A Comprehensive Overview of Clinical Depression

Depression is a prolonged, incessant and sinister disease suffered by tens of millions—if not hundreds of millions—of people in every single country around the world. The majority of those suffering depression are women, however, who may be twice as likely to suffer the disorder as men (Henderson, 2014). Many people get the blues and experience regular bouts of the blahs and even go through extensive and serious periods of intense melancholia, but to compare such emotional states to actual acute clinically depressive states is to deny the profundity of authentic depression. That denial and the inherent dismissal of depression as something that literally everybody experiences and that people just need to get over accounts for how long it took the disease to be taken seriously.

Indeed, depression is generally characterized in medical literature using “disease-state terms such as disorder, episodes, remission, recovery, relapse, and recurrence (Kanter, Busch, Weeks, & Landes, 2008). Even today, in other words, depression is still considered less of a disease such as cancer or Alzheimer’s thanks to outdated jargon like “having an episode” or the tainted connotations of words like “recovery” and “relapse” which seems to indicate a potential for willful control of the symptoms. The truth is much less cut and dry: depression can establish itself at any time and under any circumstances. Such is the extent to which depression is still misunderstood that even today there remains a natural response of shock and surprise by many upon the discovery that even people who seem to have everything they could possibly desire have received treatment for clinical depressed.

The symptoms related to depression appear in the expression of emotions and behavior that are obvious signs of a depressed state of mind, including excessive varieties of behavior and a noticeable absence of what is termed normal social interaction (Kupferberg, Bicks, & Hasler, 2016). Additionally, those suffering what may be casually termed emotional depression very often manifest physical symptoms that defy diagnostic explanation except as a comorbidity with that emotional reaction. Common physical symptoms can range from headaches to a variety of sexual dysfunction. Overly concentrated fatigue to the point of lethargic discontent typically accompanies depression the combination can lead to an emotional consequence of sublimation in the form of either extreme weight loss (anorexia) or extreme weight gain. Naturally, both these physiological symptoms only lead to intensifying the emotional strain of depression.

Depression still has a certain social stigma attached to it, though not nearly to the degree as in the past when it was still viewed by many as a personal character flaw. The causes of clinical depression are still not completely known, but are assumed to be the result of an imbalance of neurotransmitters (Pasquini, Berardelli, & Biondi, 2014). Neurotransmitters are chemicals found within the brain that serve the purpose of transmitting messages across the full range of organ. In tandem with these physiological roots are the host of external environmental stimuli which can impact the severity, degree and outcome. It is also know that depression is subject to genetic predisposition; as a result, many families can trace depression back through their ancestral lineage (Kupferberg, Bicks, & Hasler, 2016). Indeed, it is believed that those whose family has a history of depression are potentially as much as three times more likely to develop the disorder themselves (Levenson & Nichols, 2106). However, depression is not transmittable, and as such “no one simply inherits depression from their mother or father. Each person inherits a unique combination of genes from their mother and father, and certain combinations can predispose to a particular illness” (Levenson & Nichols, 2106). Those combinations genetic predisposition and external stimuli do simply produce one all-encompassing disease or disorder known as “depression.” Depression is acondition that is more appropriately termed a spectrum and not every stop along that spectrum produces the same symptoms nor responds to the same type of treatment.

Major Depressive Disorder

The common term “clinical depression” generally references this type of depressive disorder characterized by intense melancholia accompanied by various states of feeling worthless and a lowering of self-esteem. Many people experience a major depressive disorder deal with the emotional turmoil of hopeless combined with the physical turmoil of fatigue or lethargy. This situation can lead equally to serious weight loss or unwelcome weight gain. More serious cases will develop symptoms on the extreme side of the disorder such as increasing feelings of persecution, paranoid and even delusions. In more serious cases, the depression can include heightened sense of paranoia and delusions. Generally, a major depressive disorder lasts less than a year, but as it also tends to be cyclical in nature, this type of depression never goes into complete remission.

Dysthymic Disorder

Dysthymic disorder is also referred to as simply dysthymia. Dysthymia is less severe than many other types of depression, but the severity is offset by an increase in chronic persistence of symptoms. Fortunately, this part of the depressive disorder spectrum tends to be milder but manifests the same symptoms. The consequence is a depression that affords a longer cycle of less extreme symptoms such as melancholia and feelings of worthlessness.

Bipolar Disorder

Bipolar disorder used to be known as manic depression and that is actually a more accurate description as the defining symptoms include one that seems bizarrely out of place within the spectrum of clinical depression: extraordinary displays of manic happiness and energy. Suffers diagnosed with bipolar depression rather than the typical unipolar depression can often go undiagnosed precisely because of the manic exhibitions. Manic depression is plagued by connotations of extremely displays of energy and the subsequent onset of positive feelings that boost self-esteem and confidence. These period do not last long, however, and the resulting crash into low periods of typical melancholic depression becomes all the more starkly apparently due to the comparison.

Seasonal Affective Disorder

Commonly, season affective disorder (SAD) transforms an otherwise non-depressive person into someone manifesting many typical symptoms of depression as a result of the change of seasons or indoor environments which adversely affects exposure to light. SAD can just as easily affect someone suddenly exposed to the pervasive sunlight and accompanying high temperatures associated with the change over to Daylight Savings Time; it is not merely relegated to those who are affected by the change from summer into winter, though admittedly most sufferers fall within that group. The cause and effect of SAD remains among the most mysterious of all the depressive stops along the spectrum. The odd paradox is that while the cause remains a difficult proposition, the treatment is among the most effective. Many of those whose depression is related to seasonal affective problems have shown significant improvement in their symptoms simply by installing artificial light boxes to replace the illumination of sunlight absent during winter months.

Treatment Resistant Depression

Treatment resistant depression refers to those chronically depressed people for whom standard pharmacological treatments have failed to provide relief. Nevertheless, the first response of the health care industry today is with drugs and that mindset is precisely what has created the conceptual situation along the spectrum that has become known as Treatment Resistant.

Pharmaceutical treatment required a diagnosis of acute clinical depression; one cannot and should not take anti-depressant medication simply because they are feeling a little down. Even mild cases of clinical depression normally do not require drug treatment and doctors tend to prefer abandoning other types of treatment before turning to medication.

Three categories of medications are most popular for treating depression (Sperry, 2016). Tricyclics were once the most commonly prescribed drug to treat depression and the first to be tried. Monoamine oxidase inhibitors (MAOIs) are characteristically prescribed to those patients that don’t respond to treatment with trycyclics. The class of drugs more likely to be prescribed today are selective serotonin reuptake inhibitors (SSRI).

Tricyclics

Tricyclics treat depression by blocking reuptake of neurotransmitters which results in an increase in the levels external to the brain cells to increase. The consequence of this is the extending the effect of stimulation of the neurotransmitters on the brain. Formerly the most often prescribed pharmacological approach to treating depression, tricyclics are being used with increasing less frequency.

MOAI

The class of drugs called MOAIs obstruct the actions of an enzyme that breaks down neurotransmitters. This obstruction allows the neurotransmitters to increase to a higher level, thereby producing more stimulation in the brain. Those who use MOAIs generally are required to follow a strict diet and follow certain precautions related to blood pressure.

Selection Serotonin Reuptake Inhibitors

Also known as SSRI, this drug treatment for depression is popular and common because they effectively treat a wide range of symptoms including anxiety, obsessive-compulsive disorder, panic disorders, and phobias. This class of drugs is also preferred because of a reduced toxicity.

Time Frame

One of the disadvantages of drug treatments for depression is that most medications take at least two to four weeks before their efficacy can be determined. This means that they must be taken for a month before any change might be noticed. Since not every antidepressant can be counted on to work for every patient, it is quite possible that some people may take over a year and try more than a dozen different medications before finding one that works.

Side Effects

Common side effects of nearly all drugs used to treat depression include vomiting, nausea, weight gain or loss, and possible sexual dysfunction. More serious side effects can include confusion and anxiety, blurred vision, tremors, nervousness and irritability. Overdoses of depression drugs can range from increased heart rate to coma to death.

In addition to treatment with medication, certain changes in lifestyle can positive impact some of the symptoms associated with depression. Exercise, for instance, can produce the release of certain hormones which can elevated mood. Cutting back on excessive intakes of caffeine, nicotine and alcohol also reduce the severity of the melancholia that is a defining characteristic of depression.

Depression intensely afflicts enjoyment of life and often alters the life of the sufferer in intense manners. In addition, depression doesn’t just affect the patient but everyone around him, forcing lifestyle changes upon them as well. Many believe that depression is not completely treatable regardless of the approach; some experience tremendous changes upon initially taking antidepressant medication, only to relapse as the efficacy diminishes. The glut of medication to treat depression often make that kind of treatment almost worse than the disease. In order to fully comprehend whether a certain drug actually works, it usually must be taken for at least a month. Some depression sufferers may have to go through this process for over a year before they finally find a medication that helps. The frustration and expense and unpleasant side effects associated with these drugs very often lead patients to try alternative treatments including electro-convulsive therapy and hypnosis.

References

Henderson, C. (2014). Women and psychiatric treatment: A comprehensive text and practical guide. London: Routledge.

Kanter, J. W., Busch, A. M., Weeks, C. E., & Landes, S. J. (2008). The Nature of Clinical Depression: Symptoms, Syndromes, and Behavior Analysis. The Behavior Analyst, 31(1), 1–21.

Kupferberg, A., Bicks, L., & Hasler, G. (2016). Social functioning in major depressive disorder. Neuroscience & Biobehavioral Reviews, 69, 313-332. doi:10.1016/j.neubiorev.2016.07.002

Levenson, D., Dr., & Nichols, W., Dr. (2106). Major Depression and Genetics. Retrieved December 10, 2016, from http://depressiongenetics.stanford.edu/mddandgenes.html

Pasquini, M., Berardelli, I., & Biondi, M. (2014). Ethiopathogenesis of Depressive Disorders. Clinical Practice and Epidemiology in Mental Health : CP & EMH, 10, 166–171. http://doi.org/10.2174/1745017901410010166

Sperry, L. (Ed.). (2016). Mental health and mental disorders: An encyclopedia of conditions, treatments, and well-being. Santa Barbara, CA: Greenwood.