depression symptoms, causes and treatment

Symptoms, Causes and Treatment of Depression

Depression treatment usually involves addressing its immediate symptoms and delving into its underlying causes and mechanisms.

Depression and anxiety are the psychological equivalents of fever in that they are nonspecific responses to an enormous range of underlying conditions. J. Shedler, Psychologist & Researcher

Consequently, alongside alleviating depression symptoms, such as sadness, hopelessness or self-blame, depression therapy needs to address the causes of these responses.

The Concept of Depression

Over the centuries, people have explained depression diversely and divided it into various types. The ancient Greeks, who fashioned the Hippocratic way of medical practice, clearly described something called “melancholia”. They believed that “black bile” (melancholia), represented one of four human corporal substances (humours) comprising different personality types. However, they view depression as a complex physiological phenomenon. They defined depression not by the normal presence of black bile but rather by a surplus of it.

Dorothy Rowe, a  UK psychotherapist and psychiatrist, equates depression to being placed in jail, with six fixed and rigid beliefs serving as guards:

  1. No matter how decent and adequate I may appear, I am wicked and worthless 
  2. I have to be afraid of, envy and despise people around me.
  3. Life is appalling and death is worse.
  4. I experienced only evil things in the past, and only bad things will happen in the future.
  5. Getting angry is wrong.
  6. I must never forgive anyone, including myself.

Such incarcerated states of mind dramatically affect the quality of life of those who suffer from them and their environment.

Diagnostic Criteria of Major Depressive Disorder (MDD) and Symptoms of Depression

The DSM-5 diagnosis of major depressive disorder (MDD) takes into account symptom persistence, severity and combination. In addition, the symptoms comprise behavioural, physical and cognitive manifestations. MDD is a superordinate class of diagnosis, with subclassifications based on the duration and severity of symptoms.

For the MDD diagnosis, one must have at least five out of nine symptoms for a minimum of 2 weeks. Furthermore, at least one of the two core symptoms (depressed mood and the loss of interest or pleasure in activities) must be present.

The core symptoms are defined as:

  • Depressed mood;
  • Loss of interest or pleasure in activities;
  • Loss of energy, fatigue;
  • Feeling worthless or excessively guilty;
  • Recurrently thinking of death, having suicidal thoughts or attempting suicide;
  • Weakened capacity to focus or make decisions;
  • Psychomotor retardation or tension;
  • Insomnia, hypersomnia;
  • Significant loss of appetite or weight.

 Based on this list, clinicians can formulate four comprehensive diagnoses of unipolar depression:

  • Subthreshold – less than five symptoms.
  • Mild – evidence of the five symptoms required to make the diagnosis, and the symptoms cause only minor functional impairment.
  • Moderate – symptoms or functional weakening are between mild and severe.
  • Severe – most symptoms are present and noticeably interfere with daily functioning.

Moreover, the DSM-5 mentions seasonal affective disorder, post-partum depression, catatonic and atypical depression, melancholia and premenstrual dysphoric disorder as subtypes of MDD.

Causes of Depression

Given the multifaceted nature of depressive illnesses, it should come as no surprise that depression is a rather complex phenomenon with no single explainable cause. Nevertheless, there is general scientific consent that the interaction of social, psychological, genetic and biological factors contribute to the cause of depression. This factor interaction is responsible for triggering and maintaining the disorder.

Social Setting

Families and individuals function within the cultural and socioeconomic realities that influence them. Based on reliable outcomes across different countries, one of the strongest opinions considering the social roots of depression is that gender (being a female) and material and social scarcity (being jobless, homeless) noticeably elevate the risk of depression. Furthermore, among the well-studied risks of depression are traumatic childhood experiences (abuse, neglectful parenting, parental discord). 

Stress Triggers

Stressful life events, such as sickness and grief, may trigger the onset of depression. However, individual resistance to depression depends on protective factors, such as a confiding interpersonal setting.

Attachment

According to Bowlby’s attachment theory, insecure attachment with a caregiver during childhood subverts confidence in the idea that others will be present and responsive when required. Moreover, an insecure attachment may weaken an individual’s confidence in themselves as worthy of attention or love. These convictions result from traumatic childhood experiences (e.g. abuse, neglect), loss, and the related dysregulation of primary emotions of despair, guilt, rage and fear. The dysfunctional beliefs strongly contribute to the genesis of depression. 

Appraising 

For American psychoanalyst Aaron Beck, originator of cognitive behavioural therapy (CBT), the mental interpretation of events triggers emotional states, not the other way round. According to Beck, negative thoughts caused by dysfunctional core beliefs are commonly the primary reason for the occurrence of depression. Moreover, the severity of negative thoughts and depressive symptoms are positively related. That means the more negative thoughts you have, the more severe will be your depressive symptoms. Beck claims that the “negative triad”, three types of dysfunctional beliefs or schemas, rules depressed thinking. Above all, the triad comprises a negative appraisal of the self, the world, and the future. 

Biology

The two points emerging with some accuracy from existing knowledge are that no single gene representing depression has yet been identified. Geneticists increasingly consider environmental influences in establishing the biochemical “switches” that regulate gene expression. 

Neurochemicals 

 Scientists have posited that antidepressants influence the balance of three neurotransmitters—norepinephrine, dopamine and serotonin—within brain structures that control responses to stress, emotions, the drives of sexuality, appetite and sleep. However, it is still unclear whether alterations in neurotransmitter levels lead to depression or if depression produces alterations in neurotransmission.

Personality

Eysenck (1975) suggested that people susceptible to depression are often introverts. Furthermore, Gilbert (1989) indicated that this proneness of introverts to depression is due to their increased sensitivity to interpersonal criticism and the inclination to be socially subservient or withdrawn. 

Addressing Depression Symptoms – Depression Treatment

Research and clinical evidence suggest that both pharmacological and psychological interventions (such as counselling, coping skills training or psychotherapy) may be effective for depression treatment. Antidepressants may alleviate severe depression symptoms in many people, but some individuals do not improve or show a high relapse rate.  Cognitive Behaviour Therapy (CBT) has proven its value in treating depression in the long term. A trained therapist or counsellor may deliver psychological counselling, skill training or therapy for depression and other mental health conditions onsite or online via Zoom, Microsoft Teams or other internet-based communication platforms that allow users to connect with video.

Cognitive Behaviour Therapy (CBT) and Counselling for Depression  

 CBT can help you manage your problems by changing how you think and behave. CBT is the most commonly used intervention for managing anxiety and depression. Cognitive behaviour therapy cannot eradicate your problems, but it can help you deal with them more effectively. CBT is based on the assumption that your thoughts, feelings, physical sensations and actions are interconnected and that negative thoughts and feelings can entrap you in a vicious cycle. A trained CBT therapist will help you break this cycle by breaking down overwhelming issues into smaller pieces and showing you how to alter these negative patterns to improve the way you feel. 

Counselling for depression is less structured compared with CBT. Counselling aims to facilitate a deeper connection with the emotions that underlie your feelings of depression. A counsellor will encourage you to express these feelings, gain understanding and cultivate fresh perspectives on yourself and your environment. Depression counselling assists you in introspection (helping you reflect on how you are feeling), aiding the recognition of emotions that may be trapped or unresolved within you. You may uncover a disparity between your inner emotional state and your external presentation, often referred to as ‘dissonance,’ which can contribute to feeling depressed.

Face-to-face online or onsite cognitive behaviour counselling or therapy for depression looks for practical ways to improve your state of mind daily.

Depression Treatment: Conclusion

Depression is a prevalent mood disorder that profoundly affects psychosocial functioning and significantly reduces overall quality of life. It is widely acknowledged among researchers that this mood disorder arises from a complex interplay of psychological, biological, social and environmental factors. Uncertain origins and an inconsistent trajectory of depression often pose challenges for counsellors, psychotherapists and psychiatrists.

Psychological counselling or therapy for depression, such as Cognitive Behavioral Therapy (CBT), can be delivered both onsite and online (through internet-based platforms, e.g. ZOOM or MS Teams), and it has consistently demonstrated its effectiveness in managing depressive symptoms.

In addition, antidepressants help alleviate severe depression symptoms in the short term for many people.

As previously highlighted, the integrative approach to depression treatment encompasses more than just dealing with its immediate symptoms—it also involves addressing the underlying causes to prevent the symptoms from recurring over the long term. Therefore, engaging in this process might necessitate a commitment of time and dedication.

Bibliography

  • DOI: 10.1093/med:psych/9780199674145.001.0001
  • DOI: 10.1093/med/9780198795551.001.0001

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