What is it?
Depression appears as a set of symptoms of affective predominance (pathological sadness, apathy, anhedonia, hopelessness, decline, irritability, subjective feeling of discomfort and helplessness in the face of the demands of life) although, to a greater or lesser degree, they are also present symptoms of a cognitive, volitional and somatic type , for which one could speak of a global mental and physical affectation, with special emphasis on the affective sphere, according to the Clinical Practice Guideline on the Management of Depression in Adults , of the Ministry of Health, Social Services and Equality.
“There are certain people who, due to their way of being, are more prone to suffering from depression,” according to Angeles Sánchez-Cabezudo, a psychiatrist at Complot Hospitalario de Toledo.
“Responsible people, with low self-esteem, demanding, perfectionists, with a high sense of duty and respect, meticulous, low tolerance for failure and with very rigid life approaches have a higher risk of suffering from depression,” he explains. In addition, “they give a lot of importance to control, so they like to know what is happening at all times. They love routine, they hate improvisation or surprises and they suffer if they feel that they don’t control some aspect of their lives. ”
Depression can start at any age, although its highest prevalence occurs between 15 and 45 years. The symptomatology of the disorder may be different with age: young people show fundamentally behavioral symptoms, while older adults more frequently have somatic symptoms.
The causes of depression are varied, but biochemistry can help explain some cases. Depressed people show very high levels of cortisol (a hormone) and various chemicals that work in the brain, such as the neurotransmitters serotonin, dopamine, and norepinephrine. These levels may be elevated for hereditary reasons. Explanations given to the family origin of depression are that children receive a sad vision of the world for their parents’ behavior, or grow up in an environment that is not totally enriching.
Regarding depression that is not caused by family reasons, very deep emotional losses can cause biochemical changes that drive depression. These changes can cause the disease not immediately, but later.
Other factors may be the loss of a job, or the lack of ability to adapt to certain changes. Although it is not known exactly what causes depression, there are several factors identified as the imbalances of the neurotransmitters in the brain.
As stated in the Clinical Practice Guideline on the Management of Depression in Adults, depression is a complex and multifactorial process whose probability of development depends on a wide group of risk factors, without having been able to establish until now their totality or the multiple interactions between them.
The prevalence and incidence of depressive disorders is higher in women than in men, beginning in adolescence and remaining in adulthood.
The chronic diseases, both physical and mental, and the possible association with alcohol and snuff are also important risk factors.
It has been observed that patients, mainly males, with a history of panic attacks, have a higher risk of developing major depression.
An association between migraine and depression has been described, so that patients with major depression had a higher risk of suffering from migraine and, in turn, those with migraine (not another type of headache) had a higher risk of major depression.
One of the most frequent approaches in the investigation of the genes involved in the development of depression is the analysis of the role of monoamines. Among all the genetic variants studied, a factor that could influence their development is the presence of a polymorphism of the gene that encodes the serotonin transporter, which would produce a decrease in the transport of this neurotransmitter.
The presence of heart disease and various endocrine pathologies, such as diabetes, hypo or hyperthyroidism, Cushing’s syndrome, Addison’s disease, and hyperprolactinemic amenorrhea, seem to increase the risk of depression.
The first-degree relatives of patients with major depressive disorder are twice as likely to have depression as the general population, a proportion that is also important in those of the second degree.
Typically, “depression is characterized by prolonged periods, exceeding two weeks of low spirits and apathy , but it presents a wide variety of symptoms that Sánchez-Cabezudo describes:
Affective: sadness, anxiety, irritability, inability to enjoy, suicidal thoughts, hopelessness or guilt.
Cognitive: indecision, forgetfulness or loss of concentration.
Somatic: fatigue, changes in appetite or weight, insomnia, hypersomnia, sexual dysfunction, headache, stomach problems, chest pain, agitation
Apart from pharmacological or psychotherapeutic treatment, it is important, once it has taken effect and that the patient feels that his condition has improved, that certain advice or ways of life be followed.
- Have positive thoughts.
- Take care of physical health.
- Maintain a uniform daily calendar.
- Resume responsibilities slowly and gradually.
- Accept yourself. Do not compare yourself with other people you consider favored.
- Express emotions.
- Follow the treatment imposed at all times and until the end.
- Periodically meet with the therapist.
- Eat a balanced diet.
- To do physical exercise.
There are several types of depression that require a different approach:
The Major depression is manifested by a combination of symptoms that interfere with the ability of people to work, study, sleep, eat and enjoy activities that, under normal circumstances, should be pleasurable. Depression usually occurs once, but it is a disease that usually causes relapses throughout life.
The Dysthymia is a less severe type of depression. The symptoms remain long-term, but do not prevent people’s activity. It can also be recurrent, that is, appear more than once in life.
The bipolar disorder is the third kind. Also called disease manic-depressive. The prevalence of this pathology is not as high as the previous two. It is characterized by mood swings. Very high moods are followed by very low ones. These changes are abrupt at times, but most often they are gradual. In the depression cycle, people have some or all of the symptoms of a depressive problem.
In the manic cycle, they may feel hyperactive, overly talkative, and overly energetic. Sometimes mania affects an individual’s thinking, judgment, and social behavior. If the mania is left untreated it can lead to a psychotic state. If the mania is not treated it can worsen and lead to a psychotic state.
Postpartum depression. About 10-15% of new mothers cry constantly, feel terribly anxious, cannot sleep, and are not even able to make simple decisions. It is what is known as postpartum depression. This depression is a severe deformation of baby blues, a problem suffered by two thirds of mothers that manifests itself with a little sadness and anxiety. Some mothers have a total breakdown, called postpartum psychosis. The reasons why it occurs are not very clear. It can be stress, hormonal imbalance produced during pregnancy and subsequent childbirth (Female hormones circulate abundantly during pregnancy and drop sharply afterward.) In addition, during pregnancy levels of endorphins rise, a human molecule that makes the body feel good. This molecule also decays after giving birth. The main symptoms of postpartum depression include deep sadness, insomnia, lethargy and irritability.
Finally, having suffered from depression increases the risk as well. There are various treatments. One of the most used is group therapy, although sometimes it is also necessary to take antidepressants. Regarding these drugs, there is a certain way that they can be transmitted to the child through milk. In general, the only drug that causes problems is lithium, which does get into milk, so it is necessary to stop breastfeeding.
Inquiry into the patient’s history is a fundamental weapon for the professional to diagnose a case of depression. A complete medical history should be included, showing when the symptoms started, their duration, and questions about drug use, alcohol, or if the patient has thought about suicide or death.
A diagnostic evaluation should include an examination of mental status to determine if speech, thought, or memory patterns have been affected. To diagnose a depressive disorder, any of the symptoms previously treated should be given within two weeks. One of them should be change in mood, loss of interest or the ability to pleasure.
The most widely used diagnostic criteria for depression, both clinically and in research, are those of the International Statistical Classification of Diseases and Problems Related to Health (ICD) and those of the classification of the American Psychiatric Association (DSM).