Depression: It’s More than Feeling Sad

Posted by in brain, Louise Behiel, mental health | 39 comments

If you’re reading this post and don’t know a person who has been depressed (including yourself) please leave a comment below. This malady is so widespread, it is almost commonplace. 1 in 10 of us will have depression in our lifetime and for 1 of 10 of those  it is a fatal illness, culminating in suicide.

That made me sit up and take notice. It’s a scary statistic for an illness that seems so common.

Technically, depression is a syndrome in which feelings of sadness, loss, anger or frustration cause problems in a person’s life for weeks or longer for which there is not an acceptable cause (like the death of a loved one). It is diagnosed (usually after a physical) by a conversation with a doctor, because there are no medical tests for diagnosis.

As with all the other illnesses included in this series, this is an illness that originates in the brain but whose symptoms are behavioral. From the outside, it looks like the person is wallowing in self-pity and giving in to their own demons. The favorite suggestion is to ‘get up and go for a walk. Do something, you’ll feel better’. Unfortunately, for someone with major depression that’s almost impossible.

What are the symptoms?

  • Feelings of hopelessness or pessimism
  • Insomnia or early morning awakening,
  • Or too much sleeping
  • Agitation, restlessness, and irritability
  • Becoming withdrawn or isolated
  • Difficulty concentrating
  • Dramatic change in appetite, often with weight gain or loss
  • Fatigue and lack of energy; feeling slowed down
  • Feelings of worthlessness, self-hate, and guilt
  • Loss of interest or pleasure in hobbies and activities that were once pleasurable (including sex)
  • Thoughts of death or suicide
  • Persistently sad, anxious, angry, irritable, or “empty” mood
  • Crying spells
  • Problems with memory and decision making
  • Persistent physical symptoms that do not respond to treatment, such as digestive disorders, headaches and/or chronic pain.

Causes of Depression

Nobody knows for sure what causes depression. There’s lots of research being done. Part of the problem with determining cause is that it can be different for each of us. Depression is a disorder that co-occurs with many other mental illnesses. It can be the result of alcohol or drug use. And it can start as grief but morph into chronic depression.

Perhaps the simplest description I have heard refers to the level of serotonin in the brain. Remember a couple of months ago, we talked about the structure of the brain, including the neurons and neurotransmitters. I’ve recopied the image for you.

The passage of an electrical charge from one cell to the next (across the synapse) is accomplished when that charge is encased in a drop of a neurotransmitter. But the receiving cell has its own neurotransmitter, so it strips it off when it absorbs the electrical charge. This would leave an extra amount of the chemical in the brain fluid. It isn’t much on an individual cell basis, but remember these exchanges happen two trillion times a second in the brain.  So it would make a difference to the chemical make-up of the brain fluid.

Our brain cells, in their amazing wisdom take this into account. The dispatching cell ‘sucks up’ the chemical it released with the charge. Think of this as a vacuum cleaning up the unwanted material.

By now, you’re probably wondering what this has to do with depression. Well it’s actually relevant and pretty simple. If the vacuum on the releasing cell runs too long, it will remove some of the serotonin from the brain fluid. (Think of this as getting too close to the shear drapes with your vacuum.)

If you have low levels of serotonin in your brain, you have depression.

There is some thought that there is a genetic link, especially with the depression of Bipolar Affective Disorder

So how is it treated?

Usually a doctor will prescribe a low dosage of an SSRI (Selective Serotonin Reuptake Inhibitor). These are commonly known as Paxil, Zoloft, Celexa and Prozac.

The purpose of this family of drugs is to shut off the vacuum (the reuptake mechanism) sooner, by only by a nano-second, since everything must be in balance. The doctor will tell you to come back in a month. And if you haven’t had a relief of your symptoms, he will likely prescribe a higher dosage of the same drug. Ditto for month three. If the drug isn’t working then, you’ll probably have a different drug prescribed. By this time most people feel that medicine doesn’t know much and can’t help. But perseverance counts. Each drug impacts our system a little different and we have to find the right one, to shut down the re-uptake mechanism at just the right time to create chemical balance in the brain.

It is mostly medicine by trial and error. But it is the only option available to medicine at this time.

A second category of medicine is relatively new. Serotonin norepinephrine reuptake inhibitors (SNRIs), do much of the same thing for Norepinephrine. You’ve heard of one of these drugs on television, for it includes Cymbalta.

Therapy is also recommended as part of the treatment.

If the depression is severe and unresponsive to these treatments, people may be given electroconvulsive therapy, but that’s a post for another day.

I know from personal experience that lots of sunshine is important in recovery as is exercise. Walking is good medicine, once you’re well enough to consider it as a treatment option.

 

What about you? Have you had depression? Know someone who does or did? What was your reaction to the illness?

 

Credit for fact verification to:

DSM-IV

http://www.medicinenet.com/depression/article.htm

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/

Image of sad woman from:

http://www.publicdomainpictures.net/view-image.php?image=19963&picture=sad-woman

 

 

 

 

39 Comments

  1. I have dealt with depression for at least 23 years, first “diagnosed” by my obstetritian as “a PMS type personality,” and later more appropriately treated with a series of drugs (mostly Prozac,, which worked best for me). The most effective treatment to date has been reducing stressors which incllude 1) food sensitivities based on blood tests of IgA and IgG, 2) support for adrenal exhaustion by nutrition, supplementation, meditation, prayer, reducing media time, regular sleep habits, and strategies to improve my stress-management skills, 3) anti-inflammatory diet. I am drug free for the first time in 23 years. Not
    Holly Happy” but better, as long as I take care of myself and don’t return to ineffective habits and strategies. I agree that it is something you can’t just “snap out of” or “exercise away.” It is hard on the brain, the body, the spirit – and is not a character flaw. The more friends, family and clergy understand, the more likely a depressed person is to find what really does help them.

    • Totally agree – it’s not a character flaw and it is hard on the brain, body and spirit. You’ve spent lots of time and effort getting better. Well done.

  2. Great post, Louise. Depression is insidious because many people ignore the early signs. Thanks for sharing.

    • you are absolutely right, Lynette. it is insidious.

  3. I was diagnosed with depression last week and am on anti depressants, seeing a councillor and attending anger management sessions and off work till further notice. I thought I was a strong person and can’t believe this happened to me. Each day for me is a journey of self discovery and hopefully with the love and help of my partner, family and friends I will find my place in life once again?

    • with the work you’re doing, Stewart, and the support you’ve got, you will most definitely find your plac ein life again. Depression is sneaky. But the chemical imbalance is real and has real symptoms and effects. good luck. let me know how you’re doing.

  4. Wonderful post, Louise. Depression is such a tricky thing. If one is prone to it, it can be set off by something as simple as our short winter days. I’m fortunately in that I’ve only truly suffered from it once and it was triggered by a poor diet due to building our house. Combine that with working full time and the normal demands of a young family and I was sunk before I knew what was happening. Being anti-medical, I sought help from a wonderful naturopath. It took a long time to get back on track and I hope I never have to go through it again. I was lucky in that mine lasted only a year or two. I know people who have suffered for many years more and are still suffering to the day.

    • Sheila, how lucky you were to find a good naturopath who cured your depression. Well done. longer times are quite common, although if you get it early and treat it fast, often depression is rsolved in 6 months or so. (at least that was my experience with the illness).

  5. It seems to be a completely debilitating disease. I have been lucky to have a pretty positive outlook on life.

    • good for you. just be aware. sometimes the brain chemistry changes for no good reason and if we’re not aware, we’re pretty sick before we ealize.

  6. I suffered for years with clinical depression and was under a doctor’s care. I vividly remember his telling me to drink more red wine while he was writing a renewal for my Prozac prescription! Of course, I lied about how much I drank, but leaving there with the meds and a recommendation that I have more red wine (my drink of choice)… eventually landed me in AA. I’m so thankful it didn’t land me in the grave. I was obsessed with suicidal thoughts at the time. It’s a crippling condition. Without the medication, I’d never have survived long enough to realize I was drinking myself into the depression.

    • Heidi, it always amazes me that doctors believe people when they say how much they drink. I never do and I’m sure I don’t see as many people as the doctors. LOL alcohol is a depressant and as such often pushes our body chemistry into this sad state. I’m so glad you took care of yourself until you could find the rooms and health. Hugs…

  7. Great post! I’ve been dealing with depression for the past several years, and now I’m also dealing with my daughter’s bouts of mental health issues, but she’s not been diagnosed with depression per ce. She’s fighting an eating disorder and anxiety, which causes relapses in both that, and cutting. Scary stuff that makes my blue-boohoos seem minor. I might be overly sensitive and known to cry at the drop of a hat (before Cymbalta-now, not so much) but I know even at the worst of feeling low, I never ever considered anything drastic. And while my daughter assures me she’d never take her own life, it scares the hell out of me that she might do something to hurt herself. I can only hope, pray and seek out help.

    • Jordanne, there is nothing scarier than having a child with a mental illness. It is absolutely scary because we are so powerless. Watch her and be attentive (I know you are already) but don’t forget to take care of yourself – She needs a healthy strong mom right now. {{{hugs}}}

  8. I think it’s so important to talk about this since it has been such a misunderstood illness for so long. I’ve struggled with clinical depression since teen-dom and luckily have found the right combination of therapy/meds/behavior modification that works for me. It’s a constant battle, though. I think a higher percentage of writers and artists in general suffer from depression than the gen. population. There’s got to be something to that. More senstive to stimulation, stress? I don’t know but it’s nice to know we don’t fight alone.

    • Shannon, thanks so much for sharing your truth with us. It is important to talk about these illnesses, for that is what they are – illnesses where the malfunction happens to occur in the brain. I’m glad you are self-aware enough to have found the combination that works for you. So many people rely on meds only and it’s not enough, if we plan to get off them and live a full, whole life. I’m not sure about the writers have a higher proportion of depression than usual. I’m not disagreeing I just haven’t seen it (You know i’ll be watching now, though, don’t you?). I have usually ascribed it to the fact that women report and seek treatment more often than men and my circle is mostly women. but they are also mostly writers, sooo you may have a point.

      take care

  9. I have definitely dealt with what felt like depression in the past. A couple of times it really was. I’m talking about instances where it wasn’t grief related. The first time, when I was maybe 19, I went to counseling. The second time, after my car accident, I thought I was just burned out from the months of all the therapy appointments. That time I was medicated and got counseling.

    The last time I got checked for it turned out to be undiagnosed hypothyroidism…and an extremely low level of vitamin D. But it sure felt like flat out depression. Glad it was such an easy fix.Well, not ‘easy,’ but antidepressants suck. 🙂

    • Kristy, the wrong meds do more harm than good, in my opinion. Hypothyroidism is a cause for depression. You’re lucky you had a doctor who recognized that and treated it, rather than one who simply stuck you on anti-depressants. and I know you work diligently to get and remain healthy. well done.

  10. Fascinating post, Louise! I’m usually an upbeat person, but every so often something will hit me and just knock me down. Last week I was struggling to like anything in life. I was angry and bitter about the littlest things. Turns out, two medications I was taking for an ENT thing were causing my depression. Who knew!?! I researched the medications and way down in the fine print it said the medication might cause depression. They were meds for allergies and asthma. It was a huge wake up call to me to make sure I know everything I’m putting in my body and what it will do to me.

    Thankfully, I stopped taking the meds and within three days I was my happy self again. It was awful while I was in the throes of depression. Horrid.

    • Tameri, i’m so glad you figured it out. I had a similar experience a while back and getting off the meds made all the difference in the world. I’m glad you’re back to your happy self.

  11. Thanks for the information, Louise. I’ve known people who’ve suffered from depression. In most instances, it was rooted in feelings originating in childhood. Fortunately, the worst case was ‘cured’ (dare I say that?) with appropriate meds and three years of intensive therapy with an excellent psychotherapist. But it took four tries before that special therapist was found. There’s an idea for a post–how do you know when a therapist is right for you.

    • Joan, the right therapist is the key. Not one of us is good for everyone. We need to approach therapy as a consumer purchase and we need to figure out who will work for us as individuals. and yes, depression can have roots way back when. In fact we’re learning that children can be depressed. I’ll try to figure out a post on picking a therapist. Good idea, thanks.

  12. Ah, depression, my old enemy. many are the battles we have fought. Many are the wars behind us with no clear winner. I have tried so many things to defeat this demon, but this is a war that cannot be won at this time. However, I can battle it to a standstill. I use many psyching up techniques as well as exercise, and in recent years I have stooped to chemical warfare.
    The biggest problem with depression is the collateral damage. Everybody close to me is affected when the demon has the upper hand. However, I have learned a few things over the years, and I know my enemy well. At the first sign of slipping back into that bottomless pit of despair I will have my meds checked, up my Vitamin D and get outside for more exercise.
    In the battle against depression there is no turning back, no retreat, no surrender, and no prisoners. I will not allow the sweetness of life to be snuffed out.
    Prudence MacLeod recently posted..Fire!My Profile

    • Prudence, you are definitely a wise woman. Well done. Research suggests that once we’ve had a depression, we are more likely to slide back into it again and again. So you are incredibly wise to keep doing battle. Totally agree about the Vitamin D. Back before I knew better, if I was sliding down, I’d go to a tanning salon and get the rays a couple of times a week. It always helped pull me out of the hole I was trying to slide into. Now I know better so I try to get some sunlight. but living in Canada, that can be hard in the winter. So I have to be attentive. thanks for sharing your passion and your wisdom.

  13. Louise,
    I am curious as to your thoughts on how nutrition and diet play a role in depression. Working in the nutrition field as a nutritional health counselor, what I have been taught is that it plays a major role.

    I understand there are varying degrees of depression and some are a lot more severe than others. I myself have had bouts of depression and have been on medicine for it. However, when I turned my diet upside down on its head, things changed for me.

    I would love your insight on this.

    Sandra

    • Sandra, I totally agree. I have to be very careful what I eat or it can start with lethargy and then easily slide into the dark place. I find it interesting though, that in my clients, different foods can create that slide. For me, grains are the worst. I have to be very careful when I eat them because they can trip me up so easily. It’s not as hard as it sounds, since i’m a celiac and abstain from gluten. I have also noticed a propensity for obese women to slide into depression. I’ve never been sure if it’s the food they’re consuming (I often wonder about sugar and its impact on mood.) or the weight they’re carrying.

      I totally agree that all mental illnesses occur on a continuum from mild to serious. I had to use exercise and sunlight and meds to get out of depression (twice). but now I know to fight that battle before I jump off the board into the hole.

  14. Louise, fantastic post! The symptoms you listed are point on. As I read them, I answered “yep” all the way down the list. I’ve battled depression for years. I went through a “denial” period where I refused to admit it. I put on a fake smile, a fake persona, and shoved all my true emotions further inside. There was such a stigma surrounding it in the small town where I lived and I didn’t want to be seen as the “crazy girl on meds” or not “normal.” But those emotions built up and consumed me. I got to the point that even getting out of bed was a struggle, much less doing anything else. I finally got what others thought and sought help. I tried some of the lower level drugs prescribed by my doctors but they all left me feeling more empty and distant than I was without them. Therapy, to me, is a HUGE help but you need to find a therapist that you can feel comfortable with. The first couple of ones I spoke with made me feel more hopeless and wanted to shove meds at me. I didn’t want to rely on medicine. I finally found someone who was right for me and it has helped tremendously. And getting those daily 15-20 minutes in the sun is like my own personal time-out. I just sit – no thinking, no stressing – just lay back and close my eyes. Amazing how I feel afterwards!
    It is hard for others to help someone with depression because its not something that can be easily “fixed.” You can’t just put a band-aid on it, unfortunately. As always, getting educated and talking to professionals in that field will help. Information like this can be priceless – thank you for sharing it!!

  15. Well I often feel depressed, but I don’t think that’s the same thing. I have had depression symptoms in the past but my doctor did not want to treat with medicine. I guess I wasn’t that bad or considered a risk. Not sure how I overcame it, but things seemed to work out okay after I became aware of the issues and dealt with them on a deep level.

    Alwayis interesting stuff on your blog, Louise.

    Patricia Rickrode
    w/a Jansen Schmidt
    Patricia recently posted..“I’m Watching That!”My Profile

    • Pat, the more you can deal with your emotions naturally and iwthout meds, the better you are – best to save the big ugns for when you really need them. glad you enjoyed.

  16. I sought treatment for what my doctor termed a situational depression. I had a herniated disk that completely impaired all my activities. I couldn’t socialize, I couldn’t work. I was in chronic unrelenting pain. And I couldn’t sit. It was a very dark period in my life. It helped to talk about it and understand that this would pass eventually. It did after I had spine surgery that corrected the back problem.

    • Kourtnay Yes, that makes total sense that you’d end up in a depression in these circumstances. For so many these become a spiral down into chronic disability, both emotionally and physically. I’m go glad you got it fixed and recovered. Well done.

  17. I think explaining what the medicine is doing and targeting would give the patient more hope. I know from personal experience that I can’t stand it when my doctor says, “here, try this”. Uh, no. How about you tell me what you’re about to have me ingest and how its going to help me? I love that you’re doing these posts! Thanks. 😀

    • Daphne, I don’t think most doctors really understand enough nor do they have the time to explain. And in truth, my simple explanation is not what most professionals would like you to know. Medicine is riddled with people who like long words and complicated explanations . So I try to keep it simple so we can all understand.

  18. Louise, when my mom died I went through depression. I tried Prozac but that made me like a zombie. I had just wanted the feelings to stop being a teeter-totter and instead they just stopped. I should have just got through the grief with family and friends. Of course if it were that easy I was probably just depressed, not in a depression. I’m thinking, big difference there.

    • Jill, you hit the nail on the head. We talk about being depressed when we mean sad, lethargic and in grief. That gets confused with being in a depression, which is a medical state. And unfortunately medicine isn’t very good about telling the difference.

  19. I wish I had realized it was ‘okay’ to be depressed after the birth of my kids. Ten years ago, and as a pastors wife – it wasn’t okay. Fabulous post and thank you for posting it!

    • Steena, when you think of the ‘soup’ of hormones in a woman’s body after giving birth, it’s amazing that any of us are capable of functioning. Post partum depression is regularly screened now, at least in Calgary, because it’s so common.

  20. It’s amazing how many people still don’t get that depression isn’t something you can just “shake off.” I have had family with depression. Some of my daughter’s friends are dealing with depressed family now. As hard as it is for the depressed person, it’s hard on the family, too, especially children. Thanks for shedding some light on this important topic, and giving some technical info I didn’t know!
    Jennette Marie Powell recently posted..My Town Monday: Dayton’s Haunted CourthouseMy Profile

    • Jenn, you are completely right. Depression is hard on everyone, not just the depressed person. What’s really scary is the growing number of children who are depressed. I sometimes wonder if some of the obesity isn’t caused by children trying to eat away their bad feelings. The inevitible result of htat is more fat.

      I’m glad you learned something.

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