Depression is a psychiatric illness that can cause numerous psychological and physical symptoms. Its best known symptom is a deep and prolonged sadness, which does not mean that all sorrow is necessarily related to a depression.
Most adults with depression never get to be evaluated by a psychiatrist, since often their symptoms are not recognized. This confusion occurs even among physicians not accustomed to dealing with problems related to mental health. Studies show that more than half of patients are treated for clinical depression because they have physical symptoms such as pain, insomnia or chronic fatigue, and end up not being recognized as such. The correct diagnosis emerges only after months or years of symptoms and various consultations with different doctors.
Depression is a chronic psychiatric illness, extremely common, characterized by a change in the patient's mood, leaving them sad than normal, discouraged, with no energy, low self-esteem and difficulty coping with their personal and professional life.
The depression has been a disease largely misunderstood for decades, which led to misinterpretations about its causes and symptoms, leading to a stigmatization of sufferers. Even today we often find depressed people who do not accept their diagnosis or family / friends who treat depressed patients as someone mentally weak, unable to overcome the difficulties of life. One should not treat the patient as someone just sad, depressed and unable to react.
More than just a fit of sadness, depression is not a weakness or lack of discipline, nor is it something that the patient can simply resolve with only the will itself. For the depressed stop being sad is the same as for a smoker to stop smoking. It is a matter of taking the decision and to stick to it. Depression is a chronic disease that often requires long-term treatment, as are diabetes or hypertension. Just as no one ceases to be diabetic with only willpower and positive thinking, depression also needs medical help to be controlled.
Depression can occur at any stage of life, from childhood to old age. It is a disease so common that it is estimated that 12% of men and up to 25% of women will have some degree of depression throughout their lives.
Depression is twice more common in women than men and is more common in young adults than in elderly people.
The term depression is often used as a synonym for sadness. But sadness and depression are different things. In fact, sadness is often a symptom of depression, but it alone is not sufficient for diagnosis.
Sadness is a normal and expected reaction to many situations, such as the death of a loved one, the end of a relationship, job loss, etc. It's completely normal for individuals to spend a few days or weeks after sad situations. This is not depression.
Depression represents the picture of grief much more extended than above normal, it is sufficient to interfere with daily activities of the person, reducing the ability to take care of themselves, disrupting relationships, impairing their professional duties, etc. If you lose a parent and feel sad for weeks, this is normal. But if this grief is so intense that a week after the loss you are still unable to resume your routine life such as work, maintaining personal hygiene, housekeeping, it may be depression.
When in grief, an individual usually has periods of improvement throughout the day, managing to forget for a moment the cause of their grief, for example, during a visit with a loved one. The feeling is continuous and not relieved by the help of other people. Depression also tends to cause a feeling of guilt, but for no apparent reason. A depressed person feels a heavy guilt, but can not explain why.
It is significant that a depressed patient does not always present friends and family this classic behavior of sadness too. Depression can be more subtle, manifesting as loss of interest in former pleasurable activities, lack of plans for the future, changes in sleep patterns, social isolation or low self-esteem. To be depressed it is not necessary to spend the whole day in bed crying.
Sadness is always a cause of depression. Obviously, the death of someone close can trigger a depression, but not always sad situations have to occur for the individual to be depressed.
As with many psychiatric disorders there is no single cause for depression, which seems to be caused by the interaction of several factors, either physical or psychological.
Depression does not arise only because of emotional or psychological problems. Multiple risk factors and organic causes for depression have been recognized.
Genetics
Genetic factors
People who have family members with depression have an increased risk of also developing the disease, indicating that there is a vulnerability to depression that can be genetically inherited. In fact, having close relatives with other psychiatric disorders such as panic disorder, affective disorders or even alcoholism are also risk factors for depression.
Despite intense studies in the area the genes responsible for vulnerability to depression have not been yet identified.
Although genetic inheritance is apparently an important factor, it is not sufficient to trigger the disease alone. This is easily proven through studies of identical twins, where agreement in only 40% of cases is observed. Other factors besides genetics should be present to cause depression.
Neurotransmitters
Neurotransmitters
The human brain is a highly complex structure, whose functioning depends on hundreds of chemical mediators. We now know that most of the psychiatric disorders are related to at least 5 of these neurotransmitters: norepinephrine, serotonin, dopamine, gamma aminobutyric acid (GABA) and acetylcholine.
The abundance or lack of some of these neurotransmitters in certain parts of the brain can trigger serious psychiatric and neurological disorders. Examples: a lack of dopamine in certain areas of the base of the brain causes Parkinson's disease, Alzheimer's disease appears to be related to low levels of acetylcholine in the brain.
Depression stems from the abnormal functioning of certain neurotransmitters such as dopamine, serotonin, norepinephrine and GABA. Among them serotonin appears to have the greater role, and usually patients with depression have low levels of depression.
Use of drugs or alcohol
Drugs or alcohol
The addictive diseases are also under influence of these neurotransmitters mentioned above. Drugs and alcohol exert their effects by increasing dopamine release in the brain, causing euphoria and a pleasant feeling. The problem is that repeated use of drugs or alcohol desensitizes the dopamine system, causing it to become accustomed to the presence of these substances. Therefore, addicts need increasingly more drugs or alcohol to achieve the same degree of satisfaction, which can make them depressed when they are out of the effect of these substances. The brain gets used to living with ever higher levels of stimulating neurotransmitters, causing the normal start to be insufficient to control the mood.
Changes in the brain
In addition to reducing of neurotransmitters concentration, patients with chronic depression also show changes in brain anatomy, such as reductions in volume of the frontal lobe and hippocampus.
Neuroimaging studies also show changes in the functioning of several brain areas in people with depression. Researchers have found an area of the prefrontal cortex with an abnormally decreased activity in patients with depression. This region is related to emotional response and has widespread connections with other brain areas responsible for regulating neurotransmitters associated with mood, like norepinephrine, dopamine and serotonin.
Brain diseases
CVA
It is increasingly accepted that the relationship between the cerebrovascular accident (CVA) and the emergence of depression. We now know that depression is not only caused by psychological shocks due to the perceived consequences of stroke such as speech or motor sequelae. The very direct injury of the brain by a stroke increases the risk of onset of depression, even if the consequences of stroke do not have great psychological effect on the patient.
In addition to stroke, several other neurological diseases increase the risk of depression, among them Parkinson's, Alzheimer's, multiple sclerosis, epilepsy, brain tumors and head injuries.
Emotional stresses are an important trigger for the onset of depression. Often a traumatic event is a factor due to which an individual may develop a depressive process.
Childhood trauma
Childhood trauma
Traumas in childhood are an important risk factor for developing depression. Among traumas are abuse, father absence, death of someone close, aggression or lack of affection from their parents.
Problematic relationships with parents, siblings and peers are common in children and adolescents with depression. Adults with depression also often report little paternal involvement and maternal overprotection during childhood. Children who have experienced bullying are also at greater risk of developing depression.
Emotional stresses
Emotional stress
Although the depressive disorder may arise without any emotional factor precipitating stress and personal losses will certainly increase the risk. Loss of loved ones is important risk factors in younger individuals. In elderly people with long marriages loss of the husband or wife is also usually a triggering event for depression.
Chronic pain, chronic illness, disability and diseases that leave sequelae can also lead to depression. Social isolation, excessive criticism and charges by the family, persistent economic hardship, marital separation or low self-esteem are also common factors.
Having close and frequent contact with someone depressed also increases the risk of depression.
Postpartum depression
Postpartum depression
Postpartum depression is a kind of depression that some women develop after giving birth. Most women with postpartum depression begin to show symptoms in the first months of baby's life, but some take up to 12 months to develop depression. About 10% of mothers suffer from postpartum depression.
In the first 2 or 3 days after having a baby, many women often have a kind of mild postpartum depression, called postpartum sadness or melancholy postpartum. This table affects up to 80% of mothers and is characterized by moodiness, irritability, difficulty concentrating, insomnia, and crying spells.
The baby blues is caused by hormonal changes that come with the termination of pregnancy and psychological stresses caused by the responsibility of caring for a newborn associated with physical fatigue that causes the task. In most cases sadness postpartum disappears within 2 to 3 weeks.
The postpartum depression is a more important than the baby blues, lasting longer and having more severe symptoms. Women with a history of depression are more likely to have postpartum depression than women who were never depressed.
Women with postpartum depression often cannot sleep, even when their babies sleep. Also it is very typical to be very angry, unable to care for the baby with severe feelings of guilt and feel of having no bond with their new baby.
The postpartum depression can lead the mother to have thoughts of harming themselves and the baby, in most cases, however, the mother can recognize the absurdity of the idea, having the ability to control this strange thought.
The postpartum depression may disappear spontaneously, but medical help is important because in some cases, depression does not improve with time and there are risks of mother inflicting harm to the child.
In the next article in this series on depression, that is to be written in coming days, we'll talk about types of depression, its symptoms and how it is diagnosed.
