It’s often claimed that mental illnesses derivate from a ‘’chemical imbalance’’ on the brain –that occurs when there’s either too much or too little of certain chemicals, called neurotransmitters- but that would be diminishing how complex those disorders are. In fact, APA (American Psychiatric Association) defended in 2005 that ‘’the exact causes of mental disorders are unknown’’. In that same year, Drs Thomas Insel and Remi Quirion proposed that mental disorders need to be ‘’addressed as disorders of distributed brain systems with symptoms forged by developmental and social experiences.”
Pies, RW. (2014, April) Nuances, Narratives, and the ‘’Chemical Imbalance’’ Debate [Blog Post.] Retrieved from https://www.psychiatrictimes.com/view/nuances-narratives-and-chemical-imbalance-debate (last accessed on 13th October 2020)
Mental illnesses don’t simply result from an amount of certain brain chemicals, but of a set of probable causes, such ‘’as faulty mood regulation by the brain; genetic vulnerability; stressful life events such as a history of physical, psychological, or emotional abuse; medications; medical problems genetics; family history; having a history of alcohol or illicit drug use and taking certain medications psychosocial factors, such as external circumstances that lead to feelings of isolation and loneliness’’.
Harvard University. (2009, June) What causes depression? Harvard Health Publishing Retrieved from https://www.health.harvard.edu/mind-and-mood/what-causes-depression; Eske, J. (2019, September) Everything you need to know about chemical imbalances in the brain, Medical News Today Retrieved from https://www.medicalnewstoday.com/articles/326475#myths (last accessed on 13th October 2020)
However, chemicals are involved, it’s just not as simple as ‘’one chemical being too low and another too high”, but of millions and billions of chemical reactions working both inside and outside of nerve cells. There are specific areas of the brain that regulate it so scientists believe that the cause of these disorders might lie in the nerve cell connections, nerve cell growth and functioning of nerve circuits rather than on levels of brain chemicals. The use of antidepressants supports this theory because despite the immediate increase of chemical messengers on the brain, the patients take several weeks or longer to feel results. The researchers started to question why; if depression was only the result of low levels of neurotransmitters, how come people didn’t feel better as soon as their number is increased? They then progressed their theory to ‘’the real value of these medications may be in generating new neurons (a process called neurogenesis), strengthening nerve cell connections, and improving the exchange of information between nerve circuits. If that's the case, depression medications could be developed that specifically promote neurogenesis, with the hope that patients would see quicker results than with current treatments.’’ However, the understanding of the neurological function influence in disorders is incomplete and therefore, susceptible to change.
Burns, D.D. (2017, December). Do depression and anxiety result from a Chemical Imbalance in the brain? [Blog Post]. Retrieved from https://feelinggood.com/2017/12/12/do-depression-and-anxiety-result-from-a-chemical-imbalance-in-the-brain/ (last accessed on 13th October 2020)
Professor David D. Burns, a winner of A. E. Bennett Award from the Society for Biological Psychiatry, among others, dedicated a long time of his life studying the chemical imbalance theory but stopped when he ‘’realized that the chemical imbalance theory was not a productive or valid.’’ In one of his clinical studies, he flooded the brains of depressed veterans with serotonin – a neurotransmitter that was believed to cause depression when in deficiency- but there was no effect on their moods or disease. This led him to believe that the theory wasn’t accurate and he now defends that although there are biological brain disorders, he finds unlikely that mental disorders are a ‘’chemical imbalance’’ since the brain itself it’s not a ‘hydraulic system of balances and imbalances.’’. Instead, he thinks that ‘’Everything about being human results from biological (genetic) and environmental influences—such as IQ, personality, height, hair colour, and the proclivity to being naturally more negative in outlook (depression, anxiety, shyness, anger) or more naturally positive (happy, confident, outgoing). However, we do not yet have much understanding of the brain systems that are involved. To what extent is depression the result of problems with our hardware (tissue level brain abnormalities or damage) vs. software (learning, neural circuitry, etc.)? We just don’t know.’’
Burns, D.D. (2017, December). Do depression and anxiety result from a Chemical Imbalance in the brain? [Blog Post]. Retrieved from https://feelinggood.com/2017/12/12/do-depression-and-anxiety-result-from-a-chemical-imbalance-in-the-brain/ (last accessed on 13th October 2020)
Depression
Depression
Depression is a subject that over the years has been more approached by the media and society, although it is often not spoken correctly. As it is a mental illness, it still exists a prejudice against those who suffer from it. Sometimes who had depression don't seek help, even out of shame or even because they don't realise that what they feel isn't normal and that it has to be treated and accompanied by a specialist. It's very common in teenagers and frequent in adults but it can affect anyone at almost any age.
Depression is a mood disorder and is a common and a complex disease which causes a persistent feeling of sadness and loss of interest and affects the way you do daily activities, like sleeping, working and thinking. However, depression isn't just being sad. You can be sad and not be depressed. It can be lasting or continuous, and when it's quite severe depression can lead to suicide.
Depression includes two subcategories:
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Major depressive disorder: it can be classified as mild, moderate or severe, according to the number and the seriousness of the symptoms; include symptoms as loss of interest, decreased energy and depressed mood.
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Dysthymia: it is a persistent or chronic condition of mild depression, and their symptoms are identical to the major depressive disorder. However, they are of lesser intensity and last longer, but they have to be present, at least, for two years to be diagnosed as dysthymia.
Types of depression
There are some other types of depression, such as:
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Postpartum depression, it can affect women during pregnancy and/or after delivery and the most common symptoms are extreme sadness, anxiety, exhaustion (similar to those of the major depressive disorder); these feelings make their daily activities difficult and often fail to take care of their babies. Women tend to feel guilty for having these feelings since they and society think it is a time when they should be happy.
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Psychotic depression, it happens when someone suffers from severe depression and psychosis. People who had this illness have delusions and hallucinations and can listen and see people who don't exist and that nobody else can't either hear or see
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Seasonal affective disorder, it is characterized by regular episodes of an affective disorder with a well-defined relationship with the season. Winter depression begins due to the decrease of the sunlight, and some symptoms are loss of energy, increased sleep, social withdrawal and weight gain. This depression generally lifts during spring and summer.
Symptoms
The most common symptoms are:
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"Persistent sad, anxious, or “empty” mood;"
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"Feelings of hopelessness, or pessimism;"
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"Irritability;"
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"Feelings of guilt, worthlessness, or helplessness;"
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"Loss of interest or pleasure in hobbies and activities;"
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"Decreased energy or fatigue;"
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"Moving or talking more slowly;"
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"Feeling restless or having trouble sitting still;"
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"Difficulty concentrating, remembering, or making decisions;"
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"Difficulty sleeping, early-morning awakening, or oversleeping;"
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"Appetite and/or weight changes;"
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"Thoughts of death or suicide, or suicide attempts;"
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"Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment."
National Institute of Mental Health, NIMH. Depression: Signs and Symptoms. Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml (last accessed on 9th October 2020, 15:12)
Diagnosis of Depression
The Diagnostic and Statistical Manual of Mental Disorders, DSM-5, is a book released by the American Psychiatric Association that gives guidelines for clinicians who diagnosed psychiatric disorders. According to this book, the diagnostic criteria of depression includes feelings of sadness, loss of interest in their usual activities and low mood that have persisted for at least two weeks. These feelings should be accompanied by at least five other typical symptoms of depression that I have already referred to. A psychiatric must diagnose major depressive disorder to someone if it's clear that the symptoms of the patient don't have another cause, such as side effect from a medication, a medical condition or the use of illicit substances.
Factors
Some factors that can contribute to depression are:
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Genetics and family history;
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Brain chemistry imbalance;
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Physical health and certain medical conditions;
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Use of illicit substances (drugs);
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Stress;
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Poor nutrition.
Brain chemistry imbalance:
One possible biological cause of depression is an imbalance in the neurotransmitters, which are chemical substances that relay messages from neuron to neuron and it is because of neurotransmitters that diverse areas from the brain can communicate with each other (synapsis). These chemicals are associated with mood regulation, and some of them, including dopamine, serotonin, and norepinephrine, play a considerable role in mood. The lack of certain neurotransmitters may lead to the symptoms of major depressive disorder. However, scientists believe that "more important than levels of specific brain chemicals — nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression".
Harvard University. (2009, June). What causes depression? [Harvard Health Publishing] Retrieved from https://www.health.harvard.edu/mind-and-mood/what-causes-depression (last accessed on 13th October 2020, 15:03)
Areas of the brain affected by depression:
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Amygdala - The amygdala belongs at the limbic system, which is associated with emotions such as pleasure, sorrow, anger and sexual arousal. This area of the brain is activated when someone revives emotionally charged memories or a terrifying situation, and its activity is more eminent when a person is sad or depressed.
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Thalamus - The thalamus gets most sensory information and transmits it to the cerebral cortex, which directs high-level functions such as movement, speech, behavioural reactions, thinking, and learning.
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Hippocampus - The hippocampus is, like the amygdala, a part of the limbic system, and has a fundamental role in processing long-term memory and recollection. In some depressed people, this part of the brain is smaller. The exposure to the stress hormone impairs the growth of nerve cells in the hippocampus.
Physical health and certain medical conditions:
The people who have a sleep disorder, a thyroid condition or chronic illness are more probable to suffer from depression. The stress of having a physical disease may lead to an episode of major depression and some illnesses, for example, liver disease, can cause depression symptoms. This shows to us how the mind and the body are connected.
Stress:
Hormones are complex chemicals that carry messages to organs or groups of cells throughout the body and trigger certain responses. The hormone cortisol is secreted during periods of stress, and researchers presume that high levels of cortisol may influence the neurotransmitter serotonin, which contributes to depression. Stressful life events, such as the death of a loved one, an illness or the loss of a job, play an important role in depression and can lead to physical and emotional consequences.
Genetics and family history:
Genes codify proteins, but they can get it wrong and change your biology that can result in an unstable mood. In someone who is genetically vulnerable to depression, any stressful situation can lead to the unbalance of the system. Scientists aren't sure which genes are involved in mood disorders and how exactly biology make people vulnerable to depression. There is a 40% probability of someone suffering depression when their first-degree relatives (parents/siblings/children) suffer from it and there is an increased risk for the condition of 1.5% to 3% over normal. The researchers also want to understand how the interaction of biology and environment leads to depression in some people but not others.
Women are more likely to suffer from depression than men because, during times when their hormones are in flux, they are more prone to depressive disorders, although men are more likely to commit suicide. "The World Health Organization estimates 5% of men and 9% of women experience depressive disorders in any given year."
Schimelpfening, N. (2020, March 21). Causes and Risk Factors of Depression. verywellmind. Retrieved from https://www.verywellmind.com/common-causes-of-depression-1066772)
However, every people of all ages and all social extracts can experience depression at some point in their lives.
Treatments and Medicaments for Depression
The treatment of depression must be individualized. Just because you know someone who suffers from depression and takes a specific antidepressant, it doesn't mean that for your depression this medicine would be the best option. However, a medication that in the past has helped you or a close family member will often be considered. Usually, this condition is treated with medications, psychotherapy, or a combination of the two. There are other two ways to treat depression that are electroconvulsive therapy and other brain stimulation therapies. Yet, they are just an option when the usual ones do not reduce the symptoms.
Medications:
Antidepressants are medicines to treat depression and they help to improve the process the brain uses certain chemicals that regulate mood or stress. Regularly, you don't take one antidepressant, and your symptoms improve, it may be necessary to try several medicines to find the right one for your case. Usually, antidepressant just began to work 2 to 4 weeks after someone takes it for the first time.
Psychotherapies:
Some types of psychotherapies are effective for depression, such as:
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Supportive counselling: it's focused on listening to the patient who talks about whatever is messing with their minds, and the therapist gives support and understanding.
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Interpersonal therapy (IPT): it's based on the thought that relationships are at the lead of depression, and this treatment aims to help the patient to improve skills, like communication skills
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Cognitive-behavioural therapy (CBT): "focuses on helping people identify and replace cognitive distortions and behavioral patterns that reinforce depressive feelings"
Schimelpfening, N. (2020, March 21). An Overview of the Treatments for Depression. verywellmind. Retrieved from https://www.verywellmind.com/common-causes-of-depression-1066772 (last accessed on 3rd November 2020, 11:50)
Beyond Treatment: Things You Can Do
Here are other tips that may help you or a loved one during treatment for depression:
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Try to be active and exercise.
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Set realistic goals for yourself.
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Try to spend time with other people and confide in a trusted friend or relative.
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Try not to isolate yourself, and let others help you.
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Expect your mood to improve gradually, not immediately.
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Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
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Continue to educate yourself about depression."
National Institute of Mental Health, NIMH. Depression. Retrieved from
https://www.nimh.nih.gov/health/topics/depression/index.shtml (last accessed on 3rd November 2020, 11:52)
Heredity of Depression
"A British research team recently isolated a gene that appears to be prevalent in multiple family members with depression. The chromosome 3p25-26 was found in more than 800 families with recurrent depression. Scientists believe that as many as 40 percent of those with depression can trace it to a genetic link. Environmental and other factors make up the other 60 percent."
Faris, S. (2017, July 25). Is depression genetic? Retrieved from https://www.healthline.com/health/depression/genetic#genetics (last accessed on 1st November 2020, 12:45)