Everyone knows or will know someone who is affected by depression. In fact, “Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older, in a given year” (Depression and Bipolar Support Alliance, 2017, para 1). Despite there being a large number of Americans with depression, only one out of three people with depression actively seek treatment (Depression and Bipolar Support Alliance, 2017, para 7). This reluctance to seek treatment is mostly because of the social stigma surrounding depression. Many people see mental illness as a burden, as something that should be kept hidden. Others do not understand the seriousness of depression; they think that depression is just a mood that can be easily shaken. The somber consequence of this social stigma is that many people struggling with depression are afraid to seek help. Though there are many who doubt that depression is a disease, there is substantial evidence to support that it is a disease and it is in need of more social awareness.
Depression is caused by an imbalance of chemicals in the brain, specifically a decrease in the amount of neurotransmitters. In your brain, thousands of neurons communicate with each other in order to perform daily tasks. These neurons never touch— they send chemicals back and forth to each other; These chemicals are called neurotransmitters. There are three neurotransmitters that are linked to mood: serotonin, norepinephrine, and dopamine (Meisel, 2011, p. 42-43). Serotonin is directly linked to mood, so the more serotonin one has, the more that person’s mood improves. Dopamine controls behavior, emotion, and cognition, but it is also connected to the front of your brain, which is associated with pleasure and reward. Pleasure and reward together are what help us achieve our goals. Norepinephrine works as part of the body’s stress response, helping the hormone adrenaline to produce the “fight or flight” response. The fight-or-flight response is how the body deals with stress. It either chooses to stand and fight, or to run away. When this response happens all the time, chronic stress and/or depression can result. Since norepinephrine controls fight-or-flight, the more norepinephrine one has, the better that person can handle stress (UPMC Health Beat, 2016, para. 3,4,6). With the connections between these neurotransmitters and mood, it is clear how someone with low serotonin, dopamine, and norepinephrine levels would have a low mood all the time, have no motivation to achieve their goals, and have difficulties dealing with stress—all symptoms of depression. Evidence of chemical changes in the brain proves that depression is more serious than just a saddened mood; it shows that a person is not only mentally affected by depression, he/she is physically affected by it. In cases of sadness, depressed feelings are temporary. With depression, however, because of changes in the brain, these feelings are harder to get rid of. People who are sad for long periods of time suffer substantial losses to their value of life and further proving that depression is a very serious disease.
Scientists and suffers both have speculated on the causes of depression for years and they still have not come to a definitive answer. This is because there are many different factors that can lead to someone becoming depressed. Many times depression is onset by a traumatic event in someone’s life. My friend, Molly, spiraled into depression after her father died: “My father died when I was in fifth grade. My physiatrists have told me that because I have alway had anxiety and it was left untreated, it spiraled into depression” (Molly, personal communication, December 12, 2017). Just like Molly’s anxiety and the death of her father contributed to her depression, many factors together combine to onset depression. Some of these factors are gender, genetic predisposition, and other illnesses. Gender plays a large part in whether someone will be affected by depression. In fact women are affected by depression more than men: “Women experience depression at twice the rate of men. This 2:1 ratio exists regardless of racial or ethnic background or economic status. The lifetime prevalence of major depression is 20-26% for women and 8-12% for men” (Depression and Bipolar Support Alliance, para 4). Many equate this to the fact that women have more mood swings as a result of their menstrual cycle and the shifting estrogen and progesterone (a hormone that is integral in maintaining pregnancy) levels that accompany it. Women are also prone to postpartum depression (depression after giving birth) because of plummeting hormone levels after pregnancy (Mayo Clinic, Depression in women: Understanding the gender gap, 2016, para 8,11-14). Not only does gender contribute to a person’s chances of having depression, but “research has revealed that depression runs in families and suggests that some people inherit genes that make it more likely for them to get depressed” (TeensHealth, 2015, para. 10). Illness is also a factor that contributes to depression. In fact, 25 percent of cancer patients experience depression, 50-75 percent of those with eating disorders also experience depression, and one in three heart attack victims experience depression (Depression and Bipolar Support Alliance, 1999-2002, para. 2). The link between these illnesses and depression is unclear, but the statistics show that having a major illness increases the chances of being diagnosed with depression. With so many factors contributing to depression, it is easy to see how so many people are affected by this disease. Since large numbers of people are affected by depression, it should be hard to ignore the impact it has on people’s lives. Yet, as a society, Americans turn away from what makes us uncomfortable. Feelings, especially feelings of sadness, have always made people uncomfortable. So how can this be fixed? If people acknowledge that it is okay to be depressed, they validate what others are feeling, and they can then use the factors that led to depression to try and combat the disease?
The many forms of depression are just as diverse as the people who are afflicted with the disease. The most common form of depression is called major depressive disorder, but other forms of depression are seasonal affective disorder, dysthymia, bipolar disorder, and psychotic depression. These are not even all of the forms of depression, there are others like postpartum depression, and premenstrual dysphoric disorder. Someone who has major depressive disorder is diagnosed after a they have some of the following symptoms for two or more weeks: significant weight change, insomnia or hypersomnia (sleeping too much), psychomotor agitation, loss of interest in usual activities, decrease in sexual drive, loss of energy, feelings of worthlessness, diminished ability to think or concentrate, and recurrent thoughts of death and suicide (Byck, 1992, p.55). Two other common forms of depression are seasonal affective disorder (SAD) and dysthymia. Seasonal affective disorder is when depression begins in the fall or winter and ends in the spring, following a seasonal pattern. Scientists speculate that the seasonal effect has to with the waning amount of light in the winter. Although SAD is not as common as major depressive disorder, it does affects around ten million Americans. Dysthymia is milder than major depressive disorder, but episodes last substantially longer (at least two years). Although dysthymia is not as severe as major depressive disorder, it still hinders a person’s ability to function normally and requires treatment. Bipolar disorder is an entirely different kind of depression. In bipolar disorder, a person’s mood fluctuates between extremely happy moods and extremely sad moods with periods of normal mood in between. The period of time when the person is experiencing a high mood is called mania. Mania can lead to very dangerous behavior like staying awake for days, not eating, and participating in risk-taking behavior. Bipolar disorder often requires a different treatment plan than other forms of depression as it can cause hallucinations and delusions as well as extreme moods.
There are a multitude of types of depression that affect millions of people everyday. Each form of depression comes with the same debilitating sadness but each also has its own symptoms to battle. Depression can manifest in many forms and affect all types of people. Due to this, it may be hard to tell if someone has depression. Not many people are aware of the signs and symptoms of the copious kinds of depression, so it is important that social awareness increases about all forms of depression so that people can recognize depression in others and help them to start the healing process. With more social awareness, we Americans can start to combat depression together, as a society.
Even though the symptoms of depression are often debilitating and harmful, there are many effective treatments. In order to be prescribed medication, a person must first be diagnosed with depression. A doctor diagnoses a patient by talking with him or her about symptoms and family medical history. If that person has a family history of depression and/or their symptoms are consistent with depression, he or she will be diagnosed (Wasmer Smith, 2000, p.40-41). Molly, a senior in high school, was diagnosed with chronic major depression in 2016. This is what she says about the process of being diagnosed: “I was diagnosed by both a physiatrist and phycologist and that was through behavioral therapy” (Molly, personal communication, December 12, 2017). Like Molly, patients often have to go through many steps to be diagnosed with depression. The necessity of diagnosis by two separate medical professionals further proves the point that depression is a real disease. It is taken seriously by doctors, so it should be taken seriously by society.
Treatment for depression dates back almost as far as depression itself. Before it was known how many people really had depression and when it was extremely taboo to seek treatment, many people self medicated with alcohol. Thus there was (and still is) a clear link between alcoholism and depression. Molly said of her family: “There is a history of alcoholism in my family and that is generally what used to be the “diagnoses” for depression” (Molly, personal communication, December 12, 2017). This history shows the importance of recognizing depression in order to prevent alcoholism and other substance abuse. Today’s medication for depression is usually very effective in giving patients relief from the worst symptoms of depression, however, they often come with their own side effects. Thus, the kind of medication that works best depends on the individual and how his or her body reacts to the medication. Common kinds of medications are tricyclic antidepressants and monoamine oxidase inhibitors (the two most common), as well as selective serotonin reuptake inhibitors, stimulants, and mild tranquilizers. Tricyclic antidepressants are frequently used to treat depression and they work by increasing levels of serotonin and norepinephrine in the brain (Meisel, 2011, p.77). These medications are able to increase the levels of these neurotransmitters by blocking their absorption (known as reuptake) back into the brain. When less reuptake happens, more neurotransmitters result. With more neurotransmitters, the symptoms of depression start to fade. The problem is that it can take a couple weeks for the medication to start to work and there are many side effects that occur before the benefits are apparent (Byck, 1992, p.59-60). Some of these side effects are sleepiness, dizziness when standing up, constipation, dry mouth, weight gain or weight loss, excessive sweating, tremors, and decreased sex drive (Mayo Clinic, Tricyclic antidepressants and tetracyclic antidepressants, 2016, para 10,11). A concerning factor of tricyclic antidepressants is that if they are taken at high doses, they can be fatal. This is concerning when dealing with depressed patients because depression often gives patients suicidal thoughts and actions (Meisel, 2011, p.77). Suicide is a serious consequence of depression and highlights the extreme nature of depression, showing that it is more than just a feeling to ignore.
Other frequently used medications for depression are monoamine oxidase inhibitors. Monoamine oxidase is an enzyme that breaks down serotonin, norepinephrine, and dopamine in the brain. This medication inhibits the monoamine oxidase, causing a build up of these neurotransmitters in the brain (Mayo Clinic, Monoamine oxidase inhibitors (MAOIs), 2016, para. 4,5). Monoamine oxidase also has other functions in the body besides breaking down the neurotransmitters; it also plays a part in breaking down amino acids in the liver and intestines. Tyramine (an amino acid) can act like a drug when built up and can affect the heart and blood vessels. When a person taking a monoamine oxidase inhibitor eats tyramine-containing foods, like beer, wine, and cheese, there is a higher likelihood that he or she will have a dangerous increase in blood pressure (which can cause strokes and heart attacks) (Byck, 1992, p. 60-61). As a result, many patients avoid monoamine oxidase inhibitors because they require dietary restrictions.
For people with bipolar disorder, a different type of drug is needed. When people with bipolar disorder are in mania, they can experience hallucinations and/or delusions (this also occurs in psychotic depression). When this happens, patients are usually prescribed antipsychotic medications; however, they are just used as a temporary measure to insure that the person does not hurt themselves. When the hallucinations or delusions are under control, doctors often prescribe lithium as a long-term treatment option. Patients must take lithium several times a day, as it leaves the body quickly, and must get regular blood tests to insure that it does not reach a lethal concentration in the body. Not much is know about why lithium easies the symptoms of bipolar depression, but symptoms can decrease after just one week of taking it. Fortunately, it only has a few mild symptoms, such as thirst, weight gain, slight muscle tremors, and “fogginess” (Meisel, 2011, p.85). While doctors and many people rave about the wonders of medications, many find the serious side effects intolerable. These people often turn to other forms of treatment, like psychotherapy, to try and resolve their ailments.
Psychotherapy (also known as talk therapy) is when a person with depression talks to a professional who tries to help him or her find the underlying cause of the depression and teaches him or her coping skills to try and combat depression. The three main types of talk therapy are behavioral, cognitive, and intrapersonal. Doctors prescribe one over the other based on the person’s personal experiences. Behavioral therapy focuses on changing behaviors and thinking that led to the depression or make it worse (Wasmer Smith, 2000, p. 45). Cognitive therapy focuses on changing negative thought patterns so that the patient can start to have a positive view of life. When patients go to therapy, they are working with a therapist to try and break one or more negative thought patterns that are contributing to their depression. Intrapersonal therapy helps an individual to fix the toxic relationships in their lives that are contributing to their depression, and gives them the resources to work through tough relationship problems so they can live a happier life (Meisel, 2011, p.75-76). Therapy is an important and effective treatment for depression and is often prescribed before medication, if the person is not hurting themselves. Talk therapy helps a depressed person solve the emotional issues that contribute to his or her depression. Often weeks of therapy are needed for a person to gain control of his or her depression and that depression does not go away. Rather, patients must continue to practice the tactics that they were taught in therapy in order to remain in control of their depression. Molly speaks to this personally: “I go to behavior therapy with my psychologist. it helps only when I am really honest with them, which is very hard to do” (Molly, personal communication, December 12, 2017). Molly knows that in order to get better, she needs to work hard and she needs to be honest. Recovering from depression is a lengthy process that requires hard work. Depression is not easy get rid of—it is a serious disease.
When a person with depression is in great danger of hurting him/herself, or when that person does not respond to medication, a doctor may prescribe electroconvulsive therapy. Electroconvulsive therapy (ECT) is when a patient is given anesthesia to relax his/her muscles, and then administered small shocks to the brain to produce small seizures. These small seizures spark the production of neurotransmitters in the brain (Meisel, 2011, p. 88). Electroconvulsive therapy is controversial, because many do not feel that inducing seizures is safe. However, in actuality, electroconvulsive therapy today is safe and effective: “ECT has a 75-83% success rate in battling depression”(Hersh, 2013, para. 7). Had depression not been accepted by doctors as a legitimate disease ECT would not be approved as a treatment because of its controversial nature. It is the fact that depression is a severe disease that doctors need to address it as such with such stern treatment. It is clear that depression is not a symptom, it is a disease.
Some argue that depression itself is not a disease, it is a symptom of too much stress. Dr. Kelly Brogan MD, a published psychiatrist who studied at both Cornell and MIT, argues just that, “Dr. Brogan suggests that depression is not a brain disorder, the lack of one neurochemical or another, or a genetic illness. It’s an inflammatory condition which is the body’s adaptive response to stress, known as the cytokine theory of depression. The state of depression is a manifestation of irregularities in a body that can start far away from the brain and have nothing to do with chemical balances in it”(Hampton, 2016, para 7). This argument however, is flawed. There have been countless studies done to show that depression is connected to the amount of neurochemicals in the brain and can be onset by genetic predisposition. In addition, if depression is not related to neurochemicals in the brain then patients would not find relief from medications that target such neurochemicals but many patients, like Molly, do. Molly said, “I take Zoloft, a serotonin reuptake inhibitor. It makes my ups and downs more manageable and makes things seem better. It allows me to have enough motivation to move myself”(Molly, personal communication, December 12, 2017). The very fact that Molly and others have had success with medication disproves the theory that depression is just a symptom of stress and not a result of neurochemicals in the brain.
There is substantial evidence that proves that more social awareness is needed about the disease that is depression. Numerous people are affected by depression, but most are hesitant to tell people about their struggles with the disease. This is because there is a popular belief that mental illness is a sign of weakness. This forces those with depression to hide their symptoms. Without treatment a person is at risk of hurting themselves and others. However, with treatment, a depressed person can gain his or her life back. These treatments are not a cure or a quick fix. They require time and hard work in order to figure out the treatment plan that works best. The complexity of the symptoms and treatments for depression prove the complexity of the disease; they prove that depression is indeed a disease. It is not something that is easily treated and not something that one can easily get rid of. If someone seems to be struggling with depression, do not be afraid to let that person know you are there to support them. Having someone understand could be the first step towards healing. Molly wants others to know that “people with depression are doing their absolute best. They are very happy for the most part, from what you can see. Depression is not just downs, it’s extreme highs and lows. It makes it hard to get up in the morning and just causes all sorts of thoughts that we know are wrong but we can’t stop. We are not trying to be annoying” (Molly, personal communication, December 12, 2017).
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