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What is depression?
Depression is a common psychiatric condition that can affect adults of all ages, from young to old, and even children.
Contrary to popular belief, depression not only affects emotions and mood, but also affects the body, altering behaviour and manifesting as physical symptoms.
This pathology can affect both men and women, but it is estimated that women are more frequently affected by depression than men.
Depression is considered a mood disorder, a crucial psychic function for adapting to our internal and external environment due to its flexibility. In case of depression, this flexibility is lost and the mood remains constantly low, regardless of the circumstances. The mood is always bad, accompanied by negative and pessimistic thoughts about yourself, others and the future.
Depression can occur at any age, regardless of race, culture, or social status. The average age of onset is around 25 years. This disorder is not related to character fragility nor does it represent a personality disorder.
It is a persistent state of mind that becomes pathological when, together with physical, physiological and cognitive changes, it significantly impairs the individual’s ability to function.
The condition occurs when a person overreacts and over a prolonged period to a triggering, emotionally distressing and stressful event, often linked to a loss.
An untreated depressive episode typically lasts about 6 months, but may persist for 2 or more years. Episodes tend to recur repeatedly throughout life, making recurrences common for those suffering from depression.
What are the symptoms of depression?
Although there are different forms of depression, which differ in duration and presumed origin, they share some emotional, physical and cognitive symptoms that significantly affect the individual’s personal, relational and social life.
People who suffer from depression see their ability to perform daily activities impaired, tend to isolate themselves and avoid social interactions, and develop feelings of guilt and feelings of self-depreciation. If these symptoms are not recognized and treated promptly, they can become chronic.
Typical symptoms of depression include:
- Deep sadness
- Almost total loss of interest and pleasure, which leads to abandoning passions, hobbies and pleasant activities
- Appetite disorders (decreased or increased appetite)
- Sleep disorders (insomnia or excessive need to sleep)
- Chronic fatigue
- Memory problems
- Difficulty concentrating
- Lack of planning and difficulty in making daily decisions
- Negative thoughts, including suicide
The presence of at least five of these symptoms may indicate a depressive condition, which must include at least one depressive episode lasting at least two weeks. Often, psychomotor slowdown and somatic symptoms are also added to these symptoms.
Types of depression
The term “depression” does not refer to a single disease, but includes several forms of depression, each with specific characteristics. Here are some of the main types:
- Unipolar depression or major depressive disorder: This is one of the most severe forms of depression, whose symptoms prevent you from performing normal daily activities, such as sleeping and eating, as well as negatively affecting activities that normally bring pleasure.
- Dysthymic disorder or dysthymia: Characterized by symptoms similar to those of major depression, but in a milder and more persistent form.
- Depressive disorder not otherwise specified: This category includes depressive disorders that do not fall into other specific diagnostic categories.
- Bipolar disorders or manic-depressive disorders: These disorders are characterized by the alternation between depressive states and manic or hypomanic states. Bipolar disorders are divided into:
- Bipolar I disorder: Characterized by at least one episode of mania or mixed alternating with depressive episodes.
- Bipolar Disorder Type II: Characterized by episodes of hypomania (never mania) alternating with depressive episodes.
- Cyclothymic disorder or cyclothymia: It has a minimum duration of two years and is manifested by alternating mild to moderate depressive episodes and hypomanic episodes.
These forms of depression, with their respective characteristics, are described in detail in the Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fifth edition.
There are also other types of depression classified by etiology:
- Premenstrual dysphoric disorder: It includes a series of affective, behavioral and somatic symptoms that occur monthly during the luteal phase of the menstrual cycle.
- Depressive disorder due to another physical condition.
- Drug or substance-induced depressive disorder (iatrogenic depressive disorder).
Causes of depression
The etiology of depression is not entirely clear. However, its appearance can be influenced by a combination of predisposing or precipitating factors of a biological, psychological, social, genetic and physiological nature. Among these, heredity, side effects of certain medicines, hormonal and organic imbalances, traumatic events such as bereavement, severe interpersonal and family conflicts, life changes and physical illnesses may play a significant role.
About half of people with depression have a familial predisposition linked to genetic factors that alter the normal functioning of certain neurotransmitters (serotonin, dopamine, norepinephrine), negatively affecting initiative, sleep, obsessive thoughts and social interactions.
Changes in female hormone levels can cause significant mood changes, which are particularly noticeable shortly before menstruation, during pregnancy and especially in the postpartum period (postpartum depression).
Depression can also be caused by thyroid dysfunction due to pathologies of the gland or as an indirect consequence of a painful or disabling disease that compromises the quality of life of the affected person.
Seasonal affective disorder is an example of how climate and environmental changes can induce severe forms of depression in particularly sensitive individuals. Some medications, such as beta-blockers and corticosteroids, may also contribute to depressive states, especially when they are stopped.
Some mental illnesses, such as anxiety disorders, alcohol and other substance use disorder, and schizophrenia, may predispose you to depression. In addition, events that generate emotional distress can promote depression in predisposed individuals.
Role of neurotransmitters in depression
Regarding the role of neurotransmitters in depression, some hypotheses have been formulated including:
- Monoaminergic hypothesis: This theory holds that depression is caused by a deficiency of serotonin, norepinephrine and dopamine. The theory is supported by the fact that antidepressant drugs increase the transmission of these monoamines.
- Hypothesis of receptor sensitivity: According to this hypothesis, depression is not only due to a monoamine deficiency, but also to an altered sensitivity of postsynaptic receptors to these neurotransmitters.
- Permissive hypothesis: This theory underlines the importance of the reciprocal balance between serotonin and norepinephrine in mood regulatory processes. Too low a level of serotonin can disrupt the regulation of norepinephrine, leading to mania. In contrast, a drop in norepinephrine can disrupt serotonin regulation, causing symptoms of depression.
- Hormonal hypothesis: This hypothesis suggests that alteration of the hypothalamic-pituitary-adrenal (HPA) axis may affect the levels of serotonin and norepinephrine released by neurons and impair their functioning.
Traditional therapies to treat depression
When the origin of depression indicates a psychosocial nature, a path often traveled and cognitive-behavioral therapy, which focuses on the present and current symptoms.
This therapy attempts to modify the negative thoughts that contribute to depression, helping the person develop more balanced and rational thinking. In addition, it works to improve the person's coping skills, encouraging them to gradually resume abandoned activities, starting with the most pleasant ones, and to develop more functional behaviors.
Drug therapy with antidepressants, which is predominantly symptomatic, becomes necessary when depressive symptoms are so severe as to compromise social, professional and relational life. Although these drugs are widely used, the results can be modest and temporary.
Several classes of drugs are used in the treatment of depression: tricyclic and tetracyclic antidepressants, multisystem agonists Noradrenaline-Serotonin, and serotonin reuptake inhibitors (SSRIs).
For resistant depression, combinations with mood stabilizers may be used. If depression is accompanied by psychotic symptoms, the use of a combination of antidepressants and antipsychotics is justified. In any case, it is essential to integrate drug therapy with a valid psychotherapy, to help the person develop functional strategies to deal with acute depressive episodes and prevent relapses.
However, all these therapies tend to treat the symptoms without being able to dig into the neuro-psycho-physiopathological depth from which all dysfunctional processes start.
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