Doesn’t everyone get depressed at some point?
No, not everyone gets depressed. Sure, everyone has bad days, and feels sad and lonely from time to time. Everybody goes through periods when they are not completely satisfied with how their family, career, or other aspects of life are progressing. But that’s just life, and not the same as clinical depression.
What does it feel like to be depressed?
People with depression often describe an overwhelming sense of emptiness or lack of joy. Many men report that they feel constantly agitated or angry and cannot control these emotions. Often men (just like women) experience a sense of sadness accompanied with uncontrollable bouts of crying. Others report feeling on edge and a sense that something terrible is about to happen.
Many depressed people become preoccupied with thoughts of their own death, whether or not they have plans to act on them. Men frequently have unexplained physical pains such as sore backs, stomach problems, sleep difficulties and other aches. Others say that they feel absolutely nothing, and that life has no meaning. People often report an inability to concentrate, “think straight” or make what were once routine decisions.
What causes depression?
Just like every other complex health issue, depression has many associated causes. For those who get depressed there are usually many factors involved. People who live with chronic stress or who have experienced a traumatic event are more prone to depression. Individuals who tend to think about life and its events in a negative or pessimistic manner have higher rates of depression.
For others there might be a genetic link, as depression tends to run in families. The environment someone lives in can put them at a greater risk for developing depression, too. Other factors associated with the onset of depression include but are not limited to:
- Brain functioning
- Brain structure
- Drug and alcohol abuse
- Some prescription medications
- Other chronic illnesses (e.g. diabetes, heart disease)
- Ongoing sleep difficulties
- Lack of social support/network
- Ongoing marital or relationship difficulties
“The mechanisms of complex disorders such as depression cannot be defined by simple etiological models. With burgeoning neurobiological information, it is evident that depression is a disorder of multiple neurobiological systems involving molecular, cellular, neuroanatomical, neurochemical, neuroendocrinological, neurophysiological, and neuropsychological domains mediated by multiple etiological factors including genetic vulnerability, developmental insults, and psychosocial stressors.”
–Risk Factors in Depression, 2008. Keith Dobson and David Dozois
FACE IT TALKING:
Depression is really complex, it has multiple causes, and we have a lot more to learn about why it happens. At this time it seems highly unlikely that researchers will find one magic cause or cure for depression. There are simply too many factors associated with it. How or why you came to suffer from depression should not be a factor in your decision to face it. For now, forget the hows and whys, and simply get the help you need.
Is depression caused by a chemical imbalance?
It is misleading and inaccurate to attribute the onset of depression solely to a chemical imbalance. At the same time, it is inaccurate to say that there is no such thing as a chemical imbalance associated with depression, as Tom Cruise did with Matt Lauer a couple of years back.
One of the factors associated with depression is the way in which our brains manage certain “chemicals” known as neurotransmitters. Scientists have studied closely the connection between depression and serotonin (a neurotransmitter) and depression and norepinephrine (another neurotransmitter). These researchers have established associations but cannot definitively say that these two chemicals are at the root of the onset or maintenance of depression.
In addition, researchers have looked closely at the role cortisol, the hormone associated with stress, plays in depression. The research has established connections between the onset of depression and chronic stress. This connection might be explained by the way in which the body regulates and uses cortisol.
“Research reveals the mere deficiency of the biogenic amines is insufficient for the development of depression. Also, traditional antidepressant medications, which primarily target norepinephrine and/or serotonin neurons, are ineffective in approximately 40% of patients with MD or dysthymia.”
–Update on the Neurobiology of Depression, 2000. Sadek and Nemeroff
FACE IT TALKING:
If depression were caused by a chemical imbalance alone, a much higher percentage of individuals with depression would respond positively to the use of antidepressants. But to say there is no connection whatsoever between depression and brain chemistry doesn’t explain the number of individuals with moderate to severe depression who respond well to an antidepressant. What is evident is that we have more to learn about the brain and how neurotransmitters, hormones, and other brain chemistry impact our moods.
Are there different types of depression?
Yes. The term depression is often used as a catch-all for an entire spectrum of symptoms, ranging from mild to moderate to severe. When you hear the about depression in the media, Major Depressive Disorder (MDD) is usually what they’re referring to.
MDD is a very debilitating condition characterized by a distinct set of symptoms, which:
- Are present for at least 2 weeks
- Are not the result of a medical condition
- Represent a change in a person’s functioning
- Include either a depressed or sad mood and/or a loss of interest or pleasure in most activities
Other types of depression include but are not limited to:
- Bipolar Disorder (previously known as Manic Depression)
Bipolar disorder occurs when an individual suffers from both depressive episodes and manic episodes. A manic episode can be identified by an elevated sense of self-importance, a significantly decreased need for sleep, rapid speech, grandiose thoughts, excessive spending, gambling, shopping or other high-risk behaviors such as sex with strangers.
A manic episode might also include a flight of ideas, an increase in goal-directed behaviors (often social- or employment-related). These manic symptoms usually last for at least 1 week.
- Dysthymic Disorder
This is a chronic type of depression similar to MDD, but which does not meet all the criteria for MDD. Dysthymia is thought of as a chronic, lower-level depression. But this definition is tricky, because individuals with Dysthymia struggle with work, family, friends and relationships just like individuals who have MDD or Bipolar Disorder.
- Seasonal Affect Disorder (SAD)
SAD is a type of depression more common in individuals who live further north of the equator, and who are not routinely exposed to sunlight. SAD tends to have its onset in October/November, be the worst in the winter months, and generally lifts in April/May. SAD is a serious condition and should not be ignored. If you experience predictable downturns in your mood during the winter months, you should talk with a doctor or mental health professional about SAD.
Do I have to take an antidepressant?
The decision to take an antidepressant is an important one to discuss fully with your physician or mental health professional. When debating whether or not to take an antidepressant, be aware of these facts:
- Antidepressants can cause serious side effects. Before starting an antidepressant, make sure you understand the potential side effects and pay close attention to how you react to the medication. If you experience increased states of agitation, thoughts of suicide or anxiety, contact the professional who prescribed the medication immediately.
- The prescribing of antidepressants is not an exact science. For many people, the first medication or dose level they try doesn’t work. Other people respond well to the first attempt. If you aren’t responding to a medication as hoped, and your doctor wants to up your dose or put you on additional medications, be sure to ask why. Don’t passively accept these changes in your medications without understanding the rationale and the plan.
- In order for an antidepressant to work, it must be taken as prescribed. For someone who is depressed, it can be difficult to remember to take the medication every day. And you may want to stop taking your antidepressant abruptly because you feel better. But this can be dangerous. Before discontinuing an antidepressant, consult with the doctor who prescribed it.
- Realize that antidepressants, even if they are very effective for you, are often only one part of your treatment program. Other approaches for dealing with depression include managing your sleep, exercising, eating a healthy diet, socializing, staying engaged in activities, improving your skills in managing stress, and going to counseling. All of these things are just as important as a good medication. Depression is a multi-faceted problem. Your treatment program needs to be multi-faceted, too.
What is the point of going to counseling for depression?
One of the hallmarks of depression is a negative, pessimistic and self-defeating thought patterns. Depression makes it difficult for individuals to be objective about themselves, their world, the future and those they interact with. Counseling can and should be directed at helping identify and correct these negative (and often inaccurate) ways of thinking.
Counseling should be based on goals for recovery, involve “homework” outside of the counseling setting, be time limited, and the therapist should behave in a very professional manner.
Types of counseling that have been shown to be effective in treating depression include:
- Cognitive Therapy (more info at www.beckinstitute.org)
- Interpersonal Therapy (more info at www.interpersonalpsychotherapy.org)
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