Untangling The Roots Of Despair
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Depression, although one of the most common mental disorder faced by people around the globe, it is also one of the most serious disorders. Furthermore, it has one of the highest rates of suicide ideation and attempts. This disorder is characterized by persistent feelings of sadness, hopelessness, and lack of interest in activities once enjoyed. Therefore, depression greatly impairs an individual’s daily functioning (American Psychiatric Association [APA], 2013). Often called the “silent epidemic,” it is one of the most prevalent mental health conditions. With millions affected, it can take on various forms-from actions that seem to significantly affect mood but also cognitive processes, behavior, or even physical health.
Depression has multifactorial etiology. Psychosocial, environmental, psychological, and biological factors all contribute to the cause of depression. Early-life stress and trauma are psychosocial factors linked with increased risk for developing depression later in life. Individuals who have suffered abuse, neglect, or major life changes, such as divorce or loss of a loved one, are at higher risk (Hammen, 2018). Psychological factors may include neurotic personality traits or perfectionism, for example. The strongest negative emotion and higher sensitivity of stress tend to be found in highly neurotic people, making them more likely to have increased levels of depression (Ormel et al., 2013). Long-term stress generated by work, financial problems, or unsolved interpersonal conflicts is also able to exacerbate symptoms of depression (Lupien et al., 2009). Let us take the example of Sarah who was a university student. She became depressed after her parents’ divorce. The emotional turmoil, coupled with academic stress, caused her to withdraw from her friends and lose interest in her studies. She began to internalize her feelings of worthlessness, leading her to question her own identity and capabilities. It is observed in Sarah’s case that depression can result from psychological causes such as stress, trauma, and personality traits. It has been established that early adversities, such as childhood abuse or neglect, lead to long-term changes in the structure and function of the brain, particularly in stress response and emotion regulation-related areas. These changes may predispose an individual to depression later in life, especially when additional stressors are encountered during adulthood. Studies indicate that biologically, these neurotransmitter imbalances in particular with serotonin and dopamine affect the development of depression in a person. Very low levels of serotonin can indeed be said to influence unstable mood patterns and irritability in any individual. Impaired functionality of the brain reward mechanism due to deficiencies of the neurotransmitter, dopamine have been linked with the mechanism anhedonia-a kind of inability to have pleasurable feelings (Hollon et al., 2016). Abnormal functioning within the hypothalamic-pituitaryadrenal axis-the system that controls the body’s stress response-is linked to depression. Elevated levels of cortisol produced via activation of the HPA axis may contribute to neurodeeneration and loss of area in the hippocampus, which is important in regulating mood (Heim et al., 2008). However, genetics play a more significant role. Studies point out that people with an antecedent family history of depression are more at risk of developing the illness. The heritability of depression has been noted to range between 30% and 40%. This indicates that individuals from families that have a predisposition to depression are on a higher risk of having the disorder (Sullivan et al., 2000). Certain genes directly influence the synthesis and traffic of neurotransmitters like the serotonin transporter gene (5-HTTLPR), which is associated with higher vulnerability to depression, especially in the face of environmental stressors, by Caspi et al., (2003).
Symptoms of depression are more than emotional pain and appear in various aspects of life. Cognitive symptoms include difficulty concentrating, memory loss, and indecisiveness (Gotlib & Joormann, 2010). Behavioral symptoms include withdrawal from social contacts, problems with daily responsibility, and changes in appetite or sleep (APA, 2013). Many cases of depression also present with identifiable somatic symptoms such as exhaustion, chronic pain, or recurrent headaches. Sometimes, this profile might mask the psychosocial nature of depression, and thus not diagnosed early (Kroenke et al., 2010). Consequently, the connection of the two diseases-somatic and psychic-makes the treatment address elements of both psychopathological and somatic complaints. Let’s take the example of Emily who is a 34-year-old marketing professional. She could not rise from bed for days. At first, she blamed it on exhaustion at work, but weeks went by and she would find herself with a loss of appetite, sleep patterns interrupted, and once fond hobbies such as painting no longer held pleasure for her. She withdrew from friends and family, becoming “trapped in a fog.” The case of Emily illustrates the classic symptoms of depression: pervasive sadness, loss of interest in activities, fatigue, and difficulty concentrating (American Psychiatric Association, 2013).
Depression may manifest its symptoms in diverse forms and severities and even durations. While some may feel that they have the deepest level of apathy, others may suffer from insomnia or agitation. Others may develop physical symptoms like headaches or digestive issues. Depression thus becomes an all-encompassing condition, affecting not only the mind but also the body.
Depression is considered an illness and can be treated with many forms of intervention. Psychotherapy, often referred to as talk therapy, remains the most common form of treatment and is regarded as one of the most effective treatments for depression. Among the various treatments, CBT is the gold standard when it comes to the treatment of depression. This method focuses on identifying and changing maladaptive negative thought patterns and behaviors that maintain symptoms of depression (Beck, 2016). CBT teaches the patient to reframe negative or distorted thinking patterns and to do things that promote their mood and well-being. CBT has been shown to be as effective as medication in treating depression with fewer relapses (Cuijpers et al., 2020).
Another effective psychotherapeutic approach is interpersonal therapy (IPT). IPT focuses on resolving interpersonal conflicts and role transitions, which may be contributing to the depressive symptoms. IPT will help people improve communication skills and establish better support networks, which may alleviate the feelings of isolation and helplessness often associated with depression (Weissman et al., 2014).
Psychodynamic therapy can also be conducted as it deals with unresolved conflicts and unconscious emotions, thus very much needed for those who would have faced traumatic exposures (Leichsenring & Rabung, 2011).
Another important treatment in curing depression is pharmacotherapy. Mostly, it is done through the use of antidepressant medications. The most common class of antidepressants that are prescribed is the selective serotonin reuptake inhibitors, because it increases serotonin levels in the brain. The most prescribed drugs for depression are antidepressants, and SSRIs come first in the list of treatments due to their tolerably acceptable side effects (Geddes et al., 2019). SSRIs include drugs like fluoxetine and sertraline, which work by increasing serotonin levels in the brain, thus enhancing mood and lifting depressive symptoms. Other types of antidepressants are SNRIs, TCAs, and MAOIs. Each of these drugs works differently on the neurotransmitter system and may be appropriate for a patient with specific symptoms (Stahl, 2013). For those whose depression is resistant to treatment, the treatment options include atypical antipsychotics, mood stabilizers, or even ketamine-based therapies (Zarate et al., 2013). Medications help many people but are not without side effects, such as weight gain, sexual dysfunction, or gastrointestinal problems, often providing the best results when used in conjunction with psychotherapy for a holistic treatment approach (Cuijpers et al., 2020).
Alternative treatments have gained popularity in recent years due to their efficacy for treatment-resistant depression, such as exercise, mindfulness-based cognitive therapy (MBCT), and electroconvulsive therapy (ECT). For example, exercise has been shown to boost mood and reduce depression symptoms through neurogenesis and endorphin release (Schuch et al., 2016). More recently, MBCT combining cognitive therapy with mindfulness practice has also been documented to decrease the risk of relapse in recurrent depression (Piet & Hougaard, 2011).
Early diagnosis and treatment of depression help prevent the late impacts. Depression is known if not treated, to pose chronic problems related to drug abuse, anxiety disorders, as well as higher risk towards suicide (Kessler et al., 2003). High increase exists between medical comorbidity depression with unfrequented rates including cardiovascular diseases and diabetes (Penninx, 2017). Improvement through early intervention on quality can prove crucial for preventing late consequences.
A significant social support structure is significantly important in the treatment and recovery from depression. Friends, family, and support groups offer emotional comfort, practical assistance, and encouragement in seeking professional help in recovery. Beyond serving as a buffer against the adverse effects of stress, social support can provide a sense of belonging and connectedness, countering feelings of isolation, common in depression (Lakey & Orehek, 2011).
The practices of self-care include keeping a balanced diet, taking up hobbies, practicing relaxation techniques, and getting sufficient sleep. These simple self-care strategies help people feel in control again and generally improve their overall well-being.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Beck, A. T. (2016). Cognitive therapy and the emotional disorders. Penguin.
Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., & Poulton, R. (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301(5631), 386-389.
Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A., & Ebert, D. D. (2020). The effects of psychotherapies for major depression in adults on remission, recovery, and improvement: A meta-analysis. Journal of Affective Disorders, 277, 499–504. https://doi.org/10.1016/j.jad.2020.08.023
Geddes, J. R., Carney, S. M., Davies, C., Furukawa, T. A., Kupfer, D. J., Frank, E., & Goodwin, G. M. (2019). Relapse prevention with antidepressant drug treatment in depressive disorders: A systematic review. The Lancet, 367(9525), 653–661. https://doi.org/10.1016/S0140-6736(06)68265-0
George, M. S., Post, R. M., & Sackeim, H. A. (2013). Transcranial magnetic stimulation for the treatment of depression. Neuropsychopharmacology, 38(1), 233-249.
Heim, C., Newport, D. J., Mletzko, T., Miller, A. H., & Nemeroff, C. B. (2008). The link between childhood trauma and depression: Insights from HPA axis studies in humans. Psychoneuroendocrinology, 33(6), 693-710.
Aditi Singh,
B.A. Applied Psychology Honours+Research (2021-2025), Amity Institute of Psychology and Allied Sciences, Amity University, Uttar Pradesh, India