Understanding what Depression really is
Section 2: What is Depression, The Illness?
Section 3: How it Happens
Section 4: What Causes Depression?
Section 5: There is a Blood Test for Depression!
Section 6: It could never happen to me: said Professor X
Section 7: Everyone gets depressed sometimes. What’s the difference between depression/unhappiness and depressive illness?
Section 8: Depression is like Diabetes and Cancer, so why the secrecy and the shame?
Section 9: Fear of the Unknown; Epilepsy, TB, and now Depression.
Section 10: Why can’t they snap out of it? A patient’s secret story.
Section 11: Not treating Depression is Russian Roulette.
Section 11A: Treat Depression before it causes irreversible brain damage
It is not madness. It is a temporary breakdown in the balance of chemicals in your brain, as a result of stress. These chemicals (known as neurotransmitters) allow us to experience happiness, enjoy various aspects of our life, think clearly, and have the motivation and energy to carry out our normal activities in life.
Depression is like a heart attack. After a period of stress build-up, part of your functioning collapses, causing you great pain, difficulty functioning, and in some cases putting your life at risk.
When depression takes a grip on you, you slowly lose these abilities and become more sad and anxious. Your mind and your body become slowed up, like being slowly PARALYSED. In many ways, depression is like having a BROKEN BONE. It is painful. It makes every daily task much harder. depression can lead to permanent pain and permanent problems if it is not cured properly. In fact, the chances of any one of us suffering depressive illness at some time in our life are much higher than the chances of breaking a bone! Many people suffering from depressive illness state they would far prefer to have broken a bone. Broken bones are easier to understand than this creeping sickness. People with broken bones get sympathy and help from family and friends without question. Those with depressive illness seem okay on the outside, so help is not automatically given by others who are more likely instead to complain you are not the person you used to be, or not doing the tings you used to do. It is not easy being “THE WALKING WOUNDED”, carrying unrecognized internal injuries from the battles of everyday life.
Depressive illness in many ways is like a COMPUTER VIRUS, which secretly takes over your brain, telling you that everything is too hard, too sad, too meaningless, and too much effort anyway. This information, sent from your brain, seems as real as ever, but is totally distorted in fact.
Depression is like a FILTER that descends over your brain, keeping out all the positives of life. Only negatives from the present (and from the past also) are allowed space in your mind, and all negatives are greatly magnified.
Suffering depressive illness is like WEARING GLASSES. It takes a lot of trust in your family, friends and doctors to believe the world has not become a dark and frightening place, but that your glasses have become very black and distorted, due to your illness. It also takes a lot of trust to believe the medical reality that nearly every depressive illness can be cured!
At its worst, depression is like being taken over by a life-threatening alien. You become very different to your normal self, those around you may comment on the difference in you, and the alien tries to kill you by telling you lies and pushing you towards suicide.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 3
- work/no work
STRESS - money worries
- illness
- partner/spouse stresses
- children
- viruses
- always busy
- childhood traumas
+
- a relationship with good communication
- personality strengths and weaknesses
(worrying, nervous, timid, too perfectionistic)
- feeling helpless
- feeling a victim
=
YOUR INTERNAL
- COPING
- ANXIOUS
FINAL RESULT - MILD DEPRESSION
- SEVERE DEPRESSION
- THOUGHTS OF SUICIDE
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 4
The simple answer is a breakdown in brain chemicals due to stress. As explained in Section 2, “What is depression, the illness”, depressive illness is a chemical imbalance in our brain, in particular involving chemical messengers between brain cells, called neurotransmitters. The serotonin neurotransmitter pathway, also called the 5HT pathway, is the area we currently believe is most involved in depressive illness. The norepinephrine (noradrenalin) pathway is also an area of ongoing research and treatment in depressive illness. We believe most modern antidepressants produce their benefits by working to improve the function of these and other neurotransmitter pathways, and improving the effectiveness of these neurotransmitters in the transmission of their information. However, there is a huge amount of ongoing research attempting to define precisely what goes wrong in depressive illness (and indeed trying to understand how antidepressants work exactly).
We all experience stress on a daily basis.
Most of the stress is something we are used to, and barely registers as stress. However, unpleasant and worrying events, produce a burst of adrenalin and a mental sense of distress. This involves many brain areas especially the hypothalamus and pituitary, which control our hormones and many chemical reactions inside us. Frequent and / or severe reactions like this eventually exceed our brain’s capacity to cope, and we start to slide into a mixture of anxiety and depression.
How bad the illness will be, and whether or not we recover without treatment, are determined by the severity of the stresses, and our own internal resistance to stress and depression as well as the reactions of these around us at this time.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
A blood test, known as the Dexamethasone Suppression Test (DST) has been known for over 20 years, although not widely used. The test is done by giving the patient with suspected depressive illness a once-off low dose (1 mg) of dexamethasone (a steroid medication) about 11 pm one night, and taking the blood for testing late the next afternoon or evening. The level of cortisol (cortisone) in the blood is measured. The person without depression responds to the presence of dexamethasone in their body by drastically reducing (suppressing) the amount of cortisol in their blood automatically, so their blood test shows low levels of cortisol. However, in about 50 - 60% of people with depressive illness, their body ignores the presence of dexamethasone, and this blood test shows HIGH levels of cortisol the next day. The failure to suppress cortisol production despite dexamethasone confirms the diagnosis of depressive illness.
We do not know why there are two different types of depressive illness, namely one type we can measure by this test, and one type (with identical clinical symptoms) we cannot measure in the laboratory. Nor do we know why the DST is abnormal in some depressed patients while they are ill, returning to normal when they recover.
Your own physician or psychiatrist can discuss the benefits and limitations of this test in your particular case. An abnormal DST is not enough evidence alone to diagnose depressive illness (physically ill, malnourished and elderly people have abnormal DST’s in about 20% of cases). However, in people who are told their symptoms are due to unhappiness or due to unresolved emotional hang-ups, an abnormal DST is very good reason to suggest they have gone on to develop depressive illness, as a result of the stresses involved.
It must also be remembered that 50% of people with depressive illness still DO have the illness, although they respond normally on this test, just as some people have back pain without any abnormality showing on their X-rays.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 6
Professor X was a very successful teacher of Science and Advanced Mathematics, had a highly organised and successful family life, and was adamant there was no such thing as stress or depression, and indeed accused people who had time off from work due to stress as basically telling lies.
In one particular six month period, Professor X had a range of emotional stresses affect himself and his family. He went on to develop a devastatingly severe and life threatening form of depressive illness, which did not respond to every conventional antidepressant available, did not respond to cognitive therapy, did not respond to interpersonal therapy, did not respond to psychodynamic therapy, and responded very briefly to ECT (shock treatment). Professor X was hospitalised numerous times for his own protection when suicidal, but nonetheless made a number of serious suicide attempts. Professor X saw multiple psychiatrists, including myself. In fact, Professor X eventually responded to an untried combination of antidepressant medications and is now fully recovered and back at work.
Unfortunately, NEITHER YOU NOR anybody else is immune to depressive illness, just as no-one is immune to cancer. WE ALL HAVE IMMENSELY COMPLEX BUT FRAGILE BRAINS. OUR MOST COMPLEX COMPUTERS NEED THE MOST CARE.
Depressive illness has affected members of every sex, age, race, religion, intellectual level and occupation known to man.
To claim “it could never happen to me” is really to state one’s fear of this illness, which can secretly get you in its grasp.
We can only hope the depressive illness any one of us may get is not as severe as that which affected Professor X. He used to believe there was no such thing as stress; now he states that he understands why people kill themselves to escape the pain of depression.
Early diagnosis and treatment of depression lessens the suffering and the risks of this immensely common illness.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 7
Everyone gets depressed sometimes. What’s the difference between depression/unhappiness and depressive illness?
Of course it is normal to get down, be sad, feel depressed when things go wrong for us. It would be abnormal not to feel these emotions at some time, such as getting bad news, or being very disappointed about something. This is normal human unhappiness. We may use the word “depression”, but it is not an illness, of course. We all become unhappy in response to stress; however some of us will be so sensitive to that stress that we will develop depressive illness, which will heal much faster with proper treatment.
The following are some of the differences between ordinary depression / unhappiness and depression, the illness:-
1. Many people with depression illness have an abnormal special blood test, as they have a chemical imbalance. In unhappiness, this blood test remains normal (see Section 3 “There is a blood test for depression!”)
2. Depressive illness is always with you; it may be less severe at various times, but you are never free of the blackness creeping over you. In contrast, unhappiness fades away completely, pretty quickly, usually within hours or days. Unhappiness may return when you meet the same problem again, such as problems at work or at home, but it does disappear completely for periods of time.
3. When nice things are happening, such as being with good friends, unhappiness is usually wiped out completely, so you feel you are back to your normal self. If you are suffering depressive illness, it may be less severe during nice times, but you still feel you are not your normal self.
4. When you are unhappy, you can still concentrate on things that interest you, and remember them. When you are depressed, your concentration and memory are usually impaired, so you do not absorb TV programs, reading or even conversation as well as before, and you find you keep losing things, or keep repeating yourself in conversation, or forget what you have been told earlier.
5. If unhappiness lasts a long time, or multiple causes of unhappiness develop in your life, or one severe event distresses you considerably, you may slide into depressive illness, due to the stresses involved. For example, everyone is unhappy when someone close to them dies, but 40 - 50% of us will ALSO be pushed into depressive illness as a result of the distress involved.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 8
Depression is like Diabetes and Cancer, so why the secrecy and the shame? No-one is immune from diabetes, regardless of age, sex, wealth or education. This illness gradually hinders multiple aspects of human health, as blood sugar levels go out of control, causing a range of symptoms, which at times can be life threatening. Once diabetes (or depression) has been diagnosed, mild cases will respond to advice about diet and lifestyle. Severe cases will be helped by following the same advice, but without medication, the illness will remain out of control, putting the sufferer’s life at risk. Depression, like diabetes, is a chemical imbalance, in which the individual patient’s efforts are very useful, but are not enough when the illness is SEVERE.
No one is immune from Cancer, regardless of age, sex, wealth or education. There are many different varieties and severities of cancer, caused by many different factors in our lives, such as our genetic makeup and cigarette smoking. We all accept that an individual with cancer is not responsible for having developed the illness, and we all accept that an individual with cancer needs medical treatment. Similarly, depression is an illness which descends on people through no fault of their own, to which they may have been made susceptible by their genes, and which is brought about by stress. Just as everybody who smokes does not get cancer, for reasons we do not understand, everybody who faces stress does not get depression, for reasons we do not understand.
NO ONE is immune from depression, regardless of age, sex, wealth or education. Just as diabetes is an imbalance in our blood sugars, and cancer is an imbalance in cell growth in our body, depression is an imbalance in the chemicals within our brain. We all have a greater or lesser risk of depression, and it is outside stresses that will cause the chemical imbalance we know as depression to occur. With mild depression, personal effort can overcome the illness. With severe depression, personal effort will not be enough, and professional treatment, especially using antidepressant medications will usually be necessary, and will usually be far more rapid and effective than any other treatment.
Just as we would not advise someone with diabetes, or someone with cancer, to avoid treatment, or stop their treatment, we must be careful not to persuade people with depressive illness that their chemical imbalance will be better if they avoid medication or stop taking it. (There is of course a lot of confusion in the community between tranquillisers which reduce anxiety for a few hours, but which can be addictive, and antidepressant medications which are totally different and are non-addictive.)
Just as we accept that diabetes and cancer are illnesses that the patient is powerless to overcome without professional intervention, the same is true of depressive illness. We do not tell people with diabetes or with cancer to “pull yourself together and snap out of it”!
Strangely, we have discovered in relatively recent years further similarities between depression, epilepsy and cancer. In epilepsy, a patient’s brain almost learns itself to spontaneously produce the abnormal electrical rhythms which lead to convulsions, a mechanism technically called ‘kindling’. We now realise that depression is also associated with similar electrical imbalances in the brain, so that untreated depression can become self-perpetuating. Drugs normally used to control epilepsy have been found to be very effective also in controlling and preventing depression. With cancer, we realise that the longer the illness is left untreated, the more difficult it is to treat and the greater risk of serious complications and perhaps death; the same applies in the need for early diagnosis and early treatment of depression.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 9
Fear of the Unknown; Epilepsy, TB, and now Depression.
We human beings have always been afraid of illnesses we did not understand, and were therefore afraid would affect us, particularly if we regarded the illness as incurable.
In ancient Roman times, epilepsy and its associated convulsions were regarded as evidence that gods were intervening directly in the life of the affected individual. We now know that epilepsy is a condition of electrical instability within the electrical circuits of our brain, and we have multiple effective medications which can control the electric pathways appropriately. Accordingly, the vast majority of the population is no longer afraid of an individual who has epilepsy, although a minority of people still react on the basis of rumours handed down through the generations, and remain afraid.
TB (Tuberculosis) was an infectious disease that caused serious health problems and death in many countries of the world. People with TB were avoided, and indeed members of their family were sometimes avoided also. Matters even got to the stage where children and grandchildren of people who had been affected by TB were avoided, as people were afraid of this potentially serious illness. Following the discovery and use of appropriate antibiotics, TB has been eradicated almost totally from the developed countries of the world. However, in rural areas of many countries, and among elderly people in many countries, the myth of the need to avoid people and families with a history of TB continues, for no logical reason.
The current prevalent disease that frightens many people is depression. It is indeed frightening to think that the most individual part of ourselves, namely our individual brain, can be affected by a condition which creeps up on our thinking and feelings, despite the best efforts of our logic and despite our own healthy philosophy of life. However, just as we all have a breaking point at which our brains can be pushed into having an epileptic convulsion, so we all have a breaking point at which we could in theory be pushed into depressive illness. Happily, for the majority of the population, this breaking point is not reached. However, for 10 - 20% at least of the population who will be affected by depression, the stresses of life do manage to trigger off this illness.
It is indeed frightening for the sufferer, and for those around them, to watch as depressive illness converts a previously well-functioning individual into someone who functions much less well, and yet who still looks normal on the outside. It is indeed hard to be one of “the walking wounded”, who happens to be carrying severe injuries internally as a result of the battles of everyday life.
However, there is really no need to be frightened of depressive illness. We know it is a chemical imbalance brought about by stress. We have some talking therapies, and in particular multiple antidepressant medications which have repeatedly been shown by rigorous scientific research to be able to wipe out the illness. The vast majority of people with depressive illness will in fact recover completely. People suffering from depressive illness are not mad, they simply have a temporary chemical imbalance due to stress. Support and encouragement of the depressed person by those around them, who are not frightened due to ignorance, will help considerably in the depressed person recovering more rapidly.
Fear of any illness, past or present, is a manifestation of lack of knowledge about that illness, with fantasies and rumours being generated by ignorance. The introduction to this site listed a whole range of occupations, and the fact is that huge numbers of people from every one of these occupations have in fact suffered depressive illness. You are not alone, even if it seems everyone is hiding the fact of depressive illness within themselves, or their families and friends.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 10
ANSWER: Because you can snap out of being a bit unhappy or a bit down, but you cannot snap out of illness, either physical or emotional.
If your leg is broken, your body cannot function properly. If the chemistry controlling your emotions is broken, as it is in depressive illness, the affected person cannot function properly. Nobody wants to be sick and unable to function or enjoy life.
In many ways, depression is like Diabetes. When the illness is in its early stages, or is very mild, the individual’s own efforts and health precautions can wipe out most or sometimes all of the symptoms. However, when the illness becomes more severe, no amount of individual effort can compensate for the chemical imbalances that are going on inside the body and the mind. Individual efforts at this stage can be helpful, but nearly every person who is pretty sick finds they just cannot any longer make the efforts required.
It is very strange to look at someone who tells you they have depression, and try to understand that they are very sick and are suffering very badly, and indeed in some cases may die from the illness. However, internal emotional pain is with the person continuously, no matter how they look on the outside. Winston Churchill, the Prime Minister who led England through WWII, described his own depression as “a black dog that follows me everywhere”.
Most people with depression try very hard to appear normal in public, but find it too much effort to keep up the same big act 24 hours a day. Psychiatrists often describe people struggling on and trying to hide their symptoms in public situations as “the walking wounded”. Because you know the person well, you however will realise they are not their normal selves.
The following extract, written by an apparently normal and glamorous and successful woman illustrates the reality that we cannot know what goes on in the minds of other people.
The main symptom for me, is a feeling of sadness, deep inside. It is a lost, very negative feeling, almost of quiet desperation. Overlaying that is a heavy feeling of apathy, accompanied by a feeling of lethargy. It doesn’t matter.
I lose interest in everything in the outside world. Certainly I have no appetite, no desire to cook, or eat anything put in front of me. I cannot read, sometimes at all. I’m not even interested in TV.
Fear. I fear life more than death. Death is my friend, my refuge. The external sleep from which I will never have to face the despair, the disappointment of another day. When will peace finally come for me?
The sad thing is not being able to be understood because this is something that others can’t see. I am watching a move of me. Life is not reality. I see others living in reality – how I envy them – how unobtainable this seems. In a room full of people I feel so alone. I want to stop the merry-go-round so that I can get off.
I plan in detail my life’s end by night, then by day I wake with the fear of my thoughts. The hurt and anguish that I would cause those who I cherish keeps me existing in this hell. I just can’t wait to grow old so that nature will end all this torment for me – you see I also fear death. I’m a coward.
THE IRONY IS THAT IF YOU KNEW ME YOU WOULD NEVER SUSPECT.
It may put the issue into perspective when you hear that many patients who have had severe physical illness, including cancer!, state that depression causes worse suffering.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
SECTION 11
Untreated depressive illness either gets better or worse, you either live or die! Depression has been an illness affecting human beings for as far back as we can trace the history of medicine, with Hippocrates describing the illness in 400BC! In contrast, the first definitely effective treatment for depressive illness was the invention of ECT (shock treatment) in the 1920s, largely replaced now by the use of antidepressant medications, which were first discovered in the 1940s.
The reality therefore is that, in olden times, and unfortunately even now, the majority of people with depressive illness do not receive antidepressant medication or any other effective treatment. Indeed our research suggests that many people who have been diagnosed as suffering from depressive illness are treated either with inadequate doses of antidepressants or with other medications which are not antidepressants.
The human body is continuously trying to repair itself, and it appears that many cases of depressive illness are spontaneously repaired by our own brain in the first few weeks of their occurrence. However, if spontaneous cure has not occurred within one month, research indicates that the illness will continue for at least six months in at least 75% of cases.
There are a number of problems associated with leaving depressive illness untreated, especially after the first month of symptoms, when the chance of early spontaneous recovery has been missed. The complications of untreated depression include :-
1. Prolonged personal suffering. Depressive illness produces personal distress of varying levels of intensity. Not taking antidepressant medication allows this distress to continue needlessly. There are no prizes given for tolerating unnecessary physical or mental suffering in order to state that one never takes medication.
2. Worsening of symptoms. Untreated depressive illness does not necessarily relentlessly move towards eventual recovery, but in a number of cases causes the opposite to happen. Your symptoms may get considerably worse than they are now, especially if you are under stress or in a difficult relationship.
3. Risk of suicide. Depressive illness tries to convince you that everything is hopeless, and tries to convince you that the future will consist of ongoing suffering, making suicide seem an attractive escape. This is very distorted thinking due to depressive illness. International research in various countries has repeatedly shown that almost 80% of people who have committed suicide have had uncontrolled depressive illness at the time of their death. For every person dies from suicide, a further 30 to 40 people have harmed themselves, many of whom also have been driven to this action as a result of having untreated depressive illness, often unrecognised by themselves or by their doctors. Depressive illness is like an alien which controls your thinking and tries to kill you.
4. Damage to relationships. People with depressive illness seem to others to be as normal as ever, apart from their changed mood and behaviour. Unless depressive illness is recognised as an illness, many partners and friends feel alienated by the change in personality, the irritability, and the poor functioning of the person with depressive illness. Unfortunately, many relationships break down irretrievably if depressive illness goes on untreated, as the depressed person becomes more withdrawn, more irritable, less able to do their normal tasks, and usually markedly less interested in normal sexual activity.
5. Damage to children. There is widespread research to indicate increased risks of anxiety, poor self-esteem and other physical and psychological symptoms in the children of parents who are depressed, including young babies whose mothers have untreated post-natal depressive illness.
6. Loss of work or study. The World Health Organisation estimates that by the Year 2020, depressive illness will be second only to heart and blood vessel disease in the illnesses that cause marked loss of productivity in human society. Untreated depressive illness progressively handicaps an individual’s ability to work, study or carry out their home duties.
7. SOWING THE SEEDS OF RELAPSE. In many ways depressive illness is like cancer, whereby prolonged and severe symptoms increase the risks of relapse of this illness in the future. We now also believe that depressive illness is associated with changes in the electrical patterns within the brain, and our brains learn to more easily reproduce this pattern, a process known as ‘kindling’. Untreated depressive illness has at least a 50% chance of returning.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.
Section 11A:
Treat depression before it causes irreparable brain damage
Recent research using MRI scans of the brain has come up with disturbing findings. When people suffer depression, a part of their brain known as the hippocampus shrinks in size. When they recover, the hippocampus returns to normal size. However, if depression is left untreated, or poorly treated, for long, the brain fails to recover, and the person is at increased risk of permanent illness, or frequent attacks of depression.
It seems that stress causes the release of steroids in the brain, which actually damage the brain, by locking onto “glucocorticoid receptors” on the cells of the brain. Future antidepressants are in the research stage, known as Glucocorticoid Receptor Antagonists. These drugs will prevent stress-released steroids from causing this brain damage.
Many types of research in depression are increasingly clear that total elimination of depression is vital to prevent ongoing damage and suffering, just as it is vital to eliminate a cancer completely.
Medication combined with therapy have repeatedly been shown to produce the best results in treating depression.
NB: It also seems that antidepressant medication allows the growth of new neurons in the hippocampus, a remarkable change from the old idea that brain cells are too specialised to regrow once they have died.