DEPRESSION

DEPRESSION

Ana Galvão Abuchaim, MD. Psychiatry Specialist by the Brazilian Association of Psychiatry (ABP).
Claúdio Moogen Abuchaim, MD., Psychiatry Specialist by the Brazilian Association of Psychiatry (ABP).

Synonyms and related terms:

Depressive disorder, major depression, unipolar depression, including differentiated types of depression as well, such as severe depression, psychotic depression, atypical depression, endogenous depression, melancholy, seasonal affective disorder.

What's depression?

Depression is a disorder characterized by affecting an individual's mood, causing an abnormal predominance of sadness. Everyone, men and women, at any age, may be struck by it; however, women are twice as affected as men. In children and in the elder the disease has particular characteristics, and its occurrence in both groups is also frequent.

How does depression develop?

As for depression as a disease (depressive disorder), it isn't always possible to clearly find what events in someone's life led them to become depressed, unlike normal depressive reactions and depressive adjustment reactions, in which the precipitating event can be tracked down.

The causes of depression are multiple; thus, once accumulated they can get the disorder started. It originates from constitutional aspects in the individual, as genetic and neurochemical (brain neurotransmitters) factors, associated to environmental, social and psychological factors, such as:
 

	stress
	Lifestyle
	Significant events, as marital crises or breaking up with a spouse, death in the family, menopause, middle age crisis, amongst others.

How is depression diagnosed?

In depression, the intensity of suffering is high, lasting most of the day for at least two weeks, and we can't always ascertain the reason why the individual is in that state. Most importantly, we must know how the individual feels, how they keep organizing their life (work, chores, personal care with hygiene, eating, clothes) and how they have been relating with other people, so that the disorder can be diagnosed and an effective medical treatment be set in motion.

What does a depressed individual feel?

Often, a depressed individual feels sad and hopeless, out of sorts, discouraged or "down and out", with the "blues". Many people suffering from depression, however, deny the existence of such feelings, which can surface in different ways, as a stark wrath, outburts of rage, or constant attempts at blaming the others, or even as a number of pains across the body without medical causes justifying them.

Also, there may be a loss of interest in activities that were previously enjoyable to the individual, such as leisure activities, hobbies, social meetings and practice of sports. These events cease to be pleasant. Usually, sleep and eating are also altered, and a decrease in appetite is likely to occur, or even the opposite, its increase, with weight loss or gain. As regards sleep, insomnia may occur, with the individual having trouble getting to sleep, or waking up in the middle of the night, or sooner than habitually, and failing to get to sleep again. Also common are the feelings of energy decline, tiredness and fatigue, unjustifiable by any other physical problem.

What does a depressed individual think?

The thoughts that often occur to depressed people are depreciating ones, excessive guilt, and feeling of being a loser even because of past events. Many times ordinary daily issues cause such thoughts in these individuals. Many people can also experience difficulty thinking, finding it hard to concentrate or to make decisions that were previously habitual, feeling unable to make decisions or exaggerating the "ominous" effects from their possible wrong decisions.

Thoughts of death or suicidal attempts

Frequently, the individual may think a lot about death, about other people who already passed away, or about their own death. Many times there's a suicidal desire, at times even suicidal attempts, as the individual believes that's the only "way out", or with the purpose to "get rid" of the suffering, feelings that are caused by the depression itself, leading the individual to self-blaming, to feel useless or like a burden on the others. This aspect turns depression into one of the main causes of suicide, especially for depressed people who live alone. We must remember that the tendency to insulate oneself per se is a consequence of depression, which generates a depressive vicious circle that causes those who don't start a proper medical treatment to give up hoping they can get better.

Feelings that affect daily life and personal relationships

Frequently, depression can affect an individual's daily life. Many times it's hard to start the day owing to the discouragement and sadness on waking up. Thus, going about one's usual business may become a burden: to work, to devote oneself to someone else, to take care of the children, among other tasks, can become grueling duties, or even unfeasible, depending on symptom severity. Consequently, interpersonal relationship may be impaired: marital difficulties can accentuate, including a decrease in sexual desire; the lack of interest in friends and social life may compel the individual to insulate himself, also making difficult looking for medical help.

How is depression treated?

Medical treatment is always necessary, the type of treatment depending on the intensity of the problems brought about by the disease. There may be mild depressions, presenting with just a few features of the problems previously described, or there may be well more severe depressions, significantly hurting the individual's life. Anyway, mild or more severe depressions necessitate medical treatment, generally with medications (antidepressants), or psychotherapy, or, yet, a combination of both, according to the intensity of the disease and treatment availability.