14 November 2017

What kind of disease is depression

Ania Varezhkova, Atlas

Depression may seem like a minor illness, but it prevents you from living normally – studying, working, writing books and paintings, making friends and raising children. Severe forms of depression in 15% of cases end in suicide – according to WHO statistics, this is about 800,000 cases per year and the second place in the ranking of causes of death of people aged 15-29 years. Atlas tells you what depression is, how to recognize it and how to help yourself and your loved ones.

What is depression

Clinical depression is a mental disorder that, according to statistics, affects 300 million people worldwide. Depression is expressed by apathy, bad mood, reduced physical activity, sleep and nutrition disorders, anxiety, guilt and loss of the meaning of life.

With depression, it is hard to work: every sentence must be reread several times, it is difficult to focus attention and keep even simple tasks in mind, and at the same time the feeling of meaninglessness of what is happening and one's guilt for helplessness and "laziness" does not leave.

In addition to work, they stop being interested in things that usually give pleasure: books, movies, music, hobbies, children. This condition is called "anhedonia" – the inability to rejoice and have fun.

Depression is often underestimated and confused with a bad mood. If the project is not going well at work or your favorite car keys are lost, it's okay to be a little sad. To refuse dessert (or vice versa, to eat two), go to bed early, cry in the end – in a normal state, such funds are usually enough to feel better.

But in the case of depression, proven self-help tools do not help, and a bad mood may not have any "objective" reasons. A person can be supported by a family and wait for a cool job, but you still want to cover yourself with a blanket over your head and not leave the room for about ever. And this condition lasts for several weeks, months and even years.

Why depression occurs

Studies have shown that during the disease, the activity of neurons that are responsible for negative emotions and fear increases, and the activity of those that form positive emotions and a sense of satisfaction decreases. Insufficient activity of reward neurons in the brain leads to a lack of motivation. Negative thoughts are repeated in a cycle, and positive emotions fail to "interrupt" them.

Depression is associated with a violation of the balance between positive and negative emotions.

The development of depression is influenced by external circumstances, psychological factors, genetic predisposition. A stressful situation can serve as an external trigger – the loss of a loved one, separation from a partner, unexpected dismissal or relocation.

Internal causes may be related to a genetic predisposition. Research suggests that several genes may be involved in the development of depressive disorder. They are mainly related to the work of neurons in the brain.

How to Treat Depression

Psychotherapy and psychopharmacotherapy are used to treat depression. Antidepressants of various classes are used as a medicine: serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants and others.

Serotonin reuptake inhibitors block the neurotransmitter's return to neurons. Serotonin affects the receptors longer and creates a feeling of pleasure. At the same time, the drug does not increase the amount of serotonin, but only stretches the validity period – it's like turning the clock in the computer back a day to renew the license of the program.

Due to the fact that inhibitors do not interfere directly with the synthesis of the mediator, the drug is almost not addictive.

Monoamine oxidase inhibitors block the enzyme that destroys monoamines – serotonin, dopamine, norepinephrine. As in the case of serotonin, this allows neurotransmitters to remain active longer and maintain the emotional mood of patients.

Tricyclic antidepressants block the reuptake of all monoamines at once – not only serotonin, but also dopamine and norepinephrine. The effectiveness of these antidepressants is affected by the SLC6A4 gene (serotonin transporter) and the COMT gene (an enzyme that destroys norepinephrine and dopamine).

In addition to medications and psychotherapy, regular physical activity helps to cope with depression (running or swimming would be an ideal option), proper nutrition with a high content of omega-3 fatty amino acids, meditation. There are several non-drug methods: transcranial magnetic stimulation (TMS), light therapy, biofeedback.

How to help loved ones with depression

Despite the availability of treatment, only 10% of patients receive professional help – simply because everyone else does not apply for it.

This is due to the widespread attitude towards people with depression as "lazy and slobbery", with all the ensuing requirements in the spirit of "get together, rag". Under public pressure, patients themselves begin to believe that their illness is far-fetched, and they must cope on their own. It is impossible to cope – and this only increases the feeling of guilt.

Coping with depression on your own is as simple as lowering blood pressure by willpower.

If one of your loved ones is suffering from depression, try to tactfully express your support, tell us about ways to get professional help, but do not try to shake, cheer up and "fix". Acceptance and patient attitude in such cases is a more effective medicine.

To check your condition, you can fill out diagnostic tests: the WHO Wellness Index and the Beck Scale questionnaire. If the results are disappointing, consult a doctor and choose a treatment. And talk to your loved ones.

Kupfer et al., Major depressive disorder: new clinical, neurobiological, and treatment perspectives. The Lancet, December 2011.
Strauss et al., Mindfulness-Based Interventions for People Diagnosed with a Current Episode of an Anxiety or Depressive Disorder: A Meta-Analysis of Randomised Controlled Trials. PLoS One, 2014.
Grosso et al., Role of Omega-3 Fatty Acids in the Treatment of Depressive Disorders: A Comprehensive Meta-Analysis of Randomized Clinical Trials. PLoS One, 2014.
Depression. WHO, newsletter N°369. February 2017.

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