This disease hits the news pages almost daily. Juliet Jovit asks questions about what causes depression, who is prone to it and how best to cope with it
What is depression?
People who are depressed do not necessarily go everywhere with stretched faces, or cry at the first opportunity. On the US mental health website, MentalHealth.gov, this disease is defined as “loss of interest in important aspects of life.” Symptoms include an excess or lack of food and sleep; distance from people and ordinary activities; lack of energy; feeling of no meaning, numbness; unusually strong inconsistency and forgetfulness; feeling like you are on the verge of, angry, upset, worried, or scared; thoughts of hurting yourself or others.
An intuitive description is cited by the British
Mind Foundation: “It starts like a sadness, then I feel that I’m disconnected and less and less cope with reality. In the end, I feel numbness and emptiness. "
Depression is often mixed with other health problems: for example, long-term illness, excitability,
obsessive-compulsive disorder or schizophrenia.
The term "
dysthymia " is used to describe long-term and less severe depression - it usually lasts for two years or more.
Ancient disease
I do not know why I'm so sad.
To me this is a burden; I hear you too.
But where I caught the sadness, found Il got.
What makes up what will give birth to her, - I would like to know!
- says Antonio in the play "The
Merchant of Venice ". However, he was not the only character of Shakespeare who was experiencing depression: if Hamlet or Macbeth went to a modern doctor, they would have been prescribed antidepressants. And also Faust, Madame Bovary and Raskolnikov. Dante begins the Divine Comedy like this:
Earth life having come to half,
I found myself in a gloomy forest
Having lost the right path in the darkness of the valley.
And he really groped for something like that.
Clinical depression is not a 21st century problem. It is as old as humanity. New became only its scale. But in this sense it is hard to say whether more people are really depressed today than in the past, or simply they talk about it more.
How many people suffer from depression?
Clinical depression has developed to the scale of the epidemic in recent decades, and has evolved from a rarely mentioned scourge from the outskirts of society into a phenomenon that rarely leaves the news. It has spread in educational institutions and in commercial companies, in refugee camps and cities, on farms and in the suburbs.
It is estimated that 300 million people are suffering from depression at any given time — about 4% of the global population. This follows from the 2015 World Health Organization report. Women are more prone to depression than men.
Depression is the leading global problem, and unipolar depression (as opposed to bipolar) is the 10th on the list of leading causes of early death. The link between suicide, the second most common cause of death for young people aged 15-29, and depression is obvious, and around the world every two minutes two people complete their lives.
And although in the world the figures for depression and other common health problems vary widely, the United States is the “most depressed” country in the world, closely followed by Colombia, Ukraine, the Netherlands and France. At the other end of the scale are Japan, Nigeria and China.
Where does this scatter come from?
A striking contrast between countries has led to the appearance of a depression as a “first world problem” or a “luxury”. The logic is this - if a gun is aimed at your head or you don’t know where you’ll get the money for the next meal, you don’t have time for such self-digging.
Recent studies indicate a whole sea of causes, many of which overlap: in particular, less developed countries often lack the infrastructure to collect data on depression, and there it is less likely to recognize this condition as a disease. Also in these countries, society does not encourage people to talk about their feelings and their residents are less willing to turn to professionals for help.
Statistics is also not so simple as to claim that the rich are depressed, and the poor are not.
One work in the journal Plos Medicine claims that, if we reject the extreme cases, in most countries the number of cases of depression is about the same. It is also argued that depression suffers most in Eastern Europe, North Africa and the Middle East; and most years of disability due to depression lost in Afghanistan, and least of all in Japan.
What causes depression?
Since then, when it was believed that the devil had infiltrated people with mental problems, and when such people were expelled from the community or hung up for witchcraft, the situation had greatly improved. But until now, the understanding of this disease remains extremely distorted, especially the idea that people suffering from depression simply need to “pull themselves together” or “leave the house more”.
The psychiatrist Tim Kanthofer expressed a completely different opinion in his book Depressive Illness: The Curse of the Strong [Depressive Illness: The Curse of the Strong].
He argues that there is a site in the brain called the "
limbic system " [in fact, it is a combination of several brain structures / approx. trans.], acting like a thermostat that controls various functions of the body — including mood — and restores balance after inherent lifts and descents. The limbic system is a circuit of nerves that transmit signals to each other through two chemicals,
serotonin and
norepinephrine , which are not enough for people with depression. According to this description, the depressive illness is basically physical, not psychological.
Kantofer says that under the influence of stress, weak or lazy people give up very quickly; strong people continue to go forward, doubling their efforts, struggle with any pressure that forces them to surrender, and bring the limbic system to the point of failure. However, there is no scientific evidence for this theory, since it is impossible to conduct experiments on the living brain.
It is also accepted that the disease is initiated by the resulting injuries or ill-treatment; genetic predisposition, which may or may not coincide with the history of diseases in the family; life stress, including financial problems or heavy losses; chronic pain or illness; taking drugs, including marijuana, ecstasy and heroin.
There is, although actively contested, the view that extreme stress or certain diseases can cause an overly strong immune response that causes inflammation in the brain, which leads to depression.
Treatment
According to WHO estimates, less than half of people suffering from depression are treated for it. Many receive inadequate assistance, often focused on medications, with a lack of speech therapy, which is considered a critical ally.
Among the pharmacological agents for depression, antidepressants of the group of
selective serotonin reuptake inhibitors , which decrease serotonin absorption and increase its overall level, are most often prescribed. Another popular class of drugs is
selective serotonin and norepinephrine reuptake inhibitors , which work simultaneously with serotonin and norepinephrine.
Among the methods of treatment,
cognitive-behavioral psychotherapy is most often used, which smashes the person’s overwhelming problems into situations, thoughts, emotions, physical sensations and actions aimed at uncovering the vicious circle of negative thoughts.
Other types are interpersonal therapy, behavioral activation, psychodynamic psychotherapy and pair therapy. All types of speech therapy can be used alone, or in combination with medications.
In addition to the medical approach, doctors may prescribe physical activity or artistic therapy, while some patients choose alternative or supportive therapies, the most popular of which are Hypericum, meditation, and yoga.
Trends
The number of types of treatment for depression is increasing, but the problem is not solved, but growing. From 2005 to 2015, the number of cases of depression increased by almost one fifth. The probability of getting this disease in people born after 1945 has increased tenfold. According to WHO, this reflects both the growth of the population and the proportional increase in the number of cases of depression among the most susceptible age groups.
However, in the whole world, the number of suicides has decreased by about a quarter. In 1990, their number was 14.55 people per 100,000 people, in 2016 it was already 11.16 per 100,000.
The key reason for the growth of depression is that medications do not necessarily “cure” the patient, and there are often not enough other methods of treatment that can unfold the situation.
Other reasons for growth are an aging population (in the 60-74 age group, the likelihood of depression is higher than in others), and increased stress and isolation.
What's next?
Over the past 25 years, not a single new antidepressant has been developed, forcing psychiatrists to seek help in other areas.
Were conducted positive experiments with
ketamine and
psilocybin , the active ingredient of the "
magic mushrooms ". Hopes for a new generation of treatment methods appeared after the discovery of 44 mutations, which, according to scientists, increase the risk of depression. Another controversial area of research is the treatment of depressed immunity and the controversial link between depression and inflammatory processes.
Different countries increasingly understand the need to increase the number of psychologists as a substitute or supplement to drug treatment.
Probably the most important thing is a cultural shift that makes it easier for people to seek help and talk about their illness.
Among the celebrities at the head of this shift are the British princes William and Harry, who founded the charity foundation Heads Together, and spoke publicly about their problems. Also, most recently, wrestler and actor Duane Johnson spoke about his depression, and singer Mariah Carey - about bipolar disorder.