Also called clinical depression or depressive disorder, depression is a mood disorder that affects some 264 million people around the globe. As the leading cause of disability worldwide, depression is a persistent feeling of sadness, emptiness, or loneliness that affects both occupational and social functioning.
But unlike the typical sadness that people feel, depression makes it almost impossible to find motivation to perform everyday tasks. Stripping individuals of the willpower to bathe, eat, sleep, work, or even just talk, depression also comes with a feeling of meaninglessness which may cause a person to question the purpose and worth of their life altogether.
The earliest mention of depression can be found in writings from the second millennium BCE in Mesopotamia. During this time, depression was thought to be a spiritual illness caused by demonic possession. With that premise, those suffering from the condition were handed over to priests and mystic healers rather than doctors. Treatments were also particularly gruesome, with beatings and torture a common solution of choice.
And while the Romans and Greeks employed far more subtle treatment methods like music, changes in diet, bloodletting, baths, and physical exertion among others, they still held on to the belief that depression was a spiritual sickness that possibly stemmed from the displeasure of the gods.
It wasn’t until the common era when a Persian doctor started on the notion that depression was a mental problem arising from the brain. During this time, the beginnings of behavioral therapy started taking shape, with treatments involving the provision of positive rewards for desired behavior.
Many centuries would pass until Sigmund Freud identified depression, then called ‘melancholia’, as the result of either a real loss or a symbolic loss. The real loss would include the death of a loved one, while symbolic loss would be the inability to achieve a certain goal, like a promotion or landing a job.
Countless other experts in the field of psychology and psychiatry have since contributed to the growing knowledge of depression. Today, it’s understood that depression is a mood disorder which can be treated through therapy and medication.
There are two common types of depression, namely major depressive disorder and persistent depressive disorder. The main difference is that major depressive disorder or MDD is typically an episode of depressive symptoms that lasts for 2 weeks. Persistent depressive disorder or PDD on the other hand, is characterized by symptoms of depression lasting for 2 years albeit at a much milder severity.
Other kinds of depression include:
- Perinatal depression or post-partum depression, associated with fluctuating hormones during and after pregnancy
- Seasonal affective disorder, which is a mood disorder that comes and goes with changing seasons
- Psychotic depression, which manifests the same impairing sadness accompanied by hallucinations or delusions
- Disruptive mood dysregulation disorder, which is depression diagnosed in children and teens
- Premenstrual dysphoric disorder, wherein a woman might feel mood changes before or during her monthly cycle
- Bipolar disorder, which used to be called manic-depression. This condition is characterized by episodes of mania which are then preceded by depression.
While all of these types of depression involved sadness, that’s only one facet of the complex condition. Some of the other symptoms of depression include:
- Sad, empty feelings or mood
- Feelings of worthlessness
- Inability to feel pleasure
- Loss of interest or motivation
- Pronounced fatigue for no apparent reason
- Sleeplessness or oversleeping
- Lack of appetite or overeating
- Suicidal thoughts or attempts
- Restlessness or irritability
- Body pain and discomfort
- Inability to concentrate
These symptoms may provide a pattern on how to determine depression, but it happens differently in every person. This can also be affected by the individual’s age and sex.
In women, depression can be more common because of the various hormonal changes that are related to their biology. Sadness and worthlessness are more commonly reported in women, and women are often better at identifying that they have a mental health problem.
On the other hand, men experience depression through their pleasure experience. While women feel sadness more prominently, men are more likely to deal with the inability to feel pleasure with things they used to enjoy. They’re also more likely to feel irritable and sleepless, and they may engage in more risky behavior. Men with depression often won’t realize that they have it.
Teenagers and adolescents may manifest depression as irritability and isolation. They’re more likely to experiment with illicit drugs and other substances, and they have a tendency to manifest anxiety more commonly than other individuals.
Elderly individuals will also have difficulty identifying their depression. Thinking that the negative mood is simply a result of their age, individuals in this category are less likely to seek help. Any other medical conditions like heart disease or diabetes may also contribute to the exacerbation of depressive feelings.
Depression is often seen as a chemical imbalance in the brain, but that hardly captures the complexity of how this condition actually works. Some scientists believe that depression has a lot to do with cortisol – a chemical in the brain that’s responsible for the stress response.
When an individual experiences something stressful, like the death of a loved one, cortisol levels will rise. As the individual copes with the tragedy, cortisol levels will soon return to normal. But with depression, that’s not the case. In a healthy individual, cortisol levels fluctuate throughout the day, being highest in the morning. However, someone with depression might exhibit high cortisol levels throughout the day.
How exactly this cortisol imbalance happens isn’t fully understood. But what experts do know is that depression could be the result of lifelong struggle or of a one-time triggering event that captures a person’s weakness.
Another way that depression affects the brain is how it interacts with dopamine. This neurotransmitter is associated with the brain’s reward pathway and helps people feel pleasure. With depression, dopamine levels are significantly lower which is said to be the result of heightened levels of cortisol.
There are some people who are at a higher risk of developing depression than others, and this often relates to a variety of factors present in their lives. Some risk factors include:
- Poor family dynamics
- Financial trouble
- Lack of a stable, healthy, intimate relationship
If a person has more of these risk factors, then they become more likely to develop depression. That is, if a major life change, trauma, or stress occurs in the presence of these risk factors, a person may struggle to cope and thus develop the mood disorder.
Then there are others who go through life with no problems. They could be well off, have a healthy family, a thriving career, and everything that goes with it. But a triggering event that targets their ‘weak spot’, so to speak, could cause them to develop the mood disorder. That’s why some people who seem to be doing just fine might suddenly be diagnosed with depression after being laid off from work, losing a competition, or even failing a class.
The most effective treatment for depression involves the use of medications in combination with behavioral therapies. A visit to the doctor will confirm whether a person is suffering from depression and if they have any other mental disorders.
Once diagnosed, then a doctor can prescribe the proper treatment depending on the specific situation. Some individuals will require just the medications, while others will need just the therapy. Then there are more advanced cases of depression that will require close monitoring and a combination of the two treatment options.
Medications for depression are called anti-depressants, and they work to help restore the brain chemistry. These can take up to 4 weeks to show any improvement, and during that time, the patient may feel a welling up of negative emotions as the medication alters the present brain chemistry.
Anti-depressants can be dangerous to deal with especially because they may intensify suicidal thoughts before things start to get better. That said, they must be taken under the supervision of a health professional to guarantee that they work properly and that the patient is safe throughout the treatment process.
Behavioral therapies on the other hand tend to focus on habits and situations that increase the risk for depression and other mental disorders. For instance, some individuals might receive assistance and guidance on how to get a job. Others will require in-depth counseling to target and address toxic relationships within the family.
This specific strategy also focuses on helping an individual discover other, healthy habits that they can use to combat the condition. Adapting a healthy exercise routine, finding a new hobby, and involving themselves in groups and organizations are just some of the activities that are encouraged during therapy.
The feelings of hopelessness and sadness might make it seem as though there’s no way out, but all of the negative emotions and moods that come from depression are simply the result of chemical imbalances. Fortunately, these can be restored to normal with the help of behavioral therapies and medication. Many have successfully overcome the condition, opening the doors to a healthy, happy life that’s free from the darkness that comes with depression.