Understanding Depressing
Depression is a worldwide public health issue. Unipolar depression is ranked second in a ranking of disabling diseases in westernized countries, and is projected to reach the same ranking world wide by 2020.
*Average age of first onset of major depression: 25-29
*Likelihood of a second or more episodes of major depression: 80%
*Likelihood of a second or more episodes of minor depression: 100%
*Median number of major depressive episodes during a person’s lifetime: 4
What is going on? Why is depression so pervasive worldwide? What sort of a disorder is depression anyway? These are only a few of the relevant and important questions scientists, psychologists, and public health officials are asking.
As I began researching this topic, so much information was available, but none of it conclusive. Depression and the treatment of depression is of ongoing interest to anyone in my profession. So the topic of depression is not new or foreign. I greet depression daily in my office, and I always know progress may be slow and difficult for my client. Like others in my field, I seek to understand each of my client’s particular symptoms and history so I can offer the best possible treatment strategies. I explain, as best I can, how and why they may be suffering from depression, but also making it clear there is no definitive answer.
The overall picture of how depression arises in one person and not another has not become clearer over time and research. It appears depression is far more than a “mental health” issue, and what it actually may be, is up for debate amongst psychiatrists and scientists.
So, with that disclaimer, let me try to piece together some of the information gleaned from current research.
Mental Health Aspects of Depression
For the purposes of this article, the discussion is centered on unipolar depression.
Unipolar depression is experienced as depression only, while bipolar depression is a cycle experienced as both depression and mania. Bipolar depression was once called manic depression.
Depression is experienced by the people who have it as being everywhere. In other words, depression is global; their mind, their body, their brain, their work, their family and social lives – the whole of them. For the sufferer, depression literally takes over their entire life.
Some symptoms of depression include: Sadness, malaise, little to no motivation, negative thoughts, low self-esteem, feelings of guilt, unexplained physical aches and pains, tiredness for no apparent reason, poor concentration, cognitive impairment, suicidal thoughts and actions, and feelings of hopelessness and despair. These are the most common symptoms sited by people with depression, but there can be more.
With severe depression, people find it almost impossible to just get out of bed in the morning or take showers or comb their hair. Going to work or caring for their children is also out of the question for severe depression suffers.
With milder forms of depression, people are able to bathe, and get to work. Once there, they find it hard to focus and concentrate. Their desire to work hard or contribute can be challenging.
Depression is treated with psychotherapy and sometimes antidepressant medications. Severe depression that does not respond to this regimen may be treated with hospitalization or electroshock. Genetic testing may be sought to create the best possible outcome. Most suicides are due to severe depression.
Depression and Physical Health
The correlation for depression and other medical conditions is high. It has been known for some time that heart disease and depression are comorbid, but why?
One reason can be found in an article by Hara Estroff Marano published in 1999 and republished in Psychology Today where I found it. Apparently blood platelets seem to be stickier when a person is depressed, and sticky platelets tend to clot quickly. When a clot occurs due to a crack in the artery lining, the clot chokes off blood flow to the heart. Reduced or blocked blood flow to the heart may be catastrophic.
The stress of depression affects appetite and sleep. The person may find themselves sleeping and eating too much or just the opposite not enough of either. The depressed person may eat poorly, drink more alcohol, and crave sugar or they may have little desire for food. Over time, the loss of nutrition due to poor eating habits, and the increase in alcohol intake has its effect on health. At the same time, exercise is lost to poor motivation. Likewise, sleep habits are impaired. Insomnia or too much sleep are a problem.
Our physical health is always about the balance between movement, rest and proper nutrition. Health problems like high blood pressure, high blood sugar, weight gain or loss, muscle health, and so on have an accumulated effect.
What Causes Depression?
This is the question that creates the most confusion and conflict amongst the experts, and concomitantly amongst sufferers.
It is hard to answer a question, when the question is unclear. But, scientists appear to do this all the time why not then with depression? Some of the current hypotheses include: Brain chemistry, how we think and behave, environment, trauma especially in childhood, family history, genetics, brain functioning, brain structure, neurodegenerative changes, cell loss, a mistake of the brain.
Several areas of the brain have been identified as clearly correlated to depression. Three of these areas are the amygdala, the hippocampus, and the prefrontal cortex. Emotions are shaped by the neural circuitry in these areas. And these areas are identified as being culprits in both generating and inhibiting positive and negative emotions.
It has become clear to scientists that depression is not just about brain chemistry. In fact, brain chemistry is only one, possibly small, part of what causes depression.
Research is ongoing, but the second greatest public health problem is still not fully understood.