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Depression: the facts
Despite being one of the most common illnesses in the world, there's plenty of ignorance about the causes and effects of depression. It can be explained, to a certain extent, on two separate levels - the biochemical and the practical. But you should also be aware that there are several different types of depression, which act in different ways, and that depression can last for varying lengths of time.
On a biological level, our outlook on life is controlled by chemicals in our brains. The most important of these chemicals, at least where emotions are concerned, are the neuro-transmitters, which carry signals between neurons. In depressed people, there is nearly always a destabilisation of these neuro-transmitters, with the most important one being serotonin. Instead of bridging the gap between adjacent neurons, serotonin is reabsorbed, so that important brain signals relating to mood and other emotional factors - including sleep, appetite and sex drive - do not reach their destinations.
One of the most effective groups of anti-depressant drugs (selective serotonin reuptake inhibitors, or SSRIs) work by preventing this serotonin reabsorption, thus allowing the neuron signals to complete their journeys. This explanation is a simplification, and there are other neuro-transmitters and hormones involved.
One question remains unanswered, though: is neuro-transmitter destabilisation a cause of depression, or a symptom? It would seem likely that it's a bit of both. There's no doubt that anti-depressants work, but there's equally no doubt that cognitive therapy works, so the chemical imbalance is likely to be both a cause and a symptom, giving the potential for a downward spiral of increasing depression in some people, if the illness is not treated.
What this means in practice is that the sufferer's perception of reality is distorted. In general, most people have a roughly similar level of 'happiness', and although specific events - the death of a relative or a surprise windfall, for example - can lower or raise this level in the short term, over time it usually returns to where it was. This explains why extremely rich people are often, deep down, no happier than those who are poor. Conversely, it explains why people who have been through terribly traumatic events can make a full recovery. In short, the brain is a powerful, flexible organ that recovers from most changes and eventually returns to its natural state. In people with good mental health, this natural state allows them to get on with their lives, experiencing everyday triumphs and failures and maintaining a fairly positive outlook.
But in depressed people (click here for some example case studies), the 'happiness' * level of the brain is far lower than usual. Depending on the type and extent of the depression, the level may range from mild unhappiness to uncontrollable misery. Good and bad events can still raise and lower the level to a certain extent, but the underlying feeling is constantly negative, and bad events have far more influence than good. Even though there's apparently nothing wrong with their social life and career, depressed people can feel as though their life is not worth living and they are totally alone. It is a frightening, confusing and deeply unhappy experience, which is why depression can be hard to escape from without help.
Perception is the key. To someone in good mental health, the sky may seem blue, birds are singing, people are pleasantly chatty. To a depressed person, that same sky will seem grey (or unnaturally blue), birds will be screaming and people will be unpleasantly nosy. It's all a matter of interpretation and perception, which is controlled by brain chemistry, but which can also be influenced by the person concerned. To borrow a phrase, 'The optimist believes we live in the best of all possible worlds. The pessimist fears that this is true.' So it is with depression. And because depression is all about relative emotions, it can affect anyone, from a homeless person to the richest, most powerful people in the world.
* 'Happiness', though, is not quite the right word. Depressed people are unhappy, but there's more to it than that; depression is far worse than unhappiness. It's almost impossible to explain what depression is like to anyone who hasn't suffered from the illness, but have a look at our WHAT DOES DEPRESSION FEEL LIKE? page for a spirited attempt.
The different types of depression
Aside from feelings of grief and gloom that can accompany unpleasant events in anybody's life, there are several different recognised types of depression. It's not always easy to distinguish one from another as the boundaries are pretty blurred, but here's a rough guide.
The symptoms of this form of depression include low self-esteem, lethargy, a general feeling that nothing's worth doing, and a lack of interest in activities that used to be pleasurable. It's the most common form of depression, and is easily mistaken by others as simple unhappiness. Many people go through this type of depression, and recover from it, without really understanding what happened to them.
This one is a little more nasty. Few people experience major depression without it becoming very obvious to those around them that they are depressed. The symptoms are similar to those of mild depression, but much worse. The lethargy can be so profound that the sufferer has trouble even getting out of bed, while any interest in previously-enjoyable activities will have gone. Sex drive, appetite, the desire for social interaction; all these will have significantly reduced. Feelings of guilt, worthlessness and despair can be so powerful that sufferers of major depression are prone to have suicidal thoughts, or even to attempt suicide. If you, or someone you know, either mentions suicide, thinks about it or attempts it, call the doctor immediately and treat the situation as an emergency.
A less common form of depression is manic depression, in which the sufferer has dramatic mood swings, from depression to mania. One day they may feel as though their world is about to end, while another day they'll be fantastically, unrealistically optimistic and cheerful. People suffering from manic depression are often artistic, and express their pain through their art. Although treatments exist for manic depression, some people find this reduces their artistic creativity.
The feeling of gloom that accompanies shorter days, grey skies and a reduced amount of sunlight affects many thousands of people in the UK to a greater or lesser extent, and in fact gets worth with latitude - Scandinavians are particularly prone, while the disorder is virtually unknown near the equator. If you find that you, or someone you know, is regularly exhibiting the symptoms of depression during the winter months, there's every chance that the person is suffering from SAD. There is a direct link between lack of sunlight and depression in many people. This can be treated quite easily, usually without the need for anti-depressants or therapy.
Having a baby is a major change in anybody's life, but especially for the woman who's carried that baby for months. The birth of a child makes a big difference to the hormone levels in the mother. When coupled with the inevitable sleepless nights and additional stress of coping with new demands on the mother's time and attention, it's not surprising that some women slip into a state of mild depression after childbirth. In some cases this can become major depression, but regardless, if you or someone you know seems to be experiencing post-natal depression, or any other form of depression, see a doctor immediately.
It's quite possible that you, or someone you know, may be suffering from depression and yet not fit neatly into one of these categories. That's normal - these are really only guidelines as to the possible different types of depression that exist. Different people react in different ways to the chemical imbalance. in their brains. The important thing is to understand the illness and realise that it's common and treatable.
Left untreated, depression will nearly always pass eventually, although that can entail many months, or even years, of misery for the sufferer. With treatment and/or therapy, however, that time can be significantly reduced; things can start to get better in a matter of weeks, and the majority of sufferers make a full recovery. But it's important not to worry about the time taken for you to get better. Take each day at a time and concentrate on making the most of it.
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© Unusual Publishing Ltd 1999-2008. Have we helped you? Then please help us! Important note: The information carried on this site relates to the direct experience of depression sufferers and is not intended as a medical guide. Nothing on this site can replace the supervision and advice of a good doctor, psychologist or psychiatrist. Anyone suffering from depression should see their doctor immediately and regularly. Legal/privacy statement. Validate.