Depression falls into the broader category of mood disorders . In fact, they are psychiatric pathologies that involve psychological alterations, characterized by prolonged periods of excessive sadness (depression), excessive cheerfulness or exaltation (mania) or both.
Hence, we speak of mood disorder when sadness or exaltation are very intense, accompanied by other typical symptoms, and interfere with the person’s normal life activities, physically, socially and at work. In cases of depression alone , we speak of unipolar disorder. Instead, in bipolar disorders, episodes of depression and mania alternate.
Depressed people feel inadequate to cope with life situations and consider themselves inferior to others. This perception implies a profoundly negative vision of the individual and of all his existential perspective (past, present and future).
But what are the causes of depression ? Unfortunately they are still unknown and probably include hereditary factors , changes in neurotransmitter systems, changes in neuroendocrine function and psychosocial factors. In fact, the diagnosis is mainly based on the anamnesis, while the treatment includes pharmacotherapy, psychotherapy or both and, if necessary, electroconvulsant therapy at specialized centers.
Finally, after anxiety, depression is the most common mental illness and the percentage of people who suffer from it seems to increase steadily over time. In fact, the World Health Organization ( WHO ) has predicted that in a few years , depression will be the second leading cause of disability due to illness , immediately after cardiovascular disease.
Depression: what it is
The term “depression” derives from the Latin depressio and indicates a profound state of sadness and depression , perceived by the person with extreme suffering and discomfort.
In fact, the word is also often used to describe an anguished or discouraged mood , which can arise from emotionally distressing events, such as:
- natural disaster
- serious illness
- death of a loved one.
However, such a mood is not usually a disturbance. In fact, in general, it is temporary, lasts a few days and is mainly linked to the memory of the event. Furthermore, it does not interfere substantially with the individual’s functions.
Difference between depression and sadness
It would be more correct to define these moods as demoralization and pain / mourning. Unlike depression, they look like this:
- wave pattern, linked to thoughts or memories of the triggering event
- resolution when circumstances or events improve
- intervals between negative and positive emotions and mood
- absence of pervasive feelings of worthlessness and self-loathing.
Instead, depression is a feeling of sadness so intense and persistent that it compromises a person’s normal activities. In a general sense, at least two types of depression can be distinguished : endogenous and reactive .
Endogenous and reactive depression
- endogenous : it can occur suddenly, in full well-being, and in the absence of stressful events or factors.
- reactive : occurs following a triggering event, with an excessive reaction compared to the event, which lasts longer than normal. It is characterized by apathy and anhedonia , that is, the loss of interest and pleasure in aspects of one’s life previously appreciated. The latter is the symptom to which specialists in the sector give greater relevance than other clinical manifestations.
Postpartum depression is characterized by a state of profound sadness, associated with psychological disorders (mood swings, crying, irritability and anger), which can occur in the first weeks or in the first months after giving birth.
However, feeling a sense of melancholy after giving birth, sadness and discomfort, is quite common. However, these sensations tend to wear off within two weeks. Instead, postpartum depression is a more intense mood alteration and persists for weeks or months . About 10-15% of women suffer from it .
It rarely develops into a more serious disorder, postpartum psychosis, in which depression can be associated with thoughts of suicide or violence, hallucinations or bizarre behavior (the desire to harm the child may also manifest).
Seasonal depression is a form of depression that occurs at specific times of the year , generally in winter, and involves:
- mood alteration
- feeling of tiredness
- craving for carbohydrates.
However, these symptoms subside with the arrival of spring.
Throughout history, depression was described as “melancholy” , a word introduced by Hippocrates in the treatise “On the nature of man”.
In fact, Hippocrates thus described a condition associated with symptoms such as:
- refusal of food
Then, he believed that melancholy was a psychological manifestation of an organic disorder that had to do with the presence of black bile and mucus in the brain. Teofrasto and Galeno who contributed to the description of the phenomenon should also be remembered.
Instead, in the Middle Ages, the cause of depressive states was attributed to the devil , to occult magical forces or to sin.
It is only at the end of the 19th century that the German psychiatrist Emil Kraepelin described the disease based on accurate observations and descriptions, distinguishing psychotic illness from other forms of mental illness. He described the manic-depressive madness characterized by “periodic circular insanities”, “mania” and “melancholy” , outlining with this term a lowering of mood and a slowing down of physical and mental processes.
Instead, in 1911, the German psychoanalyst Karl Abraham published the first psychoanalytic study on depression, comparing depression and anxiety and analyzing some of the reasons of an unconscious nature underlying the sense of guilt.
Depression and mourning
Even Sigmund Freud in “Mourning and Melancholy”, in 1917, highlights the unconscious dynamics underlying depression, comparing them with those of mourning. In fact, according to Freud, the pain caused by mourning lasts a certain period of time . If the subject fails to process the mourning and overcome this phase, also feeling a sense of guilt and unworthiness, then the pain turns into depression .
Freud realizes that what appears to be self-accusation and guilt is actually a guilty rebuke directed at the lost, loved and hated person at the same time.
Instead, in 1924 the Swiss psychiatrist Eugen Bleuler described depression by introducing sub-categorisations into unipolar and bipolar diagnostic groups , thus anticipating future nosology.
In just under a decade, the incidence of depression on the world population has increased by 18.4%. In fact, it affects almost 5 in 100 people (4.4%) . So, translated into numbers, there are about 300 million individuals affected by this disease. It is a condition that knows no boundaries.
According to WHO data, the incidence of depression is different according to gender: women are more depressed than men, 5.1% against 3.6%. These data also vary according to age , with a peak among the elderly and adults: 7.5% of women aged 55-74, while men 5.5% .
But, it can also affect children and adolescents under the age of 15, with a lower incidence than adults.
Hence, depression is considered to be among the main pathologies that cause disabilities and, according to 2015 data, about 780,000 depressed people have committed suicide. To this figure must be added all cases of attempted suicide (suicide is among the top 20 causes of death in the world).
Furthermore, the statistics change according to the nation , gender or social class to which they belong: where the income is lower, around 78% of the registered cases are concentrated.
Also according to the WHO, depression, by 2020, will become the second most common cause of disability due to illness.
The causes of the onset of depression are not yet known. However, according to studies, risk factors include :
- family predisposition (inheritance)
- emotionally stressful events, especially if they involve mourning or loss
- female sex due to changes in hormone levels
- some related ailments and / or pathologies
- side effects of some medications.
However, depression should not be confused with character weakness and may not be due to a personality disorder, childhood trauma or difficult relationship with parents.
The stressful events that can facilitate the development of depression are:
- physical illness
- marital separations
- difficulties in family relationships
- serious conflicts and / or misunderstandings with other people
- important changes of role, home, work
- professional or economic bankruptcies
- be victims of a crime or abuse even in childhood
- loss of a loved one
- end of an engagement
- problems with justice
- failures at school.
The genetic factors contribute to the development of depressive disorders in about half of those affected . For example, it is most commonly found among first degree relatives of people with depression. In fact, genetic factors are able to affect the functioning of neurotransmitters , the substances that allow communication between nerve cells. Among these, serotonin , dopamine and norepinephrine .
In fact, most of the communication between the cells of the nervous system takes place thanks to neurotransmitters. An altered activity of these substances can lead to a different functionality of specific brain areas that regulate:
- sexual desire
Depression and female sex
According to statistics, women are more likely to suffer from depression than men and the reasons are not yet fully understood. But, among the biological factors under study, hormones are at the forefront.
In fact, changes in hormone levels can induce mood changes shortly before menstruation (premenstrual syndrome), during pregnancy and after childbirth ( childbirth melancholy or, in more serious cases, postpartum depression). Another factor, quite common among women, are changes in thyroid function .
The causes are not yet clear, but the following conditions can contribute or increase the risk:
- postnatal depression
- postpartum depression in a previous pregnancy
- previous episodes of sadness or depression that occur at certain times of the month (related to the menstrual cycle) or for taking oral contraceptives
- depression already present or developed during pregnancy
- familiarity with depression
- sudden decrease in hormone levels after childbirth
- stressful situations (marital problems, financial difficulties, absence of a partner)
- lack of support from partner or family members
- pregnancy-related problems (such as preterm birth or birth defects in the baby)
- ambivalence about the ongoing pregnancy (for example because it was not foreseen or because one wanted to terminate it).
If left untreated, it can last for months or even years.
Illness and depression
Depression can also be related to or caused by certain pathologies and organic factors, including:
- thyroid disorders
- adrenal gland disorders
- benign and malignant brain tumors
- Parkinson’s disease
- Multiple sclerosis
- Lupus, etc.
In fact, often, a physical pathology can cause depression , both directly and indirectly. For example, AIDS can be a direct cause if the virus compromises brain functions , but also indirectly due to its negative impact on the subject’s life.
Prolonged use of some medications can also cause depressive states, such as beta blockers (also used to treat hypertension) or corticosteroids.
Depression: symptoms and classification
An episode of depression usually lasts about 6 months , if left untreated, but sometimes persists for 2 or more years and generally recurs several times during existence.
It is therefore a state of subjective suffering characterized by symptoms:
- emotional-affective (depressed mood, loss of interest and pleasure, feelings of helplessness and despair, guilt, shame, worthlessness, unworthiness, inferiority)
- cognitive (negative thoughts about oneself, negative vision of the world and life, negative expectations about the future, suicide ideas)
- psychomotor slowdown
- neurovegetative (insomnia and decreased appetite) and physical (pain, fatigue, gastrointestinal complaints).
The clinical context is that of “mood disorders” which compromise the quality of life and entail an altered relationship with reality.
Symptoms: postpartum depression
The main symptoms of postpartum depression are:
- irritability and bad mood
- loss of interest in daily activities and in the child.
According to the DSM-5 guidelines , based on the duration and severity of the depressive symptoms and the degree of impairment of social and working life, depressive disorders are divided into:
- major (DDM – Unipolar Disorder)
- persistent or dysthymic
- premenstrual dysphoric
- not otherwise specified
- of Mood Due to General Medical Condition.
DDM: major depressive disorder
The diagnosis of a major depressive disorder requires the presence of at least five specific symptoms, present for at least 2 weeks:
- depressed mood for most of the day
- marked decrease in interest or pleasure in all or almost all daily activities
- weight gain or loss or decrease or increase in appetite
- insomnia or hypersomnia
- psychomotor agitation or slowdown
- asthenia or loss of energy
- feelings of self-evaluation or excessive or inadequate guilt
- decreased ability to think and concentration or indecision
- recurring ideas of death or suicide.
In addition, people with this disorder often report that they have lost the ability to experience emotions and hope for recovery. But, in some cases, these beliefs take on a delusional (delusion of guilt, ruin, bodily denial) or hypochondriac character. Sometimes, people with DDM also report hallucinations , in the form of accusing voices or visions of deceased people, accompanied by a strong sense of guilt.
About 60% of subjects may experience a second depressive episode during life . These episodes can resolve completely, partially, or never resolve (in about a third of cases).
Persistent depressive disorder
It is characterized by a chronically depressed mood , which lasts for most of the day, for at least 2 years . The onset is often early and the course is chronic.
The debut depressive symptoms usually subtly nell’adolescenz to and can persist for many years.
For the diagnosis of Persistent Depressive Disorder, subjects must exhibit the following symptoms :
- poor appetite or hyperphagia
- insomnia or hypersomnia
- low energy or tiredness
- low self-esteem
- poor concentration or difficulty in deciding
- feelings of despair.
Premenstrual syndrome and depression
Premenstrual dysphoric disorder is related to the menstrual cycle, with onset during the premenstrual phase and a symptom-free interval after menstruation.
The manifestations are similar to those of premenstrual syndrome, but are more serious, causing significant discomfort and / or impairment of the person’s social or work functioning. Prevalence is estimated at 2 to 6% of women with a menstrual cycle .
For diagnosis, the presence of the following symptoms is required during the week before menstruation. Symptoms must return within a few days after the start of the menstrual cycle, to end in the week after menstruation.
- Mood swings
- Irritability or anger
- Strongly depressed mood, feelings of despair or self-contempt
- Marked anxiety, tension or a feeling of being “on the thorns”.
Depressive disorder not otherwise specified
This disorder includes depressive manifestations that do not fall under the aforementioned disorders.
It is characterized by recurrent periods of dysphoria (pathological mood alteration), associated with other depressive symptoms that last for at least 2 weeks, and by periods of depression that last longer, but whose symptoms do not allow a clear diagnosis of depressive disorder. specific .
Mood disorder due to general medical condition
It is a significant and persistent mood alteration characterized by depressed and / or irritable mood and by anhedonia (inability to feel pleasure). From the anamnesis and clinical investigations it is clear that the alteration is the direct physiological consequence of a general pathological condition .
However, it should not be confused with the subject’s “depressive reaction” to an illness.
Depression and clinical specifiers
Major depression and persistent depressive disorder may include one or more clinical specifiers representing additional manifestations during a depressive episode:
- anxiety : the subject is tense and restless; has difficulty concentrating and experiences a state of strong concern about what could happen
- mixed characteristics: there are at least 3 manic or hypomanic symptoms (high mood, sense of grandeur, greater talkativeness, flight of ideas, sleep disturbances). These individuals are at risk of developing bipolar disorder.
- Melancholy : the subject does not respond to usually pleasant stimuli. Feels depressed or desperate, feels an excessive sense of guilt; there is also a psychomotor slowdown, agitation or significant weight loss.
- Atypia : the mood of the subject temporarily improves in response to positive events (for example, a visit by children). It has at least 2 of the following symptoms: excessive reactions to criticism, a feeling of paralysis (a sense of heaviness or fatigue, usually in the extremities), weight gain or appetite and hypersomnia.
- Psychosis : the subject is affected by delusions and / or hallucinations. Delusions often involve unpardonable sins or crimes, incurable diseases, defects to be ashamed of or feeling persecuted.
- Hallucinations can be auditory (accusatory or convicting voices) or visual.
- Catatonia : the subject presents a severe psychomotor retardation which can be characterized by grimaces and repetitions of words (echolalia) or movements (echopraxia).
Depression and comorbidity
Co- morbidity is defined as the coexistence of two or more physical or mental disorders or illnesses in the same individual. Pathologies occur simultaneously or sequentially, including as a related medical condition. However, distinguishing comorbidity from complication is not easy, especially in multifactorial diseases.
In the case of depression, the list of related pathologies is long. For example, major depression is often associated with eating disorders , such as addiction to food, chronic pain, cardiovascular disease or stroke.
Furthermore, depressive symptoms are evident in many pathologies of the central nervous system (CNS), in particular in subjects affected by neurodegenerative diseases, such as Alzheimer’s and Parkinson’s , but also in ischemic brain pathologies.
Then, depression and dementia are frequent disorders in the elderly population. But, most of the time they coexist and it is still not clear if depression represents a risk factor for dementia or if the coexistence of the two pathologies does not have direct casual relationships.
Depression and Parkinson
The association between depression and Parkinson’s is very frequent and on average it affects about 40% of the subjects affected by this disease.
However, it can be present already years before the onset of motor symptoms, affecting 15% of the subjects in the initial stages of the disease and 25-70% after 5-7 years.
Therefore, the evaluation of the clinical picture requires particular attention since some symptoms can be interpreted as an expression of both the depressive process and the primary neurodegenerative process, such as:
- hypomimia (poor variability of facial expression)
- slowing of speech
- motor delay
- loss of appetite.
Depression and epilepsy
Epilepsy is often associated with psychiatric disorders. They are mainly mood disorders (especially depression), psychotic disorders and cognitive disorders. They can precede the diagnosis of epilepsy, arise in conjunction with this or in later times. The main pathogenetic factors are:
- clinical (causes and seat of the epileptogenic zone, or the part of the brain responsible for the seizures)
- psychosocial (fear of crises and social stigma)
- biological (damaged brain areas related to psychic function)
- pharmacological (cognitive and psychic side effects of antiepileptic drugs, especially in the presence of depressive symptoms.
In fact, in the context of psychiatric comorbidities, depression represents the most frequent disorder , affecting 20-50% of subjects with recurrent crises and 3-9% with controlled crises.
The diagnosis of depression is mainly based on the clinical evaluation . In addition, blood tests can also be helpful to rule out physical ailments that can cause depression.
- thyroid hormone (TSH)
- vitamin B12
- folate levels.
Identification of symptoms is essential. But, the difference between depressive disorders and mood swings is mainly due to significant suffering or significant impairment of social and professional functioning.
Depression rating scale
There are several standardized questionnaires to identify some depressive symptoms, but they are not enough for the diagnostic definition. The most common is the Hamilton Depression Rating Scale . It is a suitable tool for quantitatively assessing the severity of depressive symptoms and for documenting changes, also based on treatments. It is made up of 21 items. The gravity is usually determined by the sum of the first item 17 , considered the main ones for the evaluation of the degree of depression:
- ≥25 severe depression
- 18-24 moderate depression
- 8-17 mild depression
- ≤7 absence of depression.
Severity level of depressive disorders
The level of severity of depressive disorders is mainly given by the degree of suffering and disability (physical, social, occupational) and the duration of the symptoms.
Hence, it is important for the physician to ascertain negative and self-injurious thoughts , previous threats and / or suicide attempts and other risk factors. Even a family history of depression can help confirm the diagnosis.
In the elderly , depression can be difficult to detect, especially in retired individuals, who have poor social contacts or economic difficulties. In fact, it can be confused with dementia , because it presents similar symptoms, such as:
- difficulty concentrating
- clarity of thought.
However, if these symptoms are caused by depression, they tend to come under proper care; in the case of dementia, however, they persist.
There are no tests that can confirm a diagnosis of depression, but laboratory tests can help the doctor determine if the depression is due to a physical pathology or to a hormonal disorder . For example, blood tests are usually prescribed to check for a thyroid disorder or a deficiency of vitamins , or especially in young people to detect drug abuse.
A thorough neurological examination may be useful to exclude or confirm the presence of Parkinson’s disease, while for subjects with severe sleep disturbances a specific examination (polysomnography) may be necessary to distinguish sleep disturbances from depression .
Depression: cure and treatments
The treatment of depression depends on the level of severity and the type:
- mild : support from doctor, family members and psychotherapy is sufficient
- moderate / severe : drugs, psychotherapy or both are required
- in severe cases an electroconvulsive therapy.
Hence, it is important for the doctor to make weekly visits and explain to the subject and their family members that depression is a disease and not a symptom of character weakness . But, the recovery path can experience positive moments and setbacks. For this reason it is essential for the subject to know the disease well and to continue the treatment without giving up.
Being more active (walking and exercising regularly) and intensifying social relationships can also be of great help.
Support groups are also an excellent resource for sharing common experiences and feelings.
Several types of antidepressant drugs are available:
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- New generation antidepressants
- Tricyclic antidepressants
- Ketamine-like drugs.
Most antidepressants must be taken regularly for several weeks before they begin to take effect. In fact, it is a time of 6-12 months to avoid relapses . The treatment can use only one drug or a combination of drugs. Side effects vary based on the type of antidepressant.
Selective Serotonin Reuptake Inhibitors (SSRIs)
They are currently the most commonly used and effective class of antidepressants and to treat depression and other mental illnesses that often coexist with depression.
These are selective serotonin reuptake inhibitors (SSRIs), which inhibit, at the level of presynaptic nerve receptors, the reabsorption of serotonin (also known as the “good mood hormone”).
Although SSRIs can cause nausea, diarrhea, tremors, weight loss, drowsiness and headache, these side effects are usually mild or disappear as treatment continues.
However, prolonged use can lead to other side effects , such as weight gain or loss and sexual dysfunction (in one third of people).
New generation antidepressants
They are functioning drugs like SSRIs, have similar side effects and also act on other neurotransmission systems, such as noradrenergic (SNRI).
Hence, they have a therapeutic efficacy superior to tricyclic drugs and a significant reduction of side effects. They are also suitable for those categories of subjects, such as the elderly and heart patients , for whom tricyclics are not recommended.
They are the least used antidepressant drugs today because of the side effects . In fact, they can induce:
- increase in body weight
- blurred vision
- dry mouth
- confusional state
- difficulty starting urination.
- Ketamine-like drugs
Ketamine is an anesthetic drug. However, the researchers found that brain mechanisms influenced by ketamine play a role in the appearance of depressive disorders. The Food and Drug Andministration ( FDA ) recently approved esketamine, a derivative of ketamine, for the treatment of people with major depressive disorder who do not respond to traditional treatments. However, in Italy the drug is not yet approved at ministerial level.
Indeed, side effects include increased blood pressure, nausea and vomiting . Instead, on a psychic level, they can manifest themselves:
feeling of disconnection from oneself (derealization)
feeling of a distortion of time and space
So, the drug is usually administered in a doctor’s office or hospital , to keep the person under observation for a few hours.
Side effects of antidepressants
Antidepressants and suicide risk
The diagnosis of depression must be made carefully to rule out some particular clinical pictures.
In fact, in these cases, the administration of antidepressants could facilitate the appearance of suicidal ideations. In addition, family members should be advised that, in some cases, individuals receiving drug treatment with antidepressants may appear more agitated, depressed and anxious within a week of starting treatment or increasing the dose.
Hence, in these circumstances it is important to keep the situation under control because in some subjects it may increase the suicidal risk if agitation, the increase in depression and anxiety are not quickly detected.
According to several studies, antidepressants in general are associated with an increased risk of suicidal ideation and suicide attempts in patients under 24 years of age. In this, there is no particular difference between the classes of antidepressants. However, scientific evidence is not yet adequate to demonstrate this association.
Depression and psychotherapy
In cases of mild depression, psychotherapy can have the same effectiveness as drug therapy. Instead, in the most serious depressive disorders both drugs and psychotherapy are needed.
Therefore, the elements that can guide the doctor in choosing the psychotherapy treatment, alone or in combination with the pharmacological one, are the following:
- psychosocial stressors
- intrapsychic conflicts
- interpersonal difficulties
- comorbidity with personality disorders.
Furthermore, the choice of the type of psychotherapy to be undertaken depends on various factors :
set goals of therapy
response obtained from previous psychotherapies
needs and characteristics of the subject.
For example, psychotherapy should be the first choice treatment if depression occurs during pregnancy and while breastfeeding.
Cognitive behavioral therapy
Cognitive-behavioral therapy is composed of a set of interventions based on a specific premise: subjects suffering from major depression have cognitive distortions and maladaptive behavioral patterns that contribute to the appearance and maintenance of depressive symptoms.
Developed by Aaron Beck in the 1960s, this approach has undergone numerous efficacy studies. According to Beck’s cognitive model, depression is caused by the way people interpret and internalize the adverse experiences of life .
Negative beliefs are triggered by unfavorable events that produce negative thoughts about yourself, the world and the future, resulting in a negative mood.
Cognitive therapy therefore aims to modify the subject’s negative thoughts to facilitate the change of mood and improve the ability to manage stress.
It is a rather short and particularly suitable approach in the treatment of major depressive disorder , especially in cases of postpartum depression , in adolescents and the elderly.
This psychotherapy originates from the theories of Harry Stack Sullivan and Frieda Fromm-Reichmann , who have focused attention on family and environmental factors in the development of psychopathology. Hence, the goals of interpersonal psychotherapy are to improve interpersonal relationships and reduce depressive symptoms .
Recently numerous studies have highlighted the validity of group therapies to improve depressive symptoms. It is an approach that has proven to be very effective in subjects with major depression , especially if it derives from a significant mourning or if in comorbidity with physical pathologies.
Therapy for those who live with a depressed person
About 60% of people with major depression live with their family members, who often experience daily, practical and psychological management of the disease with great difficulty. So, to improve the family atmosphere, some psychotherapeutic approaches have been developed, such as
- systemic-family therapy
- family counseling
- psychoeducational interventions.
In particular, the family psychoeducational intervention has the aim of:
- provide information to subjects and their families on the disease, symptoms, course and treatment, recommending practical strategies for managing the side effects of drug therapy
- improve communication within the family
- enhance the problem-solving skills of the family unit
- encourage the social participation of all family members.
Furthermore, some studies have shown that the family approach improves the effect of drug treatments, the social functioning of the subject, leading to a significant reduction in relapses .
Other therapies to treat depression
It is sometimes used in people with severe depression who threaten suicide or refuse food. It is generally a very effective therapy and can quickly improve depressive symptoms. However, it is necessary to turn to highly specialized centers and in Italy there are not many.
In electroconvulsive therapy (known as electroshock ), electrodes are positioned on the subject’s head for the passage of an electric current. This induces a convulsion in the brain which, for unknown reasons, can improve serious depressive disorders.
Phototherapy (or light therapy ) is the most effective treatment for seasonal depression . It can also be useful for other types of mild depressive disorders.
This technique involves exposing yourself to a certain distance from a light source that emits light at a particular intensity. But, you don’t have to look at the light directly and you have to stay exposed for at least 30-60 minutes a day.
Repeated transcranial magnetic stimulation
It is a non-invasive technique for electromagnetic stimulation of the brain area that is believed to regulate mood. The electromagnet produces painless impulses that stimulate nerve cells to release chemicals, neurotransmitters, which help modulate mood and can relieve the symptoms of depression. However, this therapy may be suitable for people with severe depression who do not respond to pharmacological and / or psychotherapeutic treatments.
Vagus nerve stimulation
It is a neurostimulation therapy used in subjects with even chronic depression who do not get results with drug treatments. The vagus nerve , fundamental structure of the autonomic nervous system, performs various functions including:
- motility of the stomach and intestines
- heart rate regulation
- transmission to the brain of all information concerning the viscera.
In this technique we use a device that generates electrical impulses (pacemaker type). It is implanted in the armpit and connected to the vagus nerve in the cervical area via a subcutaneous wire. Thus, impulses, stimulating the nerve, increase the activity causing , in some subjects, an improvement in mood. It can be performed in specialized centers, although there are not many in Italy.
What is the prognosis in depression ? The perspectives are different and depend on the severity of the condition:
the average duration of a depressive episode is 6/8 months and in case of mild depression spontaneous healing is possible;
in cases of major depression , about 80% of subjects, despite treatment, may incur another episode in their life, with an average of four episodes;
the outlook is not the best : according to studies, only about a third of the subjects manage to feel good for more than 10 years, while for about 20% the course is chronic.
Surely the timeliness of the diagnosis and adequate therapy guarantee a good prognosis. In addition, life expectancy is highly dependent on the severity of the depressive disorder. In more severe cases, it can be shorter, not only because of the risk of suicide , but because they are in any case the most vulnerable subjects for some pathologies such as heart disease, for example.
Diet and depression
Can a balanced diet reduce the symptoms of depression ? According to a study published by the journal PLoS ONE it is possible.
The research involved 76 men and women, aged between 17 and 35. All had depressive and anxiety disorders and consumed a significant amount of fat and sugar .
The subjects were divided into two groups . A first group followed the instructions of a dietician to healthier diets, the Mediterranean diet pattern :
- 5 servings of vegetables per day
- two or three fruit
- Whole grains
- lean meats.
In addition, the daily consumption of three tablespoons of nuts and seeds, two tablespoons of olive oil and a teaspoon of turmeric and cinnamon was also recommended . Finally, requests were made to reduce refined carbohydrates, sugars, fatty or processed meats and drinks.
Instead, the second group continued to eat as before.
After three weeks of a healthier diet, the symptoms of depression in the first group decreased, while they remained unchanged in the group that maintained the usual diet.
So, according to the researchers, some macro and micronutrients make the difference:
- omega 3 fatty acids
- vitamins B1, B9, B12, D, E.
In fact, these nutrients determine the stabilization of the neuronal membrane and have an anti-inflammatory effect .
Sports and depression
Sport is one of the best antidepressants available. In recent years, numerous studies have shown that people with major depression live less long, especially for an unhealthy lifestyle, including incorrect eating habits, poor exercise, nicotine addiction and substance abuse.
The importance of physical health in people with depressive and mental disorders in general has led to the development of numerous psychosocial interventions. The goal is to promote new lifestyles to reduce mortality and the risk of metabolic (for example, obesity and diabetes) and cardiovascular diseases.
Benefits of sport on the mind
In fact, exercising produces a series of physiological and psychological effects that improve mood and self-esteem, reducing stress and anxiety levels . Among these are: reduction in blood pressure, weight loss, increased levels of endorphins, the modulation of neurotransmitter production and the hypothalamic-pituitary-adrenal axis, in charge of the stress response.
The psychological effects should not be underestimated. Moving, doing gymnastics or any other activity, leads the subject to distract himself for a while from the sense of negativity that pervades him, from the feelings of loneliness and sadness and increases the sense of self-efficacy and self-esteem.
Research on the beneficial effects of sport in depressed subjects is many and in some cases have shown that physical activity can be a valid alternative to drugs .
Because sport is good
Exercise improves depressive disorders because:
- stimulates the body to release endorphins
- It reduces the level of cortisol in the blood, the hormone involved in stress and depression
- helps to see life with more optimism
- induces a feeling of satisfaction that helps increase self-esteem
- increases the level of serotonin.
What type of physical activity is most suitable for those suffering from depression? Anything, from cycling to swimming, from walking to volleyball. Even gardening is indicated. The important thing is to be constant and practice the exercises at least two or three times a week.
Yoga and depression
Even the yoga seems to have better effects of an antidepressant. If the physical and mental benefits of yoga have been known for some time, a recent study by Boston University has confirmed this. By practicing yoga twice a week, the symptoms of depression can be alleviated. How? Thanks to the combination of asanas (the yoga postures) and deep breathing .
The study, published in the Journal of Alternative and Complementary Medicine , examined a sample of 30 people aged between 18 and 64 with depressive disorders.
After about three months, they underwent a questionnaire to assess the level of depression . For all subjects there was a decrease in symptoms of at least 50%. All those who had taken three weekly lessons had a lower depression score than those who had limited themselves to two weekly practices.
When it comes to preventing depression, especially major depressive disorder, a distinction must be made between primary and secondary prevention .
Primary prevention aims to identify risk factors that may favor the development of a depressive state. For the family it is a question of recognizing any changes in the subject’s mood, promptly directing him / her to specialist figures, avoiding “do it yourself”. For the doctor, it is a matter of recognizing the first signs or symptoms of a depressive state to avoid the evolution towards full-blown depression.
Instead, secondary prevention is to reduce the risk of relapse and the chronicity of the disease. In fact, about 50% of people who have had a first episode of depression incur a second episode.
In addition, when the first episode occurs at a young age (before the age of 20) or in old age, the possibility of relapse increases.
How to prevent postpartum depression
After giving birth, it would be useful to take some precautions:
- rest as much as possible
- get help from friends and family
- talk to someone about your feelings
- take a shower and get dressed every day, don’t let yourself go
- go out as much as possible (running errands, meeting friends or going for a walk)
- spending time with your husband or partner
- talk to other mothers about common experiences and emotions
- attend a support group
- admit that tiredness and doubts about the ability to be good mothers are normal in new mothers and that usually these effects cease with time.
How can relapse of depression be prevented
International guidelines on the treatment of depression recommend:
- in the case of drug therapy, the administration of antidepressant drugs for about 6 months after the acute episode
- in subjects with high risk of relapse, continuation of drug treatment, at full dosage, for at least 2 years from the first episode of depression.
Instead, as regards psychotherapy , the guidelines recommend, for both cognitive-behavioral treatment and interpersonal therapy, a duration of 3-4 months for the acute depressive episode, followed by another 3-4 control sessions.
Finally, it is very important to avoid rumination , that is, to focus on negative thoughts. Ruminating on thoughts, losses, failures, on the sense of inadequacy, leads to staying focused only on unfavorable aspects, increasing suffering and therefore depressed mood.