Index
Togglesummary about depression
Depression is a very common illness, especially in the western world. Stress and loneliness are probably two important elements of this truly global epidemic. According to the WHO, in 2030 it could even be the most common disease in the world, ahead of certain cardiovascular diseases. Currently, more than 5% of the world’s population is affected by depression, more women than men.
The causes of depression are numerous, such as external factors (death, loneliness), genetic causes, consumption of substances such as drugs, diet, stress, other illnesses, etc. On a physiological level, depression is caused by a hormonal imbalance in the brain.
Researchers are increasingly moving towards an inflammatory cause in some patients with depression.
Depression is characterized by a pathological state with a sad and painful mood, associated with a reduction in physical and psychological activity. Other frequently associated symptoms are insomnia and anxiety .
It is important to distinguish between passing sadness after difficult moments in life (death, separation, unemployment) and depression. In the latter case, the symptoms of sadness last for many months or even years and the reasons are more difficult to identify than during a moment of sadness.
The diagnosis of depression is usually made by a general practitioner or a psychiatrist. The clinician or family doctor usually prescribes antidepressants, while the psychiatrist can practice psychotherapy and/or use medication against depression. Therefore, some people believe that depression should be treated by a psychiatrist for a more complete and effective therapy.
Depression is a potentially very serious illness that can lead to suicide. That is why it is very important that all people suffering from this disease are accompanied by a doctor. Surrounding people should also force anyone with depressive symptoms to seek medical attention.
The main treatments for depression are medication and psychotherapy.
When it comes to medications, known as antidepressants, doctors have many options. These treatments are generally well tolerated by patients and have scientifically proven effects.
Probably the most widely used class of drugs are the SSRIs (selective serotonin reuptake inhibitors), such as fluoxetine, citalopram, and paroxetine. You can find more information in the depression treatment section
There are also alternative methods to treat this disease such as lifestyle changes (more exercise) and herbal medicine, especially hypericum. Attention, the use of this plant is reserved for cases of mild to moderate depression.
To prevent and treat depression, there are several effective tips to complement conventional therapy, such as exercising regularly, sunbathing and fighting loneliness.
News: 10 foods against depression – Depression, sleep deprivation treats
Definition
Depression or nervous depression is a pathological state with a sad and painful moodassociated with reduced psychological and physical activity. The person affected by depression feels helpless and the disease is almost always accompanied by other symptoms, such as anxiety or insomnia (see all symptoms ).
Depression belongs to the group of diseases of our time and according to the WHO (World Health Organization in Geneva), it is among the three diseases that increasingly worsen people’s quality of life. We also emphasize that depression affects twice as many women as men.
Antidepressant
The first antidepressant, iproniazid (an MAOI) appeared in the 1950s, and was put on the market in 1958. This molecule was originally intended for the fight against tuberculosis, but an “inappropriate happiness” and euphoria in patients who used this medicine gave the idea to scientists and doctors to use this medicine to treat depression. For more information click here (in English)
Epidemiology
– According to the WHO, an estimated 350 million people, about 5% of the world’s population, suffer from depression each year [source: WHO, 2012 data].
– In Brazil, 12 million Brazilians have depression and it is estimated that 6% of the population suffers from depression. The disease represents almost a quarter of outpatient and hospital mental health care in the SUS (source: Ministry of Health, April 2017).
– In the United States, it is estimated that 7% of the population suffers from depression.
– In France, it is estimated that depression affects about 8% of the population between 15 and 75 years old, women are twice as affected as men.
– In Italy, a study published in October 2014 showed that about 8% of the population suffers from depression. In 10 years (2004-2014) the rate of depression doubled in Italy.
– In Japan, it is estimated that 4.5% of the population suffers from depression.
Causes
Behind depression there are very different causes.
– External causes: bereavement, stress (including stress at work, see also Burnout Syndrome), professional or private problems such as divorce, loneliness or a breakup with a lover that leads to suffering. The risk of depression increases 20-fold during the year following a breakup, according to Dr. Leonie Koban of the University of Colorado, Boulder, who spoke in a press release of a scientific study published in April 2017.
Read: Civil Servants: Overwork Doubles the Risk of Depression– Hormonal Causes: Pregnancy, Menopause , Problems in the thyroid gland.
– Physical problems or illnesses such as stroke, infections, herpes.
– Genetic (hereditary) factors.
– Lack of sunlight. Read also A bit of light therapy while waiting for a bus in the Swedish winter– Advanced age.
– Excessive consumption of toxic substances such as alcohol, certain medications and marijuana (usually after long-term consumption).
– A study published in 2009 showed that depression in young adults can be caused by excessive exposure to television and computers, and appears to be more pronounced in men than in women.
– Poor diet: a Spanish study from 2011 (January) showed that the consumption of trans fatty acids and saturated fats, present in fried foods, increases the risk of depression. In contrast, olive oil and other products containing unsaturated fats reduce the risk of this mental illness.
– Inflammation. Some researchers believe that depression may have, in some patients, an inflammatory origin.In fact, scientists observed that 40% of psychiatric patients (including depression) had excessive levels of molecules typical of an inflammatory reaction (eg cytokines, protein C -reactive) in your blood.
– Side effects of certain medications such as hormonal contraceptives, blood pressure and heart medications, proton pump inhibitors (PPIs) such as omeprazole, antacids and pain relievers.
According to a study published on June 12, 2018 in the Journal of the American Medical Association (DOI: 10.1001/jama.2018.6741) and conducted by researchers at the University of Illinois at Chicago, more than 200 commonly used drugs used has potential side effects of depression or suicide. The results show that the concomitant use of several of these drugs, called polypharmacy (polymedication), is associated with a greater likelihood of depression.
That’s why psychiatrists don’t hesitate to prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or celecoxib in the treatment of depression. Read more on depression treatment
Only a doctor can make an accurate diagnosis based on the cause of depression and offer effective therapy, we advise you to consult a doctor as soon as possible if you suspect depression.
Physiological Origin of Depression
On the physiological level, depression is caused in part by a hormonal imbalance in the brain. Some scientists believe that neurotransmitters such as dopamine, serotonin (see also SSRI antidepressants) or norepinephrine may play a key role in the brain. But this hypothesis was challenged by a study published on July 20, 2022 in the scientific journal Molecular Psychiatry (DOI: 10.1038/s41380-022-01661-0 ). Other scientists are more cautious and have some doubts about the mechanisms and biochemical origins of depression, they believe that depression remains a poorly understood disease.
Groups of risk
People who have just lost a loved one, people stressed at work, addicted to alcohol or drugs, etc. are more likely to develop depression.
Symptoms
Depression is difficult to recognize, as it can be confused with melancholy or temporary sadness, which usually lasts for a few days.
Depression is often long lasting (weeks or months) and is often associated with anxiety. In addition, it is often difficult for the doctor to distinguish between depression and anxiety .
Sleep disturbances and pain are often present in cases of depression.
In detail, the main symptoms of depression are:
– Physical signs: sleep disorders such as insomnia, the depressed person wakes up in the middle of the night (from 00:00 to 04:00 in the morning) and sleep can be associated with distressing dreams. Among the various physical symptoms is loss of appetite (which is characterized by weight loss), digestive disturbances, loss of sexual desire (libido), fatigue and loss of energy.
– Psychological signs (mood swings): there is often a constant feeling of lack of pleasure (the person feels a loss of interest in most activities of daily living), sadness, a feeling of despair and difficulty expressing feelings. Anxiety is often present.
Performing daily tasks becomes difficult and requires great effort.
A confinement and change in close relationships can also be observed.
– negative thoughts: negative thoughts occur repeatedly, sometimes associated with a decrease in perception of reality. In some cases, suicidal thoughts may occur.
Early detection of the disease (see a doctor or psychologist as soon as possible) is highly recommended. In fact, many times the depressed patient is taken to the doctor by his family or close people, because he himself has lost his critical sense.
You should know that there are different forms of depression and that the disease can vary greatly depending on each case: in addition to the so-called classic nervous depression, there is also postpartum depression (baby-blues), bipolar disorder (manic-depressive), seasonal depression or Seasonal Affective Disorder (SAD), premenstrual syndrome, vital tiredness, etc…
Depression in the elderly
Depression in the elderly must be described separately and with judgment criteria different from other forms of depression.
In the elderly, it is often difficult to recognize depression, because the symptoms are easily confused with the normal aging process and with certain diseases typical of age, such as Parkinson’s and Alzheimer’s.
You should know that in advanced age, brain activity decreases due to a decrease in oxygen supply, which can favor the development of depression.
Older people often face difficult and painful situations such as the loss of a loved one, the onset of physical illness and the difficulty of giving meaning to life. Social isolation, loneliness and lack of support from family members are also aggravating factors in our increasingly Western modern societies.
Diagnosis
An interesting method developed by a team of Swiss doctors in 2012, based on a rapid test that allows a general practitioner to detect depression through two simple questions: “In the last month, have you often felt sad, depressed or hope? ” and “Have you ever felt a lack of interest and pleasure in most of the activities you normally enjoy?”.
The test is considered positive (the person suffers from depression) when the patient answered positively to at least two questions.
According to the doctors who developed this test, these two questions can detect major depression in nine out of ten cases.
Complications
Depression can be a very serious illness, and in the worst case it can lead to suicide. Therefore, there is a need, for the patient and his surroundings, to treat this disease as soon as possible.
Other complications of depression can include:
– increased risk of heart disease;
– headaches and pain in general;
– sleep disorders (insomnia, difficulty falling asleep,…);
– difficulties in sex life
Treatments
To treat depression, the doctor can use medication (antidepressants) and psychological treatments focused on the word: psychotherapy and psychoanalysis, as well as new and original treatments (sleep deprivation, diet, practice of sports, electrical and magnetic impulses).
The doctor (usually a psychiatrist) can combine different treatments, such as drug therapy and psychotherapy. You should know that the use of medication combined with psychotherapy provides the best results for depression (a study with American youth revealed an 85% success rate using these two therapies combined, compared to 69 and 64% success, respectively , using antidepressants or psychotherapy).
It is estimated that 60 to 80% of patients can achieve a cure for depression and its symptoms with current treatments.
antidepressants
Here we will detail possible treatments for depression (strictly on prescription, only your doctor can prescribe these medications, with the exception of hypericum or St. John’s wort, which are available over-the-counter). This class of drugs is generally divided into the following types of antidepressants:
– Tricyclics , for example amitriptyline , clomipramine and doxepin. These molecules or drugs are relatively effective, but beware of side effects such as dry mouth and eyes, constipation, weight gain, drowsiness, etc.
– MAOI(Mono Amino Oxidase inhibitors). Molecules of this class are, for example, iproniazid (first antidepressant on the market), phenelzine and selegiline (MAOI type B, used mainly in Parkinson’s disease). The physician should preferably choose an MAOI qualified as reversible (there are 2 types of MAOIs, reversible and irreversible).
These molecules or drugs are relatively effective, but beware of side effects such as: weight gain, drowsiness, anxiety, etc.
– Serotoninergics or selective serotonin reuptake inhibitors (SSRIs) : such as citalopram , fluoxetine , sertraline and paroxetine. They are effective and widely prescribed medications for the treatment of depression. This class of drugs can lead to side effects such as: insomnia, nausea and erectile dysfunction in men.
– New generation of antidepressants: these new drugs have fewer side effects and fast action, they are also known as atypical antidepressants. In this class we can find venlafaxine, duloxetine, bupropion, etc.
Venlafaxine and duloxetine belong to the selective serotonin and norepinephrine reuptake inhibitors (SNRIs) class of drugs.
Bupropion belongs to the selective norepinephrine and dopamine reuptake inhibitors (in English: NDRIs). It is one of the few antidepressants that does not affect sexuality.
Atypical drugs, which are difficult to classify, are Trazodone, Mirtazapine or Vilazodone.
Side effects vary with each molecule, please read the leaflet and consult your doctor or pharmacist.
– Hypericum (also known as St. John’s wort): medicinal plant useful for mild to moderate depression. For more information on Hyperic, click here .
Important notes about antidepressants
– Most antidepressants do not work immediately. These medications usually require several days (10 to 20 days) for the effect to take effect. So, be patient and ask your doctor or pharmacist if the effects are very noticeable or not.
However, there are important differences between the medicines, please read the leaflet and consult a specialist.
– In about 20% to 40% of patients, conventional treatment (drugs and psychotherapy) has no effect. In these cases, the doctor will look for more original treatments (electric or magnetic pulse) and psychotherapy.
– German researchers have shown that each person reacts differently to antidepressants, at least with those that have been tested (citalopram and amitriptyline). This difference is due to a difference in gene expression.
Read: Americans increasingly addicted to antidepressants
– A report released on August 15, 2017 by the US Centers for Disease Control and Prevention showed that the number of Americans who claimed to have used an antidepressant in the previous month increased by 65% between 1999 and 2014. In 2014, about 1 in 8 Americans age 12 and older reported recent use of an antidepressant. Women were about twice as likely to be taking an antidepressant as men, with 16.5% of women taking this type of medication compared to 9% of men.
– Death rate from antidepressants
A Canadian study published in September 2017 showed that taking antidepressants over a long period of time increases the death rate. Most antidepressants are known to block the reuptake of serotonin by neurons. It is important to know that most organs (heart, kidney, liver, lungs) use serotonin from the bloodstream. The problem is that antidepressants also block the absorption of serotonin in these organs. Researchers warn that antidepressants can increase the risk of death by preventing organs from working properly. Researchers at McMaster University of Canada reviewed ( reviewin English) studies that contained hundreds of thousands of people. They found that those who took antidepressants had a 33% higher risk of death than those who didn’t take these medications. Those taking antidepressants also had a 14% greater risk of having cardiovascular events such as stroke or heart attack. However, the researchers found that for people with heart disease or diabetes, antidepressants did not increase the death rate. This makes sense because antidepressants have (blood) thinning effects that are helpful in treating these illnesses. This study was published on September 14, 2017 in the scientific journal Psychotherapy and Psychosomatics .
– An alternative to the use of chemical antidepressants (medicines) is sleep deprivation . This method allows for a quick response with an improvement in depression symptoms, often within 24 hours.
Ketamine, alternative treatment against depression
– Ketamine , is basically a molecule used as a general anesthetic, can also be used against depression. American psychiatrist Dr. Carlos Zarate had positive experiences with this molecule in the fight against depression. Ketamine affects the regulation of the neurotransmitter glutamate.
– In 2017, a team from the Department of Pharmacy at the University of California, San Diego, analyzed a series of FDA reports ( FDA Adverse Effect Reporting System ) from patients suffering from symptoms of depression and taking ketamine to manage pain.
– Californian scientists found that depression was 2 times less common among the 41,000 patients taking ketamine, compared to patients taking another medication or a set of medications to manage pain.
As reported by the San Diego researchers in a May 2017 press release, ketamine is a fairly inexpensive molecule. This study was published on May 3, 2017 in the scientific journal Scientific Reports .
– An Australian study published in June 2017 in the American Journal of Geriatric Psychiatry(American Journal of Geriatric Psychiatry) has shown that ketamine is effective in depressed people age 60 and older who have not responded to other types of depression treatment. The study included 16 participants, 14 completed the procedure. Of these 14 participants, the researchers observed that 7 were in remission after ketamine treatment and 5 with ketamine doses less than 0.5mg/kg. This was a double-blind, controlled, multiple-crossover study with a 6-month follow-up.
Ketamine and decreased suicidal thoughts
A study published online December 5, 2017, in the American Journal of Psychiatry(DOI: 10.1176/appi.ajp.2017.17060647), showed that ketamine can reduce suicidal thoughts. Conventional antidepressants can also reduce suicidal thoughts, but they usually take several weeks to act, so ketamine seems to be an interesting alternative. This study by Columbia University Medical Center in New York showed that ketamine was significantly more effective in reducing suicidal thoughts in depressed patients than a commonly prescribed sedative, midazolam. The American researchers also found that the anti-suicide effect of ketamine appears just a few hours after its administration (by injection).
Treatment of depression based on anti-inflammatory drugs
As indicated under causes, depression can have an inflammatory origin in about 40% of patients. Only those who have an abnormal amount of inflammatory molecules (cytokines, C-reactive protein) in their blood can benefit from the anti-inflammatory effect of some medications. In other words, in patients who do not have excess inflammatory molecules in their blood, an anti-inflammatory treatment is ineffective.
The treatments used in depression, in individuals with an inflammatory profile, are based on non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and celecoxib. In some cases, doctors have observed that after a few days of treatment with NSAIDs, depressive symptoms significantly reduce.
Sleep Deprivation During Depression
Sleep deprivation may prove to be an effective method, at least for some patients. Sleep deprivation can be partial (sleeping 3 to 4 hours, followed by a 20 to 21 hour forced awakening) or total (sleep deprivation for 36 hours). In fact, a meta-analysis (review of studies) published in 2017 showed that partial or total sleep deprivation rapidly reduced symptoms of depression in approximately 50% of patients with the condition. This study was performed by researchers at the Perelman School of Medicine at the University of Pennsylvania ( University of Pennsylvania)in the United States. The advantage of sleep deprivation over antidepressants is its speed, as antidepressants (chemicals) often take weeks to become effective, whereas sleep deprivation leads to effects on depression symptoms often in less than 24 hours.
To reach these conclusions, American researchers analyzed 66 studies published over a period of 36 years (studies after 1974 were included). This study was published on September 19, 2017 in the Journal of Clinical Psychiatry (DOI: 10.4088 / JCP.16r11332).
Note on the treatment of Seasonal Affective Disorder (SAD)
One of the best treatments to treat SAD is light therapy.
Phytotherapy (medicinal plants)
– St. John’s wort (hyperk) is often used, an effective medicinal plant in the treatment of cases of mild to moderate depression.
Attention, hypericum can interact with many medications, talk to your doctor or pharmacist. Read also: A study points out the high risk of interactions with St. John’s wort (2014)
– Studies have also shown a positive effect of lemon balm (melissa) and gentian (pictured) against mild to moderate depression .
Intake of omega-3 can have a positive effect on depression. The fact that they act as an anti-inflammatory may explain their effectiveness. Read about Causes and Treatments to better understand the relationship between inflammation and depression
– The mulungu : medicinal plant with anxiolytic and antidepressant effect.
Depression and Magnesium (Study)
A study published in June 2017 showed that magnesium taken as a dietary supplement tablet was as effective in treating mild to moderate depression as classic antidepressants often used, such as selective serotonin reuptake inhibitors (SSRIs) such as citalopram or fluoxetine. In this randomized clinical trial, a portion of 126 patients with mild to moderate depression received 248 mg elemental magnesium (500 mg magnesium chloride) daily for a period of 6 weeks or no treatment. The researchers found that in 112 of the participants with usable data, magnesium chloride consumption for 6 weeks led to a significant clinical improvement in the measurement of depression and anxiety symptoms. Another interesting result of this study was that the antidepressant effect of magnesium appeared quickly, already after 2 weeks of treatment and without causing significant side effects. This study was conducted by a team from the University of Vermont in the United States and published in the specialized journalPLoS One on June 28, 2017. Read more
Tips
First, depression is a serious chronic illness that requires medical care. Medicines and/or psychotherapy are usually used. The advice below can complement the treatment and help prevent the disease.
– In case of mild to moderate depression, consider using herbal therapies ( hypericum , etc.).
– Try to find small pleasures that will make you happier with your life (sport, meeting friends, hobbies, gardening, family, etc.) and also think about your soul (religion, philosophy) to find a balance between pleasure and problems existential.
– Practice sports or regular exercise, in addition to being good for health in general, they act in various conditions such as cardiovascular disease; physical activity contributes to the release of endorphins (hormones produced by the brain, close to the opiate family). These molecules favor a certain euphoria and act against depressive symptoms. Choose a physical activity that you enjoy, be it walking, running, swimming, etc.
– Get a good nights sleep, a key to improving depression symptoms. However, in some severe cases of depression or resistance to conventional treatments, sleep deprivation can have the opposite effect and improve symptoms.
– Try to have projects, set goals. Be more careful not to set too ambitious goals.
– Do not hesitate to ask for help if you suspect depression, especially a doctor.
You must imagine the depressive as at the bottom of a hole with almost no chance of getting out on his own and that he must ask for help.
It’s important to talk about your problems with someone you trust, whether it’s a doctor, a friend, a family member, a religious leader (pastor, priest), etc.
– Do not hesitate to expose yourself to the sun (in moderation and using sunscreen). We know that light plays an important role.
– According to a study published in October 2013, depressed people can improve their mood by sleep deprivation. According to this study, with controlled sleep deprivation, most patients are awakened in the second half of the night and need to stay awake until the next night, explains the University of Zurich, Switzerland, which conducted the study. The process is repeated three or four times. Following this protocol, 40 to 60% of depressed patients experience an immediate improvement in mood. In most cases, however, the positive effect only lasts for about three days.
– Try to socialize with positive people, if possible, who understand your illness. Avoid meeting people who are pessimistic and who have hurt you. You can also try to help others, a good way to socialize.
– Avoid using alcohol and drugs. These substances can make symptoms of depression worse.
– Use some relaxation techniques such as massages. They are especially recommended for the treatment of stress and anxiety.
Prevention
– Regular practice of sports or physical exercise (see also Tips above), even one hour a week can already have a beneficial effect, as demonstrated by a study published in 2017 (read below).
Influence of physical exercise (study)
A study published in 2017 showed that exercising just 1 hour a week helps prevent depression. This study, the largest ever undertaken on this topic, focused on analyzing 33,908 Norwegian adults regarding their exercise levels, depression and anxiety symptoms that were measured over an 11-year period. The researchers found that 12% of cases of depression could have been prevented if people engaged in an hour of physical activity a week. However, this research did not show a beneficial effect of exercising 1 to 2 hours a week to prevent anxiety. This study was conducted by Prof. Samuel Harvey, who works at two Australian institutions, the Black Dog Institute and the University of New South Walesin Australia. This study was published on October 3, 2017 in the American Journal of Psychiatry (DOI: 10.1176 / appi.ajp.2017.16111223).
– According to studies, loneliness favors the development of depression. Man is a social being who needs company. If you are alone, why not imagine living with family or friends?
– Try to reduce the stress of everyday life, as this is an important risk factor. A possible source of inflammation in the body (read on causes and treatments and inflammatory origin of some cases of depression)
– Try to get enough sleep, a good night’s sleep can be a means of prevention.
– According to a study carried out by the University of Las Palmas in the Canary Islands (Spain), with about 15,000 people, the risk of suffering from depression would be reduced by 30% on the Mediterranean diet . This study was published September 17, 2015 in the journal BMC Medicine .
The Mediterranean diet , sometimes called the Cretan diet, is a practice based on the consumption of natural foods, and is the food base of many peoples around the Mediterranean such as Greeks, Italians, French, Spanish, Moroccans, Lebanese, etc. This scheme is based on regular and high consumption of fruits, vegetables, grains, fish and polyunsaturated fats, found especially in olive oil, in addition to a low consumption of meat, eggs, dairy products, sweets and processed foods. Olive oil is the main source of fat. Alcohol is generally consumed in moderate amounts, with wine often being the drink of choice.
How to act towards those who suffer from depression?
– It is important not to blame the patient, we must recognize the disease and not the person suffering (as you would, for example, with a person with diabetes or hypercholesterolemia)
– Be careful when giving advice and recommendations, you should avoid giving “lectures”, as it can aggravate depression and make the patient feel misunderstood. Remember that the person is suffering and they want to heal. “Must” and “must” are generally not useful.
– Find the balance between being willing to listen attentively and showing understanding, but avoid doing too much for the patient, as the patient can do the same, especially towards the end of his illness, when re-entering a sometimes hostile and low-tolerance society to psychic illnesses.
– Don’t “hurry” it too much. For example, inviting you on a vacation can be more stressful than staying at home in your usual environment. Remember that a depressed patient often suffers from anxiety.
– Don’t be afraid to talk openly about suicide if the depressed person wants to. Suicidal thinking is one of the symptoms of depression, and the conversation can only do good for the person, who can feel relieved. However, ask a doctor about how to properly approach this issue.
Read also: 10 foods against depression
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