Depression

Depression
Depression

The word “Depression” is Used to mean So Many Things

The word “depression” is used to mean different moods of all sorts.  With people we know we usually know what the other person means.  But if talking to someone you don’t know or talking to someone with an unknown situation, maybe not so much.  You see, at times we use the word to describe the most minor and brief down feeling, “I’m depressed.”  Some say “depressed” to mean bored.  And, being both bored and depressed might be the “Sunday afternoon blues”.  Yet depression can mean the worst medical, clinical, down, dark mood, with hopelessness and suicidal thinking.  And even at times, with completed suicide.  Dead.  This terrible, life-threatening depression requires real medical care.  And depression can mean every shade and type of moodiness in between the least and the worst.

At NeuroSci R&D Consultancy We Mean Medical Major Depression

To be clear, then, we want to say what we of the Neuroscience Research and Development Consultancy mean.  On this website and on this page we mean medical depressed mood, clinical depression.

Different Types of Major Depression

There are different types of major depression.  There’s bipolar disorder, or manic-depressive disorder.  Bipolar depression is a time of down mood sandwiched between times of mania.  Depression without ever having mania is called unipolar depression.  Unipolar vs. bipolar, you see, one way vs. both ways.  Then there are depressions that are unusual, that is, not typical.  No puzzle here, they are referred to as atypical depressions.  And “psychotic” depressions are another type, during which one loses touch with reality.  And postpartum depression after childbirth.  Premenstrual dysphoric disorder is depression (and again, we mean real serious depression) associated with one’s monthly period.  They are all bad depressions.  They are all medical conditions just as much as diabetes, heart failure, or a broken arm.  And just like these other medical conditions, depression needs real medical treatment.  

So, What Are Lonely Saturday Night Blues or Sunday Afternoon Blues?

If you’re feeling down and lonely on a Saturday night but a friend and a hot fudge sundae makes the world great again, that’s not the kind of depression we’re talking about.  Same with Sunday afternoon.  We do like hot fudge sundaes, though, and they’re better with friends.  (A one month subscription to our site costs about 1/3 of the cost of a hot fudge sundae.)

Depression is Common

This severe type of depression, medical depression, is common, sadly, really common.  (No pun intended.)  Among all of the medical and surgical conditions, it’s the fourth leading cause of disability worldwide.  One out of every 10 people on this planet will have at least one episode of major medical depression at some time during his or her life.  So the likelihood is that you know someone who has had such a depression.  Or maybe that you have had one.

What Depression Looks Like

While most of the time it’s true that depressed individuals are and appear to be sad, there are also irritable depressions.  Some people, when depressed, are angry, irritable, and overbearing.  Hostile, even.  Most always a non-angry depressed person has a low energy level and they don’t do much.  They have an empty, useless feeling inside.  It’s quite common for anxiety to be mixed in with the depression.  Life is a downer and I’m all nervous and it’s all just a pile of…  All of life takes on a grey, colorless feel.  Nothing is fun and life is, at best, dull. 

Appetite and Sleep in Depression

When one of us is depressed, our appetite can vary between two extremes.  One person might eat to sooth their soul (comfort food) and eat too much.  Another might have no appetite and eat very little.  Gaining or losing weight goes with appetite.  No appetite and people get skinny.  Munching on potato chips with Coca Cola, and the pounds add on.  Sleeping also can be one of two extremes.  Bad insomnia and can’t sleep.  Or, sleep as an escape and sleep a lot.  But, either way, when you’re depressed sleep won’t feel restful.  Your body, including your brain, is just not right.

Spotting Depression from Across the Room 

A good friend might be able to tell if you have a bad depression.  A close relative who cares about you might also be able to tell.  There are many easy, short computer or paper-and-pencil tests that will say maybe you have a medical depression.  An experienced and skilled doctor can probably spot depression in a person from across the room.  The bottom line is, seeing depression and telling if a person is depressed is not a mystery.

What Is Depression, Really?

This one is a question sent by a reader.  What’s really going on in depression?  What is it?

We don’t know.

Or, to be fair, medical science has not fully and clearly defined all the little bits and pieces of brain and body chemistry that are there when a person is depressed.  There is more to be found.

What we know, or what we think we know, comes from 70 years of seeing which medicines treat depression, at least for most people most of the time.  The first good medicines for depressed mood were discovered accidently.  The first, iproniazid, was made for treating tuberculosis.  Along the way, it was noticed the people with tuberculosis who were also depressed and got iproniazid became less depressed.  Learning how these first few antidepressants worked showed the way to finding more, new antidepressants.  It has been a slow step by step from one medicine that works to the next one that works.  The hope always is that the newer one will work at least a bit better.  (This isn’t always true!)

Why Not Just Maximally Stimulate Everything?

This is another question from a reader.  If someone is down why not just give them an “upper”?

Well, it’s been tried for over a 100 years.

It doesn’t work.

One would think that if you give a depressed person an “upper” drug, their mood should go up.  Problem is, it just doesn’t work right.  Maybe they would feel up and energetic for a few hours, but then the “up” stops and down they crash.  And “crash” is the right word because when they come down they are more depressed that before the stimulant drug.  We all know what “uppers” are, they’re stimulants of various sorts.  They’re medicines like the several varieties of amphetamines.  But odd as it seems, the amphetamines don’t treat depression well at all.

Trying to Treat Depression with Amphetamines

So, a depressed person takes a stimulant drug and for a few hours they might feel a bit better.  After that first few hours the depressed mood is back, maybe even worse.  The stimulant can be used again but then a higher dose is needed to boost mood and energy.  Each try to stop the depression needs a higher dose.  Within a few days of chasing this up and down roller coaster there is no dose high enough to change the depression.  But with higher and higher doses of the drug the side effects add up to full-blown toxicity.  Keep pushing the dose and soon the person is dead or on their way in an ambulance to the nearest Emergency Department.

Slow But Sure, Well, Almost Sure

Another curiosity that medical science has not yet understood adequately is that the medications that eventually treat depression take weeks for the benefit to become obvious.  Not good.  We need a quickly-acting treatment for depression.  Maybe ketamine or esketamine, which is being used more and more, will be the drugs to save the day.

So, What To Do If You Are Medically Depressed?

Get help.

See a doctor.  Get a diagnosis and a prescription for a medicine.  Get involved in therapy.  The good news is that there are many medicines and therapies that work well.  The best sure cure is medicine plus therapy together.  Sometimes more than one medicine is needed and a second one is added to help the first one work better.  When doctors use ketamine or esketamine, two medicines are started together.  One works fast but might fade in benefit over time and one starts working more slowly but, once it works, it will keep working for a long time.  And remember that each person is an individual and needs a treatment plan that is made for just her or him.  Medical care for depression is not “one-size-fits-all”.

And Now for a Bit of Medical History…

We find descriptions of what was likely clinical, medical depression written 4000 years ago.  But even philosophers and physicians of those ancient times held the false belief that depression was based in moral and spiritual beliefs like possession by the devil, not that it was a physical illness.  The one bright scholar was the Greek physician Hippocrates who lived around 2400 years ago.  He was the first to understand that “melancholia”, as it was called, was a medical disorder.

Troubled Waters for the Diagnosis of Depression

Despite Hippocrates, the next 2300 years were not kind to depressed individuals.  The accepted causes remained choices like the devil, witchcraft, inherited immutable character weakness, and similar superstitions.  “Treatments” were a grim list as well, such as beatings, starvation, exorcisms, burning, drowning, incarceration, enemas, and induced vomiting.  In 1895, the German psychiatrist Emil Kraepelin started describing depression, bipolar disorder (manic depression), and dementia praecox (schizophrenia) as medical disorders.  He correctly saw depression as a brain disorder.  During the 20th century Sigmund Freud distracted psychiatry from this medical view, but medical science is finally discarding Freud and getting back to understanding depression as a physical brain disorder.

Did You Know That…  Michael Phelps Has Had Medical Depression?

Michael Phelps has had episodes of clinical depression.  He won 28 Olympic medals, 23 of them gold.  An incredible athlete with remarkable accomplishments.  But even with this high stature as an athlete, he’s not immune to being human.  He has said that before the 2012 games, “I was in the lowest place I’ve ever been.  Honestly, I sort of, at one point, I just, I felt like I didn’t want to see another day.  I felt like it should be over.”  But, then, after the games, an even worse depression set in.  He said, “I didn’t want to be in the sport anymore…  I didn’t want to be alive anymore.”  He sat alone in his bedroom for 4 days, with insomnia, no appetite, and “just not wanting to be alive.”

There’s more… 

During another episode in 2014 he again stayed locked in his bedroom, depressed, for several days.  Finally realizing that he needed help, he checked himself into an inpatient mental health unit.  At times through the years he has contemplated suicide.  After treatment and better health, he has become an advocate for depression recognition and treatment.  Understanding that depression is a recurring medical condition, he’s grateful for the tools therapy has provided him to continually be as healthy as he can be.  His advice, if one is depressed, is to see a medical doctor, to get help.  In addition to his inpatient treatment and outpatient professional help, Phelps credits his wife Nicole and their two sons for helping him with his emotional health.  He retired from swimming in 2016.

Helpful links:

Depression – National Institutes of Health, National Institute of Mental Health

Depression – National Library of Medicine (United States), Medline Plus

Depression (major depressive disorder) – The Mayo Clinic

What is Depression? – American Psychiatric Association

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