Depression is a severe mental disorder that affects millions of people all over the world. Although the term “depression” is often used in everyday life to describe a temporary state of sadness, clinical depression is far more complex and persistent. In this article, we will explore in depth what depression is, its causes, the existing types, the symptoms, the diagnosis and the treatment options.
What is depression?
Depression is a mental disorder characterised by profound changes in mood, thoughts and behaviour. It is more than a normal reaction to difficult life events and it can affect a person's ability to function in everyday life. Clinical depression is diagnosed when the symptoms persist for at least two weeks. It is important to underline that depression can affect anyone, regardless of age, sex or socio-economic status, and that seeking help and appropriate care are essential steps for managing and overcoming this mental disorder, given the significant impact it can have on quality of life and on individual functioning.
The causes of depression
The causes of depression are complex and can involve a combination of genetic, biological, psychological and environmental factors. They include:
- Genetic predisposition: People with a family history of depression have a higher risk of developing this disorder.
- Chemical imbalances in the brain: Changes in the levels of neurotransmitters, such as serotonin and dopamine, can contribute to depression.
- Traumatic events: Traumatic experiences, such as the loss of a loved one or a stressful life event, can trigger depression.
- Chronic stress: Prolonged stressful situations at work or in personal life can contribute to the development of depression.
- Hormonal problems: Hormonal imbalances, such as those associated with pregnancy or the menopause, can influence mood.
Types of Depression:
There are several types of depression:
- Major depression: also known as major depressive disorder or unipolar depressive disorder, is one of the severe forms of depression and is characterised by intense and persistent symptoms that deeply affect a person's daily functioning. This form of depression can affect a wide range of areas of life, including interpersonal relationships, performance at work, general health and quality of life.
- Persistent depressive disorder: Also known as dysthymia, it is a chronic and milder form of depression that can persist for at least two years. This mood disorder can significantly influence a person's quality of life, even if the symptoms may be milder compared with major depression
- Seasonal affective disorder: SAD is a specific form of recurrent depression, characterised by seasonal changes in mood. This mental disorder usually appears during the cold season, and its symptoms can persist until spring or summer. The main cause of seasonal affective disorder appears to be linked to changes in sunlight and in the circadian rhythm.
- Bipolar depression: also known as bipolar affective disorder (BAD), is a mental disorder characterised by extreme changes in mood, comprising periods of mania or hypomania and episodes of depression. This complex condition can have a significant impact on the individual's life and can vary in intensity and frequency. It includes a persistent state of sadness, loss of interest or pleasure in activities, changes in weight and appetite, insomnia or hypersomnia, agitation or lethargy, feelings of worthlessness and suicidal thoughts. People with bipolar depression can experience a significant drop in their energy levels and difficulty in carrying out daily activities.
- Postnatal depression: is a mental health condition that affects a significant number of women after giving birth. This disorder, also known as postpartum depression, can appear in the first weeks or months after the birth of a child and is characterised by symptoms of depression, anxiety and stress, which can have a significant impact on the mother's ability to adapt to her new role and to the responsibilities of motherhood.
- Psychotic depression: is a severe form of depression that involves psychotic symptoms, such as hallucinations and delusions, in addition to the typical symptoms of major depression. It is a serious condition that can significantly affect a person's thinking, perception and behaviour, amplifying the impact and the suffering associated with ordinary depression.
- Premenstrual dysphoric disorder (PMDD): is a medical condition characterised by intense and debilitating symptoms that appear cyclically before the start of a woman's period. It is a severe form of premenstrual syndrome (PMS) and it significantly affects the well-being and daily functioning of the women who suffer from this disorder.
- Situational depression: also known as reactive depression, is a form of depression that develops following a stressful event or a trauma. This type of depression can appear as a normal reaction to difficult circumstances and can vary depending on the intensity and the duration of the stressful event.
The Symptoms of Depression:
The signs of depression can vary, but they usually include:
- A persistent state of sadness or anxiety.
- Loss of interest or pleasure in usual activities.
- Changes in weight or appetite.
- Insomnia or hypersomnia.
- Agitation or lethargy.
- Feelings of worthlessness or guilt.
- Difficulty concentrating or making decisions.
- Thoughts about death or suicidal thoughts.
The Diagnosis of Depression:
Establishing the diagnosis for each form of depression requires a careful evaluation of the symptoms and of the patient's history. In general, the diagnosis depends on meeting the specific criteria set out in diagnostic guidelines such as the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) for depression, or other relevant clinical resources.
Here is a general overview of how the diagnosis is established for the various forms of depression mentioned above:
Major Depression
- The DSM-5 criteria: The diagnosis of major depression is established on the basis of the DSM-5 criteria, which include the presence of at least five specific symptoms of depression, such as a persistent state of sadness, loss of interest or pleasure and changes in sleep or appetite.
- Clinical evaluation: Mental health professionals carry out a clinical evaluation in order to rule out other medical conditions or psychological disorders that could contribute to the symptoms.
Persistent Depression (Dysthymia)
- The duration of the symptoms: The diagnosis of persistent depression is based on the presence of symptoms for at least two years, and these can be less severe than those of major depression.
- DSM-5 criteria: The DSM-5 criteria for dysthymia are taken into account, including the specific symptoms and their prolonged duration.
Seasonal Affective Disorder (SAD):
- The seasonal character of the symptoms: The diagnosis is based on the presence of symptoms of depression that appear cyclically in certain seasons and remit in others.
- Monitoring the symptoms: Professionals can use symptom diaries or other monitoring methods in order to identify the seasonal pattern.
Bipolar Disorder (Bipolar I and Bipolar II):
- Manic or hypomanic episodes: For the diagnosis of bipolar disorder, the presence of manic episodes (Bipolar I) or hypomanic episodes (Bipolar II) in combination with depressive episodes is taken into account.
- Family history: The evaluation of the family history of bipolar disorders can be taken into account.
Postnatal Depression:
- Onset after birth: The diagnosis of postnatal depression involves the onset of symptoms after birth.
- Evaluating the well-being of the mother and of the baby: Professionals can evaluate the mother's well-being and carry out screenings to detect the symptoms.
Psychotic Depression:
- The presence of psychotic symptoms: The diagnosis of psychotic depression is established when the depressive symptoms are accompanied by hallucinations or delusions.
- Ruling out other disorders: Evaluations are carried out in order to rule out other psychotic disorders or medical conditions that can cause similar symptoms.
Premenstrual Dysphoric Disorder (PMDD):
- The cyclical onset of the symptoms: The diagnosis of PMDD involves the presence of severe symptoms appearing cyclically before menstruation.
- Ruling out other causes: Other medical or psychological conditions must be ruled out in order to establish the diagnosis.
Situational Depression:
- The link with stressful events: The diagnosis of situational depression involves identifying a direct link between the symptoms and the stressful events.
- Ruling out other contributing factors: Other medical conditions or psychological disorders must be ruled out.
Diagnosing depression is a complex process and it is always advisable to consult a mental health professional for the evaluation and for establishing an appropriate care plan.
It is important to underline that only mental health professionals can make an accurate diagnosis and that this can change on the basis of shifts in symptoms and circumstances.
The Treatment of Depression:
How do you get rid of depression? Well, the care for depression can vary and can include:
1. Cognitive Behavioural Therapy (CBT)
CBT is one of the therapeutic approaches used in treating depression. This form of therapy focuses on changing negative thoughts and the behaviours associated with them, with the aim of improving the individual's mood and daily functioning.
Here is how cognitive behavioural therapy works in treating depression:
- Evaluating negative thoughts: The therapist and the patient identify and analyse the negative and distorted thoughts that contribute to the depressive state. These thoughts can be automatic, meaning that they appear without us being aware of them.
- Reframing harmful thoughts: The patient learns to recognise negative thoughts and to question them. The therapist helps them explore more realistic alternatives and reframe their thoughts in a more balanced and positive way.
- Identifying and changing harmful behaviours: The behaviours associated with depression are explored, such as social isolation or the avoidance of enjoyable activities. The patient learns to identify these behaviours and to change them gradually, encouraging controlled exposure to difficult situations.
- Setting realistic goals and concrete actions: Together with the therapist, the patient sets realistic goals and concrete actions for reaching them. This process helps to restore a sense of normality and to increase personal satisfaction.
- Monitoring thoughts and emotions: The patient learns to monitor their thoughts and emotions regularly, identifying negative patterns. This self-observation helps them anticipate and better manage the situations that can trigger depressive symptoms.
- Developing skills: Cognitive behavioural therapy also focuses on developing the skills needed to cope successfully with life's challenges. These can include communication, problem-solving and stress management skills.
- Returning to enjoyable and important activities: The patient is encouraged to return gradually to the activities they abandoned or avoided because of depression. This contributes to regaining pleasure and meaning in life.
The Limitations of Cognitive Behavioural Therapy:
- It requires active involvement: The therapy requires the patient's active participation and can be emotionally demanding at certain moments.
- Variable effectiveness: The effectiveness can vary from one person to another, and some people can benefit more from other forms of care.
- It is not a universal solution: For some cases of depression, a combination of approaches may be needed, including therapy and medication.
2. Antidepressant Medication:
How It Works: Antidepressants regulate brain chemicals, such as serotonin and norepinephrine, in order to improve mood.
Benefits: Effective in treating depressive symptoms, especially in severe cases.
Potential adverse effects: Possible side effects include insomnia, reduced libido, weight gain and gastrointestinal disorders.
3. Interpersonal Therapy (IPT):
How It Works: Interpersonal therapy focuses on improving interpersonal relationships and on addressing the social problems that contribute to depression.
4. Neurofeedback Therapy:
Neurofeedback therapy is an innovative technique based on monitoring brain activity and providing real-time feedback so that the patients' brain can regulate its own activity, and it is an effective method in treating any type of depression.
How Does It Work?
During a neurofeedback session, a cap with lightly moistened electrodes is placed on the patient's head, measuring and recording the electrical activity of the brain. The procedure is non-invasive and painless. Through visual, auditory and/or tactile stimuli, the patient receives real-time feedback about their brain activity, which makes self-correction and regulation easier.
The Benefits of Neurofeedback:
- Non-invasive: It does not involve medication or surgery, offering a safer option for those who are looking for non-invasive methods.
- Personalised Care: The neurofeedback therapy protocol is adjusted according to the specific needs of each patient, on the basis of a complex analysis called BrainMap (qEEG). You can find out more details by looking at the case study on the effectiveness of neurofeedback therapy in depression here.
- No side effects: Neurofeedback has no adverse side effects.
The Advantages of Non-invasive Methods:
- Safety: Non-invasive therapies, such as neurofeedback, have a higher safety profile compared with invasive or drug-based approaches.
- Personalisation: Non-invasive approaches allow the care plan to be personalised according to the individual needs of the patient.
- Reducing Side Effects: Non-invasive methods are associated with a lower risk of adverse side effects, which makes them an option preferred by many patients.
Complications associated with depression
Depression is a complex and debilitating mental disorder which, if left unaddressed or handled incorrectly, can lead to a series of complications that affect both mental and physical health. It is important to recognise and address depression at the first signs in order to prevent or manage these complications. Here are some of the complications associated with depression:
Self-sabotage and suicidal thoughts:
One of the most serious aspects of depression is the increased risk of self-destruction and suicidal thoughts. People with severe depression may feel that life no longer has meaning or that they can no longer cope with the suffering, which can lead to self-destructive behaviours or, in extreme cases, to suicide attempts.
Physical health problems:
Depression can contribute to physical health problems. People with depression may have an increased risk of cardiovascular conditions, diabetes, obesity and other medical conditions, because a lifestyle affected in this way can lead to unhealthy habits, such as poor nutrition, lack of exercise and insufficient or poor quality sleep.
Social isolation and relationship problems:
Depression can cause social withdrawal and isolation, which can lead to problems in interpersonal relationships. People with depression may have difficulties in communicating, in maintaining relationships and in fulfilling their social responsibilities.
Problems at work and a decline in academic performance:
Everyday functioning affected by depression can have consequences for performance at work or in an academic setting. Absenteeism, reduced productivity and difficulties in completing tasks can lead to occupational and financial problems.
Substance abuse:
Some people turn to psychoactive substances, such as alcohol or drugs, in an effort to cope with the symptoms of depression. This self-medication can lead to addiction and to further complications.
Sleep disturbances:
Insomnia or hypersomnia are often associated with depression. Sleep disorders can have a negative effect on general health and can worsen depressive symptoms.
A decline in quality of life:
Depression can affect quality of life in general. People may feel that they no longer enjoy the activities they used to like, and the loss of interest and pleasure can contribute to a significant decline in quality of life.
Complications during pregnancy and postpartum:
Depression can have an impact on women during pregnancy and postpartum, increasing the risk of complications such as prematurity, delayed growth of the baby and mental health problems for mother and child.
The impact on family and friends:
Depression can have a significant impact on the family members and friends who try to support the affected person. Relationships can become tense, and the people around may feel frustration or helplessness in the face of their loved one's suffering.
Can we prevent depression?
Preventing depression involves adopting a healthy lifestyle and developing effective strategies for managing stress and emotional difficulties. Here is what you can do in order to prevent depression:
1. Maintaining a healthy lifestyle:
- Balanced nutrition: Eating a healthy diet, rich in essential nutrients, can have a positive influence on well-being and emotional balance.
- Regular exercise: Physical activity is associated with the release of endorphins, the chemicals of happiness. Regular exercise can help with managing stress and maintaining mental health.
2. Managing stress:
- Relaxation techniques: Learning relaxation techniques, such as meditation or deep breathing, can contribute to managing stress effectively.
- Balanced planning: Establishing a balance between work and free time, avoiding overload and taking regular breaks, can reduce the pressure and the risk of depression.
3. Supporting social relationships:
- Open communication: Keeping open communication with friends and family, sharing thoughts and feelings, can contribute to creating an effective support system.
- Social activities: Taking part in social activities and spending time with loved ones strengthens bonds and provides a support network.
4. Setting and reaching goals:
- Realistic goals: Setting realistic goals and reaching them can contribute to developing self-esteem and to a feeling of personal achievement.
- Keeping a purpose: Having a purpose in life and a direction can offer a sense of meaning and motivation.
5. Avoiding the excessive use of psychoactive substances:
- Alcohol and drugs: Excessive alcohol consumption or drug use can contribute to the development or the worsening of depression. Limiting or avoiding them can help to maintain mental health.
6. Monitoring mental health:
- Self-observation: By being aware of changes in mood and behaviour, we can step in earlier and look for help if we notice signs of depression.
- Regular consultations: Regular consultations with a mental health professional can contribute to maintaining mental health and to preventing depression.
7. Managing risk factors:
- Social isolation: Avoiding social isolation and cultivating healthy interpersonal relationships helps to prevent depression.
- Family history: People with a family history of psychological disorders can be more prone to depression and could benefit from early monitoring and early intervention.
8. Looking for professional help:
Preventive therapy: Therapy can be beneficial even in the absence of severe symptoms. The BrainMap analysis is an effective tool in identifying a predisposition to depression. If a predisposition to depression is discovered at brain level, it can be anticipated, and its manifestation prevented by the therapy called Brain training.
Depression is a complex disorder that can deeply affect a person's life. Even so, it is important to understand that effective options are available and that asking for help is an essential step towards recovery. Through awareness, education and appropriate support, we can help reduce the stigma associated with depression and encourage a holistic approach to mental health.
If you are dealing with depression or if this disorder has been present in your family history, you can contact us to take the first step towards gaining and maintaining mental health, by booking a free consultation here.
References:
- Cristine, Bastos, M., Renan Cassiano Ratis, Nunes, F. and Bonini, J.S. (2023). Effects of neurofeedback on major depressive disorder: a systematic review. Einstein (Sao Paulo), [online] vol. 21.
- J. Fernández-Alvarez, Grassi, M., Colombo, D., Botella, C., P. Cipresso, Perna, G. and Riva, G. (2021). Efficacy of bio- and neurofeedback for depression: a meta-analysis. Psychological Medicine, [online] vol. 52(2), pp. 201-216.
- Patil, A.U., Lin, C., Lee, S.-H., Huang, H.-W., Wu, S.-C., Deepa Madathil and Huang, C.-M. (2023). Review of EEG-based neurofeedback as a therapeutic intervention to treat depression. Psychiatry Research: Neuroimaging, [online] vol. 329, pp. 111591-111591.
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