DEPRESSION

Causes, Symptoms, and Treatment by
Joseph M. Carver, Ph.D., Psychologist

Introduction:

Depression is perhaps the most common of all mental health problems, currently felt to affect one in every four adults to some degree.

Depression is a problem with mood/feeling in which the mood is described as sad, feeling down in the dumps, being blue, or feeling low. While the depressed mood is present, evidence is also present which reflects the neurochemical or "brain chemistry" aspects of depression with the depressed individual experiencing poor concentration/attention, loss of energy, accelerated thought/worry, sleep/appetite disturbance, and other physical manifestations. When this diagnosis is present, the individual will exhibit at least five of the following symptoms during the depressive periods:


- Depressed mood, most of the day or every day
- Markedly diminished interest in all or almost all activities
- Significant weight loss or gain or appetite disturbance
- Insomnia or excessive sleeping
- Psychomotor agitation or retardation (restlessness)
- Low energy level or chronic tiredness
- Feelings of inadequacy, loss of self-esteem, and/or self-deprecation
- Decreased attention, concentration, or ability to think clearly
- Recurrent thoughts of death or suicide, an expressed desire to be dead

Causes of Depression:
Depression can occur under many circumstances but most commonly is present in these two situations:

Sudden Severe Loss In this situation, the individual has experienced a sudden, perhaps surprising severe loss. This loss may be the death of a loved one, loss of a job, loss of friendship, or other grief process. In this type of depression, the patient can clearly identify what is creating the depressed mood.

Long-term High Stress Level In this situation, the patient is depressed but can't quite put their finger on the cause, the "I'm depressed but I don't know why" condition. Imagine running a video tape of your life, reviewing the past 18 months. Look at the stress you've been under, the amount of responsibility, the number of pressures, and the number of hassles. In actual clinical practice, this cause of depression is seen more often than sudden loss. This type of depression creeps up on you. When this type of depression is experienced, the patient offers comments such as: "I don't know what's wrong!" "I don't know how I feel." "My feelings are numb."

Brain Chemistry and Depression:
The human brain operates, much like your automobile, on fluids called neurotransmitters. Just as your automobile has brake fluid, antifreeze, transmission fluid, and oil - your brain runs on these neurotransmitters. Some give us energy, like those related to adrenalin, some control body movements ("dopamine" as an example), and some control mood.

The brain neurotransmitter often associated with depression is called serotonin. Serotonin is the brain's "oil", a rather slow-acting neurotransmitter that is associated with sleep, appetite, energy, alertness, and mood - just to name a few. Using the automobile as an example, if we drive our car to California at a speed of 120 mile per hour, running the engine hot for a long time, it would obviously use more oil. As long as we provided gas, however, it would continue to run. Now suppose in our trip that for every two quarts of oil we burn, we only replace one quart. By the time we reached California we'd be several quarts low and our engine would be obviously overworked and overheated.

During long-term high stress, the brain burns its' oil, serotonin, at a higher rate. The bottomline in depression and stress: The brain burns up more serotonin than it can replace! In the end result, after many months of severe stress, the brain is using serotonin faster than it can create/replace it. Your neurochemical level of serotonin drops and you become depressed.

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You'll know your Serotonin level is low (and depression is here) by the following symptoms:

1. Most depressed folks experience early morning awakening, usually around 4:00 am (farmers are exempted). Serotonin, you see, controls our sleep cycle.

2. Concentration and attention will drop. Depressed children/students will experience a drop in grades. You'll start putting odd things in the refrigerator (a bowling ball is the office record!), forget why you went to the grocery, and become very forgetful and scatterbrained at work/home.

3. You'll lose physical energy. You can sleep for ten hours and you'll still be bone tired. You will cry at the drop of a hat - driving down the highway, doing dishes, sitting at work, etc.

4. Sexual interest, appetite, and general interest will rapidly drop. You will stop answering the phone, stop visiting friends/relatives, and pull the blinds.

5. Most dangerous - your mind speed will increase. Your mind will race at what seems like 200 miles per hour. Depressed people often tell their doctor "I can't get my mind to stop!" The minute you wake up in the morning - it will start up. Your brain will then turn against you. It will reach in your memory and pull out every bad memory it can find - abuse as a child, failed relationships, etc. - anything to make you feel bad and especially guilty. You will be tortured by your own thoughts.

6. As your mind speed picks up, the "garbage truck" will arrive. While the brain is already torturing you with the past, it will create/invent new ideas/thoughts to torture you. In every case of depression, if the depression stays long enough, you will receive the same "garbage" thoughts from your mind. You will be told:
- you are a burden to your family/friends
- you have failed/disappointed your family
- no one really cares about you
- your children would be better raised by someone else
- your family would be better off without you
- your spouse would be better off without you
- you are going crazy and there's no hope
- it would be better if you weren't around
- you would be better off dead
- you should probably kill yourself
If you're depressed - then you already know about the garbage truck. It's almost impossible to explain this part, and the excessive mind speed, to someone who has never been seriously depressed. If your depression goes untreated, this constant "garbage" will totally destroy your self-confidence. Try as you may, you will be unable to control this part of depression.

7. As part of the "garbage truck", your mind will try to make you as uncomfortable as possible. You may be flooded with thoughts of violence (against yourself and others), you'll think you are condemned by God, or you'll think you deserve this condition for some reason. Your garbage will also tell you that if you seek professional help (physician, psychologist, psychiatrist, etc.) that you'll be committed to an institution forever.

8. When depressed, your brain begins running a mental "video tape" of your worst hits/experiences. If married, a mental tape of the marriage is played daily, only focusing on the worst experiences. If you are young, you will suddenly become preoccupied with your upbringing, who got the best gym shoes, the favorite child, the car you never received. Frequent if not constant thoughts and preoccupations about past problems and issues is a common sign of depression.

In short, depression is a neurochemical reaction to severe and prolonged stress, either suddenly surfacing or gradually creeping up on you over a period of many months. The treatment for this dark cloud is much easier than you think.


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Current Treatment for Depression:

Treatment for depression frequently involves two programs, one using antidepressant medication and the other repairing the damage done by months of "garbage". In all current research, the best way to recover from a severe depression is using both methods.

Medication Treatment: Remember the automobile example, being several quarts low after running too hot for too long. Depression is treated medically in a similar manner - we add a few quarts of oil until the fluid level (Serotonin) is normal. In depression, we use antidepressant medication to "add" the brain's oil, in most cases, Serotonin. An antidepressant medication slowly increases the Serotonin in the brain. Prozac, Zoloft, and the newest "Paxil" are antidepressants especially made for this purpose. They form a new class of antidepressant medications, SSRI's, or (ready for this?) Selective Serotonin Reuptake Inhibitors (SSRI).

As in the automobile, as your "oil" level goes up, your symptoms go down. Most antidepressant medications require at least four to six weeks to increase the serotonin level significantly although you'll notice improvements after the first week. Antidepressant medications, the SSRI's for example, often stop crying spells in five to seven days and stop the "garbage truck" in five to ten days.

Psychological Treatment: Psychologists and other therapists work with you to repair the damage done by the "garbage", helping you sort out reality from what your brain has fed you over the past many months. Many people feel going to a psychologist or therapist involves laying on a couch and talking about your toilet training during childhood - Nonsense! Modern psychologists are experts in not only brain chemistry, but how to repair "thinking" damage and rebuild/reconstruct your confidence. The combination of medication and therapy is extremely effective.

Usually, successful treatment for severe depression involves both medication and therapy/counseling. With both, you can expect normal sleep to return first, followed by a slowing of mind speed and the garbage truck leaving.
Some General Thoughts:

1. Depression is the most common mental health problem treated by modern psychologists and psychiatrists. In most cases, hospitalization is not required unless you have waited until you have active suicidal thoughts.

2. If you are depressed, expect your brain to be filled with mental garbage - get ready for it! During this time, do not take action on those garbage thoughts and make no major changes in your life. It's best to wait until the garbage truck leaves before making decisions that will or may change our life.

3. Depression has been researched by physicians, psychologists, psychiatrists, scientists, and others. Listen to the advice of your professionals who study depression - not your neighbors or your aunt Gladys. If placed on medication, you may be told "Don't take that Dope!". Remember, the people giving you advice don't have a 200 mile-per-hour garbage truck following them! Stick with professional opinion. Depression is a chemical problem, not caused by demons, devils, poor eating habits, a new moon, or other old-wives tales.

4. You may have other symptoms with your depression, such as severe anxiety or agitation (pacing, no sleep at all, "hyper", etc.). That only means another neurochemical has kicked in. In these cases, a psychiatrist can best select the medication for the combination of anxiety and depression.

5. When you are depressed, those who love you will become a pain-in-the-butt. They will "bug" you constantly, trying to cheer you up, giving you advice ("snap out of it" is most common), and trying to be by your side. Children will become shadows when their mother is depressed, almost protecting Mom. Be prepared for this.

6. During depression, remember that your brain goes on a bad-memory hunt, looking for old memories to torture you. Be prepared to relive or re-feel old hurts, old doubts, old guilt, and old sorrows. Be curious about what memory files the brain selects rather than focus on those memories. You can expect your brain to constantly replay the video tape (your "worst hits" tape) of your life. You'll feel guilty for things you did as a child, mistakes you made ten years ago, etc. You'll live in the past as long as the depression remains. It may interest you to know that as the serotonin level increases, the "past" returns to the past as a memory - not a torture.

7. As your brain tortures you, it may "lock on" horrible thoughts. You may feel you have a terminal disease. You may become preoccupied with guns, evil thoughts, etc. Often, individuals feel they are somehow contaminated by a killer disease, fearing they will pass it to their family. One husband brought his wife in for treatment when she began fixing breakfast in a surgical mask and rubber gloves! One man sought treatment at the office after nailing his closet door shut with 148 nails - his brain became preoccupied with the shotgun in that closet, telling him to kill his family and then himself.
In other depressed situations, people become obsessed with other issues, almost always "the road not taken". Often viewed as mid-life crisis, a straight-laced businessman now wants a Harley and a tattoo while another individual begins suddenly thinking about a past sweetheart. In almost all of these situations, the individual acts totally out of character.

8. All depressed folks look for escapes. Common methods of trying to escape depression are excessive alcohol use, drugs, sexual relationships, changing jobs, etc. A lot of good marriages are lost during these times as the spouse of the depressed partner hears "I've got to have space" or "I've got to get away and find myself!" You'll find these escapes don't work. These methods only complicate your depression and your recovery. Best bet - don't make changes, just get to a professional.


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