Daily events and the way that we react to them can sometimes trouble our peace of mind. Anyone can go through a period when they feel sad and lonely every day. But when feelings like this go on for weeks or even months, they may be the first signs of depression.
An estimated 1 out of 5 women and 1 out of 10 men will experience depression at some time in their lives, which makes this a very common ailment. Depression can prevent people from coping with their normal activities, their work, and their relationships, thus seriously compromising their sense of well-being and their ability to live their lives.
Causes
Research on the causes of depression has increasingly revealed how complex this disease is and how many different factors can contribute to its onset.
Environmental factors
Environmental factors are events external to the individual that can contribute to the development of depression. Examples include the death of a loved one, divorce, job loss, financial problems, and a disabling illness or injury.
It is estimated that nearly half of all cases of depression are related to stressful situations. Also, several studies have shown that stress at an early age can predispose an individual to develop depression in adult life. In light of the harmful effects that chronic activation of the stress axis is known to have on neurogenesis, it is not surprising that inhibition of action can seriously predispose someone to depression.
Symptoms.
Psychological factors
A person's history—whether they had a hard childhood or, on the contrary, were given lots of encouragement and opportunities to grow and flourish—shapes their personality and makes them more or less susceptible to depression.
People who are constantly having problems in their relationships, or trouble in communicating, or feelings of loneliness are at a greater risk of experiencing depressive episodes. The lack of a close, trusting relationship, whether with a friend or with a lover, can also increase the risk of depression. The quality of the support that we receive from our interpersonal relationships thus helps to reduce our physical and emotional reactions to stress and thereby protect us from depression.
Genetic
(hereditary) factors
We now know that some genetic factors that affect the functioning of the brain may make people more vulnerable to depression.
For example, people with close relatives who have suffered from depression have a 15% risk of developing it themselves, while people with no such relatives have only a 2 to 3% chance. Interestingly, children who are born to parents with histories of depression but adopted by parents with no such histories still have a 15% risk of developing this condition. In identical twins (who have exactly the same genes), the probability that one twin will experience depression if the other has done so jumps to 70%.
We now know that some genetic factors that affect the functioning of the brain may make people more vulnerable to depression.
For example, people with close relatives who have suffered from depression have a 15% risk of developing it themselves, while people with no such relatives have only a 2 to 3% chance. Interestingly, children who are born to parents with histories of depression but adopted by parents with no such histories still have a 15% risk of developing this condition. In identical twins (who have exactly the same genes), the probability that one twin will experience depression if the other has done so jumps to 70%.
The incidence of mental disorders in children and adolescents, and
particularly of depression, is often underestimated. On the surface,
young people’s problems may seem less serious, because what seems
important to them (academic pressures in school, being rejected by
friends, etc.) may seem trivial to adults. But these problems are just
as real, and 2% of all children and 5 to 10% of all adolescents
experience episodes of depression.
Children who are subject to depression tend to blame themselves, and only themselves, for any unfortunate event. Usually, these are children who receive little support from their family setting.
Depression in young people is a serious concern. For one thing, the frequency of suicide attempts in children and adolescents is related to depression in most cases. For another, preventing depression in children seems to be the best way of preventing it in adults.
Children who are abnormally preoccupied with negative ideas should be identified as early as possible. The appropriate interventions would then consist in helping these children to see their problems as temporary, to perceive reality from different angles, and not to take more than their fair share of responsibility when things go wrong.
Children who are subject to depression tend to blame themselves, and only themselves, for any unfortunate event. Usually, these are children who receive little support from their family setting.
Depression in young people is a serious concern. For one thing, the frequency of suicide attempts in children and adolescents is related to depression in most cases. For another, preventing depression in children seems to be the best way of preventing it in adults.
Children who are abnormally preoccupied with negative ideas should be identified as early as possible. The appropriate interventions would then consist in helping these children to see their problems as temporary, to perceive reality from different angles, and not to take more than their fair share of responsibility when things go wrong.
Pregnancy and childbirth depression.
Pregnancy and childbirth
are very intense experiences that can cause all kinds of
upheavals for women. The terms “baby
blues” and “day 3 syndrome” refer
to the episodes of crying and short-term depression that
about 50 to 70% of all mothers experience on the second or
third day after giving birth. This condition is attributed
to the sudden drop in their levels of certain hormones, as
well as to the exhaustion resulting from childbirth, lack
of sleep, recurrent strong emotions, and so on. This mild
form of depression does not require any treatment and generally
disappears after about 10 days.
But 10 to 20% of women experience a more severe form of depression, known as postpartum depression. Its symptoms are similar to those of major depression, but it is often diagnosed late, because both the woman and the people around her tend to attribute it to the usual overwork following the birth of a baby. Postpartum depression can appear at any time during the year following childbirth and lasts an average of three to six months, though it sometimes stretches out for over a year.
A final note: cases of depression during pregnancy are at least as common as postpartum depression.
But 10 to 20% of women experience a more severe form of depression, known as postpartum depression. Its symptoms are similar to those of major depression, but it is often diagnosed late, because both the woman and the people around her tend to attribute it to the usual overwork following the birth of a baby. Postpartum depression can appear at any time during the year following childbirth and lasts an average of three to six months, though it sometimes stretches out for over a year.
A final note: cases of depression during pregnancy are at least as common as postpartum depression.
Winter and depression.
During the short days
of winter, many people have less energy and feel a little
down, but 2 to 6% of the population of northern countries
actually experience a particular form of depression known
as seasonal affective disorder. The exact causes of this
disorder are not yet known. But it is known to be associated
with the lack of light due to the reduced hours of sunshine.
Various studies have shown that nearly 65% of the people
with this disorder feel better after undergoing treatments
with “light therapy”, which simply means spending
about 30 minutes per day under a lamp that gives off a very
bright light.
Symptoms.
Psychiatrists generally consider someone to be suffering from depression when they present at least 5 of the following symptoms almost every day for at least 2 weeks:
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Treatments.
Once a doctor diagnoses depression, it is important to begin a
course of treatment as
quickly as possible, to prevent the depressive state from getting
worse. Left untreated, depression tends to become chronic or recurrent,
and major depression leads to suicide in about 15% of the people
who suffer from it.
There are now many options for the effective treatment of
depression. They fall into two major categories: treatment with
antidepressant drugs, and various forms of psychotherapy.
| Antidepressants Depression can be treated with medications called antidepressants, which improve patients' moods by correcting certain imbalances in the neurotransmitters in their brains. By correcting these imbalances, various categories of antidepressants help patients to start sleeping and eating normally again, regaining their energy and pleasure in life, and thinking positively. These effects normally take two to three weeks to begin, but in order to minimize the risk of relapse, antidepressants must be prescribed for about four to six months. Antidepressants are effective in about 75% of people with severe depression. Antidepressants do not result in dependency, but like all medications, they do have side effects that vary from person to person. These effects will influence the decision of which antidepressant to prescribe, and in what dosage. |
Depression has been linked to imbalances in certain chemical
messengers in the body, such as serotonin,
norepinephrine, and dopamine. Antidepressants—medications
that effectively relieve the symptoms of depression—act
directly on these neurotransmitters, which represents strong
evidence that these chemical messengers are involved in this
disorder.
Starting in the mid-20th century, as scientists began to suspect
that there were some biochemical
bases for depression, they developed several hypotheses that
attributed a key role to neurotransmitters: chemical
messengers such as serotonin,
norepinephrine, and dopamine. The discovery of antidepressant
medications-molecules that could effectively calm the symptoms
of depression-lent support to these hypotheses, because these
molecules acted specifically on these neurotransmitters.
Psychotherapy
Psychotherapy lets patients work on the psychological and social issues that may be associated with their depressive episodes. This form of therapy can help patients to achieve profound changes. But it is a long process, where a great deal clearly depends on the therapist's skill and the natural rapport between the particular therapist and the particular patient.
There are several different types of psychotherapy, but two have proven especially effective in treating depression: cognitive behavioural therapy and interpersonal therapy.
Cognitive behavioural therapy attempts to change the dysfunctional thoughts and behaviours that accompany depression. Depression often causes people to have distorted thoughts about themselves and their relations with other people and with the world in general. In this form of therapy, the therapist teaches the patient exercises that help him or her to develop new thought schemas. This kind of therapy can provide effective help to people who suffer from mild to moderate depression. It can also help to prevent relapses.
In interpersonal psychotherapy, the basic premise is that most people have problems in their interpersonal relationships, and that if these problems can be solved, then the symptoms of their depression can be stabilized as well. For example, the therapist may try to help the individual to deal more effectively with feelings of grief or mourning, or to adapt to a new role, or to reduce interpersonal conflicts at work, or to overcome interpersonal deficits such as a lack of communication skills, and so on.
For people who are dealing with mild forms of depression, psychotherapy
may provide good results all on its own. People suffering from
moderate or severe depression will often improve considerably when
treated with antidepressants. But in general, it is combined therapies
that are the most effective: the medication quickly relieves the
patient's symptoms, while the psychotherapy helps him or her to
discover new approaches to dealing with the stresses of daily life.
Electroshock treatment is also used to alleviate symptoms of depression. In this treatment, the patient is given either an anaesthetic or a muscle relaxant, and small electric shocks are then applied to his or her brain for one or two seconds. The exact mechanisms by which this treatment works are not fully understood, but it appears to promote the production of certain neurotransmitters whose levels are abnormally low in depressed individuals.
In general, electroshock treatment is tried when treatment with medication has proven ineffective. Electroshock treatment generally causes only temporary memory loss and is effective both for depressive persons and for people experiencing manic episodes. It often enables patients to go back to living a productive life faster than medication does.
Electroshock treatment is also used to alleviate symptoms of depression. In this treatment, the patient is given either an anaesthetic or a muscle relaxant, and small electric shocks are then applied to his or her brain for one or two seconds. The exact mechanisms by which this treatment works are not fully understood, but it appears to promote the production of certain neurotransmitters whose levels are abnormally low in depressed individuals.
In general, electroshock treatment is tried when treatment with medication has proven ineffective. Electroshock treatment generally causes only temporary memory loss and is effective both for depressive persons and for people experiencing manic episodes. It often enables patients to go back to living a productive life faster than medication does.
Even though there are some treatments that, alone or in combination, may prove
effective in treating depression, an understanding of the multiple
factors that can cause depression may eventually help us to prevent certain
forms of it.