What is depression?
If you are suffering from depression, then you are not alone. Because according to statistics, nearly 10 million people in the world are currently in the same predicament. Depression has afflicted humans throughout history. As early as 2,400 years ago, Hippocrates, a famous Greek physician, defined depression as a type of temperament called “melancholy”. It is also worth noting that although we cannot know how animals feel, they probably also have the ability to feel depressed, or at least act as if they are depressed at times. Thus, we all have the potential for depression to a greater or lesser extent, just as we all have the potential for love, anxiety, and pain. Depression is not a gauge of life conditions or luck. In fact, many people throughout history have experienced depression, including King Solomon, Abraham Lincoln, Winston Churchill, and the Finnish composer Jane Sebelius. Sebelius is a good example of this.
It is worth remembering that depression is not a human weakness. What is the meaning of ‘depression’?
This is a difficult question to answer exactly, because the answer depends very much on the person who answers it. The word depression itself can be used to describe weather conditions, the fall of the stock market, holes in the ground, and, of course, the emotional state of a person. It originates from the Latin word deprimere, meaning “downward pressure. The word was first used to describe an emotional state in the 17th century.
If you are in a depressed state, you may notice that depression is more than just moodiness. It affects not only our perception and thinking, but also our energy, concentration, sleep, and even sexual desire. Let’s examine the impact of depression on our lives from a number of perspectives.
Motivation
Depression affects our motivation to do things. We can feel apathetic, lethargic, and uninterested in many things – as if nothing is worth doing and we don’t even feel the need to try. We likewise lose interest in our children, and then we feel guilty about it. Projects that we were once passionate about now become boring. We feel incapable of doing anything, and even if we keep our daily activities to a minimum, we still feel pained by it.
Emotions
People often think of depression as simply being low in mood or feeling saturated – and that’s only part of depression. In fact, the core symptom of depression is called “anhedonia” (of Greek origin), which means the loss of the ability to experience joy. We can feel that our lives have become incredibly empty and joyless. However, despite the loss of our ability to experience joy, our feelings of unhappiness grow and we become irritable. We may keep our discontent and anger bottled up inside us, and sometimes we become irritable and even fight with our loved ones and children. Afterwards, we regret it and our depressive symptoms become more severe. Another two common symptoms of depression are anxiety and fear. When we are depressed, we become vulnerable. Things that used to be easy for us to cope with are now inexplicably frightening. Therefore, anxiety and fear are important components of depression. In addition, other negative emotions associated with depression are sadness, guilt, shame, and jealousy.
Thoughts
Depression affects our thinking in two ways. First, it affects concentration levels and memory. We may find ourselves unable to concentrate on anything, including reading and watching TV. Our memory also becomes poor and we forget easily. Even when we do recall something, the electricity is mostly negative and unpleasant.
The second way depression affects our thinking is that it affects how we see ourselves, our future, and even the world at large. Few people feel good about themselves when they are depressed. Usually they see themselves as having no strengths, full of flaws and worthless. If you ask a depressed person what they think about the future, they will usually respond, “What future?” For them, the future is dark and full of failure. Like many strong emotions, depression can cause us to think in extremes, and our thinking becomes an “all or nothing” paradigm – we are either a complete success or a complete failure.
Imagination
When we are in a depressed state, the imagery we have is somewhat similar. We might say we feel like we are under a dark cloud, or like we are stuck in a deep pit, or locked in a dark room. Churchill called his own depression a “black dog. The imagery of depression is nothing more than darkness, the inability to break free. If you were to describe depression in a painting, you would probably use dark and obscure colors rather than bright colors. Darkness and entrapment are the dominant imagery of depression.
Behavior
When we are depressed, there are some changes in our behavior. We are less likely to engage in positive activities, and instead we try to avoid interactions and hide ourselves. Many activities that we used to enjoy doing now become overwhelming because anything we do is too much work and we seem to do less than we used to. The way we treat others has also changed. We may find ourselves interacting less positively with others and having more conflicts with them. If we feel anxious because of this, we avoid contact with others and thus lose confidence in our interactions.
People who are depressed sometimes become tense and have difficulty relaxing. They feel like trapped animals, walking around trying to do something, but not knowing what to do. Sometimes, the idea of escaping is very strong, but it is not clear where to go or what to do. On the other hand, some depressed people become unresponsive, and pools walk slowly, stopping at times. Their thinking also becomes sluggish and they feel “heavy” about everything.
Physiology
When people are anxious, their bodies produce adrenaline. Similarly, depression can cause physiological changes that affect the activity of our body and brain. Currently, no harmful effects have been found from these changes. However, it is clear that changes in brain activity occur in depressed states. In fact, any mental state, such as pleasure, sexual arousal, excitement, anxiety or depression, is closely linked to changes in brain physiology. Recent studies have shown that some of these mental states are associated with the secretion of stress hormones (e.g., cortisone), suggesting that the depressive response contains a component of stress activity. Depression also affects the secretion of brain chemicals known as neurotransmitters, the most studied of which are monoamine neurotransmitters. In general, the secretion level of these chemicals in the brain decreases in depressed states, which is the reason why taking monoamines can alleviate depressive symptoms.
It is speculated that the above physiological changes may be responsible for the adverse symptoms we experience. Depression not only affects our energy but also our sleep (but some people also sleep more in depressed states). In addition, lack of appetite is also a common symptom of depression; we may feel that food tastes like wax and lose weight as a result. Of course, some people also experience weight gain when they are depressed.
Social interaction
Although we try to hide our depressed state, it can still have an impact on others. When interacting with people, we can become drained, irritable, and often reject others. It is worth mentioning that these reactions are common to depression and it is necessary for us to recognize them without having to be ashamed of them, otherwise they will aggravate our depressive symptoms. As for why depression affects our relationships with others, there are a variety of different reasons. It may be that we harbor conflicts that we cannot sort out, it may be that we show silent resentment towards others, it may be that we feel out of control, or it may be that our friends and partners cannot understand what is happening to us. In short, remember the saying, “Laugh, and the whole world laughs with you; cry, and you are the only one who cries to the corner.” Sometimes, it is hard for others to understand our depression. Does depression manifest itself in exactly the same way?
The answer to this question is no. There are many different types of depression, and what experts usually refer to as “dominant depression”. According to the American Psychiatric Association, a person can be diagnosed as having a dominant depressive disorder if he or she experiences five or more of the following possible symptoms for two consecutive weeks.
For professional research, these symptoms are important, but they do not fully reveal the complexity and diversity of depression. For example, while I consider feelings of being trapped to be a common symptom of depression, psychologists may consider feelings of hopelessness to be a common symptom.
Researchers have made a distinction between depression that occurs alone and depression that alternates with mania.
In a manic state, people may feel unusually energetic, confident, and sexually desirable. If the manic state is not particularly severe, these people are likely to have excellent performance. People who have alternating episodes of depression and mania are often diagnosed as having a “bipolar disorder” (meaning they may experience bipolar states of mood – high and low), which is known in the old school of thought as bipolar disorder. Those who experienced only depressive states were diagnosed as “monophasic depression.
Another distinction that researchers have made regarding depression is between psychotic and neurotic depression. Patients with psychotic depression experience a variety of misconceptions known as “delusions. For example, a person with no physical illness will feel that he or she is terminally ill and will die soon. Many years ago, one of my patients contacted her attorney about a will and funeral before she was hospitalized, convinced that she would not live to see Christmas. She believed that the medical staff had withheld the truth from her to avoid upsetting her, and she kept telling her children how they should live after her death (which, of course, caused a lot of stress for her family).
Sometimes, patients suffering from psychotic depression develop strong feelings of guilt. For example, they may stubbornly believe that they started the Bosnian War or did other terrible things. As of today, psychotic depression is a very serious psychological disorder, which is relatively rare compared to non-psychotic depression.
Experts also make a distinction between depression rooted in melancholy and event-related depression (e.g., depression caused by job loss, death of a loved one, or interpersonal breakdown). At present, this distinction remains meaningless, although we find that the nature of the various types of depression does differ, as do the clinical symptoms. In psychotherapy, a deeper understanding of the patient reveals that depressed patients who appear to be rooted in depression also have corresponding early experiences. This is not to say that some people are more likely to suffer from depression than others, but simply to suggest that it is not wise to categorize depression according to its cause.
Clearly, some depressions are more severe and destructive than others. Many depressed patients live with their symptoms until they go away on their own. Other, more severe depressions have symptoms that are difficult to resolve on their own and professional treatment is essential. The different types of depression differ significantly in onset, severity, duration, and frequency of episodes.
Onset
Depression can have an acute onset (for example, within a few days or weeks) or a gradual onset (over several months or years). It can occur at all times of life, but late adolescence, early adulthood, and late adulthood are sensitive periods for the onset of depression.
Severity
Whether depressive symptoms are mild, moderate or severe varies according to individual differences.
Duration of illness
Some depressed patients have symptoms that disappear completely within a few weeks or months, while others may have a prolonged course that lasts for several years. It is generally accepted that “chronic depression” lasts for more than two years and accounts for 10-20% of all depression.
Frequency of onset Some depressive disorders are transient, while others are recurrent.
The recurrence of depression is noteworthy, but not surprising. Imagine if you feel inferior and worthless when you are young, there will come a time when this inferiority complex will completely overcome you and make you feel like a failure in life. Although medications can help you alleviate the symptoms, the underlying sense of failure, the inferiority complex, is still there. Medications cannot make us mature or rid us of the underlying misconceptions. Is depression a common illness?
As mentioned earlier, depression is a common illness, and the prevalence of dominant depression, for example, is as follows: occurring at some – time: 4-10% in women and 2-3.5% in men
Lifetime prevalence: 10%-26% for women and 5%-12% for men; inpatient treatment accounts for 1 in 1,000 and outpatient treatment ranges from 2 to 30 in 1,000. The above data suggest that one in four or five people will suffer from depression at some point in their lives, and that the incidence is three times higher in women than in men. Studies have found that certain social groups (such as the unemployed) are more likely to suffer from depression. Recent studies have shown that the incidence of depression is slowly increasing in this century, and the reasons for this are not yet known. Changes in socio-economic conditions, family break-ups, feelings of hopelessness among young people (especially the unemployed), and rising expectations of themselves may all contribute to this phenomenon.
How does depression arise?
When we are depressed, we often wonder what has caused our current state. Sometimes the cause of depression is easy to find, such as a broken relationship, but other times, the cause of depression is not easily discovered.
Theories about the causes of depression can be divided into three categories: biological, psychological, and sociological theories. Some of these theories may be difficult to understand, but not understanding them will not stop you from reading this book. The reason I present these theories here is that some people are indeed interested in them. In fact, if you wish, you can skip it and go straight to the second part. If you wish to do some understanding of the theories related to depression, you may find that there is something for you in each theory. Of course, no single theory dares to claim to answer all the questions.
What causes depression? This has been a topic of interest for thousands of years. About 2,000 years ago, the Greeks believed that depression was caused by an excess of “blackbile” in the body, and that the word “melancholy” itself means “blackbile “. As people studied this problem, another question arose, namely, what is the cause of the increase of black bile? The Greeks had a very complex view of this issue, believing that some people are born with black bile – a melancholic type. However, they also believed that stress, diet and seasonal changes could affect the amount of black bile in the body. It is evident that the Greeks had realized that events that happen to us cause us to be depressed and that depression in turn affects our physiological processes, namely the production of black bile. Today, we have abandoned the old “black bile” theory and are looking for the causes of depression by studying brain chemistry, or more precisely, “neurochemistry”. Unfortunately, however, we are not as discerning as the Greeks: some people believe that brain chemistry causes depression, but although those depressed patients do produce brain chemistry, this does not mean that brain chemistry causes depression. For example, we know that adrenaline production is related to anxiety, but that is not the same as saying that adrenaline is the direct cause of depression or that reducing adrenaline will cure anxiety. It is as if a robber forces us to give money, our adrenaline levels may increase, causing us to experience a certain amount of anxiety, and if we want to eliminate this anxiety, the proven way is to get rid of the robber, not to take some kind of drug.
Our theories often lack an interactive perspective, i.e. we do not consider the interaction between our life circumstances (the way we think about things) and our bodies. If you go to the doctor and she or he diagnoses you precisely as depressed and prescribes you some medication, those medications effectively ease your mood, improve your sleep, and reduce your anxiety. But the medications can’t help you find what caused the depression in the first place or teach you to learn to control it better.
On the other hand, some psychologists blame depression solely on our relationships and the way we see the world. They ignore the fact that our brain does work differently in a depressed state compared to a non-depressed state. The mind and body are unified, and our brains do change when we are anxious, angry, ecstatic, or orgasmic. In other words, our brains are in different states of operation in different psychological states. This fact shows that once we fall into depression it is very difficult to extricate ourselves. Sometimes, antidepressants can help (assuming the side effects are not so severe) and, in some cases, they can play a very important role. Therefore, to clarify the problem, we must consider the interaction of various factors, i.e., the interaction between the brain, our perceptions, and the social environment. Biological aspects
We have already talked about the fact that some kind of change in cortical activity occurs in depressive states. For example, sleep mechanisms are affected, the cerebral cortex controlling positive emotions is inhibited, and the cerebral cortex controlling negative emotions has increased excitability. Most importantly, there are also changes in the brain’s information retention processes. Current research does not yet reveal these changes definitively, but it is generally accepted within the community that the most important of these changes are changes in the brain’s monoamine circuits. The real changes in brain neurochemicals are very complex, and all we know is that antidepressants increase the activity of the monoamine system that controls positive mood and inhibit the activity of the monoamine system that controls negative mood. The mechanism of action varies slightly from one antidepressant to another (see the section on antidepressants).
The key question is: Why do these changes occur in the brain?
Our brains are affected by at least three factors that cause us to become depression-prone
Genes
The first possibility is that some people are born with a predisposition to depression. We become depressed because we have abnormalities in the production of neurochemicals in our brains, which are rooted in our genes, the segments of DNA that control a large number of biochemicals. If this insight holds true, then we would see a continuation of depression in the family, i.e., depression is heritable.
Similarly, if the above hypothesis holds true, we would find the same susceptibility to depression in twins who are placed in different families. This is indeed the case. If one twin suffers from depression, the other is much more likely to be depressed than the general population. And, the more severe the depression (e.g., psychotic depression or bipolar depression), the greater the probability of co-morbidity. For dizygotic twins, the probability of this co-morbidity, although also higher than in the general population, is lower than for identical twins. The above facts suggest that certain depressive disorders have a genetic basis and that genes lower the threshold for depressive states in the brain induced by life events.
Of course, we should avoid the simplistic mistake of concluding that “all depressive disorders are genetic”. Because, first, whether it is inherited depends very much on the definition of depression, and although there is growing evidence that some types of depression have a genetic basis, not all types of depression have a genetic basis. Second, if someone has a close relative with a certain psychological disorder, such as anxiety or alcoholism, the probability of developing the disorder himself is greatly increased. However, common sense tells us that anyone other than an identical twin has a very different genetic structure from one another and we cannot be a carbon copy of another person. Studies of infants show that from birth, infants exhibit different temperaments, with some being timid and others more interested in exploring new things.
Growth
Genes are the foundation of life. They determine the color of our eyes and hair, and are the driving force behind our growth. For example, as we grow, genes ensure the development of our sexual organs. However, the brain is not a closed system independent of the external world according to a given pattern; instead, early relationships influence the type of connections of nerve cells in our brain. As far as we know, the brain is highly plastic in this respect. Early brain growth and development in children is dependent on social influences. A child who grows up in a loving environment has a different brain development than a child who is often abused and threatened.
The above perspective connects external events to internal changes in our somatic body and brain, making us aware that experiences shape our brain. As an example, if we are in a stressful situation, stress chemicals such as cortisone begin to act on the brain, and over time, changes in the brain’s messaging processes occur. These chemicals affect not only the activity of “neuroreceptors” but also the way nerve cells (or neurons) are connected to each other. Thus, from birth, the brain is connected to the outside world. The seeds of susceptibility to depression are planted early in life. There is now growing evidence that those patients who suffer from chronic depression have a history of abuse, and that some of them – in some cases – have a markedly increased sensitivity of the stress system.
The biological sensitivity to depression may stem from childhood experiences that affect brain growth and development. However, this assertion should not lead to pessimistic thoughts, because mindfulness interventions can be very helpful in changing this symptom. If a person is aware that he or she has this sensitivity, learns about the relevant psychology, and actively engages in psychological training, he or she can not only cope better, but also change this sensitivity.
Uncontrollable Stressful Events
Another factor that traps our brain in a depressed state is stress. Many years ago, Martin Seligman found in his research that if animals were given uncontrollable stressful stimuli, they would exhibit all the negativity and passivity of depressed patients. Later, other researchers studied this further and tried to figure out what kind of changes occurred in the brain of animals under uncontrollable stress stimuli. The results of the study showed that some of the brain changes were very similar to those in humans when they are depressed. For example, the cerebral cortex, which controls positive emotions and behavior, was inhibited. If a controlled stress stimulus is given to an animal, the animal produces a completely different brain change, i.e., the cortical activity that controls positive emotions and behaviors is greatly increased. The same stressful stimulus, at different levels of controllability, can lead to completely different biological changes in the animal’s brain. If you are in a stressful situation but you are able to take positive action, your brain is one mode of change; if you are in a stressful situation but powerless to do anything about the situation you are facing, your brain produces completely different changes in which coping style is the key factor.
These findings are crucial and suggest that the better we are at coping with stressful stimuli in real life, the less biochemical changes occur in our brains.
The evolutionary dimension
Evolutionary theory tells us that we often fall into various distressing psychological states because we have “a specific potential”. For example, if someone we love dies suddenly, we will be in great pain. We may let others share this pain, or we may suffer alone, but either way, we all have the potential to grieve. Similarly, each of us has the potential for aggression, and if another person hurts your child, you will develop a strong desire for revenge. Likewise, we all have the potential for sexuality or anxiety.