Depression
Low Mood or Depression
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How might this affect me?
Everyone gets down and feels depressed at some point in his/her life. Sometimes we hear people casually say, "I'm depressed," when they have had a bad day at work or a fight with their partner or friends. Typically, these kinds of feelings pass or lessen within a short period of time. In cases such as these, we are not really "depressed," but we experience normal and temporary feelings of sadness, frustration, or stress. These normal feelings are different than the more extreme and pervasive feelings associated with clinical depression. However, if depressive symptoms persist for a period of two weeks or more, or they are particularly distressing, then it is probably time to consult your GP or a mental health professional.
Remember you are not alone and that you can get help.
If you are depressed
Some or all of the symptoms listed below may apply to you.
Physical effects
- Tiredness and loss of energy
- Sleeping problems – difficulties in getting off to sleep or waking up much earlier than usual
- Loss of appetite
- Loss of sex drive and/or sexual problems
- Physical aches and pains.
Psychological effects
- Thinking about suicide and death
- Persistent sadness or variations in mood such as feeling really down in the mornings and better as the day progresses or visa versa
- Feelings of helplessness and hopelessness
- Undue feelings of guilt or worthlessness
- Self-harm
- Loss of self-confidence and self-esteem
- Difficulty concentrating
- Irritability, anger or resentment.
Social effects
- Not being able to enjoy things that are usually pleasurable or interesting
- Avoiding other people, sometimes even your close friends
- Finding it hard to function at home/work/college/school
- Lack of interest in activities and events.
What causes me to be like this?
Personal or at risk factors
Everyone is at risk of developing a depressive illness. Regardless of age, race, religion or social class clinical depression can affect anyone. No one is completely immune to this condition. However, it is important to know that the more common illnesses of major depression and bipolar disorder do tend to affect some groups of individuals more so than others. Some features of these groups, when associated with the development of a depressive illness, are known as "risk factors."
Please remember that no one is predestined to develop clinical depression. However, it can be very important to be aware of risk factors so that those of us who may be vulnerable can educate ourselves, be attentive to warning signs and take steps towards recognising and preventing this illness.
Risk factors for serious depressive illness
Gender
Women are much more likely than men to be diagnosed and treated for a serious depressive illness. Approximately 20–25% of women and 12% of men will experience a serious depression at least once in their lifetimes. Among children, depression appears to occur in equal numbers of girls and boys. However, as girls reach adolescence, they tend to become more depressed than boys do. This is a gender difference which continues into older age.
There are several theories as to why fewer men than women are diagnosed and treated for depression:
- Men may be less likely than women to seek treatment. They may be less willing to accept that they have emotional symptoms of depressed mood and feelings of worthlessness or hopelessness
- Men may be less willing to acknowledge and talk to someone about their emotional symptoms and more apt to suppress their depression through the use of alcohol or other substances. In such cases depression can be "masked," or viewed only as alcohol or drug dependency/abuse rather than as clinical depression
- Depression typically shows up in men not as feeling hopeless and helpless, but as being irritable, angry and discouraged; hence, depression may be difficult to recognise as such in men
- Women may tend to be under more stress than men. In Scottish society women often have to manage a variety of conflicting roles. They have many responsibilities and full schedules at home and work
- Women may be more prone to depression because of the possible effects of hormones. Women have frequent changes in their hormone levels, from their monthly menstrual cycles, to the time during and after pregnancy, to menopause. Some women develop a depressive illness around these events.
Marital factors
Women who are unhappily married, divorced, or separated, have high rates of major depression. The rates are lower for those who are happily married.
Age
While clinical depression usually occurs for the first time when a person is between the ages of 20 and 50, people over the age of 65 may be especially vulnerable.
Previous episode
If you have had major depression once before, your chances of developing it again increase. According to some estimates, approximately one-half of those who have developed depression will experience it again.
Heredity
People who have relatives who have had clinical depression have a greater chance of developing it themselves. Also, having a close relative with bipolar disorder may increase a person's chances of developing major depression.
Risk factors for bipolar disorder
Bipolar disorder is diagnosed in equal numbers of men and women. It is not known for sure why major depression seems to affect more women than men while mania affects both equally. One reason may be that mania, with its very conspicuous symptoms, is much more easily recognised than depression. Depression may also go unrecognised in men.
Previous episode
If you have had major mania once before, your chances increase of developing it again. Most of those who have had an episode of mania once will have a second.
Heredity
People who have relatives who have had bipolar disorder have a greater chance of developing it themselves. Immediate relatives (parents, siblings, children) of those with bipolar disorder are 8 to 18 times more likely to develop the condition than those not related to people with bipolar disorder. Having a close relative with bipolar disorder may also increase a person's chances of developing major depression.
Environmental causes
Environmental causes of depression are concerned with factors that are outside of us. They are not directly related to brain function, inherited traits from parents, medical illnesses, or anything else that may take place within us.
Childhood difficulties
People who become clinically depressed have generally experienced more severe difficulties in childhood than those who do not become depressed. These difficulties may include sexual or physical abuse, a turbulent upbringing, separation from a parent, or mental illness in a parent. Some researchers believe that a problematic childhood may trigger an early-onset of depression (first episode occurs before age 20). The most significant event that seems to be related to clinical depression is separation from or death of a parent before the age of 11.
Traumatic events
Many times, people who become depressed report that a single traumatic event happened just prior to their becoming depressed. Painful experiences such as the death of a loved one, divorce, a medical illness, or losing everything in a natural disaster may be so impactful as to trigger clinical depression. Events like these take away a sense of control and cause great emotional upheaval. Some traumatic events may cause more distress for one person than for another. For instance, a man who loses his wife to death may be more prone to becoming clinically depressed than a woman who loses her husband. This may be because the loss of a wife can lead to additional losses for a man. He might lose contact with children and other family members. He may also become more emotionally distressed and isolated if he has difficulty reaching out to others. Women who lose their husbands may be more willing to seek out emotional support.
Stress
There appears to be a complex relationship among stressful situations, our mind and body's reaction to stress and the onset of clinical depression. It is clear that some people develop depression after a stressful event in their lives. Events such as the death of a loved one, the loss of a job, or the end of a relationship are often negative and traumatic and cause great stress for many people. Stress can also occur as the result of a more positive event such as getting married, moving to a new city, or starting a new job. It is not uncommon for either positive or negative events to become a crisis that precedes the development of clinical depression.
Whether a stressful event itself can actually cause a person to become depressed is not fully known. There are times when we all must struggle with very painful situations in our lives. Often these changes do not result in a person becoming clinically depressed. In fact, sometimes people become depressed even when there is little or no stress in their lives and everything seems to be going very well. And, no single stressful event will cause depression to develop in every person. The same type of stressor may lead to depression in one person, but not another.
Seasonal Affective Disorder
Some people suffer from symptoms of depression during the winter months, with symptoms subsiding during the spring and summer months. This may be a sign of Seasonal Affective Disorder (SAD). SAD is a mood disorder associated with depression episodes and related to seasonal variations of light. SAD may be an effect of this seasonal light variation in humans. As seasons change, there is a shift in our "biological internal clocks" or circadian rhythm, due partly to these changes in sunlight patterns. This can cause our biological clocks to be out of "step" with our daily schedules. The most difficult months for SAD sufferers are January and February and younger persons and women are at higher risk.
Genetic causes
It has long been known that depressive illnesses can run in families, but until fairly recently it was not fully known whether people inherited a susceptibility to these illnesses or if something else such as the environment was the cause. Those who research depression have been able to determine that to some extent depressive illnesses can be inherited. What appears to be inherited is a vulnerability to depression. This means that if we have close relatives who have clinical depression, we may inherit a tendency to develop the illness. It does not mean that we are destined to become depressed.
Twin studies
Much of what we know about the genetic influence of clinical depression is based upon research that has been done with identical twins. Identical twins are very helpful to researchers since they both have the exact same genetic code. It has been found that when one identical twin becomes depressed the other will also develop clinical depression approximately 76% of the time. When identical twins are raised apart from each other, they will both become depressed about 67% of the time. Because both twins become depressed at such a high rate, the implication is that there is a strong genetic influence.
A gene for depression?
Research on the genetic causes of clinical depression has attempted to identify one or more specific genes that may lead to the development of a depressive illness. Although there have been a number of studies that appear to name a particular gene as the culprit there has been little consistency among their results. However, the outcome of some research has suggested that there may be specific genes that cause clinical depression to develop within certain families and not in others.
Biological causes
Biological causes of clinical depression continue to be studied extensively. Great progress has been made in the understanding of brain function, the influence of neurotransmitters and hormones and other biological processes, as well as how they may relate to the development of depression.
Brain function in depression
The brain is the "command centre" of the human body. It controls the basic functions of our bodies, our movements and our thoughts and emotions. Researchers studying clinical depression tend to look at several aspects of brain function including the structures of the limbic system and the function of neurotransmitters within neurons.
Limbic system
Those who research clinical depression have been interested in a particular part of the brain called the limbic system. This is the area of the brain that regulates activities such as emotions, physical and sexual drives and the stress response. The activities of the limbic are so important and complex that disturbances in any part of it, including how neurotransmitters function, could affect your mood and behaviour.
Neurotransmitters
It is unknown whether changes in levels of neurotransmitters(brain chemicals) cause the development of depression or depression causes changes in neurotransmitters. It may happen both ways. Researchers believe that our behaviour can affect our brain chemistry and that brain chemistry can affect behaviour. For instance, if a person experiences numerous stressors or traumas this may cause his or her brain chemistry to be affected, leading to clinical depression. On the other hand, that same person may learn how to change depressed thoughts and behaviour and cope with stressful events. Doing this may also change brain chemistry and relieve depression.
Hormones and the endocrine system
The hormones that are released into the body by the glands regulate processes such as reaction to stress and sexual development. It has been found that a great number of people who are depressed have abnormal levels of some hormones in their blood despite having healthy glands. It is believed that such hormonal irregularities may be related to some depressive symptoms such as problems with appetite and sleeping since they play a part in these activities. Further clues to the role of the endocrine system has to do with the fact that those who have particular endocrine disorders sometimes develop depression and some individuals who are depressed develop endocrine problems despite having healthy glands.
The development of clinical depression may be a symptom of a disorder present within organs that produce hormones. Such conditions include thyroid disorders, Cushing's syndrome and Addison's disease.
Cortisol
Of those individuals who are clinically depressed, about one-half will have an excess of a hormone in their blood called cortisol. Cortisol may continue to be secreted even though a person already has high levels in his or her blood. This hormone is believed to be related to clinical depression since the high levels usually reduce to a normal level once the depression disappears.
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