Depression and depressive disorders

What is depression?

Most of us feel sad or under the weather from time to time, but depression is much more than that. If you're persistently down for weeks or months on end, it could be that you're clinically depressed. Depression is a real illness with both mental and physical symptoms. There are many different causes of depression. The important thing is to see your GP if you think you may be living with depression. The great news is that once diagnosed, and with the correct treatment and support, you can escape depression and live a happier life.

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 What causes depression?

The potential causes of depression are many, but it is sometimes described as a chemical imbalance in the brain. This explanation does, however, according to many, not quite describe how complex depression really is. Often, there's no single cause, and many different triggers set off a depressive episode. Those triggers can include stressful events, such as losing your job, struggling with relationship issues or even managing divorce, loneliness, illness, and alcohol and drug use. Genetics are also thought to play a part, as some people may be prone to depression if it runs in the family. Depression can also be triggered by certain medications or health problems.

What does depression feel like?

Depression symptoms vary widely depending on the severity of the condition. Generally speaking, if you're depressed, you'll feel down, sad, hopeless, tearful, anxious, and feel like you have very little interest in the things you once enjoyed. Depression is more severe than the feelings of sadness that can typically come and go with traumatic life events. Physical symptoms of depression include disturbed sleep, lethargy, changes in weight and/or appetite, and loss of libido. You may have suicidal thoughts or want to harm yourself, in which case it is especially crucial to seek help from a doctor or talk to a loved one who can support you in talking to a professional.

What types of depression are there?

Depression comes in many different forms, and there are other conditions where depression is an acute symptom. One example is seasonal affective disorder (SAD) is a seasonal depression usually related to winter and the lack of sunlight during that season. Another type of depression is postnatal depression quite commonly occurs in some women after giving birth. Women can also suffer from Premenstrual Dysphoric Disorder on a monthly basis during their menstrual cycle. Another example is bipolar disorder, which includes episodes of deep depressions coupled with excessively high moods (mania). Atypical depression is another type, which is actually far more common than the name suggests, and presents symptoms that are not considered "typical" of depression.

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How to fight depression?

The way in which you go about treating depression will depend on the severity and type of depression you have. However, it usually involves a combination of talking therapies such as CBT cognitive behavioural therapy, medication and self-help. Regular exercise, practising mindfulness and meditation, and eating balanced healthy eating are some of the ways you can fight depression naturally. It is also important to try and educate yourself on your depression and learn more about it. Talking to a friend or family member that you trust can also help, as it can reduce the feelings of loneliness. Journaling is another recommended thing you can do as it can help you identify what triggers your depression and learn a bit about the patterns you find.

How is depression diagnosed?

In the main, being officially depressed will mean obtaining a diagnosis from a mental health specialist. In most cases, however, accessing the professional opinion of a specialist will not be the first step on the road to obtaining a clinical diagnosis. Most people will see their general practitioner in the first instance who is likely to ask a number of questions about all-round health to help him or her make a speculative diagnosis about the mental state of their patient. The sorts of questions that might be asked include how long you have been in a depressive state for and whether these have featured in your past before or not. You can also expect to be asked about other negative emotions and even suicidal thoughts as part of the diagnostic procedure. In most cases, a diagnosis will require you to give blood samples and for the activity of your thyroid gland to be measured, too, since these can often be useful indicators.

What does depression do to your brain?

Being clinically depressed means that your brain will be affected. Clinicians have noticed that certain parts of the brain will reduce in size over time among the most depressed people from their brain scans. The hippocampus, the frontal cortex, the pre-frontal cortices and the thalamus can all appear smaller in scans of depressed people. In other studies, parts of the brain can appear to be inflamed among depressed patients, something that may explain the difficulty some depressed people have with memory function and concentration. In some cases, depressed people have been found to have reduced levels of oxygen in their brain, which could, if sustained, lead to serious damage. It may be this is why oxygenating blood through sports and physical activity could be so beneficial for altering depressive moods. In some people, the mood hormones that regulate how we feel are out of kilter in the brain. Someone with too many stress-related hormones is more likely to feel depressed than someone who has a brain with a good hormonal balance, for example.

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Can depression be cured?

Major depressive disorders can be successfully treated. Indeed, some people who have known multiple depressive states in their lives may find that their treatment is so successful that they never suffer from another one again. In this sense, a cure is possible. However, most clinicians would choose to avoid this term. This is because it is such a complex disorder that dealing with it in one way may not mean that it will not come back in another form. Most people who suffer from the range of depressive disorders there are will benefit from treatment that means they enjoy prolonged remission but are not fully cured of it.

Are depression and anxiety the same?

No, they are not, but they are linked conditions. In other words, someone who suffers from a great deal of anxiety can go on to suffer from depressive states. However, you do not need to suffer from anxiety to feel depressed. Both mental health conditions have similar symptoms which is why they are sometimes incorrectly lumped together. For instance, people with anxiety will often suffer from tiredness, weight loss, insomnia and muscle tension. All of these physical manifestations of anxiety can also be detected in people who are clinically depressed, too. Some medical professionals will treat both disorders as a single entity where the symptoms are so closely bound as to be indistinguishable. This is often referred to as mixed anxiety and depressive disorder, otherwise known as MADD.

Why can depression make you tired?

Chronic fatigue is something that people with depression will often feel. Like anxiety, however, feeling excessively or abnormally tired does not mean you are depressed. Tiredness is merely one aspect of being depressed that some people suffer from. Not all do, so it is important to understand that sleeping badly is not necessarily a sign of the onset of a depressive state. Usually, dealing with chronic fatigue will involve breathing exercises, the use of massage and getting into good pre-bedtime routines. However, depressed people will often find that they are tired because they cannot sleep at all. Often their mind will be racing, or they will feel too distracted to drop off. The most common explanation for why this happens at a neurological level is because normal brain function through neurotransmitters is interrupted because of a lack of the right sort of hormones, such as serotonin or dopamine, for example.

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Does depression run in families?

Being depressed is not an entirely environmentally acquired condition. In other words, some people are more pre-disposed to it than others because of the genes they have inherited. This is why depression has, for so long been known to have a family connection. Although this was noted by the very earliest psychotherapists, the proof of a genetic link in depressed patients was not established for some time. However, scientists have now singled out one gene in particular as being associated with the condition although there may be others that also play their part which are still unknown. The family gene in question is known as chromosome 3p25-26, and it has been found in hundreds of patients who have a history of depression in their family trees.

Does depression count as a disability?

In some cases, suffering from clinical forms of this mental health disorder will count as an official disability, but the fact is that it is not always treated as such. There are a number of factors that limit this recognition, not least in successfully obtaining the right diagnosis. Overall, it is only in the most extreme cases that it tends to be recognised as a disability. Clinically depressed people in the United States are said to be suffering from a psychiatric disability under the Americans with Disabilities Act. In the UK, the Equality Act of 2010 covers mental health disorders and disability. It states that normal day-to-day behaviour must be impacted to count as a disability and that this must be considered long-term, which is usually taken to be a clinically depressive state of twelve months or more.

What is post-natal depression?

This is a form of depression that is noted in some mothers who have recently given birth. According to the NHS, this condition affects around 10 per cent of new mothers, but it can also impact fathers and other life partners of the newborn's mother. Symptoms of this condition include withdrawal from society, alarming or outrageous thoughts and a persistent feeling of sadness. Several treatments are known to be successful for depressive post-natal states which include self-help and talking therapies. Science has no good explanation for why this form of depression is so common among new mothers. Left unchecked, it can worsen, so seeking help from a doctor or health visitor is advisable. Sometimes, the condition is referred to as 'the baby blues' which can mean that people do not take it as seriously as they should. Although such mental states can pass naturally, they shouldn't be downplayed or made light of.

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Depression in summary

Being depressed does not necessarily mean that you are suffering from a clinical disorder. The sense of mental anguish, worry and loneliness we can all feel from time to time is a normal part of life, just as is enjoying feelings of levity, joy and pleasure. In other words, being down is just as natural as being up. However, when people are in low moods for prolonged periods of time or when there is nothing that would account for their negative mental state – such as sadness at a relationship breakdown or suffering from grief, for example – then it may be that a clinically depressive state is at play. This can only be diagnosed by a professional as can other depressive mental states, such as the extreme mood swings that are associated with bipolar disorder, something that used to be called manic depression by clinicians.

There are numerous reasons for suffering from depressive states. Sometimes, they can be induced by substance abuse or sometimes from another type of medical condition. Some people will go through them because they have a particular mental health disorder, such as hypomania, that is characterised by depressive moods even though they are not clinically depressed. Whatever the underlying cause of such mental states, professional help can make them less severe and, in many cases, speed the onset of a more normal mental state without such low moods.

That said, offering an accurate diagnosis to someone who is depressed is not always easy. There are all sorts of symptoms that can lead to a misdiagnosis which is why it will often take multiple sessions to hone in on the right sort of treatment. In some cases, the use of drugs to rebalance the brain's chemical make up will be appropriate but, in others, talking therapies such as cognitive behavioural therapy (CBT) will be a preferred route. Many famous people have suffered from clinical depression, such as the humorist Spike Milligan, the actor Linda Hamilton and the politician Winston Churchill, to name but three.

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