When is it depression?
“Severe lethargy has set in…………..I thought that I was merely tired and in need of rest at year’s end, but it drags on, becoming the death-in-life that I know all too well, when my capacity for joy shrivels up and, like drought stricken grass, I die down to the roots to wait it out. The simplest acts demand a Herculean effort, the pleasure I normally take in people and the world itself is lost to me. I can be with people I love, and know that I love them, but feel nothing at all. I am observing my life more than living.”
Excerpt from Kathleen Norris’ “The Cloister Walk”
Major Depressive Disorder
Major depressive disorder, (MDD), is the most common mental disorder in the United States. How many readers can relate to the quote above? MDD may occur as a singular episode or it may occur numerous times over the course of one’s life. Dysthymia, which can last up to two years, is a less severe form of MDD. Depression does not discriminate. Depression affects people of all ages, races, ethnicities, social strata, and gender.
In this blog, we will define depression and its associated symptoms. We will look at risk factors and causes. We will give an overview of common and complementary treatment options. In conclusion, we will consider self-care strategies.
Definition
Depression is a common but serious mood disorder. It severely effects how a person feels, thinks, and handles daily activities such as sleeping, eating, and working.
Diagnosis
The following is a list of signs and symptoms associated with MDD. One may be diagnosed with MDD if any of these symptoms persist for longer than 2 weeks:
- Extreme sadness or empty mood.
- Hopelessness or pessimism.
- Irritability, frustration, and restlessness.
- Guilt, worthlessness, or helplessness.
- Loss of interest in pleasurable activities. Social isolation.
- Decrease in energy, feeling slowed down.
- Difficulty concentrating, remembering, and making decisions.
- Difficulty sleeping, oversleeping, or waking early in the morning.
- Change in appetite. Unexplained changes in weight.
- Physical aches and pains and digestive problems that don’t resolve with treatment.
- Increased use of alcohol or drugs.
- Inability to meet the responsibilities of work or family.
- Thoughts of death or suicide attempts.
Causes & Risk Factors
The number one cause of MDD is stressful events, and the associated changes in brain chemistry. Adapting to a change in environmental conditions mobilizes an enormous amount of our reserves often resulting in high cortisol levels. Depressed patients frequently exhibit elevated cortisol levels. MDD is also linked to altered levels of serotonin, norepinephrine, and dopamine. Together, these substances which are both hormones and neurotransmitters influence mood, sleep, and digestion. Norepinephrine mobilizes the brain and body for action. Dopamine effects movement, motivation, and reward.
More women are diagnosed with MDD, but men also suffer from depression. They are just less likely to talk about it and seek help. Men are more likely to turn to alcohol and drugs to cope. They are more likely to seek medical attention for rapid heartbeat, chest tightness, and digestive issues, present during depressive episodes.
Many adult mood disorders begin with high levels of anxiety in childhood. A family history is another risk factor. A study on depression in twins showed a 37% heritability factor, although it is unclear whether severity is influenced by the mother or the father.
Sleep disorders can be a risk factor for MDD, as well as a consequence of MDD.
MDD can co-occur with other illnesses such as diabetes, cancer, heart disease, Parkinson’s, as well as thyroid disease. Side effects of certain medications can also contribute to depression.
Treatment
One of the leading interventions for MDD is anti-depressant medication aimed at regulating body chemistry in regards to the above mentioned hormones and neurotransmitters. Potential side effects are: nausea, weight gain, trouble sleeping, dry mouth, blurred vision, dizziness, anxiety, headache, diarrhea, constipation, tremors, and increased sweating. Medications typically take 4-6 weeks to take effect. Patients are monitored closely, especially in the first 2 weeks for side effects.
MDD is considered medication resistant after unsuccessful use of two different medications. In the case of medication resistant depression, brain stimulation therapy may be used. Another option that is now approved by the FDA is intranasal esketamine. It is a rapidly acting nasal spray administered by the physician that reduces depressive feelings almost immediately. It is often used in conjunction with traditional medications.
Psychotherapy is another leading treatment for MDD. The following are some effective methods.
EMDR, Eye Movement Desensitization, and Reprocessing, is a form of psychotherapy founded by Francine Shapiro. It is endorsed by the World Health Organization, the American Psychiatric Association, and the Department of Defense.
According to EMDR the brain information processing system tends toward mental health. Shapiro believes people can heal from the symptoms of emotional distress. Through EMDR new associations are forged between traumatic memories and more adaptive memories, information, and insights, leading to the elimination of emotional distress.
Cognitive Behavioral Therapy, CBT, emphasizes helping patients become autonomous in developing coping skills on a behavioral, thinking, and emotional level. The focus is placed on the current situation and developing strategies for moving forward. Some studies show that it is as or more effective than psychiatric medications and other psychological care.
Some strategies used are: facing one’s fears instead of avoiding them, the use of role playing to prepare for potentially problematic interactions, and learning to calm and relax one’s body.
Studies have shown that acupuncture can be effective for depression. It may possibly trigger the release of serotonin. Acupuncture in concert with anti-depressant medications has shown better treatment outcomes for patients with clinical depression, than medication alone.
There is research to show that the NADA, (National Acupuncture Detox Association), protocol for ear acupuncture which is used by not only acupuncturists, but nurses, social workers, disaster relief workers, psychiatrists, and others, is effective in the treatment of PTSD. Research shows that when used in drug and alcohol addiction recidivism is significantly reduced when used in concert with other comprehensive interventions.
Self Care
The following are recommendations from the National Institute of Mental Health to prevent or attenuate MDD:
- 30 minutes a day of physical activity. You may want to break it into three, 10 minute intervals.
- Establish regular waking and sleeping times.
- Eat regular healthy meals.
- Break large tasks into small ones. Subtract items from the ‘ToDo’ list.
- Connect with people.
- Delay making important life decisions regarding marriage, divorce, and job changes, while you are depressed.
- Avoid drugs and alcohol.
Conclusion
Celebrities have been public about their mental health challenges. And while their depression may persist, they have found support in the following things:
Golden Globe winner Taraji P. Henson says prayer, meditation, and therapy have helped her manage her depression and anxiety.
Pop star Justin Bieber turned to drugs to cope with his mental illness. He said religious faith and the support of his loved ones helped him turn his life around.
Jim Carrey was on Prozac, but not for good. When he stopped taking Prozac, he realized he needed to get out of bed every day and say that ‘life is good’, even though at times it was difficult. He also mentions the importance of a healthy diet and supplements to support mental health.
MDD may be as individual as the person suffering from it. This blog is by no means a replacement for medical attention. Please seek medical help if you suspect you are suffering from MDD. Know that your path back to mental health can take many routes.
Sources and links
https://acupuncturetoday.com/article/32819-studies-acupuncture-effective-for-depression
https://acupuncturetoday.com/article/30234-depression-and-combined-therapies
https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077049/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153313/
https://www.nimh.nih.gov/health/topics/depression
https://www.socialworkdegreeguide.com/30-famous-people-alive-today-battled-depression/
https://www.verywellmind.com/celebrities-open-up-about-depression-5094126
https://www.webmd.com/depression/side-effects-antidepressants