Depression: cases, symptoms, treatment (14.02.2014)

What is clinical depression really, how does it look from the outside and from the inside? When should one seek help? American psychologist Joseph Carver discusses this and more in his article, which I have translated for those who do not read the original. Using a simple example with a car, Joseph clearly explains the complex chemistry of the brain.

Joseph M. Carver, practicing psychologist, Portsmouth, Ohio
Translation: Marina Fateeva

Depression is perhaps the most common mental health issue, affecting one in four adults in one way or another. Depression involves mood problems, feelings of sadness, despondency, longing, or apathy. While a depressive mood is present, a symptom also exists that affects the neurochemical aspects of depression or "brain chemistry," when a person with depression struggles with concentration and attention, experiences a loss of energy, increased anxiety, appetite/sleep disorders, and other physical manifestations. When diagnosed, a person with depression typically exhibits at least five of the following symptoms:

• Depressed mood most of the day, nearly every day;
• Noticeable decrease in interest in all or most activities;
• Significant weight loss or decrease in appetite;
• Insomnia or excessive sleeping;
• Psycho-motor agitation or retardation (restlessness);
• Low energy level or chronic fatigue;
• Feelings of worthlessness, loss of self-esteem, and/or self-reproach;
• Decreased attention, concentration, or ability to think clearly;
• Recurrent thoughts of death or suicide, a desire to die.

Causes of Depression:

There can be many causes of depression, but two situations are most commonly encountered:

Sudden serious loss.
This occurs when a person faces an unexpected serious loss. It could be the death of a loved one, loss of a job, friendship, or other grief. In such cases, the client is clearly aware of what is causing the depressive mood.

High level of stress over an extended period.
In this situation, the client is in depression but cannot "point a finger" at the cause, in a state of "I am depressed, but I don't know why." Imagine you are reviewing a video recording of your life over the past 18 months. Look at the stressful situations you have been in, how much responsibility, pressure, and conflict there has been. In clinical practice, this type of depression is more common than sudden loss. This depression creeps up on you gradually. When this happens, the patient often says something like, "I don't know what's wrong!" or "I don't know what I'm feeling," "My feelings seem to have gone numb."

Brain Chemistry and Depression:
The human brain functions like a machine that runs on fluids called neurotransmitters. Just as your car has brake fluid, antifreeze, and oil, your brain operates on neurotransmitters. Some of these provide energy, like those related to adrenaline, some control body movements (dopamine being one example), and some regulate mood.

The neurotransmitter often associated with depression is serotonin. Serotonin is the "oil" for the brain, a relatively slow-acting neurotransmitter that affects sleep, appetite, energy, and mood. Using the car example, imagine you are driving on the highway at high speed for a long distance; the engine is warmed up for a long time, and obviously more oil will be used. As long as we refuel the car, it keeps going. Now imagine that during our journey, after using a liter of oil, we only add half a liter. By the time we arrive, we will be short a few liters, and the engine will overheat.

When stress lasts for a long time, the brain increases its consumption of its oil, serotonin. What this leads to is that the brain burns through more serotonin than it can replenish! As a result, after months of stress, the brain uses serotonin faster than it can produce and replace it. The neurochemical level of serotonin drops, leading to depression.