Depression

depressed woman

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.  And then, none of us are Superman.  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, even a 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.”  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 professional, 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.

Articles related to Depression:

Depression – The Not-That-Bad, the Bad, and the Ugly

The word “depression” confuses just about everybody.  It’s a misunderstood word.  We all use the word to describe the most minor and brief down feeling, “I’m depressed.”  Some call being bored and “depressed” the “Sunday afternoon blues”.  Yet the same word, depression, can mean the worst medical, clinical down mood, with hopelessness and suicidal thinking, with suicide.  This terrible, life-threatening version of depression requires real medical care.  And this same word can also mean every shade and type of moodiness in between the least and the worst.

We Mean Major Depression

Thus, we of the NeuroSci R&D Consultancy would like to be clear.  On this website and on this page we mean medical depressed mood, clinical depression.  In DSM-5 terminology, the Diagnostic and Statistical Manual, “Major Depressive Disorder”.

Different Types of Major Depression

There are different types of major depression.  There is bipolar disorder, or manic-depressive disorder, wherein the episodes of depression are sandwiched between manic episodes.  Major depression in which people are always either depressed or normal mood but never manic is called unipolar depression.  Unipolar vs. bipolar, you see.  Then there are atypical depressions and psychotic depressions.  And postpartum depression after childbirth.  Premenstrual dysphoric disorder is depression associated with one’s monthly period.  Conceptually, we are trying to make it clear that depression is indeed a medical condition just as much as diabetes, heart failure, or a broken arm, and as such it needs real medical treatment.  

We’re Not Referring to Lonely Saturday Night Blues

So 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.  We do like hot fudge sundaes, though, and they’re better with friends.

Depression is Common

This severe type of depression, medical depression, is common, really common.  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 their life.  So the likelihood is that you know someone who has had a clinical depression.  Or maybe you have had such an episode.

What It 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.  Most always a 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.  All of life takes on a grey, colorless tone.  Nothing is fun and life is without merit.  Appetite can vary between two extremes, in that a depressed person might eat too much or instead have no appetite.  As one might expect, weight varies with appetite: they might lose weight because they have no appetite or gain weight because they eat a lot of “comfort food”.  Sleep duration also varies between two extremes.  Some individuals when depressed can’t sleep while other people when depressed find sleep is a good escape and they sleep a lot.  Either way, the depressed person almost never finds sleep to be restful and restorative.  Their body, including their brain, is clearly physiologically and metabolically off kilter.

Spotting Depression from Across the Room

A good friend might be able to tell if you are badly, medically depressed.  A close relative who cares about you might 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 health care professional 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.  It’s straightforward.

What Is Depression, Really?

So, 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 little bits and pieces of brain and body chemistry that are there when a person is depressed.  There is more to be discovered, to be understood.

What we know, or what we think we know, comes from 70 years of seeing which medications successfully treat depression, at least for most people most of the time.  The first good medications for depressed mood were discovered accidently.  The first, iproniazid, was developed for treating tuberculosis and, by the bye, it was noticed to treat depression.  The mechanisms of action of those first few antidepressants lit the pathways for new antidepressant discovery and development.  It has been a slow step by step from one medication that works to the next one that works, hopefully that new one working a bit better.

Why Not Just Maximally Stimulate Everything?

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.  We all know what “uppers” are, they’re stimulants of various sorts.  They’re medications like the several varieties of amphetamines.  But odd as it seems, the amphetamines don’t treat depression well at all.  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 yet higher dose.  Within a few days of 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 a full-blown adverse event of 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 will be the one to save they day in this regard.

So, What To Do If You Are Medically Depressed?

Get help.

See a health care professional.  Get a good diagnosis and a prescription for an effective medication.  Get involved in therapy.  The good news here is that there are many medications and therapies that work well.  The best sure cure, the most reliable “silver bullet”, is medication plus therapy together.  Sometimes more than one medication is needed and a second one is added to help the first one work better.  With ketamine and esketamine two medications are started together, one that works fast but might fade in effectiveness over time and one that starts working more slowly but, once it works, will remain effective for a long time.  As with so many medical conditions, each person is an individual and needs a treatment plan that is made for just her or him.  Medical care, and certainly medical care for depression, is not “one-size-fits-all”.  The trial and error to find the right mix will be faster with the right treatment plan.

And Now for a Bit of Medical History…

We find descriptions of medical depression written 4000 years ago.  Even great 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 was a medical disorder.  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 saw depression as a brain disorder.  During the 20th century Sigmund Freud distracted the field from this medical view, but medical science is finally discarding Freud and getting back to understanding depression as a physical brain disorder.

Helpful links:

National Institutes of Health, National Institute of Mental Health

https://www.nimh.nih.gov/health/topics/depression/index.shtml

National Library of Medicine (United States), Medline Plus

https://medlineplus.gov/depression.html

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

American Psychiatric Association

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