Article

Understanding Depression
To treat or not to treat?

Copyright © 2010 Dorian S. Cole

Graphics property of the Experience Project

General

Depression falls into at least 3 broad causes: clinical, situational, and attitudinal. Clinical requires medication. Situational can be cured with a change in the situation, better coping skills, counseling, or talking to a friend. SAD (Seasonal Affective Disorder, which occurs during lack of sunshine for prolonged periods) can be helped with more exposure to sunshine. Attitudinal requires a change in attitude or perspective on life or situations, or counseling. The most important point is that if you "can" change your depression (or situation) then you aren't clinically depressed.

Different Types of Depression http://ezinearticles.com/?Different-Types-of-Depression---Six-Common-Categories&id=817100

Non-clinical depression

Before considering whether or not you have the more serious, but very treatable, condition of clinical depression, it would be best to consider what other things might be causing your depression. If your depression is characterized by despair, hopelessness, mental anguish, and a complete lack of involvement in life and others, it is disrupting your life and you should get treatment.

There are a number of areas in our life that we have to conquer, and these usually occur in succession and repeatedly. If these aren't satisfactorily resolved, these are very disruptive to our lives, and may set us up for depression.

These are: identity; competence; a place and meaningful purpose in life; to love and be loved; a sense of contribution to our families, job, or the world, and growth. These challenges often recur as our situation in life changes. For example, being fired or retiring from a job with which your identity is closely associated, can bring a crisis that can cause severe depression, which can appear like clinical depression in that it lowers serotonin levels. It can also set us up for clinical depression if our body chemistry is already out of balance.

Depression that results from our situation or attitude can be identified and treated by a counselor or therapist. Counseling can help you conquer the obstacle so that you can move forward in your life, and do it happily. If the situation is intractable, such as a chronic medical condition, and the depression is minimally treatable through counseling, medication may help as a temporary tool in treatment, or long-term.

Clinical Depression

Clinical depression has several causes. It can occur naturally in people whose families have a history of depression. Childhood trauma, such as loss of a parent or abuse, can cause permanent brain changes that result in adult depression. Serious medical illnesses and some medications can cause depression. Major physical trauma to your body that alters neurotransmitter levels can cause depression. For example, women sometimes get severe depression (post-partum depression) after the birth of a child, when they should be happy, but changes in body chemistry cause them to be depressed. Some psychoanalysts feel that there is often a psychological cause to clinical depression that can be treated with therapy. Alcohol and drug abuse can also cause depression. Mayo Clinic on depression. http://www.mayoclinic.com/health/depression/DS00175/DSECTION=symptoms

Depression can also occur following some really upsetting event in a person's life. The beginning of serious depression often lags the upsetting event by several months. But that doesn't mean that the event caused the depression. Brain chemicals may have already been low, so that the event triggers the slide into depression.

In medical science, it is common for a triggering event to spark some condition from which there is no recovery, even though the triggering event may have been dealt with. I've had personal experience with this twice with high blood pressure due to medication changes. I was OK until they changed one medication, then my BP spiked way way out of control. Changing the medication back accomplished absolutely nothing. An underlying problem had been developing but it took a triggering event for it to show up. Genetically there are many tendencies that don't show up until a triggering event launches them.

The cause of depression has little or nothing to do with happiness. We all have different body chemistries and dispositions, and some of us tend to be naturally happier or unhappier than others. Feelings of happiness are often fleeting, and depend on situations and events.

Identifying clinical depression

It takes a doctor or psychiatrist to properly identify clinical depression. Clinical depression is characterized by despair, hopelessness, mental anguish, and a complete lack of involvement in life and others. The person wants to be involved in life at one level, but can't bring himself to get involved, or enjoy it when others get him involved. The severity varies from time to time and person to person.

Clinical depression is relatively common and ranges in severity from mild to severe. Many people (50%) never seek treatment. Some people get accustomed to being depressed and even cynical, and actually prefer that state of mind. Others don't want to be medicated. (Medications today are ways of controlling natural body chemistry, not like older medications that caused severe side effects.) Moderate to severe depression puts people into a debilitating mental anguish that the rest of us can't see or understand.

People who are clinically depressed can't escape the black hole they have slowly been sucked into. Nothing escapes a black hole. They may muster the initiative to try, but they fail, and the best they can do is fake a smile so that they don't drag others down.

The cause of clinical depression

Clinical depression is caused by a chemical imbalance in the endocrine system. The endocrine system modulates our response to various internal and external things by controlling several chemical messengers, including serotonin, norepinephrine, and dopamine. Serotonin regulates mood, appetite, sleep, muscle contraction, and some cognitive functions that include memory and learning.

Serotonin is a very powerful psychoactive chemical that is thought to regulate the depth of mood. Your body is actually loaded with serotonin, but it can't get through the blood-brain barrier, so the brain is it's own serotonin manufacturing and control center. Taking serotonin doesn't help.

Norepinephrine acts in our systems like adrenaline (epinephrine), which gets you excited - makes your heart pound. Dopamine affects the brain's reward center, sexual gratification, sleep, mood, attention, working memory, and learning.

Our brains regulate serotonin and these other messengers. Serotonin is produced at a relatively constant rate, which if left unchecked would lead to hallucinations. So the brain has a "re-uptake" mechanism that collects this neurotransmitter from receptors and stores it for later use.

Our brains have receptors that respond to serotonin and other neurotransmitters. The larger the number of receptors that are affected by serotonin, the happier we feel. Serotonin is released during exercise (responsible for the "runners high"), while laughing and playing, and through sexual activity. Additionally, oxytocin is released as a result of touching, which enhances sexual excitement and bonding.

In the clinically depressed, the serotonin level becomes abnormally low, and remains there. The depressed can no longer interact normally with people, or engage in life's activities. They are in a state of mental anguish that can be severe, and may not be able to get off the couch or even out of bed. Anxiety is very similar to depression, and is often a symptom that accompanies depression. The medical treatment for both is similar.

Normal activity, such as exercise, laughing, and sex, are not sufficient to lift people out of clinical depression. Alcohol may be desired, but is totally inappropriate. Alcohol depresses the central nervous system, which is the opposite of what is needed. Alcohol can deepen depression, and interfere with the activities of any drugs taken for treatment.

Clinical depression treatment

The treatment for depression, as you might have already guessed, has been accomplished by increasing the body's natural serotonin level. Adjusting the level entails finding the right medication (we don't all respond the same to meds), and getting the quantity right. This often takes months of trial, error, and monitoring. The body responds slowly.

Mild to moderate depression, regardless of cause, often responds to a combination of over the counter medications, exercise, plus interaction with close friends. Note that some friends and family can make depression worse. It is friends who are empathetic, non-critical, conversant, and encouraging who are the most helpful. Over the counter medications include Kava (careful with this one - NIH studies have shown that it can have serious side effects), Saint John's Wort, and others. Often the anticipation that a drug will be helpful is a major part of the operation of the drug - it's a trigger whether it actually works or not.

Moderate to severe depression was treated for years with SSRIs. SSRIs simply prevent the re-uptake of serotonin, so the level of your body's own natural serotonin stays higher.

You are not made "artificially happy" by some artificial medication. SSRIs are not "happy pills," they simply help the body correct the imbalance. They allow you to react normally to life.

All medications have side effects. The major difficulties with SSRIs are that they can cause some weight gain, and since they increase levels of serotonin they make your body feel satisfied, you may have less sexual desire.

Enter the hero, the NSRI. The NSRI affects norepinephrine, which in turn regulates serotonin and dopamine levels. Use of this medication has limited impact on sexual desire and weight gain, and has very limited side effects. The side effects in a few people can be nausea and vomiting, however side effects usually go away after your body adjusts to the drug. It has one good side effect: it helps you pay attention. It's considered more effective than SSRIs. Some other classes of drugs with minimal side effects are SNRIs, which affect both norepinephrine and serotonin, and DNRIs, which affect both dopamine and norepinephrine, and decrease the desire for tobacco.

The treatment for moderate to severe clinical depression usually involves finding and adjusting the right meds, exercise, counseling, and interaction with close friends. If there is a more deeply rooted problem, depth counseling will be needed to get to it. But in general, commiserating regularly with a friend is considered an effective substitute for counseling. When the right meds are found, depression usually alleviates partially or completely, in 2 weeks to 2 months, and remains controllable unless there is another medical change.

If clinical depression was simply a psychological problem, it would respond to counseling, exercise, interaction with friends, and getting reengaged with life. Usually clinical depression does not get better without the meds. It's a body chemistry problem and will likely require life-long attention.

The best advice: If you are having depression that affects your ability to function in life, and lasts for over a month, see a doctor. If there isn't a psychological cause, don't be afraid to take prescribed medications.

To treat or not to treat?

Life brings a lot of difficulties, and it is a constant question whether these difficulties are meant as lessons, or just things that we have to endure. Technology brings tremendous benefits to our lives and alleviates considerable suffering, while extending our lives by many years or decades. Generally we grasp technology with open arms, particularly when it relieves suffering.

Many have been less ready to accept treatment for depression because of past mood changing drugs that were used for treatment, and because of a feeling that depression indicates that something is wrong in our lives. But body chemistry has been shown through things like SAD, post-partum depression, childhood and adult trauma, and depression among the aging, to have a chemical imbalance cause. While it's best to check for psychological causes first, those who have clinical depression suffer unnecessarily when not treated.

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Yours in Christ,

- Dorian Scott Cole

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