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Depression

What is depression?

Pharmaceutical companies would have us believe that depression is a well-understood condition caused by insufficient serotonin in certain parts of our brains. Thus, the correct treatment is to simply choose the right pill to adjust one's serotonin levels back up to normal levels. Although that's a persuasive and simple story for marketing drugs to busy doctors and the public, it's probably not completely accurate. A great neurobiologist said not so long ago: "Explaining human brain function based upon our current knowledge of neurobiology and neurochemistry is like analyzing samples from the sewers of Moscow and deciding what Muscovites had for breakfast that morning."

We do know that depression interferes with the function of several parts of the brain, including the limbic system and the cerebral cortex. So depression interferes with how we feel, some of our bodily functions such as appetite and sleep, and how efficiently we are able to think.

Diagnosis

Depression isn't always obvious, especially to the sufferer. Sometimes it looks like irritability, or it might be confused with dementia or senility. The traits used for diagnosis of depression reflect the parts of the brain affected. Clinical diagnosis requires that several of the following symptoms must be present with enough severity to significantly interfere with one's ability to perform day-to-day activities:

sleep disturbance (early awakening/insomnia or always sleeping)
appetite changes (loss of appetite/weight or overeating)
low energy
feelings of hopelessness, sadness, despair
poor concentration
difficulty making decisions

Risk factors

There is a definite genetic link: if parents, grandparents, or siblings suffer from depression, risk is significantly increased. Certain hormonal changes, such as those seen following pregnancy or menopause, are associated with increased risk of depression. Sudden, unexpected emotional trauma or loss can precipitate a depressive episode. Certain times of year, such as Christmas or anniversaries of times of grief, may be associated with depressive episodes. Some drugs (alcohol, marijuana, barbiturates, benzodiazepines, beta-blockers, clonidine, corticosteroids) cause depression or make it worse. Depression is often associated with medical conditions such as heart disease, multiple sclerosis, some types of arthritis, stroke, hypothyroidism, Cushing's disease, Parkinson's disease, and some types of cancer.

Once you have had one depressive episode your risk of future depressive episodes increases with every bout. After a single episode one's likelihood of a further bout of depression is 50%, after 2 episodes it goes up to 70%, and after 3 it is 90%.

Treatment

A wide variety of treatments have proven effectiveness in the prevention and treatment of depression. Adequate rest, a good exercise program, and balanced nutrition are important, especially for those who have increased risk of depression. Cognitive behavioral therapy (CBT) is a counseling technique in which the therapist helps the person identify and correct inaccurate, negative patterns of thought. CBT has been shown to be at least as effective as antidepressant medications in treating mild and moderate depression.

A wide variety of antidepressant medications have been developed that have been shown to have some effectiveness. Interestingly, although they all work for some people, they have a remarkably wide range of actions in the brain. Some are stimulants, like amphetamines, that increase the secretion of dopamine. Some block the reabsorbtion of serotonin, increasing its levels in the brain. Some work apparently by increasing the concentration of norepinephrine, another excitatory neurotransmitter.

There have been conflicting scientific reports on the effectiveness of herbal remedies, especially St. John's wort. One study showed the placebo group with depression did better than either the group taking St. John's wort or those taking an expensive new SSRI medication.

Some people whose severe and crippling depression has not responded to other types of treatment are successfully treated with electroconvulsive therapy. Although an extreme measure, it is important to remember that severe depression is a horrible, potentially fatal disease.

As with other chronic illnesses that have biological as well as psychosocial roots and manifestations, the best treatments combine biological or pharmaceutical interventions with psychosocial treatments in the form of group or individual counseling and behavioral change, including exercise, diet, social activities, and spiritual activities. A study reported in the British Medical Journal showed that patients who had been successfully treated for depression were much less likely to relapse and to have much better emotional and physical functioning if they received ongoing support by health care providers The group who only received a brief single treatment intervention were much more likely to relapse into depression. The take-home message from this study is that depression is a chronic disease subject to relapse, so effective treatment requires maintenance of relapse-prevention activities, including medication, social support, counseling, exercise, and balanced activities.

What to do

Read about it. Talk to your doctor and your community mental health agency. Consider getting cognitive behavioral therapy from a skilled psychotherapist, but ask first to make sure the therapist has experience with this method. Work out a rigorous, regular exercise program. Pay attention to what you eat. Get out of the house and connect with others through social activities, hobby groups, music, or mutual support groups. Remember, depression is a chronic, often recurring illness for which recovery or long-term remission can be expected, especially if sufferers continue to do the things that work for them.