Depression – Symptoms, Causes And Treatment
Major depression is now understood to be a complex illness involving inherited genetic susceptibility and symptoms associated with specific alterations in brain functioning and structure. Major depression is defined as depressed mood on a daily basis for a minimum duration of 2 weeks.
The American Psychiatric Association states that a diagnosis of major depression requires the presence of multiple symptoms that are intense enough to cause distress(stressful in an uncomfortable way) and to persistently impair psychosocial functioning. It means that when we are depressed we are basically incapable of going on with our lives the way we usually do. Although taken lightly, major depression is a common cause of suicide.
The illness frequently occurs as a comorbid disorder with serious physical illness as well as other mental disorders. Major depression can also develop as a serious secondary illness or illness complication.As a result of the potentially serious disability, morbidity and mortality risks directly associated with the illness, The World Health Association (WHO) ranks major depression among the top five glob health problems.
Depression Ethiology and Neurobiology
There has been some progress made in determining the neurobiological mechanisms of major depression. Nevertheless, the specific cause of major depression remains unknown.
Neurobiological changes associated with major depression are thought to involve:
- neurotransmission dysregulation (serotonin)
- altered hippocampal and prefrontal cortex cell structure and functioning
- hypothalamic -pituitary-adrenal (HPA) system activation
based on observations of low central nervous system levels of SEROTONIN in persons with severe symptoms of depression, the basic neurobiology of depression has been said to be reduced brain serotonin neurotransmision activity.
The fault is thought to be either through excessive presynaptic uptake or through stress-related downregulation of postsynaptic receptors.Serotonin is quite ay strange molecule for many reasons. First of all, it is formed from the amino acid L-tryptophan, which is one of the 20 standard amino acids required for life as we know it. Interestingly, it is also one of the few essential amino acids that the body does not synthesize itself, and have to get it from the diet. But we’ve usually got plenty. This image explains the variations in the levels of postsynaptic serotonin:
Chronic or persistent vulnerability to depression is thought to be related to decreased hippocampal volume or capacity and suppressed hippocampal neurogenesis.
HPA axis dysfunction has been associated with depression. Genetic susceptibility to depression seems to mediate the link between stress and depression.
Cognitive- behavioral models of depression particularly learned helplessness have been shown to correlate with the basic neurobiology of depression. Avoidant persons, when faced with a stressful situation avoid confronting the situation despite opportunities to do so. Persistent avoidance eventually conditions thee person to automatically respond to stressful situations with strong feelings of helplessness.
Sleep studies of depression have shown significantly reduced slow-wave(stages 3 and 4) sleep and increased light sleep(stage 1). The periods of REM sleep latency are shortened. Sleep is restorative for brain cells.Severe reduction in serotonin activity have been associated with less restful sleep.Disturbed sleep is a hallmark symptom of depression. The classic sleep disturbances include difficulty falling asleep, early morning waking, and decreased total sleep time.
Circadian rhythms are closely associated with symptoms of major depression. The pineal gland in the brain produces the hormone melatonin.Brain melatonin levels can fluctuate significantly with annual and daily increases in light and dark periods. Depressed persons have been shown to suffer from low melatonin levels when their symptoms include disturbed sleep.
Depression Signs And Symptoms
Depressed mood and the loss of interest or pleasure are hallmark symptoms of major depression. Depressed mood is usually experienced as painful, numbing and bottomless. Loss of interest or pleasure can be more difficult to recognise. Others may notice this change before the depressed person does.
- Fatigue-or loss of energy is a common yet alarming symptom of depression. Fatigue associated with depression can make ordinarily daily activities once performed automatically nearly impossible, it is immobilising. Depressed people may associate their severe or sudden fatigue with serious physical illness such as cancer, diabetes, cardiovascular disease.
- Restless, irritable agitation– associated with depression can range from mild hyperactivity and sarcasm to aggression. Compulsive physical activities such as pacing are not uncommon.
- Impaired concentration-is experienced as a highly disturbing symptom of depression. Thoughts slow down and the process of thinking literally becomes difficult. Impaired decision making is one of many consequences.Minor choices and simple preferrences become difficult. The content of thought is typically dominated by highly depressive themes.
- Low self-esteem-is the psychological hallmark of depression.Negative appraisals range from pointless guilt to self- hate nearly every day.In some cases self guilt reaches delusional proportion or is markedly disproportionate to actual misdeeds or perceived failings. People generaly find ways to protect their self- esteem for the normal assaults of daily life.With severe depression, positive self -esteem can be absent and only rarely is the loss related to actual life events.
- Negative thinking-expressed as negative views of self, life and the future. This is a common symptom of severe depression often misunderstood. Severe depression is an empty experience that makes life itself seem futile.Negative thinking associated with depression can be mistaken as willful or so unpleasant that others avoid contact with the depressed person.
- Vegetative states-manifest as slow or reduced physical activity.Normal daily activities such as bathing and dressing may not be performed. These symptoms typically are described as feeling as though one is sleep walking, living in slow motion or has become a robot.
- Sleep disturbances-Insomnia is most common, but some people may sleep more (hypersomnia) or shift their sleep hours from night time to day time.Sleep symptoms include difficulty falling asleep, early morning awakening, frequent awakenings and waking tired. The cognitive activity generated by obsessive negative thinking disturbs sleep essentially by preventing it or by literally waking the person.
- Apetite disturbance-significant weight loss when not dieting or weight gain (a change of > 5% of body weight) or decreas/increase in appetite nearly every day. The person may experience marked change in food preferences. Severly depressed persons may become unaware of their hunger or thirst. Diminished salivary and gastric activity can dampen appetite.Overeating also occurs, but this disturbance seems to be more related to restlessness than to appetite. People who normally use food for emotional comfort may increase their consumption of high in fat, sugar, and salt foods (comfort food).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide.
A sign of worry is when five or more of these symptoms have been present during the same 2- week period and represent a change from the previous functioning.
Depression that lasts 2 years or more is commonly referred to as minor depression(dysthymia).
Most antidepressants currently available act by improving brain noreprinephrine and serotonin activity.
Tricyclic antidepressants (TCAs) blocked the reuptake of norepinefrine and serotonin, thereby admitting more neurotransmiter activity.
Selective serotonin reuptake inhibitors (SSRIs) became widely available in the 1990s and were the first antidepressants with selective serotonin effects. SSRIs sucha as fluoxentine,paroxentine, sertaline have been shown to relieve depression symptoms three times faster than earlier medications with far fewer side effects. SSRIs became quickly the primary class of antidepressants. Altough they are improved they aren’t side effect free. Serotonin syndrome is a serious side effect that can result from excessive serotonin activity. Symptoms of serotonin syndrome include: altered mental status, restless agitation, myoclonus, hyperreflexia, sweating, shivering, tremor, gastrointestinal upset, ataxia, headache. Sexual dysfunction is also thought to result from SSRI-induced excessive serotonin activity. Onset can be immediate or gradual with effects ranging from loss of interest to anorgasmia. SSRI cellular and neurochemical mechanisms continue to be the subject of clinical research.
Asking from outside help is not a shameful thing tot do when confronted to the suspicion of major depression. Psychiatric or psychological evaluation may confirm the diagnosis of major clinical depression and the patient can be helped accordingly.
Psychotherapy (“therapy” for short) actually involves a variety of treatment techniques. During therapy, a patient with depression talks to a trained mental health care professional who helps him identify and work through the problems that may be causing their episode of major depression. Taking care of the psychosocial and psychological aspects of major depression is not to be neglected.
Psychotherapy helps patients with major depression:
- Understand some of the behaviors, emotions, and ideas that contribute to his state
- Understand and identify the life problems or events — like a major illness, a death in the family, a loss of a job or a loved one that lead to their major depression and makes them understand which aspects of those issues they may be able to solve or improve.
- Regain a sense of control and pleasure
Sometimes psychotherapy can replace pharmacological therapy altogether but most of the times they complement each other in helping the depressive patient to gain his previous life back.