Depression: what is it? Is it really something you can control? How much does it really affect someone? Why do people suffer from depression? Several of these questions are brought to the attention of various professionals such as psychiatrists, psychologists, social workers, and physicians, but not enough people seek the truth. Depression is commonly viewed as a bad day; people either believe they have control, or they can just snap out of it. However, depression is more than a bad day. It could be caused by a chemical imbalance, genetics, family history, or trauma. All of these may cause symptoms; yet, there are successful treatments available such as medications and/or psychotherapy.
A bad day- what does it consist of? Maybe things did not go the way one planned them with friends. The telephone call never came. Perhaps a teacher surprised the class with a pop quiz. There are many more causes to create a bad day. Nevertheless, that is all it is, just a bad day. A definition of depression is “an emotional state in which there are extreme feelings of sadness, dejection, lack of worth and emptiness” (Depression, n.p.). When an individual feels “depressed,” he or she believes that he/she can simply snap out of it by thinking happy thoughts to replace the bad thoughts, or do something nice for him/herself such as going to a movie. After all, a positive experience is just the thing to change the negative thoughts. Certainly, it is just in the head, and it can be controlled! Unfortunately, depression is a lot more than just a few bad days or sad thoughts. Snapping out of it is harder than it sounds. “Depressed people are not merely unhappy but profoundly miserable” (Hales, 19). Depression causes individuals to feel and act out of control. Depression cannot be controlled, however, since it controls its victim until the problem is addressed and professional help is sought.
Most symptoms of depression are frequently overlooked. However, when one has the opportunity to learn about, or more seriously, when opportunity is forced on the person, the symptoms become much more obvious. The symptoms of depression range from mild to severe. Twelve commonly known warning signs are the most identified:
Depressed people lose interest in food, friends, sex, favorite activities, or any form of pleasure.
Lack of enthusiasm, energy, or motivation
Confusion or difficulty with decisions
Perfectionism and restlessness (APA, 327).
The DSM-IV states that if five or more of these symptoms exist in one’s life for a span exceeding two weeks, this is considered an episode of depression. “When you are depressed, nothing works out the way you hope. Whatever you try to do seems to go wrong. After a few failures, you begin to think that nothing will ever work out. Soon you’re asking yourself, ‘Why bother trying? I know I am going to fail’”(Ayer, 10).
There are many different causes of ‘depression’ that range from genetics to family history. A chemical imbalance in a person’s brain or a trauma that could have occurred earlier in a person’s life, or even more recently, are examples within this range. The exact cause of depression is still being researched. Genetics is still an unresolved topic for researchers; they have identified genetic markers for manic-depressive disorder on different chromosomes, but have yet to identify a specific gene for any depressive disorder (Hales, 48). Although genetic and family histories sound familiar, they are different when dealing with depression. It is stated that two-thirds of depressed patients have family members who have suffered from depression. “Although mild depression does not seem to be inherited, more serious forms run in families” (Hales, 48). Another study done the epidemiologist Myrna Weissman of Columbia University suggests that adolescents with depressed parents are at a higher risk for developing major depression or another psychiatric disorder. These adolescents also tend to show symptoms of these disorders much earlier in their life than a child whose parent did not suffer from depression (Hales, 48).
There are a few identified types of neurochemicals called neurotransmitters. This substance carries impulses between nerve cells. A group of pathways in the nervous system closely related to depression is called norepinephrine. Norepinephrine pathways are released from the end terminal of one nerve cell, and pass across a small space called the synaptic cleft, to a receptor on the adjacent nerve cell; that is where the electrical impulse is stimulated. Some of the norepinephrine is absorbed into the cell and the rest is broken down into smaller molecules or metabolized (Oltmanns, 189). The nerve cell has nerve terminals, which have their own receptor sites, which are sensitive to norepinephrine, and they tell it to shut down production. In depressed patients, this neurotransmitter is either “oversensitive or insensitive.” Therefore, when it is functioning poorly, and put under stress, symptoms of depression can result. Another brain chemical, which a depressed person’s body may not produce properly, is serotonin. This chemical enables brain cells to communicate with each other. An imbalance of serotonin may cause the symptoms of sleep problems, irritability, and or anxiety, which are suffered by many depressed patents (Oltmanns, 189).
Trauma can be something as little as a breakup in a relationship, loss of a parent, a traumatic car accident, or even built up stress. Other factors such as neglect, abuse, separation from parents, serious illness, and/or divorce can lead to depression in adolescents. This in turn increases the risk of depression in adulthood (Hales, 49-50).
When the physical body begins to feel stress, it goes through a series of stages, the first being worry or alarm. In this stage, one’s heart rate goes up, one’s blood pressure increases, and feelings of being overwhelmed are experienced. Next, the body becomes resistant or tries to fight the stress. After that, resistance occurs to the stress with attempts to bring it under control. Next, a person begins to worry more, which causes more stress. Finally, the body goes into a state of exhaustion. The person’s body is simply worn out. When the stress gets so bad, the body goes into the fight or flight response. This is when the body produces the hormone adrenaline. This chemical helps the person react under pressure. “Stress can and very often does lead to depression. When this happens, only a trained specialist using the proper therapy can help a depressed person to get well” (Ayer, 23). Left untreated, depression can become sever enough that suicide develops into an option of treatment. “Suicide is not about being dead, but about relieving the intense pain of depression’s symptoms” (Meyer, 1).
“Depression is probably the most widespread, most extensively studied and best understood major psychiatric disorder,” notes psychiatrist Martin Keller, M.D., of Harvard Medical School. She continues, “Yet, according to the American Psychiatric Association, less than thirty-three percent of depressed people seek treatment.” There are five main reasons psychiatrists prescribe medications for patients:
Have physical symptoms such as loss of appetite and weight, sleep disturbances, and fatigue
Report cycles of mood or symptoms at specific times of the day, month or year
Do not respond to psychological approaches (Hales, 80).
Various medications have been found effective in the treatment of depression. Some medications may have negative side effects; many are short-term and decline or go away over time. Selective Serotonin Reuptake Inhibitors or SSRIs are the more frequently recommended and prescribed medications for depression. They are a relatively new class of anti-depressant medications and were developed in the early 1980s. “The SSRIs inhibit the reuptake of serotonin into the presynaptic nerve ending and therefore promote neurotransmission in serotonin pathways by increasing the amount of serotonin in the synaptic cleft” (Oltmann, 188). SSRIs account for more than half of all prescriptions written for anti-depressant medications.
“With the right therapy, as many as eight out of ten depressed people can recover from their depression” (Ayer, 58). The most widely used form of therapy is often called “talking therapy.” This can be associated with the stereotypical image of the patient lying on the couch, talking to the psychiatrist. This type of treatment is a short-term, structured treatment, generally ranging from twelve to twenty sessions over a period of twelve to sixteen weeks. Another very common form of therapy is called therapy; this teaches patients to identify and change their negative thinking patterns and progress to incorporate more positive views of themselves and the world. “A doctor or therapist can only help depressed people get better. Patients must decide for themselves that they want to get better. They must believe that recovery is possible and be willing to work hard to make it happen” (Ayer, 56).
Currently, there are many misconceptions about depression. Yet, it is easier today to obtain the facts and disregard the rumors and hearsay about depression. There are many causes researchers just do not understand at this time; yet, for as many causes of depression there are also just as many flourishing treatments. A forty-year history of research validates the physical causes of depression. People do no choose to suffer from depression, nor do they talk themselves into suffering from depression any more than one would choose to suffer from diabetes. “Depression has been considered to be the major psychiatric disease of the twentieth century, affecting approximately eight million people in North America. Adults with psychiatric illness are twenty time more likely to die from accidents or suicide than adults without a psychiatric disorder” (Blackman, 1). Ayer says it simply: “Depression is a real illness, with a cause, with recognizable symptoms, and a cure” (Ayer, 10).
American Psychiatric Association(APA). Diagnostic and Statistical Manual of Mental Disorders (4th ed). Washington DC, 1994.
Ayer, Eleanor H.. Everything You Need to Know About Depression. New York: The Rosen Publishing Group, 1994.
Blackman, Maurice. “Adolescent Depression.”The Canadian Journal of CME. May, 1995. http://mentalheath.com (1 May 2000).
“Depression.” Jan. 2000 http://health.yahoo.com/health/diseases_and_conditions/disease_feed_data/depression/#definitions (11 May 2000).
Hales, Dianne. Psychological Disorders and Their Treatment, Depression. New York: Chelsea House Pub., 1989.
Meyer, Deborah. “A Miracle or a Curse.” 1993.
Oltmanns, Thomas F., Emery, Robert. Abnormal Psychology. New Jersey: Prentice Hall, 1995.