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Depression: chronic depression or depression? Symptoms causes and treatment

Definition of depression

Depression is a disease that is characterized by a great sadness, a feeling of despair (depressed mood), a loss of motivation and decision-making, and a decrease in the feeling of pleasure, eating and sleeping disorders, morbid thoughts. And the impression of not having value as an individual.

In the medical community, the term major depression is often used to describe this disease. Depression usually occurs in the form of depressive periods that can last weeks, months or even years. Depending on the intensity of the symptoms, the depression will be described as mild, moderate or major (severe). In the most severe cases, depression can lead to suicide.

Depression affects mood, thoughts and behavior, but also the body. Depression can be expressed in the body by a backache, stomach ache, headache; this also explains why a person who suffers from depression may be more vulnerable to colds and other infections as their immune system is weakened.

Depression or depression?

The term “depression”, still taboo not so long ago, is often misused in everyday language to describe the inevitable periods of sadness, boredom and melancholy that all are called to live at a time when to another without being an illness.

For example, being sad after losing a loved one or having a feeling of failure in case of problems at work is normal. But when these states of mind return each day for no particular reason or persist for a long time even with an identifiable cause, it can be a depression. Depression is actually a chronic disease, meeting specific diagnostic criteria.

In addition to sadness, the depressed person has negative and devaluing thoughts: “I am really bad,” “I will never succeed”, “I hate who I am”. She feels worthless and has trouble projecting herself into the future. She no longer has interest in previously popular activities.

Prevalence

Depression is one of the most common psychiatric disorders. According to a survey conducted by public health authorities in Quebec, about 8% of people aged 12 and over reported having experienced a period of depression in the last 12 months1. According to Health Canada, approximately 11% of Canadians and 16% of Canadian women will experience major depression during their lifetime75. And 7.5% of French people aged 15 to 85 have had a depressive episode in the last 12 months90.

According to the World Health Organization (WHO), by 2020, depression will become the second leading cause of disability worldwide, after cardiovascular disorders2.

Depression can occur at any age, including childhood, but it appears for the first time most often in late adolescence or early adulthood76.

Causes of depression

It is unclear what causes depression, but it is likely a complex disease involving several factors related to heredity, biology, life events, and environment and habits. Of life.

Genetic

As a result of long-term studies of families as well as twins (whether separated at birth or not), depression has been shown to have some genetic component, although it has not been identified. Of specific genes involved in this disease. Thus, a history of depression in the family may be a risk factor.

Biology

Although the biology of the brain is complex, in depressed people there is a deficit or imbalance of certain neurotransmitters such as serotonin. These imbalances disrupt the communication between the neurons. Other problems, such as hormonal disruption (hypothyroidism, contraceptive pill use, for example), may also contribute to depression.

Environment and lifestyle

The bad habits of life (smoking, alcoholism, little physical activity, excess of television88 or videogames, etc.) and the living conditions (precarious economic conditions, stress, and social isolation) are likely to deeply harm the psychological state. For example, the build-up of stress at work can lead to burnout and, eventually, depression.

Life events

The loss of a loved one, divorce, illness, loss of employment or other trauma can trigger depression in those who are predisposed to the disease. Similarly, childhood abuse or trauma is more sensitive to depression in adulthood, in part because it permanently disrupts the functioning of certain stress-related genes.

The different forms of depression

Depressive disorders are classified into several entities: major depressive disorders, dysthymic disorders and unspecified depressive disorders.

Major Depressive Disorder 

It is characterized by one or more major depressive episodes (depressed mood or loss of interest for at least two weeks associated with at least four other symptoms of depression).

Dysthymic Disorder (dys = dysfunctional and thymic = mood)

It is characterized by a depressed mood most of the time for at least two years, associated with depressive symptoms that do not meet the criteria for a Major Depressive Episode. This is a depressive tendency, without major depression.

Nonspecific depressive disorder is a depressive disorder that does not meet the criteria for major depressive disorder or dysthymic disorder. This may be, for example, an adjustment disorder with depressed mood or an adjustment disorder with both anxious and depressed mood.

Other terms are used next to this classification of the DSM4 (manual classification of mental disorders):

Anxious depression. In addition to the usual symptoms of depression, there is excessive apprehension and anxiety.

Bipolar disorder previously described as manic depression. 

This psychiatric disorder is characterized by periods of major depression, with manic or hypomanic episodes (exaggerated euphoria, overexcitation, inverted form of depression).

Seasonal depression. 

Depressive state that manifests itself cyclically, usually during the few months of the year when the sun is at its lowest.

Postpartum depression

In 60% to 80% of women, a state of sadness, nervousness and anxiety manifests itself in the days after childbirth. We talk about baby blues that lasts between one day and 15 days. Usually, this negative mood resorbs itself. However, in 1 in 8 women, a real depression sets in immediately or appears in the year following birth.

Depression following bereavement in the weeks following the loss of a loved one, signs of depression is common, and this is part of the grieving process. However, if these signs of depression persist for more than two months, or if they are very marked, consult a specialist.

Complications

There are several possible complications related to depression:

  • Recurrence of depression: It is frequent since it concerns 50% of people who have experienced depression. The management considerably reduces this risk of recurrence.
  • The persistence of residual symptoms: these are cases where depression is not fully cured and where even after the depressive episode, signs of depression persist.
  • The transition to chronic depression.
  • Suicidal risk: Depression is the leading cause of suicide: about 70% of people who die by suicide suffer from depression. Depressed men over 70 are the people most at risk of suicide. Suicide ideas sometimes called “black ideas” are one of the signs of depression. Even though most people with suicide ideas do not make an attempt, it is a warning sign. Depressed people think of suicide to stop suffering that seems unbearable to them.

Disorders Associated with Depression: Depression has physical or psychological links to other health problems:

  • Anxiety,
  • Dependence: Alcoholism; substance abuse such as cannabis, ecstasy, cocaine; dependence on certain drugs such as sleeping pills or tranquilizers …
  • Increased risk of certain diseases: cardiovascular diseases and diabetes. In fact, depression is associated with a higher risk of heart problems or strokes . Moreover, the fact of suffering from depression could slightly accelerate the onset of diabetes in people already at risk. The researchers argue that depressed people are also less likely to exercise and eat well. In addition, some medications can increase appetite and cause weight gain. All of these factors increase the risk of type 2 diabetes.

Symptoms of depression

According to the DSM4-R definition, the main characteristic of a depression is

  • a depressed mood,
  • with a loss of interest or pleasure for almost all activities,
  • Lasting at least two weeks.

In a depressed child or teenager, irritability can sometimes be observed rather than sadness. For the depression to be effective, that the diagnosis is made, the person must moreover present at least four additional symptoms:

– A change in appetite or weight, sleep and psychomotor activity;
– a reduction of energy;
– Ideas of worthlessness or guilt;
– Difficulty thinking, concentrating or making decisions.

Other symptoms may be present:

  • An unusual aggressive attitude or a great irritability.
  • Excessive emotional sensitivity (nothing causes tears)
  • Agitation, unable to sit, wandering, twisting hands, manipulation and friction of the skin, clothing or other objects) or on the contrary the impression of thinking and acting “slow motion”.
  • A drop in libido.
  • Headaches, stomach or back pain.
  • A feeling of emptiness,
  • An impression of not feeling anything anymore.

These symptoms of depression are accompanied by significant suffering or impairment of social, occupational or other important areas of functioning.

Note that severe depression is often accompanied by other psychiatric problems such as anxiety disorders, eating disorders (anorexia, bulimia) or an abuse of drugs or alcohol. Many depressives use these substances to relieve their symptoms, which can create other health problems (mental or physical).

In the elderly, depression is also common. It often goes unnoticed because the symptoms (fatigue, loss of motivation, isolation) can be attributed to aging. A significant part of this population is not diagnosed or treated. Some symptoms of depression are more common in the elderly than in the youngest, especially:

  • Aggressiveness and anger.
  • Various and unexplained pains (backache, headache …).
  • Isolation, withdrawal.
  • Confusion and memory problems.
  • Feeling of being useless, frequent suicidal ideation.
Recognize depression in children and adolescents

In children. Depression is quite rare (0.5%) in their case. However, one must be particularly attentive to any sudden change in behavior and to signs of withdrawal, absence, or on the contrary, irritability or agitation:
– he does not want to play, go out or see his friends;
– he is very irritable and often cries;
– he complains of headaches or belly;
– he says that he does not want to live anymore or that he should not have been born;
– he experiences exclusion and failure at school;
– he grows up, but takes up very little weight.

In adolescents. Depression can be difficult to distinguish from moments of crisis or confrontation specific to this stage of life. It affects 3% to 4% of adolescents, especially girls. The following signs are to be monitored:
– an abuse of alcohol, drugs, drugs,
– a state of agitation,
– verbal abuse,
– an apparent indifference,
– a tendency to isolation;
– disinvestment in studies;
– signs of self-injury;
– verbalization of suicidal ideation.

People at risk for depression

Nobody is immune to depression. The following people would be slightly more at risk.

  • People with a family or personal history of depression.
  • People who take certain medications, such as psychostimulants, steroids, corticosteroids, anabolic steroids, anticonvulsants or birth control pills. Indeed, the progestins contained in the contraceptive pill can affect the mood. If so, discuss it with your doctor.

From a sociological point of view, the following groups are more affected by depression.

  • Women. About twice as many women as men will experience depression at least once in their lifetime, even though some marginal studies have sometimes found equal frequency in both sexes. Women are more likely to consult than men when they have symptoms of depression, which may partly explain why the disease is more often diagnosed in their home. Also, we advance at least two hypotheses to explain the phenomenon:
    – the hormonal system of women, more likely to influence brain chemistry; thus, menopause may be associated with early depression
    – more frequent problems of poverty and spousal violence.
  • Men living alone.
  • Young people. The first depression often occurs in late adolescence or early adulthood. Suicide is the 2 leading cause of death among young people after road accidents.
  • The elderly. Between 15% and 20% of elderly people experience depressive periods. They often go unnoticed. Possible causes include:
    – loneliness;
    – the death of the spouse or friends;
    – physiological factors related to aging, such as a significant decrease in serotonin and other metabolic changes;
    – Undernourishment, which can cause nutritional deficiencies contributing to depression (especially folic acid and vitamin B12).
  • Homosexual people. Several data, a large cohort study in New Zealand, show that gays, lesbians and bisexuals are at higher risk of mental health problems, particularly depression, anxiety disorders and suicidal behavior.
  • People suffering from a chronic disease. Having chronic pain (migraines or back pain, for example) or a disabling illness (diabetes, stroke …) greatly increases the risk of depression, especially among youth .

Risk factors for depression

  • Live repeated losses (death of a spouse or parent, miscarriage, divorce or separation, loss of employment, etc.).
  • Live a chronic stress. Too busy a schedule, a lack of sleep, etc.
  • Feeling constantly overwhelmed and having the impression of losing control over one’s existence.
  • Consume alcohol or drugs, including tobacco.
  • Having experienced traumatic events in childhood (sexual abuse, abuse, neglect, witnessing parental violence …).
  • Have nutritional deficiencies. Vitamin B6 deficiency (especially in women taking oral contraceptives), vitamin B12 (especially in the elderly and people who consume a lot of alcohol), vitamin D, folic acid, iron, omega-3 fatty acids or some amino acids could cause depression.
  • Living in difficult circumstances, receiving low wages or social assistance, being a single parent,being part of an Aboriginal community in Canada, living in a sensitive urban area in France.
  • Having already experienced a major depression makes it more likely to suffer another.
  • Living with a spouse or depressed parent.

 

Resilience: knowing how to rebound

Resilience is the ability to overcome difficult or tragic experiences: loss of a loved one, fire, rape, accident, humiliation, etc. It requires a good deal of inner security and confidence in life. The psychiatrist Boris Cyrillic, who put this concept in the public square, said that resilience is “the art of navigating the torrents”.

This mental attitude is built through the bonds of trust created with one or more important people. According to Boris Cyrulnik, resilience “is not a catalog of qualities that an individual possesses. It is a process that, from birth to death, we constantly knit with our entourage “7. Resilience seems to be acquired more easily during the first years of life. Later, we can still achieve it, but with more effort.

Prevention of depression

Basic preventive measures
Sometimes, in cases of depression without signs of major depression or dysthymia in cases, just organize a life plan healthier for some time, like going to bed early, get more exercise and eat so balanced, to feel better. But other ways can help not to sink into depression, and especially to avoid relapses after a first depression. Indeed, several studies show that about half of people with depression suffer more than once during their lives.

Activities, Relationships, Spirituality
– Exercise Regularly and the intensity and frequency of exercise increases its effect. People who exercised regularly would be even protected from depression between 2 and 9 years after stopping this activity.
– Do not hesitate to open up on what you feel with people around you when you feel depressed.
– If needed, seek help from a trained psychologist, social worker or psychotherapist (see Psychotherapy).
– Do not be too demanding on yourself.
– Live in the moment. Avoid negative thoughts, rewrite the past, or anticipate the future.
– Practicing mindfulness meditation (mindfulness -based cognitive therapy (MBCT) for depression developed to reduce depressive access.
– Getting to know and undertake projects.
– Recognize and overcome his fears.
– Feeding a form of spirituality.

Food
If we cannot end a depression only through food, we can probably aggravate it by poor food choices. But we can also prevent a relapse by good choices. Depending on the case, a dietitian or an osteopath can help establish the appropriate diet.

– Ensure a sufficient daily intake of nutrients. According to the naturopathic therapist JE Pizzorno, the recommendations proposed to the population in the food guides to maintain optimal health remain the same in case of depression. However, he recommends a multivitamin and mineral supplement.
– Consume more fatty fish (such as mackerel, herring and salmon) because their flesh is rich in omega-3 fatty acids, an essential nutrient.
– Also, be sure to eat foods high in folic acid, such as organ meats, legumes and dark green leafy vegetables. Some pasta and breakfast cereals are fortified with folic acid.
– A study has shown that the Mediterranean diet reduces the risk of depression. A diet containing a lot of processed products increases the risk of depression by 58% in this study. On the contrary, the Mediterranean diet reduces the risk of depression by 30%. How can a diet act so much on depression? Probably by bringing omega-3s, antioxidants, folates, and maybe other elements …

Measures to prevent relapses
To prevent a relapse, it is recommended that all treatments (whether medications or natural health products as well as psychotherapy) be continued from 6 months to 24 months after complete healing.

If the treatment is stopped as soon as the person feels well, the risk of relapse would exceed 50%. At this time, the disease may be more difficult to treat. It is also more likely that depression will become chronic, hence the importance of self-care to prevent depressive episodes (treatment, psychiatric follow-up, psychotherapy, and lifestyle changes).

Medical treatments for depression

The treatment varies according to the severity of the depression.

dysthymic depression, mild to moderate depression can usually be effectively treated by psychotherapy. In the case of major depression, the recommended treatment is psychotherapy associated with taking an antidepressant medication.

Several recent studies have shown that antidepressants are most effective in case of major depression. In practice, however, antidepressants are often prescribed for moderate depression.

Regardless of the severity of depression, combining “classic” medical treatment with therapy is effective.

In cases where suicidal behavior is evident, hospitalization is necessary. Treatment with ECT, the aim is to cause a seizure to stimulate the brain, is used in some cases of major depression who do not respond to other treatments. They are administered under general anesthesia, 2 to 3 times a week for 6 to 12 weeks. It is not clear exactly how these treatments work.
In recent years, a new treatment would give promising results in case of failure of the usual treatments: Transcranial Magnetic Stimulation (transcranial magnetic stimulation) or TMS). It is prescribed to people with major depression who have resisted two antidepressants of different classes.
This treatment is carried out using a powerful electromagnet which is at the origin of a magnetic field of short duration. During the sessions, the brain is therefore subjected to brief and repeated magnetic pulses for a time defined by the protocol. It does not require general anesthesia, unlike electroshocks.

Psychotherapy

Undertaking psychotherapy often helps to understand the meaning of her depression or, at least, what triggered it. Such therapy also helps to find ways to feel better on a daily basis. One learns to better react to the trials and the successes that punctuate the existence. It is then possible to adopt behaviors that protect a relapse.

There are several psychotherapeutic approaches. The cognitive behavioral therapy is one of the most effective methods against depression, short-term. Similarly, therapy based on mindfulness (“mindfulness”) is a new approach that has proven itself. But the effectiveness of the treatment is not based solely on the type of approach. The personal commitment and willingness of the depressed person, as well as the relationship of trust he weaves with his therapist, would be even more important factors of success. To learn more about the different types of psychotherapy, see our Psychotherapy fact sheet.

Antidepressant medications

About drugs

Called psychotropic of natural or artificial substances capable of modifying the chemical balance of the brain. Their action is mainly on the synapses of neurons, that is to say the spaces allowing the transmission of information between neurons.

The term antidepressant is reserved for a group of psychotropic drugs whose action aims at the disappearance of depressive symptoms. Antidepressants are divided by class, depending on the type of action they have on the brain (blocking or stimulating a particular function). Each class of antidepressants has its advantages and disadvantages.

 

There are several classes of antidepressants. Here are the most frequently prescribed.

  • The imipramiques antidepressants , including clomipramine (Anafranil), amitriptyline (Elavil, Redomex, Laroxyl) and imipramine (Tofranil), dosulepin (Prothiaden), doxepin (Sinequan, Quitaxon) , maprotiline (Ludiomil), nortriptyline (Nortrilen). Used since the early 1960s, they cause a lot of side effects (drowsiness, weight gain, constipation, dry mouth, low libido, etc.). There is less use nowadays.
  • The selective inhibitors of serotonin reuptake (SSRI or serotonin reuptake inhibitors) including citalopram (Celexa, Seropram), fluoxetine (Prozac), fluvoxamine (Luvox, Floxyfral), paroxetine (Paxil, Deroxat, Divarius) and sertraline (Zoloft). This is usually the first choice of treatment for severe depression. Their effectiveness is equivalent to that of tricyclic antidepressants, but they are better tolerated. However, they can be associated with certain undesirable effects: agitation, nausea, nervousness, insomnia, headaches and low libido.
  • The reuptake inhibitors of serotonin and norepinephrine or norepinephrine (SNRIs) such as venlafaxine (Effexor), duloxetine (Cymbalta), milnacipran hydrochloride (Ixel). They are among the most effective antidepressants because they act on two types of neurotransmitters at a time. However, they can cause more side effects. Usually, they are used when other drugs are insufficient to relieve symptoms.
  • MAOIs (monoamine oxidase inhibitors.
    They are little used in France . Iproniazid phosphate (Marsilid) Moclobemide (MOCLAMINE) Phenelzine (Nardelzine, Nardil)
Caution. According to an opinion issued by Health Canada, SSRI and SNRI antidepressants expose children and adolescents to an increased risk of suicidal ideation or behavior (compared to placebo). Health Canada states that these antidepressants are not indicated in children and adolescents, as the studies have failed to prove their effectiveness in these children. Other reports indicate that they can cause agitation, hostile behavior and self-harm to anyone who uses it, including adults. The taking of such drugs should therefore be rigorously monitored by the doctor.

In addition, according to a study published in 2010, antidepressants during the first trimester of pregnancy increase the risk of miscarriage by 68%. Talk to your doctor if you are pregnant and taking any medications.

It is not easy to find a drug whose therapeutic effect is optimal. To achieve this, you sometimes have to experiment with different products for several weeks or months.

In addition, a significant proportion of people with depression respond little or nothing to antidepressants. The psychiatrist can then prescribe 2 drugs of different classes simultaneously.

Note on withdrawal of antidepressants

Sudden antidepressant therapy should never be discontinued, as it can lead to symptoms if it stops. The dose should be reduced gradually over a few weeks, following the advice of the doctor. That said, there are normally no dangerous withdrawal symptoms with antidepressants, only transient discomforts .

It is desirable, but not always essential, to wait a few days (or more, depending on the drug) before starting another pharmacological or natural treatment. Check with your doctor.

Support or self-help groups

Group psychotherapy sessions are organized in hospitals, clinics and even in private practice for brief therapy (12 to 15 weeks). For depressed people, this is a way to break the isolation or maintain a valuable social bond. There are also groups for relatives of people living with depression.

For more information and resources, visit the Douglas Mental Health University Institute website (see Sites of Interest). See also Depression support groups .

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