What is depression?
Many of us have mood swings, and there are times when we get so caught up in the “down” mood that we need help. Depression can manifest itself in a variety of ways including loss of energy, loss of interest in activities and life, sadness, loss of appetite, weight loss, irritability, difficulty making decisions, and thoughts of suicide. Many depressed people also feel anxious, and they often feel worried, nauseous, dizzy, with bouts of cold or hot skin, blurred vision, rapid heartbeat, and sweating.
Clinical depression ranges from mild to severe. For example, some people complain of mild depressive symptoms from time to time. Others, those who suffer from severe depression, complain of much more frequent and very disturbing symptoms that last for a long time.
Clinical depression is different from the grief caused by loss, separation, or divorce after the death of a loved one. Feeling sad, empty, diminished energy, and loss of interest in daily life while grieving, and anger and anxiety are often common in the normal grieving process. However, clinical depression is different from grief in that the former can occur in the absence of loss. In addition, clinical depression often lasts longer than grief and is accompanied by feelings of self-criticism, hopelessness and despair.
Who gets depressed?
Depression is not something that happens to people who are “unusual” or “crazy”, but to anyone. Depression is often accompanied by anxiety and is an emotional cold. In any given year, a significant proportion of people will suffer from major depression. Over the course of a lifetime, 25% of women and 12% of men will suffer a major depressive episode. After a first episode of depression, the probability of having another depressive episode is high. Fortunately, there are some very effective ways to treat depression and significantly reduce its recurrence rate.
The reasons for gender differences in the prevalence of depression are not clear. Possible reasons include women’s greater willingness to admit sad feelings and self-criticism to others, and men’s possible tendency to “hide” depression behind alcohol and substance abuse. In addition, women are taught from an early age that being female is helpless and dependent. Women may have less control over rewarding resources than men, and their accomplishments are often discounted.
What are the causes of depression?
There is no single cause of depression; we believe that depression is “multifactorial” —— meaning that a range of different factors contribute to depression. These factors can be biochemical, interpersonal, behavioral or cognitive. For some people depression may be caused by some of these factors, but it is more likely to be caused by a combination of these factors. Biochemical factors can include genetic predisposition in the family as well as the chemical state of the brain. Interpersonal conflict and loss of relationships may also be factors contributing to depression, as well as behavioral factors such as an increase in stressful pressure and a decrease in positive and pleasant experiences. Cognitive factors include a variety of distorted dysfunctional thinking. Let’s examine these behavioral and cognitive factors more closely.
How does behavior affect depression?
The following is a more detailed list of behavioral factors involved in depression.
1. Lack of rewards. Have you recently experienced a significant loss in your life? Examples include loss of work, friendships, intimate relationships, etc. Many studies confirm that people who suffer significant loss in their lives are prone to depression —— especially when they are unable to adopt appropriate coping strategies.
2. Decreased rewarding behavior. Are you participating in fewer rewarding activities than in the past? A characteristic of depression is less activity/inactivity and withdrawal. For example, people with depression often spend a lot of time on passive, non-rewarding behaviors such as watching TV, lying in bed, thinking about problems, and complaining to friends. They spend little time on challenging, rewarding behaviors, like active social contact, exercise, recreation, learning, and constructive work.
3. Lack of self-reward. Many depressed people are unable to engage in positive behaviors to reward themselves. They rarely praise themselves and are hesitant to spend money on themselves. Depressed people often never praise themselves because they believe they are not useful. Other depressed people fear or worry that if they praise themselves, they will become lazy and do less.
4. Not using skills. Are there social skills and problem-solving techniques you never use? Depressed people have trouble supporting themselves, maintaining friendships, and solving problems with their spouse, friends, or co-workers. This is because they either lack these skills or don’t use them. They will have more interpersonal conflicts and less opportunity to make rewarding things happen to them.
5. Facing new requirements. Are you facing some new demands that you’re not ready for? Moving to another city, starting a new job, becoming a parent, ending a relationship, starting to find new friends, all of these can become stressful for many people.
6. Being in an environment where you feel helpless. Depression can be caused by being in an environment where you have no control over rewards and punishments. You feel sad, fatigue, loss of interest and hopelessness because you believe that no matter what you do, you can not make things a little better. The lack of rewards for work and relationships on the verge of ending can also bring these feelings.
7. Continually being in a punishing environment. This is a particularly helpless environment, you not only can not get rewards, but also often by the criticism and rejection of others. For example, many people suffering from depression will be used to stay with people who criticize them and hurt them in different ways.
8. Avoidance and passivity. You can avoid difficult, unpleasant situations and certain feelings. This leads to fewer rewards and more feelings of helplessness.
Although each of the factors described above that lead to loss and stress can cause depression, these factors do not necessarily lead to depression. (Imagine someone experiencing loss who is coping with it by increasing rewarding behaviors, learning new skills, focusing on new goals and being motivated to do them, and self-supporting.) Some of the ways you think may increase your risk of depression, such as if you feel blameworthy, can’t change anything, and should be perfect at everything. These “interpretations” of stress and loss are your “perceptions” of yourself and your surroundings. Cognitive therapy is concerned with identifying, examining, challenging and changing these overly negative perceptions of life and living.
How do thoughts affect depression?
Some of the ways you think (your perceptions) can lead to depression. Some are listed below.
1. Dysfunctional automatic thinking. This type of thinking produces automatic thoughts that occur naturally and seem to make sense, but they often reflect negative feelings and distorted feelings such as sadness, anxiety, depression, anger, and hopelessness. Examples of negative thoughts resulting from these distorted ways of thinking are as follows.
Mind reading: “He thinks I’m a loser.”
Labeling: “I’m a loser” or “He’s a dumb person.
Predicting the future: “I will be rejected”, “I will make a fool of myself”.
Catastrophizing: “It would be terrible if I get rejected”, “I can’t help but be anxious”.
Dichotomous (all or nothing) thinking: “I can’t do anything right”, “I’m not happy doing anything”, “Nothing ever comes to fruition with me”.
Discount thinking: “This is nothing, anyone can accomplish it”.
2. Malfunctional maladaptive assumptions. These are thoughts about what you think you should be doing. These are also used as rules in life by people with depression. For example.
”I should get everyone’s approval.”
”If someone doesn’t like me, it means I’m unlovable.”
”I never do things well on my own.”
”If I fail at something, I’m a failure.”
”I should criticize myself for failing.”
”I’ve had problems for a long time and can’t change them.”
”I shouldn’t feel depressed.”
3. negative self-concept. People who are depressed often focus on and magnify their flaws and underestimate their good qualities. They may think they are unlovable, ugly, stupid, weak, or even evil.
4. The brain is overrun by negative thinking. Many people stop in negative thinking and negative feelings, and therefore become very passive and avoidant.
Is medication effective?
A variety of medications have been shown to be effective for depression, so as part of treatment, all people with depression should consider medication as an option. Medications take 2-4 weeks to reach a certain level in your body and take effect, and are quite effective in boosting motivation, energy, appetite, concentration, etc. This is especially true for those with severe depression. Doctors will choose medications based on each patient’s condition, and some medications may have adverse effects. Some medications may have adverse effects, but these effects may be temporary and may be reduced gradually, or may be combined with other medications to reduce the adverse effects. All medications on the market have undergone rigorous safety testing, and the risk of adverse reactions to these medications is not as frightening as the benefit of a cure for depression. However, medication must be administered under the supervision of a qualified physician and should not be purchased or used at random.
How does psychotherapy work in depression?
There are many psychological treatments for affective disorders, and the main ones that have been used in depressed patients and have credible empirical support are interpersonal therapy, behavioral therapy and cognitive therapy. These psychotherapies intervene with psychosocial factors associated with depression, such as cognitive, neurotic, and depressive qualities. The therapist may first assess your symptoms in the form of an interview and standardized questionnaires, and then use certain procedures for psychotherapy depending on the treatment approach. The effectiveness of psychotherapy requires that you and the therapist form a good therapeutic alliance. The therapist will schedule enough short-term sessions to establish step-by-step short-term goals, provide feedback on previous failures and maintain confidence in possible future progress, and evaluate regularly in therapy, establishing intermediate and long-term goals when short-term goals are achieved. The acute phase of treatment may take 3 to 6 months, and it is recommended that maintenance treatment be maintained for 4 to 6 months after that.
How does neuromodulation therapy work in depression?
Electroconvulsive therapy (ECT): The history of neuromodulation therapy is not short. As early as 1938, it was discovered that placing electrodes on a person’s forehead and applying electricity could treat certain psychological disorders. This is known as electroconvulsive therapy (ECT) and is one of the most classic methods of neuromodulation therapy. With refinements, the twitch-free electroconvulsive therapy (MECT) now used can be painless. This therapy has been found to increase brain 5-hydroxytryptamine levels, reduce the effects of stress hormones, and stimulate hippocampal regeneration. In terms of efficacy ECT is able to treat depression quickly and consistently compared to other antidepressants. The medical community’s view is that the more severe the depressive symptoms, the earlier ECT treatment should be considered.
Transcranial magnetic stimulation (TMS): Although ECT has cured countless depressed patients, many are unable to undergo ECT because of the need for general anesthesia and the possible effects on memory.
Transcranial magnetic stimulation is a newer neuromodulation treatment. It works based on the principle of electromagnetic induction. In 2008, the U.S. FDA adopted TMS as a safe and effective treatment for refractory depression. The effectiveness of this treatment is highly dependent on the number of sessions engaged. In the same way that learning a new skill requires repeated practice, transcranial magnetic stimulation requires a certain number of sessions to create lasting conditioning in the brain, with a course of approximately 15 to 20 sessions in the acute phase.
What do you need to do as a patient?
The treatment of depression requires your active participation. During the initial phase of treatment your doctor will ask you to come weekly until the depression subsides. You will also be asked to fill out forms to assess depression, anxiety and other problems and to read materials related to depression treatment. In addition, your doctor may ask you to complete weekly depression assessments and other forms related to treatment goals. Your doctor may also assign homework assignments that involve practicing at home how to adjust your behavior, thinking, and relationships. Although many people with depression feel there is no hope that they will get better, there is a good chance that your depression will gradually decrease and heal with this treatment.