Depression

Depression is a mental illness that consists of intense emotions of sadness, irritability, and guilt, amongst many other negative emotions.

What is depression (APA, 2021)?

  • Depression is a mental illness that consists of intense emotions of sadness, irritability, and guilt, amongst many other negative emotions

  • What sets apart depression from typical grief or sadness is that depression lasts for two weeks or longer

  • Depression negatively affects emotional and physical wellbeing and often impacts regular bodily function at home and at work

  • Those who suffer from depression also may have thoughts of suicide or self-harming

  • A depression crisis refers to daily loss, grief, detachment, and unachieved dreams and goals due to the impact of depression

 

What are the symptoms of depression (APA, 2021)?

  • Symptoms of depression include:

    • Feeling sad or having a depressed mood

    • Feeling on edge or irritable

    • Feeling “empty”

    • Loss of interests in activities or hobbies you used to enjoy

    • Sleeping too much or too little

    • Fatigue

    • Slowed movement or speech

    • Uncontrollable meaningless physical movements (pacing, fidgeting, handwringing, etc.)

    • Feelings of unworthiness or guilt

    • Difficulty concentrating, thinking, or decision making

    • Thoughts of death or suicide

 

What happens to your brain when you are depressed (Transformations Treatment Center, n.d.)?

  • Depression causes the brain to lose gray matter volume (GMV)

    • The more severe the depression, the more GMV that is loss

    • When we are depressed, our brain does not produce as much cortisol (a hormone that promotes brain cell growth) which causes a decrease in GMV

  • The majority of the brain’s neurons and nerve cells are located in the GMV so when the brain’s GMV decreases, so do cognitive abilities

  • Lack in production of the cortisol hormone causes cerebral areas to shrink and also causes the amygdala to enlarge

    • The amygdala can be thought of as the control center for our emotions. When our amygdala is enlarged, we experience more intense emotions, sleep disturbances, and mood swings

  • The cerebral damage to the brain that is caused by depression affects the following:

    • Your sleep and emotions

      • As stated above, your amygdala is enlarged when you are depressed causing fluctuation in emotions

      • Sleep disturbances are often linked with an enlarged amygdala due to the increased activity in that region

      • As emotions and sleep disturbances are closely linked with one another, this creates a feedback loop which often worsens depressive symptoms even more

    • Cognitive capabilities

      • As a result of cerebral damage, neurons degrade which causes loss in cognitive function

      • Depression also causes stress hormones to release – long-term cortisol hormone exposure can cause neuron development to slow, stop, or even decline

      • Damage to the hippocampus (embedded in the cerebral cortex) causes memory problems, trouble with concentration, and executive dysfunction.

    • Susceptibility to physical issues and illnesses

      • Stress hormones released during depression cause an increased heartrate which could eventually lead to heart issues as our hearts were not made to beat fast for extended periods of time

      • Depression negatively impacts your digestive system which often leads to rapid weight gain causing obesity or even diabetes

      • Many individuals who suffer from depression also use drugs or alcohol to alleviate symptoms which often leads to addiction

 

Patient Story: Living With Depression: My Experience

Depression... it just eats you up from the inside out. It’s like a monster inside your head that takes over. The worst thing is to know that my family and friends were doing all they could, yet I still felt so lonely. Anything that was said to me, I managed to turn into a bad thing. I was literally my own worst enemy. I would come home and feel so exhausted from all the voices in my head that I would just sleep to block it all out. I didn’t want to wake up because living was a nightmare. I felt sick with the fear of nighttime because that’s when the voices got even louder. I would get so frustrated because it seemed impossible to sleep, as if insomnia and depression go hand in hand.

I knew I needed help but asking for it just made me feel like a burden. I wanted to be free of meds, doctors, counsellors, hospitals, and negative thoughts. I felt as if I had lost myself and wouldn’t ever be the same again. I had no motivation to do anything because I couldn't see a future for myself. Anxiety caused me to believe everyone was faking their love for me. ‘Cheer up’ was the worst thing anyone said to me. Those two words triggered thousands of horrible thoughts and I was beating myself up for not hiding how I felt well enough from everyone around me.

I wanted everyone to know how I felt but I didn’t dare tell them. Eventually I just isolated myself in my room because no contact with people meant nothing could go wrong, surely?

At the moment I rely on medication, and I am grateful to have it because I know it has really helped me. At the same time, I balance the wish that I could be free of it with the fear that it might lead to a relapse.

The scariest thing about my whole recovery process is that the only person who can truly help me is me. I have learnt to change my thought processes and stop bullying myself, it's a habit that's been hard to break but I know I've made some positive changes.

2013 was a rollercoaster ride and admittedly one with more lows than highs. I feel I have been to hell and back, but would I change what I have been through? If I was to be totally honest, I don’t think I would. That doesn’t mean that depression is a good thing because it definitely isn’t, but I believe you must turn your negative experiences into positive ones if you can.

If I hadn't been through these things, I wouldn’t have learnt that the most important thing in life is to be happy. I have now received all my university offers to study football business and I can now see a future. I hope to build a career in something that I love, something that will make ME happy, not focusing on what others want from me.

If I was to give one piece of advice to others who are struggling, it would be not to suffer in silence. There are people out there who have been through everything that you are experiencing and have come out on the other side. In fact, their experiences have made them who they are today. It may seem impossible to overcome but believe me, you will get there.

You shouldn't feel guilty for feeling the way you do because depression is an illness like any other, it isn’t any more self-centered than having a broken leg. I was always told to show myself the same respect and concern that I would show for others. We are so accepting of other parts of our bodies breaking, why can't we be that way about our minds too? 

 

Retrieved from: https://www.mind.org.uk/information-support/your-stories/living-with-depression-my-experience/

 

How does depression impact daily living?

  • Depression can cause distress and impairment in occupational, social, and other important areas in one’s life (APA, 2013)

  • Behavioral impacts include (Better Health, 2018):

    • Withdrawing from close family and friends

    • Uninterested in going out

    • Stopping usual enjoyable activities

    • Failing to complete tasks at work or school

    • Relying on alcohol and other substances

  • Physical impacts include (Better Health, 2018):

    • Constant fatigue

    • Feeling ill or “rundown”

    • Frequent muscle pains and headaches

    • Feelings of “knots” in the stomach

    • Sleeping problems

    • Change in appetite

    • Significant weight gain or loss

  • Feelings and moods impacted include the feelings of (Better Health, 2018):

    • Sadness

    • Miserableness

    • Unhappiness

    • Irritability

    • Being overwhelmed

    • Guilt

    • Frustration

    • Lack in confidence

    • Indecisiveness

    • Difficulty in concentration

    • Disappointment

  • Depression can also destroy important relationships. Depression and stress tend to create a self-depriving cycle which distorts our perception of life, especially when it comes to our relationships (McClelland, 2020).

    • In fact, a 2015 study found that romantic relationships were negatively affected by depression in the following ways (PsychCentral, 2019):

      • Emotional toll

      • Lack of romance and sexual intimacy

      • Lack of communication

      • Feelings of isolation

      • Lack of energy and motivation

      • Co-dependency in the relationship

      • Lack of understanding

      • Uncertainty

 

Who is at risk for depression (APA, 2021)?

  • Depression can affect anyone at any age but, there are a few factors that make those more prone to depression than others. These factors include:

    • Biochemistry – chemical differentiation contributes to depressive symptoms

    • Genetics - depression can be hereditary

    • Personality – research shows that those with low self-esteem, who are easily overwhelmed by stress, and are pessimistic are more likely to experience depression

    • Environmental – exposure to violence, neglect, abuse, and poverty

    • Substance use – drugs and alcohol can trigger or intensify depressive symptoms such as loneliness, sadness, and hopelessness (Addiction Center, n.d.)

 

What can depression lead to?

  • Those who suffer from depression may also experience suicidal ideation (SI). This occurs when one experiences suicidal thoughts or ideas (NIH, 2021)

  • Those who are experiencing SI may have thoughts such as:

    • “I don’t want to live anymore”

    • “I would be better off ending it”

    • “Life isn’t worth living”

  • Depression may also lead to suicide, which refers to an individual taking their own life. Suicide is a tragic reaction to life’s stressful situations and is often seen by those suffering from depression to be the “only way to stop the pain” (Mayo Clinic, n.d.)

 

What should I do if I’m having suicidal thoughts?

  • If you are having suicidal thoughts, you need to go to the nearest emergency room, contact your mental health provider, or reach out to crisis resources

    • resources are provided on the last page of this education

 

How can I cope with suicidal thoughts (HelpGuide, 2021)?

  • Things to do:

    • Talk to someone daily – it can be a friend, family member, or even a crisis hotline

    • Develop a safety plan – create a plan with steps you should take when you’re feeling suicidal. This plan should include important contact information (therapist, emergency room, people who will help you in an emergency, etc.)

    • Make a daily schedule – this helps keep you on track and busy throughout the day

      • Make sure you stick to this schedule no matter what!

    • Make time for things that make you happy

    • Get out in the sun for at least 30 minutes a day

    • Get daily exercise – aim for at least 30 minutes a day

    • Strive to achieve personal goals – whether big or small, aim to achieve to work towards your goals in each day as this will help keep your mind busy and gives you a sense of purpose

  • Things NOT to do:

    • Being alone – solitude can make SI and depression even worse

    • Drugs and alcohol – substance use increases depressive symptoms and hinders problem-solving ability, and increases impulsive behavior

    • Doing things to make yourself feel worse – this could be listening to sad music, looking at photographs, visiting a loved one’s grave, reading old hand-written letters, etc.

    • Thinking about negative thoughts – Do your best not to become preoccupied with suicidal thoughts as this will only make the thoughts more intense. Instead, find a distraction to give yourself a break from these thoughts. Even distracting yourself for a short period of time is helpful.

 

If you are feeling suicidal or need someone to talk to, please refer to the following crisis resources:

  • NAMI HelpLine

  • NAMI Crisis Text Line

    • Text NAMI to 741-741

  • COPE (Hennepin County)

    • Adult: 612-596-1223

    • Child: 612-348-2233

  • Ramsey County

    • Adult: 651-266-7900

    • Child: 651-266-7878

  • Text Connect (Crisis counseling via text)

    • Text “HOME” to 741741

  • National Suicide Prevention Line

    • 800-273-8255

 

 

References

 

Addiction Center. (n.d.). Understanding depression.

 https://www.addictioncenter.com/addiction/depression-and-addiction/

 

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental       

disorders DSM-5 (5th ed.).  American Psychiatric Publishing.

 

American Psychiatric Association (APA). (2021). What is depression?

https://www.psychiatry.org/patients-families/depression/what-is-depression

 

Better Health. (2018). Depression Explained.

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/depression

 

HelpGuide. (2021). Are you feeling suicidal? https://www.helpguide.org/articles/suicide-

prevention/are-you-feeling-suicidal.htm#   

 

Mayo Clinic. (n.d.). Suicide and suicidal thoughts. https://www.mayoclinic.org/diseases-

conditions/suicide/symptoms-causes/syc-20378048

 

McClelland, J. (2020). How depression can affect relationships.

https://www.tmswashington.com/2020/06/26/how-depression-can-affect-relationships/

 

National Library of Medicine (NIH). (2021). Suicidal Ideation. 

https://pubmed.ncbi.nlm.nih.gov/33351435/

 

Transformations Treatment Center. (n.d.). What happens to the brain during depression?

https://www.transformationstreatment.center/treatment/what-happens-to-the-brain-during-depression/

PsychCentral. (2019). How depression affects relationships and what you can do.

https://psychcentral.com/depression/how-depression-affects-relationships#takeaway