Depression as a condition
What is depression?
We all sometimes feel sad, bored, lacking the mood. Most of the time it’s enough to think about something else, to put everything aside, to exchange a word with someone to feel better. Sadness is a healthy emotion, a normal reaction to unwanted, unfortunate events that can happen to all of us in life. Sadness allows us to remain functional in a non-destructive way for ourselves and others. Many people use the word “depression” to explain these kinds of feelings, but depression is much more than sadness.
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest.
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Symptoms of depression can make it impossible to carry out normal everyday activities, change the way we perceive ourselves, things and the environment, make everything seem hopeless and even make us feel that life is not worth living. More than just “a bad mood”, depression causes pain for both the depressed person and those around them and may require long-term treatment. Most people with depression get better with medication, psychotherapy or both.
Depression is a major risk factor for suicide. The despair and hopelessness that come with depression can make suicide the only way to escape the pain. Recognising the warning signs can prevent suicidal acts.
Warning signs for suicide include: talking about suicide or self-harm, expressing strong feelings of worthlessness and hopelessness, unusual preoccupation with death, risky and self-destructive behaviors (substance abuse, speeding), withdrawing from social life and wanting to remain alone, farewell visits or phone calls, giving away personal belongings, obtaining the means for suicide (stockpiling drugs, buying a gun, etc.). When a person feels extremely depressed and suicidal the problems seem overwhelming and never-ending, but by seeking specialist help the difficult period can be overcome.
What causes depression and what are its signs?
The current hypothesis is that most likely, depression is based on a complex pattern to which biochemical disturbances in the brain contribute (brain imaging techniques have shown different images between the brains of depressed and non-depressed people), psychological causes (personality traits), social causes (everyday stress, negative life events) and genetic factors (some types of depression can run in families). Any stressful life situation can trigger a depressive episode, and other depressive episodes can occur with or without an obvious trigger.
People suffering from depression experience the symptoms of the illness differently, with the severity, frequency and duration of symptoms varying according to individual circumstances.
Some people describe depression as a life lived in a black hole or as a terrible punishment.
Others do not feel sad, but lifeless and apathetic, and some may feel angry, aggressive and agitated.
Signs of depression can be cognitive, emotional, behavioural and physical.
Cognitive symptom
At the cognitive level, dysfunctional negative-centred thinking occurs, so that positive life events are ignored. People suffering from depression have a negative view of themselves and their current experiences that extends to the future. Examples of dysfunctional thoughts: ‘I’m no good’, ‘I’m a failure’, ‘It’s my fault’, ‘I’m worthless’, ‘Nothing good can happen to me’, ‘I have no future’, ‘Life is not worth living’.
Emotional symptoms
These negative thoughts preoccupy the person excessively causing at the level emotional sadness, despair, emptiness, hopelessness, irritability, frustration, anxiety, hopelessness, feelings of helplessness, worthlessness, guilt, loss of self-confidence. Negative emotional experiences support dysfunctional thoughts leading to inappropriate behaviours.
Behavioural symptoms
The level behavioural Inappropriate behaviours such as a tendency to social isolation, inactivity, loss of pleasure, restriction of interests, reduced personal performance, psychomotor sluggishness or agitation, substance abuse.
Physical symptoms
The depressed person may have physically fatigue, fatigability, low energy, exhaustion, headache, osteo-articular and muscular pain, palpitations, chest pain, feeling dizzy, loss of appetite, weight loss, insomnia, difficulty concentrating and memory impairment, sometimes even in the absence of depressed mood.
Untreated depression can progress to worsening with delusions of worthlessness as well as suicidal ideation, with the person finding death as a solution to their problems.
How is depression diagnosed?
The first step in getting a diagnosis and appropriate treatment is a visit to a mental health specialist. Certain medications, as well as some medical conditions, can cause the same symptoms as depression. A doctor can rule out other conditions that may cause depression by a thorough evaluation of symptoms, physical examination, laboratory investigations. The interview will also include questions about family history of depression or other mental illness, alcohol or drug use, other illnesses that co-exist with depression.
Useful in the diagnosis of depression is psychological assessment through the application of tests, questionnaires and depression scales.
The diagnosis of depression is made if the diagnostic criteria are met. Diagnostic criteria refer to the typical symptoms that occur during the course of the illness, the duration of symptoms, the degree to which symptoms affect normal social and professional life, and the differential diagnosis of depression with other conditions with similar symptoms.
At least five of the following symptoms present for a period of two weeks and producing a change from the previous level of functioning are required for diagnosis:
- Depressed mood
- Diminished interest or marked pleasure
- Significant weight loss in the absence of a slimming regime
- Insomnia or hypersomnia
- Restlessness or psychomotor sluggishness
- Fatigue or lack of energy
- Feelings of worthlessness or inadequate guilt
- Decreased thinking ability or concentration
- Recurring ideas of death
It is important to consult a doctor in the presence of depression-like symptoms. The sooner the diagnosis is established, the sooner the person with depression is on the road to recovery.
What are the types of depression?
The most important reason a patient needs to know what type of depression they have is to make sure they get the right treatment that will help them feel better as soon as possible. In each type of depression there are variations in the number, timing, severity and persistence of symptoms. The most common types of depressive disorders are the following:
Major depressive disorder (unipolar depression) is characterised by a combination of depressive symptoms that last for at least two weeks at a time and interfere with daily activities, manifesting themselves at all professional, social and personal levels. Some people experience only one depressive episode in their lifetime, but more commonly major depression is a recurrent disorder.
“One of the most important components of the psychotherapeutic learning model is that the patient begins to adopt many of the therapist’s techniques.”
(Beck et al., 1979).
How is depression treated?
The choice of treatment depends on the outcome of the assessment. Antidepressant medication and psychotherapy are very effective for most people suffering from depression.
Milder forms of depression can only be improved with psychotherapy, without medication.
People with moderate to severe depression benefit from antidepressant medication or combination treatment: medication to get relief from symptoms relatively quickly and psychotherapy to learn more effective ways of coping with life’s problems, including depression.
Depending on the severity of symptoms, the therapist may prescribe medication and/or one of several forms of psychotherapy that have been shown to be effective for depression.
In some people, depression is so severe that hospitalisation is needed. This may be necessary if the person is unable to care for themselves adequately or when they are in immediate danger of self-harm or pose a danger to others. Psychiatric treatment in a hospital can help keep you calm and provide safe conditions until your mood improves
Psychotherapy
The effectiveness of psychotherapy in depression is recognised as a fascinating and rewarding way for the person suffering from depression to discover new, more tailored perspectives on their problems. There is evidence that combining drug treatment with psychotherapy is much more effective in reducing the number of depressive episodes and increasing quality of life.
Different types of psychotherapy are effective in depression: cognitive-behavioural therapy, interpersonal therapy, psychoanalytic therapy, family therapy and others.
Psychotherapy involves assessing the stressors that led to the onset and maintenance of depression, identifying negative thoughts, beliefs and dysfunctional behaviours and replacing them with healthy ones, finding better ways to adapt and solve problems, setting realistic goals, learning social interaction skills, regaining a sense of satisfaction and control over one’s life.
The effectiveness of therapy comes from the fact that it is not a passive process, but one that depends on the active participation of the client. It takes time, effort and consistency to learn the skills needed to deal with relapse and the main goal is to teach the client to become their own therapist.
Antidepressant medication
It aims to reduce depressive symptoms by achieving complete remission, to prevent relapses and to avoid structural brain changes (depressive disorders have been correlated with changes in brain structures involved in affective-emotional circuits, untreated depression having irreversible destructive consequences). There are many classes of antidepressant drugs available and in choosing the antidepressant it is useful for the patient to be actively involved, knowing the action of the drug, the adverse effect profile, the duration of treatment will increase compliance with treatment.
The main classes of antidepressant drugs are:
First generation antidepressants
- Tricyclic and tetracyclic (Imipramine, Clomipramine, Amitriptyline, Doxepin, Nortriptyline, Maprotiline, Mianserin).
They are effective drugs, but because of side effects and risks of administration their use is limited to cases who have tried other treatments without success.
Adverse effects may include urinary retention, constipation, increased intraocular pressure, sedation, weight gain, orthostatic hypotension, cardiotoxic effects, confusional states, risk of death by overdose, and are contraindicated in patients at high suicide risk. Cardiological, neurological, haematological, ophthalmological and urological assessment and subsequent re-evaluations at 3-6 month intervals are recommended before treatment is instituted.
Second generation antidepressants
- Selective serotonin reuptake inhibitors – SSRIs (Fluoxetine-Prozac, Fluvoxamine-Fevarin, Paroxetine-Seroxat, Sertraline-Zoloft, Citalopram-Celexa, Escitalopram-Cipralex)
- Norepinephrine reuptake inhibitors – NRI (Reboxetine)
- Norepinephrine and dopamine reuptake inhibitors – NDRI (Bupropion-Wellbutrin)
- Serotonin, norepinephrine reuptake inhibitors – NSRIs (Venlafaxine-Effexor, Duloxetine-Cymbalta, Minalcipran-Ixel, Mirtazapine-Remeron, Trazodone-Trittico)
- Antidepressants with serotonergic modulatory action (Tianeptine-Coaxyl) and serotonergic/melatonin (Agomelatine-Valdoxan)
Second-generation antidepressants are currently used as first-line treatment for depression due to their much lower spectrum of adverse effects than first-generation antidepressants, which makes them safe and tolerable to administer, with significantly increased treatment compliance, and they can be used in long-term outpatient therapy. Among the most common side effects are: digestive manifestations (nausea, vomiting), sedation or insomnia, sexual dysfunction, restlessness, dizziness. Most of the time these effects occur when treatment is started and are insignificant and transient.
Transcranial electrical stimulation
Transcranial electrical stimulation is a non-invasive treatment that has been studied extensively over the last 10 years and has numerous benefits for the human body. It is based on the simple principle of direct current polarisation, namely the direct application of low intensity electric current to the scalp. The electric current passes painlessly through the scalp and influences the neural activity of specific areas in the brain, modulating spontaneous neuronal discharge (either stimulating or inhibiting neural activity) at that level.
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