What is depression?

People sometimes confuse the word depression with feeling sad. While sadness is a symptom, depression affects more than just your emotions. It also changes how you think, how you perceive, and how you act.

Symptoms of depression can range from mild to moderate and include:

    • Sad or depressed mood
    • Loss of interest in activities
    • Loss of joy from activities
    • Change in apetite and or weight
    • Sleep too much or have trouble sleeping
    • Loss of energy, feelings of fatigue
    • Increase in purposeless activity (wringing hands, pacing)
    • Slowed movement or speech
    • Feelings of worthlessness or guilt
    • Trouble concentrating, thinking, or making decisions
    • Thoughts of death/suicide

    Be aware there are medical conditions that mimic symptoms of depression such as thyroid issues, vitamin deficiencies, and brain tumors.

    Comparison of Grief and Depression

    It’s easy to see why people use the term depressed when they mean they are sad or grieving when you look at the similarities of the two. But the differences between the two help to distinguish them from one another.

    Symptoms shared by grief and depression

    1. Sadness 2. Insomnia 3. Poor Appetite 4. Weight loss

    Grief/Sadness versus Depression

    ❏ Emotional pain comes in waves mixed with happy memories
    ❏ Self esteem remains steady
    ❏ Can bring on depression

    ❏ Mood and interest are decreased for long periods of time
    ❏ Feelings of worthlessness and self loathing

    What complicates the diagnosis of depression is due to the person who is suffering. Their mind has convinced them of things that aren’t true. Depression changes how they perceive themselves and the world around them.

    People with depression don’t reach out because of these changes and feelings of being a burden on others. They become experts at pretending everything is great when they’re around those they love in order to not worry their family and friends.

    Tragically, often times when we do learn someone was suffering from depression, it’s too late. The disease took complete control of the person and the only end they saw was through suicide. And only when it’s someone famous like actor Robin Williams, do we sit up and take notice.

    What causes depression?

    Depression is caused by a combination of life events (long-term struggles, abuse, isolation/loneliness, prolonged stress), personal factors (family history, personality, medical illness, drug use), and biological components. Depression is more than a chemical imbalance in the brain. It’s more complicated than too much of this or too little of that.

    Billions of chemical reactions make up the complex system of mood, perception, and experience. While these chemical reactions do play a role, researchers believe depression stems from problems with nerve cell connections, nerve cell growth, and functioning of nerve circuits. In other words, bad wiring in the brain is more likely the cause of depression.

    Brain and Biology Components

    There are three sections of the brain linked to depression: the amygdala, thalamus, and hippocampus.

    • Amygdala
      • Associated with anger, pleasure, sorrow, fear, and arousal
      •  Emotional memory storage
    • Thalamus
      • Receives sensory data
      • Relays information to the cerebral cortex
      • Believed to be connected to bipolar disorder
    • Hippocampus
      • Processes long term memory
      • Sluggish hormone production may be source of depressed moods
      • Found to be smaller in depressed patients

    In addition, there are six neurotransmitters that play a role in depression:

    • Acetylcholine: memory and learning
    • Serotonin: regulates sleep, appetite, and mood; inhibits pain, low level linked to high suicide risk
    • Norepinephrine: motivation and reward system, raises blood pressure by constricting blood vessels
    • Dopamine: movement, motivation, and perception
    • Glutamate: excitatory neurotransmitter, linked to bipolar and schizophrenia
    • Gamma-aminobutyric acid: inhibitory transmitter, quells anxiety

    Research has identified genes that affect low mood vulnerability and how effective treatment would be for the individual. Family history also indicates mood disorders have a genetic component. Understanding how these genes function will lead to more individualised treatments.

    The final component that has influence on the development of depression is your temperament. How excitable you are or whether you withdraw from social situations is one part of your temperament. Genetic inheritance and life experience combine to create your worldview which reflects how you perceive life situations. Are you an optimist or a pessimist?

    Treating Depression

    Depression is the most treatable mental disorder with an 80-90% improvement rate. The more we learn about the risk factors - biochemistry in the brain, genetics, personality/temperament, and environmental influences, the better chance we have of creating individualized treatments.

    Medications like antidepressants, modify the brain chemistry to help regulate mood but it’s a time consuming game of trial and error, to find the right prescription and correct dose since no two cases of depression are exactly alike.

    Psychotherapy, or talk therapy, has shown to help in cases of mild to moderate depression. Some situations may call for couples or family therapy to help address interpersonal relationships that may have led to the depression.

    Severe cases of depression or people with bipolar disorder may require electroconvulsive therapy when other methods of treatment have failed. ECT is administered by a team of doctors and requires electrical stimulation to the brain while under anesthesia.

    Theories about new nerve growth and nerve connections and the role they play in improving mood will lead to development of more effective medications and treatments. The future of mental health may lie in understanding the science of neurogenetics.