Depression: What is it?

Depression is a syndrome characterized by intense grief, feelings of guilt, low self-esteem, loss of interest in life, and hopelessness. In the medical field, it is used in several contexts; one would be as a normal part of the grieving process.

Depression, seen in light of the grieving process, is something that is healthy, normal, and ultimately leads to acceptance. However, depression that lasts for an extended period of time can be classified as a disorder. Used in this context, depression becomes a debilitating disease that currently is the fourth major cause of disability in the world. By the year 2040, if nothing is done to prevent it, it will have turned into the second most debilitating disease. Indeed, depression is not something that should be taken lightly.

Clinical Depression

Depression is a mental disorder that is characterized by dysphoria (a marked feeling of sadness), anhedonia (an inability to feel pleasure from activities that used to give pleasure), and is usually accompanied by insomnia or hypersomnia, anorexia, decreased libido and, sometimes, even psychomotor retardation. People who are depressed usually have low self-esteem, feelings of guilt, activity intolerance, poor concentration, and feelings of hopelessness. People who are depressed usually have ineffective coping strategies.

The course of this illness varies widely among patients. Some people may suffer clinical depression only once in their lives while others may have it periodically. There are even some people who suffer through it their whole lives. Oftentimes, the people who suffer from depression for a markedly long time are those who do not seek medical treatment. This is because society still harbors several misconceptions about depression and the circumstances surrounding it.

Many people view depression as a ‘weakness’ and refuse to acknowledge it. Oftentimes, people think that those who suffer from depression should just ‘snap out of it’ because it’s all just psychological – a misconception that has several ramifications.

Depression isn’t something that people can just ‘snap out of’. It is a serious disorder which is believed to be linked with genetics, neurotransmitters, and the endocrine system.

Genetics

People who have been diagnosed with depression are more likely to have an immediate family member who suffered from depression as well. If a patient has a family member (father, mother, sister, or brother) who has been diagnosed with depression, then this puts that person at risk for developing depression.

Neurotransmitter Dysregulation

Several studies have shown that the neurotransmitter, serotonin, also has something to do with depression. A study showed that people who committed suicide have low levels of 5-hydroxilindoleacetic (5-HIAA) in their cerebrospinal fluid; 5-HIAA is the metabolite of serotonin.

Depressed persons also have low levels of tryptophan, which is the precursor to serotonin. It is believed that depression is linked to an abnormality in the transport, release and synthesis of serotonin.

The success of anti-depressant drugs further support this theory, as some anti-depressants, like prozac, work by inhibiting the reabsorption of serotonin; this helps maintain healthier levels of serotonin.

Neuroendocrinology

Cortisol has been found to be markedly increased in people who suffer from depression. When a person encounters a stressor, the hypothalamus releases the hormone CRH, which then stimulates the Pituitary gland to secrete ACTH. The ACTH goes to the adrenal glands and tells it to secrete cortisol. The cortisol normally causes the stress response to stop. But for a depressed person, this process goes a bit awry. Somehow the hypothalamus does not respond to the cortisol, causing a hypercortisolemia, or an increase of cortisol in the body.

Since the hypothalamus is the center for appetite, libido, and cicardian rhythms, this theory becomes highly plausible. After all, depressed people usually experience disturbances in eating, sleep, and libido.

Depression is known to be preceded by events that cause severe physical and emotional stress. The death of a loved one, for example, is the most common trigger for depressive episodes. Other common causes include marital or relationship problems, financial problems and serious health problems. Thus, depression has also been linked to causes that are not biological but psychosocial.

Theories on Depression

Noted psychologists such as Karl Abraham and Sigmund Freud believe that feelings of depression can somehow be linked to a person’s experiences in early childhood. If a person encountered major loss during the crucial early years of his life, then he is more likely to develop depression later on in life and may be unable to form meaningful relationships with others.

According to the learned theory of helplessness, people get depressed when one or more of the following are encountered: (1) when the cause of the event is perceived by the person as internal (leading to guilt), (2) when the cause is perceived to be unchangeable and permanent, an (hopelessness), (3) when the event affects a wide range of areas of living. That is, whether a person will become afflicted with depression or not, depends on his perception of the events that happen in his life.

Another theory, the cognitive theory, states that depression happens when the person has a negative outlook about himself, the world and the future. People who have this kind of negative view often misinterpret the things that happen to them. When a positive event happens to them, they may view it as something negative. For instance, when someone gives them a compliment, they may take it as an insult. Of course, this – that is, misinterpretation of events – can happen to the best of us and therefore merits no undue concern. A pattern like this, however, is continually applied by depressed persons their whole lives – and that is something that merits grave concerns indeed.

Whatever depression stems from, it surely isn’t something to be taken lightly. People who suffer from depression may have recurrent morbid thoughts about death. They are always at risk for suicide. The risk is increased when that person has formulated a specific plan on how to commit suicide. For example, a person who says “I will jump from the top of the building at 8:00 AM tomorrow, you will find my suicide note inside my drawer” is a lot more at risk than the person who just says that he’s thinking about killing himself. However, any person who states a desire to kill himself should be taken seriously and assessed for depression, regardless of the actual risk.