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Causes of depression
You may have heard
people talk about chemical imbalances in the brain
that occur in depression, suggesting that
depression is a medical illness, without
psychological causes. However, all psychological
problems have some physical manifestations, and
all physical illnesses have psychological
components as well. In fact, the chemical
imbalances that occur during depression usually
disappear when you complete psychotherapy for
depression, without taking any medications to
correct the imbalance. This suggests that the
imbalance is the body's physical response to
psychological depression, rather than the other
way around.
Some types of depression
do seem to run in families, suggesting a
biological vulnerability. This seems to be the
case with bipolar depression and, to a lesser
degree, severe major depression. Studies of
families, in which members of each generation
develop bipolar disorder, found that those with
bipolar disorder have a somewhat different genetic
makeup than those who are not diagnosed.
However, the reverse is
not true. Not everybody with the genetic makeup
that causes this vulnerability to bipolar disorder
develops the disorder. Additional factors, such as
stress and other psychological factors, are
involved in its onset as well. Likewise, major
depression also seems to occur, generation after
generation, in some families, but not with a
frequency that suggests clear biological causes.
Additionally, it also occurs in people who have no
family history of depression. So, while there may
be some biological factors that contribute to
depression, it is clearly a psychological
disorder.
A variety of
psychological factors appear to play a role in
vulnerability to these severe forms of depression.
Most likely, psychological factors are completely
responsible for other forms of mild and moderate
depression, especially reactive depression.
Reactive depression is usually diagnosed as an
adjustment disorder during treatment.
People who have low
self-esteem, who consistently view themselves and
the world with pessimism, or who are readily
overwhelmed by stress are more prone to
depression. Psychologists often describe social
learning factors as being significant in the
development of depression, as well as other
psychological problems. People learn both
adaptive and maladaptive ways of managing stress
and responding to life problems within their
family, educational, social and work environments.
These environmental factors influence
psychological development, and the way people try
to resolve problems when they occur. Social
learning factors also explain why psychological
problems appear to occur more often in family
members, from generation to generation. If a
child grows up in a pessimistic environment, in
which discouragement is common and encouragement
is rare, that child will develop a vulnerability
to depression as well.
A serious loss, chronic illness, relationship
problems, work stress, family crisis, financial
setback, or any unwelcome life change can trigger
a depressive episode. Very often, a combination of
biological, psychological, and environmental
factors are involved in the development of
depressive disorders, as well as other
psychological problems. When you feel depressed,
and don't know where to turn, talk to someone who
can help.... a psychologist
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Questions
Diagnosis of
depression
The first step to getting appropriate treatment,
for depression or any emotional problem, is a
complete psychological evaluation to determine
whether you have a depressive illness, and if so,
what type of depression. Consultation with a
psychologist will include a review of your
physical health history. Some medications as well
as some medical conditions can cause symptoms of
depression, so your psychologist will ask your
family physician to rule out these possibilities
if other physical symptoms are evident.
However, physicians often focus only on the
physical aspects of depression, and may prescribe
medication without referring you for psychological
treatment or evaluation. If you experience the
symptoms of depression, as described on this
website, you should talk to a psychologist, to
assess whether psychological treatment is
indicated, even if it not suggested by your
physician. As a general rule, you should never
take antidepressant medication alone, without also
beginning psychotherapy, or at least seeing a
psychologist for an evaluation.
A good psychological diagnostic evaluation will
include a complete history of your symptoms, i.e.,
when they started, how long they have lasted, how
severe they are, whether you've had them before
and, if so, whether you were treated and what
treatment you received. Your psychologist should
ask you about alcohol and drug use, and if you
have had thoughts about death or suicide. Further,
a history should include questions about whether
other family members have had depression and if
treated, what treatments they may have received
and which were effective.
Lastly, the psychological diagnostic evaluation
will include a mental status examination to assess
the full range of psychological symptoms and
problems. This will help identify any other
psychological problems that might be present, and
will help determine the most appropriate treatment
for you.
Treatment choice will depend on the outcome of the
evaluation. Most people do well with
psychotherapy, but some require treatment with
antidepressants in addition to psychotherapy.
Medication can allow you to to gain relatively
quick symptom relief, if you are experiencing
severe and disabling symptoms. However, medication
does not "cure" the depression, it only treats the
symptoms. If you are depressed, you need
psychotherapy to help you to learn more effective
ways to deal with life's problems, and to change
the negative thoughts and attitudes that have
caused you to develop depression.
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Questions
Types of
depression
Depressive disorders come in different forms.
There are several different diagnoses for
depression, mostly determined by the intensity of
the symptoms, the duration of the symptoms, and
the specific cause of the symptoms, if that is
known.
My website
www.MentalHealthIndia.net
provides information on the following depressive
disorders:
·
Mild Depression or Temporary Sadness
·
Moderate Depression
·
Major Depression or Major Depressive Disorder (MDD)
·
Dysthymia or Dysthymic Disorder
·
Bipolar Disorder or Manic-Depressive Psychosis (MDP)
·
Cyclothymia or Cyclothymic Disorder
·
Postpartum Depression or Post-Natal Depression
·
Premenstrual Dysphoric Disorder
·
Winter Depression or Seasonal Affective Disorder (SAD)
·
Mood Disorder due to a General Medical Condition
·
Substance-Induced Mood Disorder
·
Reactive Depression or Adjustment Disorder, with depressed mood
·
Endogenous Depression or Melancholic Depression
·
Unspecified Depression or Atypical Depression (AD)
·
Severe Depression with Psychotic Features
Mild Depression
This type of depression is a Temporary Sadness
phase, which anybody and everybody can get. We all
get sad or feel low/down sometime or the other due
to various reasons. Here, the depressed people
seem to be aware of the reason for their feeling
sad (or miserable) but cannot get rid of that
feeling easily. This kind of 'reactive depression'
begins to affect their daily routine. Support,
understanding, a little warmth and sharing of
grief by family members and friends is often
enough to relieve the symptoms.
Moderate
Depression
Moderately depressed people often feel that their
lives are falling apart. Such depression may be
caused by Adjustment Disorders. Like an illness or
sudden death in the family, the loss of a
lucrative job or a marriage break-up. It takes a
fairly long time for moderately depressed people
to get out this situation. It generally requires
the help of some psychotherapy and counseling. If
moderate depression is not treated in time there
is always the danger of the person slipping into
what is described as major depression. Such
depression affects a person's career and family
life. Typically, they can hold on to their jobs
(quite functional) but they in turn are
non-productive; they can stay with their family
and friends but do not enjoy their company.
Major
Depression
It is also called
Major Depressive
Disorder (MDD).
Severely depressed people feel like they have
fallen into a black hole or a bottomless pit. They
are quite convinced that things are in a very bad
shape and that they will only get worse. They
cannot cope with their daily routine. As compared
to a moderately depressed person, severely
depressed people may absent themselves from work
and are usually non-functional. They can see their
life, family, career falling apart but are unable
to do anything about it. They may even harbor
suicidal tendencies. This illness impairs a
person's ability to work, sleep, eat, and function
as he or she normally would. It keeps people from
enjoying activities that were once pleasurable,
and causes them to think about themselves and the
world in negative ways. Major depression is often
disabling and may occur several times in a
person's lifetime. Anyone who is severely
depressed should (and with full encouragement from
others) seek immediate professional care and help.
Major depression is the leading cause of
disability (measured by the number of years lived
with a disabling condition) worldwide,
including
India.
Dysthymic
Disorder
This is sometimes referred to as Chronic
Depression. It is characterized by many of the
symptoms that are seen in major depression. Though
much less intense, like moderate depression; but
the symptoms tend to last much longer.
Dysthymia is described as a "veil of sadness".
In this type of depression, there may not be
disturbances in sleep, appetite, sexual drive etc.
Suicidal thoughts are usually not present. However
the family, social, professional lives of such
persons may be impaired because they exhibit a
much lower level of physical and emotional energy.
Bipolar Disorder
Also known as Manic-Depression or
Manic-Depressive
Psychosis (MDP).
It is a relatively uncommon medical illness. A
person suffering from Bipolar Disorder exhibits
extreme mood swings from 'low' to 'high'. This
condition is characterized by mood that alternates
between periods of (low) depression, and periods
of (high) elation and excitable behavior known as
mania (see symptoms below). For people who have
bipolar disorder, the depressions can be severe
and the mania can seriously impair one's normal
judgment. When manic, a person is prone towards
reckless and inappropriate behavior such as
embarking on risky business ventures, engaging in
wild spending sprees or having promiscuous sex.
They often speak very rapidly and may jump from
one subject to the next. He or she may not be able
to realize the harm of his/her behavior and may
even lose touch with reality. People with bipolar
disorder are usually unaware that there is a
problem with them. Some of them may spend months
together in one phase and then swing to the other
extreme, while others swing between the two
extremes more frequently. Bipolar depression,
which is caused by chemical imbalances, can be
treated with proper medications and psychotherapy.
Cyclothymic Disorder
Cyclothymia is a
milder yet more enduring type of bipolar disorder.
A person's mood alternates between a less severe
mania (known as hypomania) and a less severe
depression.
Postpartum Depression
A rare form of depression occurring in women
within approximately one week to six months after
giving birth to a child. Also called
Post-Natal Depression.
Premenstrual Dysphoric Disorder
This is an uncommon type of depression affecting a
small percentage of menstruating women. It is a
cyclical condition in which women may feel
depressed and irritable for one or two weeks
before their menstrual period each month.
Seasonal Affective Disorder (SAD)
This condition affects people during specific
times or seasons of the year. During the winter
months individuals feel depressed and lethargic,
but during other months their moods may be normal.
SAD is also called Winter Depression.
Mood Disorder Due to a General Medical Condition
Depression may be caused or precipitated by a
known or unknown physical medical condition such
as hypothyroidism.
Substance-Induced Mood Disorder
Depression may be caused or precipitated by the
use or abuse of substances such as drugs, alcohol,
medications, or toxins.
Adjustment Disorder, with depressed mood
This is also called a Reactive Depression.
The diagnosis of an adjustment disorder implies
that specific psychological symptoms have
developed in response to a specific and
identifiable psychosocial stressor. However, this
diagnostic group (adjustment disorders) is a "last
resort" category. If the symptom picture suggests
that the person meets the diagnostic criteria for
another psychological disorder, than this
diagnosis is not used. For example, if a person
experiences a trauma, and develops the symptoms of
a major depression, then the diagnosis of
adjustment disorder is not used, even though the
depression developed in response to a psychosocial
stressor. So, adjustment disorder with depression
is used to categorize mild to moderate depression,
following a stressful event.
Endogenous Depression
Depression that is not
caused by any external factor. Usually used to
describe a depression that is purely the result of
biological factors, such as a brain disorder or
neurological dysfunction affecting Serotonin,
Dopamine or other neurotransmitter. It is
increasingly believed that environmental toxins
may be a hidden cause of endogenous depression. In
other words, it is a state of depression for which
there is no apparent precipitating cause. This is
also known as
Melancholic Depression.
Unspecified Depression
This is also called
Atypical Depression (AD).
Some professionals portray this category as a
"garbage pail" diagnostic category for depression.
If someone is obviously depressed, but does not
fit into any of the other categories, then this
diagnosis is made. However, it is not a garbage
pail, but provides a valuable way to categorize
depression that does not fit into the other
categories. The alternative would be to have
several additional diagnostic categories. That is
not useful, unless the different diagnoses require
different treatment. This category includes people
with serious depression, but not quite severe
enough for a diagnosis of a major depression, so
moderate depression would be included here. This
would include people with mild to moderate
depression, who have not been depressed long
enough to be diagnosed with dysthymic disorder,
which requires depressive symptoms for two years.
It also includes those individuals who continue to
be depressed, in response to some traumatic event,
but the depression has lasted longer than expected
for an adjustment disorder with depression. In an
adjustment disorder, the expectation is that the
depression will last no more than about six months
after the stressor has ended.
Severe Depression With Psychotic Features
A person experiences hallucinations or delusions.
Psychoses may develop in about 15% of those with
major depressive disorder. The presence of
delusions and hallucinations often interfere with
a person's ability to make sound judgments about
consequences of their actions and this may put
them at risk for harming themselves. Psychotic
symptoms are serious and a person in this
condition needs immediate medical attention and
possibly hospitalization.
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Questions
Depression
& medical problems
Clinical depression commonly accompanies general
medical illnesses, although it is often undetected
and untreated. In fact, while the rate of major
depression among persons in the community is
estimated to be between two to four percent, among
primary care patients it is between five and ten
percent, and among medical inpatients it is
between ten and fourteen percent. An additional
two to three times as many persons in these groups
experience depressive symptoms.
Some studies have suggested that nearly 65% of all
visits to primary care physicians involve
emotional symptoms associated with psychological
problems, with depression being the most common
problem. Yet, very few primary care patients are
referred for psychological treatment. For this
reason, you should consult a psychologist when you
have signs of depression, even after you consult
your family physician. Research suggests that
recognition and treatment of co-occurring
depression may improve the outcome of medical
conditions, enhance your quality of life, and
reduce the degree of pain and disability
experienced by the medical patient.
Recently, there has been research suggesting a
better recovery rate from many serious illnesses,
when psychological treatment is offered as well as
medical treatment. This makes a lot of sense,
since a serious medical condition can easily
result in a reactive depression. There has also
been some research that suggests that
psychological distress can reduce the
effectiveness of your natural immune system,
making it more difficult for your body to fight
disease. While conclusive evidence of all of
these factors is not yet available, there is
enough evidence to suggest that psychological
treatment may be a benefit to your health, in
addition to any medical treatment.
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