Understanding depression

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Depression is classified as a mood disorder by psychiatric manuals. It can be characterized by constant feelings of sadness, apathy, loss of motivation or interest in things, feelings of anger or irritability that significantly interfere with a person's daily activities.

Increasingly common, according to the Vigitel 2021 survey (one of the most comprehensive health surveys in the country), more than 11% of the population is diagnosed with this condition, being more common among women (14.7%) than among men (7.3%).

It is not uncommon for people to confuse depression with feelings of sadness, which can be caused by a difficult situation or a one-time traumatic event, such as the loss of a loved one.

Disturbing events that shake our emotions happen all the time, and feeling sad about them is absolutely normal.

In the case of grief, for example, feelings of pain and sadness can be accompanied by positive emotions, such as when we have fond memories of the deceased.

In cases of depression, on the other hand, the feeling of sadness tends to be constant and can be accompanied by self-loathing, loss of self-esteem, and even feelings of guilt when there are moments of happiness. These are common reports among people for whom grief becomes chronic and triggers depression.

Depressive symptoms can vary greatly from person to person, and at different stages of the condition's progression. While for some people mood changes are what affects them most, for others the effects start with the body.

Symptoms can also vary in severity, frequency, and intensity. Among them, the most common are:

• Anxious feelings, sadness, or "emptiness"
• Hopelessness
• Self-loathing, feeling worthless and pessimistic
• Low self-esteem
• Frequent crying
• Anger/irritation
• Loss of interest in hobbies and/or activities you used to enjoy
• Tiredness/Fatigue
• Difficulty concentrating, remembering things, or making decisions
• Insomnia
• Changes in appetite, with weight loss or gain
• Physical pain with no apparent cause that doesn't improve with treatment (headaches, cramps, digestive problems, or body aches)
• Suicidal thoughts
• Self-harm
• Decreased sexual interest

But what causes depression?

There are several theories about possible causes for depression, and it is common, in most cases, for there to be an overlap of factors. It is almost never just one cause.

The most common factors are:

• Brain chemistry - There is a hypothesis that there may be a biochemical imbalance in parts of the brain that control mood, thoughts, sleep, appetite, and behavior. However, there are controversies among scientific studies about what comes first—whether changes in neurotransmitters trigger depression or whether depression itself alters communication between them.
• Hormone levels - Changes in the female hormones estrogen and progesterone can increase the risk of depression. These changes occur during different periods in a woman's life, such as between menstrual cycles or during menopause.
• Genetics - People with a family history of depression or other mood disorders are more predisposed to developing similar conditions. Additionally, genome studies indicate that there are specific characteristics among certain genes that can increase vulnerability to depression.
• Early childhood trauma - Some events during childhood can leave significant emotional marks and shape how the body reacts to fear and stressful situations. Some examples include parents' separation or experiencing bullying (threats through humiliation, exclusion, or discrimination).
• Other trauma - The definition of trauma is somewhat complex, as it varies from person to person, but situations involving loss or that threaten physical or psychological integrity can increase the risk of depression.
• Brain structure - There is a higher risk of depression when the frontal lobe of the brain is less active. However, as with the biochemistry hypothesis, there is no consensus among scientists and studies that actually prove whether this reduction in brain activity occurs before or after the onset of depressive symptoms.
• Medical conditions - Chronic medical conditions that bring limitations to life can increase the risk of depression. This can occur with cancer, heart disease, neurological diseases, chronic pain, or sleep disorders such as insomnia and sleep apnea.
• Substance use - A history of abuse or misuse of drugs and other chemical substances, including alcohol, can increase the risk of depression.

Types of depression

Depression can also vary into subtypes:

• Dysthymia: Considered the mildest and most chronic form of depression. It usually appears during adolescence or early adulthood and is present most days for a minimum period of 2 years. Someone with dysthymia shows persistent worry, tiredness, and discouragement, which can also be characterized as chronic bad mood.
• Postpartum depression: Can occur up to one year after the birth of a baby.
• Endogenous depression: Definition for when the predominant symptoms are loss of interest in activities previously enjoyed, lack of energy upon waking, memory and appetite loss (causing weight loss), and profound sadness.
• Atypical depression: Definition for when the predominant symptoms are increased appetite and weight, insomnia, sensation of heavy body, and exaggerated sensitivity to rejection.
• Seasonal depression: Common in young people or those living at high altitudes, it is a condition that begins in fall/winter and persists until spring, not being common in summer. For diagnostic confirmation, symptoms need to be observed for 2 consecutive years.
• Psychotic depression: Considered a more severe condition, involving the occurrence of hallucinations and delusions.
• Secondary depression: Definition for when a condition is accompanied by other medical conditions, whether those mentioned above or other conditions such as fibromyalgia, rheumatological diseases, and cases related to medication use, such as corticosteroids.
• Bipolar depression: Most patients with bipolar disorder begin their condition with a depressive episode, before presenting what specialists call a manic switch. The earlier the depressive episode, the greater the chances of bipolarity.

Recognizing the possible origins and types of depression manifestation is an important step for those who are suffering or in treatment, after all, we can only fight what we know.

Before concluding, I would just like to emphasize that the manifestation of depression can vary from person to person, so hardly anyone can know better than you what is going on inside. Furthermore, life events themselves can change how we deal with symptoms and our perception of them, which is why diagnosis should always be made with great care.

Come with me, as we will still see a lot of information and strategies to deal with symptoms and how to overcome them!