Depression: A Therapeutic Insight

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Depression is a common mental health disease which affects over 120 million people worldwide. However, most people are still not aware of the extent of this mental health problem, nor the treatments that are currently available. To improve general understanding of this problem, we've gathered information from several areas involving depression - from its roots to therapies that assist with its control.

Historical Background*

The Ebers papyrus (c.a. 1550 BC) contains a short description of clinical depression. Though full of incantations and foul applications meant to turn away disease-causing demons and other superstition, it also evinces a long tradition of empirical practice and observation.

The modern idea of depression appears similar to the much older concept of melancholia. The name melancholia derives from 'black bile', one of the 'four humours' postulated by Galen.

Clinical depression was originally considered to be a chemical imbalance in transmitters in the brain, a theory based on observations made in the 1950s of the effects of reserpine and isoniazid in altering monoamine neurotransmitter levels and affecting depressive symptoms. Since these suggestions, many other causes for clinical depression have been proposed.

Causes of Depression**

Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful change (positive or negative) in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stressors, or none at all.

Types of Depression**

Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. This pamphlet briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterised by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of Depression**

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

- Persistent sad, anxious, or "empty" mood;

- Feelings of hopelessness, pessimism;

- Feelings of guilt, worthlessness, helplessness;

- Decreased energy, fatigue, being "slowed down";

- Difficulty concentrating, remembering, making decisions;

- Insomnia, early-morning awakening, or oversleeping;

- Appetite and/or weight loss or overeating and weight gain;

- Thoughts of death or suicide; suicide attempts;

- Restlessness, irritability;

- Persistent physical symptoms that do not respond to treatment;

- Mania;

- Abnormal or excessive elation;

- Unusual irritability;

- Decreased need for sleep;

- Grandiose notions;

- Increased talking;

- Racing thoughts;

- Increased sexual desire;

- Markedly increased energy;

- Poor judgment;

- Inappropriate social behavior.

Awareness of Depression

In a survey conducted in October 2002 with 2,000 Australians aged over 18 years, depression and general mental health problems were not included in the context of health. The surveyed were asked about the major health problems in Australia, and the responses included coronary heart disease, obesity and Cancer - but excluded depression. (Mathers, Vos, Stevenson 1999)

In the context of mental health, though, depression is perceived to be a major health problem. Like suicide and schizophrenia statistics, most people fail to observe the extent of the problem and are not aware of the number of people that suffer from depression. According to the World Health Organisation (WHO), depression affects about 121 million people worldwide, being one of the leading causes of disability worldwide.

Therapy and Depression**

Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioural" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioural patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioural therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioural therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, may require medication along with, or preceding, psychotherapy for the best outcome.

Content Sources

* Wikipedia: http://en.wikipedia.org/wiki/Clinical_depression.

** National Institute of Mental Health (NIMH): http://www.nimh.nih.gov/publicat/depression.cfm.


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