It’s a strange phenomenon. We have more material wealth, more political and economic freedom, and more health security today than at any time in history, yet anxiety, stress, pain, and depression are more prevalent than ever before, even leading directly to suicide for many people, especially young people,. So, why? Where the heck has our happiness gone?
Depression is influenced by everything from molecular changes in genes to the family and social environment; even the causes and development of symptoms vary for each specific depressed person. Even so, we must still try to understand depression, because only by knowing its mechanism can we find a solution to cope with it.
I. What is depression?
Depression is not just a “bad mood”, it is a disease; it is not something to be ashamed of, but it needs to be treated.
Many people often confuse depression with depressive disorder – this leads people to think of depression as the sadness of everyday life, but they do not understand that depression is actually a very serious psychiatric syndrome that is a combination of many emotional disorders; it includes not only despair, depression and sadness, but also loss of interest, fatigue, anxiety, and depression. It includes not only loss of interest, fatigue, anxiety, anorexia or bulimia, insomnia or drowsiness, and other factors.
There are nine main diagnostic criteria for depressive disorders, as follows.
1. loss of interest and unpleasantness.
2, loss of energy or fatigue.
3, psychomotor retardation or agitation.
4, low self-esteem, self-blame, or feelings of guilt.
5. difficulty in association or reduced ability to think consciously.
6. recurrent thoughts of death or suicidal or self-injurious behavior.
7. sleep disorders, such as insomnia, early awakening, or excessive sleep.
8.Decreased appetite or significant weight loss.
9.Decreased sexual desire.
Depression may be diagnosed as long as any four of these symptoms are met simultaneously and the depressive episode lasts for more than two weeks.
In fact, what we usually call “depression” does not refer to a single clinical disorder. Depression in the everyday context often corresponds to what used to be called “mood disorders”. Depression is sometimes accompanied by many other types of mental illnesses, such as anxiety disorders, schizophrenia, borderline personality disorder, etc. The severity of depression varies, the same patient does not always have a depressive episode, and the degree of each episode varies. It is difficult to make the best treatment plan based on experience – it is likely that each patient is a new case. For ease of description here, depression is referred to as major depressive disorder in the absence of specific instructions.
II. What causes depression?
Depression is often not caused by a single factor, so don’t take it for granted that you can “diagnose” and “treat” yourself, but seek professional help.
The prevailing medical opinion on the causes of depression is that “depression has many possible causes, including misregulation of the mind by the brain, genetic predisposition, stressful life events, medications, and substance abuse problems. Usually we believe that some or all of these factors work together to cause depression.”
1. Genetic correlation: The occurrence of depression is closely related to genetics. The rate of relatives with the same disease is much higher than that of the general population, and the closer the blood relationship, the higher the consistent rate: In a survey of depressed patients, it was found that about more than 40% of patients have a genetic predisposition, and if a person’s first-degree relatives have parents, children and siblings with major depression, he or she will have a 1.5-3% higher prevalence rate than those who do not have relatives with depression. In addition, people with mutations in genes related to depression, such as the 5 serotonin transporter gene and the nerve growth factor gene, are also more likely to suffer from depression.
2. Imbalance of biochemical systems in the body: Imbalance of biochemical systems in the body such as hormones and neurotransmitters – i.e., over- or under-secretion of biochemical molecules – can also cause depression. This imbalance can be caused by abnormalities in the genes that encode these molecules or molecular receptors, or by external causes such as drugs, extremely disordered work and rest, or strong and prolonged stress reactions. There are certain thresholds for changes in the levels of chemical molecules in the body, and many of them interact with each other to form a balanced network called endostasis. Many symptoms of depression are triggered by the disruption of this endostasis, and once the endostasis is disrupted, it is difficult to restore it to its original equilibrium state. Antidepressant medications can effectively raise or lower the levels of the corresponding chemical molecules, but if the endostasis is not restored, it will quickly fall into a state of chaos after stopping the medication. The disruption of endostasis is often accompanied by an imbalance of the endocrine system.
3, Organic and functional changes in the brain: for example, a decrease in neurons and glial cells in the hippocampus associated with memory, a decrease in the volume of neurons in the prefrontal region responsible for controlling higher cognition, and a weakening of functional links between brain regions are all associated.
4.Social environment and personality psychology related: depression as a psychiatric disorder is also closely related to social environment and personality psychology and other factors. Major life events, such as the death of a loved one or the loss of a relationship, can be a direct factor leading to depressive disorders. The person’s personality also partly determines different adaptation strategies to stress – the presence or absence of good habits, and the degree of tolerance to environmental stress, etc., and thus has a greater impact on endocrine balance and endostasis in the body. Adverse experiences in childhood often constitute an important risk factor for depressive disorders in adulthood. Experiences during the critical period of growth also have an important impact on depressive disorders or depressive episodes in adulthood.
5, other physical diseases: other physical diseases may also lead to depression, especially chronic central nervous system diseases or other chronic diseases, such as malignant tumors, metabolic and endocrine diseases such as diabetes, cardiovascular diseases such as coronary atherosclerotic heart disease and rheumatic heart disease, neurological diseases such as Parkinson’s disease, epilepsy, etc.
6, psychoactive substances: psychoactive substances abuse and dependence can be a risk factor for depressive disorders, these substances include opiates heroin, morphine, central stimulants caffeine, cocaine, hallucinogens cactus toxin, alcohol, sedative-hypnotic drugs, etc.. Especially alcohol abuse.
7, drugs: drugs can also trigger depressive disorders: certain antipsychotic drugs such as chlorpromazine, antiepileptic drugs such as sodium valproate, phenytoin sodium, etc.; anti-tuberculosis drugs such as isoniazid; certain antihypertensive drugs such as colistin, reserpine; anti-Parkinson’s disease drugs such as levodopa; glucocorticoids such as prednisone, etc.. These drugs can cause depressive disorders in some patients when used in conventional therapeutic amounts, or aggravate the existing depression.
It is easy to see that depression has a considerable number of risk factors, and it is noteworthy that these risk factors work together in many cases. In particular, for each additional risk factor, there is a significant increase in the probability of developing the disease. However, these causes do not directly translate into depressive symptoms. The predominant self-perception of depression is abnormally negative thoughts, and this state is a “cognitive bias” – the greatest difficulty in treating depression.
Depressed mood and cognitive bias
Chronic depression is a result of abnormal brain function. It is an abnormality that can and should be corrected; depression is not a “punishment” that you “deserve”.
Different areas of the brain are not isolated from each other; although they perform different functions, they are connected to each other by neuronal pathways that form a complex network of brain connections. Once the connections between some nodes in this network are disrupted, the brain functions abnormally, producing abnormal cognitive and emotional biases. In the brains of depressed patients, this abnormality is manifested in the active network biased toward negative emotions and negative thoughts and the reduced function of the network biased toward happy emotions and positive thoughts. This cognitive bias due to abnormal brain function is the main cause of chronic depressed mood in depression.
This cognitive bias also causes a memory bias, resulting in only negative stimuli entering the memory system for encoding and extraction, which is the most fundamental reason why depressed people are unable to think positively and can only face life negatively. It can be said that it is this abnormal brain function and cognitive pattern that takes away the happiness of depressed people.
Fourth, am I considered depressed?
The diagnosis of depression relies mainly on scales, but even if you use self-rating scales, please seek professional guidance whenever possible. Do not trust various depression self-tests from unknown sources.
At this stage, the diagnosis of depression is still done mainly through a large number of clinical scales. A series of questionnaires are filled out to determine the mental and psychological state of the person filling them out, and the results of these questionnaires are quantified to determine the degree of depression of the person filling them out before further counseling and treatment can take place.
The biggest difference between psychiatric disorders and other diseases is that there is no systematic physiological indicator or indicators to reach a diagnosis. Although there are neurobiological mechanisms involved in depression, these genetic or molecular changes are only phenomena and are not determinants of depression, therefore, diagnosis can only be made by psychological means at present.
Some of the depression scales can be read and filled out by yourself, such as the Self-Rating Depression Scale (SDS), and others need to be filled out by a trained assessor after observing and talking with the patient, such as the Hamilton Depression Inventory (HAMD), although these scales are easy to find, but as mentioned above, the specific assessment should be done under professional guidance to avoid delays.
V. What is the treatment for the disorder?
Medication
Medication is a very effective way, do not be afraid to take medication, disease is not a stigma, treatment is even less.
The most convenient and fast means of treating depression is still medication. There are many types of antidepressant drugs, most of which target the chemical system in the body. Traditional antidepressants basically target monoamine transmitters in the brain, such as 5-hydroxytryptamine or norepinephrine. Please note that these medications are prescribed and should be taken strictly according to your doctor’s instructions and with a confirmed diagnosis, not just because you feel “down”!
Psychotherapy
Psychotherapy is also used independently of, or in conjunction with, medication, and its principle is to directly address the patient’s cognitive biases. There are many types of psychotherapy available for patients with depressive disorders, and the main ones commonly used are: supportive psychotherapy, kinetic psychotherapy, cognitive therapy, behavioral therapy, interpersonal psychotherapy, marital and family therapy, etc. In clinical practice, although it is not always possible to treat patients with depressive disorders, it is not possible to treat patients with depressive disorders.
In clinical practice, although a combination of medication and psychotherapy is not recommended for most patients, for some patients a combination is more effective.
Electroconvulsive therapy
For many patients with severe depression, where medications fail to improve symptoms and psychotherapy fails to eliminate negative thinking, a more drastic but highly effective treatment, electroconvulsive therapy (ECT), is the only option. ECT, also known as electroconvulsive therapy (ECT), is a method of treatment by passing a certain amount of electric current through the brain to cause loss of consciousness and spastic seizures. A large number of clinical studies and observations have confirmed that ECT is a very effective symptomatic treatment method, which can bring about rapid relief with an efficiency of 70%-90%. However, there are many contraindications to electroconvulsive therapy, for example, it cannot be used on the elderly and children, patients cannot have organic brain disease, cardiovascular disease or respiratory disease, and it is accompanied by complications such as headache, nausea, vomiting, anxiety, reversible memory loss, and generalized muscle aches and pains.
In recent years, with the development of technology, a class of non-invasive therapeutic instruments has been proven to be effective in relieving the symptoms of depression and is expected to be used in a large number of clinical applications. Transcranial magnetic stimulation, or TMS for short, is one of these devices, which treats depression by applying magnetic pulses to the scalp to stimulate the nerves in the corresponding functional brain regions, and is effective for some patients with refractory depression. However, this instrument is still being studied and repeatedly confirmed for antidepressant efficacy, and has not yet been formally entered into clinical treatment use.
VI. How should we treat depression?
Depression is often incomprehensible to the uninitiated. Why does a person who seems to be doing well in life suddenly become depressed? Please remember that depression is a disease. Depression is not just a bad mood one day that simply passes because you slept on it. “Just pull yourself together”, “Things will always get better”, or “If the sky is going to give you a big responsibility, you must first suffer from it”? The simple reassurance of others does not always come true.
To make matters worse, unlike other patients who are grateful for the care they receive from family and friends, depressed people are unable to feel such care or express gratitude after having their ability to feel joy stolen from them. This negative attitude can be very difficult for others to accept and can easily demotivate them. Sometimes, understanding is not enough, but selfless devotion and tolerance are needed.
Depression is ultimately an individualized illness, and what the patient needs most is professional treatment for himself, which no article or book, no self-test or self-medication can replace.