It has been called the "dark night of the soul", and for the millions of people suffering from depression this condition also destroys their physical and emotional well-being. Major depression is the most predominant psychological disorder in the Western world. It is predicted to be the second most disabling condition (after heart disease) by the year 2020, with the highest growth in the teenage segment of our society. Depression affects people of all ages, races and background. The average age for the first episode of depression is between the ages of 25 and 29 years of age. It is estimated that between 35 and 40 million Americans will suffer from major depression at some time during their lives and half of these individuals will experience recurrent episodes.
What causes depression? The current understanding is that it results from a combination of biochemical, genetic, environmental and psychological factors. Brain imaging technologies, such as magnetic resonance imaging (MRI), have shown that people suffering from depression have heightened activity in a particular area of the limbic system. When this area of the brain is less active people are generally more positive and hopeful. However, when it is very active it correlates with depression and negativity. It appears to color events depending on your state of mind. The limbic system controls mood, sleep, appetite, and colors our perceptions. In addition people with depression have a deficit of two particular neurochemicals, norepinephrine and serotonin. There is a genetic predisposition for depression with men more likely to experience depression if their mothers were depressed. For women, some studies indicate that the contributing factors are separation from a parent during childhood and early adolescence and poor marital relationships. Some of the contributing psychological factors appear to be deficits in self-esteem, and the tendency to set unrealistic goals. People with a predisposition to depression tend to underestimate their own skills and abilities while overestimating the talents and capabilities of others.
Why is depression increasing in our culture? It is currently believed that the increase in social isolation and a heightened focus on the "individual" (and not the group) has contributed to the growth of depression in our culture. In developed countries, most people are getting their basic human needs such as food, water, and shelter. What is lacking is a strong sense of community, family cohesion and social support where individuals feel emotionally connected and supported. Research indicates that in communities such as the Amish society and tribal communities like the Kaluli tribes of New Guinea depression is almost unknown. What these societies appear to provide is a strong sense of connection and community. People help each other and support each other and the needs of the community are more important than the needs of the individual. In our Western view point the "self" is more important than the community.
Current brain imaging studies and research on the limbic area of our brain support this hypothesis between depression and lack of social bonding and connectedness. Brain scans of individuals presenting with major depression indicate heightened activity in a particular area of the limbic system. This area of the brain controls and is affected by social bonding and isolation. When people are depressed they tend to isolate themselves which results in lessening bonding with others. This negatively stimulates the limbic system which in turn worsens the depression.
What are the symptoms of major depression? People with depression do not experience all the symptoms listed. The frequency, severity and duration of the symptoms also vary depending on the individual.
Symptoms include:
- Depressed mood with feelings of sadness or "empty" feelings
- Feelings of helplessness, guilt, and/or worthlessness
- Loss of interest and pleasure in activities and hobbies, including a decrease in the sexual drive
- Feelings of hopelessness and increased negative thinking
- Difficulty concentrating and making decisions
- Loss of appetite or overeating
- Fatigue and loss of energy nearly every day
- Insomnia or excessive sleeping
- Thoughts of suicide, or suicide attempts
What is the treatment for depression? The most common treatment for depression is medication and psychotherapy. The first step to getting the right treatment is to first visit your doctor and rule out the possibility that your symptoms may be a result of a virus or a thyroid condition. These conditions can cause symptoms similar to depression. Your physician will either recommend a medication or refer you to a psychiatrist for an evaluation for the appropriate medications and a psychologist for therapeutic treatment.
The types of psychotherapy that have been most effective in treating depression are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). CBT helps with changing negative patterns of thinking and perception that contribute to depression. IPT focuses on improving troubled relationships that may have contributed to the depression.
For cases of mild or moderate depression, psychotherapy may be the best treatment. However, if the depression is severe and for certain groups of people the combination appears to bring the best results.
How can I help myself? The following are just a few suggestions on how to alleviate some of the depressive symptoms. However, when a person is experiencing a major depressive episode the best course of action is to seek professional help. These suggestions are effective when the depression is moderate or mild or when the major depressive episode is abating.
The first is to become aware of your thinking and realize that thoughts are real and create changes in brain chemistry. Begin by developing an awareness of the quality of your thoughts. How negative are they and how does your body feel when you have these negative thoughts. Notice the difference when you have positive thoughts. Challenge the negative ones, correct them. Each negative thought adversely affects your depression. Working with a psychologist will help you in developing skills to deal with negative patterns of thinking that contribute to depressive states of mind.
Exercise on a daily basis. It can be a simple 15 minute walk. Exercise releases endorphins that induce a sense of well-being. It increases blood flow to the brain which allows it to function properly. Physical exercise can be very healing to the area of the limbic system associated with depression.
Surround yourself with positive people that make you feel good about yourself. Make of list of the people in your life you spend the most time with and evaluate how supportive they are and generate ways in which they can be more supportive. Increase your social activities and social interactions. Research studies show that how you get along with people can either help or hurt the limbic system. The better you get along with those around you, the better you will feel. This is another area that can be directly addressed in therapy.
The area of the brain associated with depression stores memories that are highly charged. Many of these can be negative but there are many that are positive. Make a list of some of the happiest moments of your life. Get a journal a write a very descriptive account of these beautiful memories. Review this list on a regular basis. Whenever you recall a particular memory the brain releases chemicals similar to the ones released when the event occurred. This exercise will enhance your well-being and improve your relationships if the memories are associated with current family members.
Set realistic goals for yourself and have reasonable expectations about your speed of recovery from a depressive episode. Try not to make any important life changing decisions such as switching jobs, moving, or getting married until you feel better. Most importantly, know that depression is highly treatable and you will get better.
In a crisis situation, if you are thinking of harming yourself or know someone who is, contact the following numbers:
- Call 911 or go to a hospital emergency room to get immediate help.
- Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-8255 or 1-800-799-4889 to talk to a trained counselor.
