down for a long period of time. Bipolar depression is characterized by alternating periods in which a person feels depressive periods and subsequent periods of energy and activity.

The World Health Organization estimates that 350 million people suffer from depression worldwide. 

Some facts about depression:

  • It is the second largest cause of death after heart disease and it has been shown that depression is a major contributor to coronary diseases
  • Depression is twice as common in women than in men and is most common betwee the ages of 25-45 years
  • Less than 30% of people with depression feel a reduction in symptoms by taking antidepressants such as Paxil (paroxetine), Effexor (Venlafaxine), Cipramil (Citalopram), Remeron (Mirtazapine) or Doxepin.
  • Depression causes more absenteeism from work than any other disorder
  • Globally, depression ranks fourth on the list of the most common diseases.

What causes Depression?

It is difficult to give one cause for depression as it is often a combination of several factors, as outlined below:


Biochemical factors

Research has shown that depression is a disturbance in the balance of certain substances in the brain (such as serotonin, norepinephrine and growth factors such as BDNF). However, recent research also shows that this is more complex than just a reduced serotonin level. Also, recent research has shown that depression is associated with a specific pattern of disturbed brain activity as well as the extent to which certain areas of the brain communicate. Treatment with rTMS is specifically aimed at restoring communication between brain regions (e.g. dorsolateral prefrontal cortex, anterior cingulate).

Light

A specific form of depression is associated with shortened daylight, called Seasonal Affective Disorder (or SAD) which is mainly caused by light deficiency. Light therapy can be used to prevent this kind of depression.


Biogenetic factors

Genetic components also play a role in depression. Children of parents with depression are three times as likely to also experience depression as compared to children of parents who have not had depression.

Psychosocial factors

Major life events such as divorce, death, resignation, promotion or the arrival of a child can play a significant role in the development of depression. These are events that can evoke a lot of tension and stress.

Often depressive episodes can be alleviated through a healthy and active social life. Stable employment, stable relationships and frequent contact with friends, particularly those who are supportive,  often give a person a form of a social safety net for better stability and life-structure.

Psychological factors

Blocking painful feelings and thoughts through unprocessed traumatic (childhood) experiences can increase the onset of depression.

Organic factors

Certain medications and different types of drugs (some high blood pressure medications, sedatives, alcohol, amphetamine, cocaine) are known to be a possible cause of depression. There are also a number of physical disorders which increase the risk of depression, such as stroke.