Depression: Symptoms, causes and treatment

 “You don’t feel pleasure anymore, you’re tired, you feel sad and you cannot motivate yourself to do something.”

For a lot of people these symptoms are recognizable, you feel down. Often these complaints disappear within a few days, in contrast to a depression. Several factors may contribute to a depressive episode.

Studies show that both ‘biological’ and environmental factors play a role in depression. Hereditary factors play an important role in the onset of depression, although the exact genetic causes – even over 10 years after the end of the Human Genome Project – are still not known. In another context is often talked about the importance of certain chemicals in the brain like serotonin, growth factors such as BDNF or an imbalance of brain activity between the right and left frontal cortex. On the other hand is also known that severe emotional or traumatic experiences in the past or emotional neglect may increase the risk of a depression. In the following we will elaborate on what depression is, and what treatments for depression there are and what is known about these treatments. For more scientific background on depression, EEG and Personalized Medicine see also our Research Institute and for more information about rTMS treatment for Obsessive Compulsive Disorder (OCD) see here

What is a depression?

Depression is one of the most common mental disorders and is distinguished from “normal” sadness by the nature and duration of symptoms. To speak of a disorder at least 5 out of 9 total symptoms should appear, including at least sadness and / or loss of interest or pleasure, have been present within a period of two weeks and indicate a change from previous functioning. In general it can be said that depression in women appears 2 times more often than in men. Women get the disorder more frequently than men, but when the depression appears its course and the recurrence rate is approximately equal. Research shows that in The Netherlands 6% of the adult population recently suffered from a depression. That’s a total of approximately 750,000 Dutch. Experience also shows that 1 in 7 people ever becomes depressed.
Not every depressed, gloomy or sad mood is a mental disorder. Depression is not just a negative mood where you can easily ‘recover’ from. It also has nothing to do with personal weakness or defects. It is a serious mental disorder where people of all ages can suffer from. More than half of people with a depression experience serious impairment in social functioning, such as increased absenteeism from work, fewer social contacts, poorer functioning in the family or in a relationship. In many cases, the depression leads to temporary or permanent disability for work.

Clinical Depression

A (clinical) depression is a mood disorder that is characterized by a loss of life pleasure or a heavily depressed mood. When depression is not treated in the right way, it can worsen and even lead to a life threatening situation.

Clinical depression must meet certain criteria as defined in the DSM-IV, the diagnostic manual for psychological disorders.

Symptoms depression

Psychological symptoms:

  • Depressed mood: sadness, depression, hopelessness, sometimes mood is worst in the morning
  • Tiredness, loss of energy, initiative and strength
  • Feeling: fear is often a characteristic feeling of depression, sometimes there is a strong flattening of emotions: one feels nothing, no sadness, joy, fear or happiness
  • Disorders of the form of thought: problems with concentration and memory, thinking inhibition and indecision
  • Thoughts about guilt, self-blame, worthlessness and loss of self-respect

Behavioral symptoms:

  • Social withdrawal behavior, loss of interest in the surroundings
  • Loss of the ability to have fun
  • Physical agitation or even inhibited behavior
  • Reduced productivity
  • Suicidal thoughts / tendencies
  • Crying

Functional symptoms (vital or biological functions):

  • Eating disorders: decreased or increased appetite
  • Sleep disorders: sleeping late, awake during the night, waking up early, or just lethargy
  • Sexual disorders: decreased need (loss of libido)
  • Physical symptoms: constipation or diarrhea

Psychotic symptoms

In 10 to 15% of the depression cases there are psychotic features; there is a strange look at reality. This manifests itself in a psychotic depression usually in delusions (uncorrectable thoughts). Often the content of those delusions are in accordance with the depressed mood: the themes are dominated by personal shortcomings, failures, guilt, death, penalty or nihilism.

Types of depression

There are different types of depression. A unipolar depression is characterized by someone feeling down a long time. Bipolar depression is characterized by the alternating periods in which a person feels depressed with periods when someone has a lot of energy. When a person experiences this, we speak of a mania. Bipolar depression is also called manic-depressive.

Depression occurs worldwide with about 121 million people. In the Netherlands, 6% of people suffer from depression or have recently had it. One in seven people in the Netherlands will ever have to deal with depression.

Some facts about depression:

  • It is the second largest cause of death after heart disease and it has been shown that depression is a major contributor to coronary diseases
  • Depression is twice as common in women than in men and is most common in the age 25-45 years
  • Less than 30% of the people with depression feel a reduction in symptoms by taking antidepressants such as Paxil (paroxetine), Effexor (Venlafaxine), Cipramil (Citalopram), Remeron (Mirtazapine) or Doxepin
  • Depression provides more absences from work than any other disorder, and it gives many employers ‘production loss’
  • Globally, depression ranks fourth on the list of most common diseases

Depression: Causes

It is difficult to give one cause for depression, it is often a combination of several factors.

Biochemical factors
Research has shown that depression is a disturbance in the balance of certain substances (such as serotonin, norepinephrine and growth factors such as BDNF) in the brain. However, recent research also shows that this is more complex than just a reduced serotonin level. Also, recent research has shown that depression is associated with a specific pattern of disturbed brain activity, either in the extent to which certain areas of the brain communicate. Treatment with rTMS is specifically aimed at restoring the communication between brain regions (dorsolateral prefrontal cortex, anterior cingulate, etc.).

A specific form of depression associated with the shortening of the days, Seasonal Affective Disorder (or SAD), is mainly caused by a lack of light. You can use light therapy to prevent this kind of depression.

Biogenetic factors
There is a genetic component that plays a role. Children of parents with depression are three times as likely to be depressed themselves, than children of parents who are not depressed.

Psychosocial factors
Major life events such as divorce, death, resignation, but also getting a child and promotion can play an important role in the development of depression. These are events that can evoke a lot of tension and stress.
The social life can also just provide a healing effect on the depression. A stable relationship, friends who support you and help you and a fine job can provide a good structure in your life and form a social safety net.

Psychological factors
Blocking painful feelings and thoughts through unprocessed traumatic (childhood) experiences can increase the onset of depression.

Organic factors
Certain medications and different types of drugs (some high blood pressure medications, sedatives, alcohol, amphetamine, cocaine) are known for the possible cause of depression. There are also a number of physical disorders that increase the risk of depression (such as a stroke).

Depression: Treatment

There are several treatments being used in the treatment of Depression, such as:

  • Psychotherapy including cognitive behavior therapy (CBT)
  • rTMS (also called TMS)
  • EMDR in cases of trauma
  • Antidepressant medication (such as Paroxetine, Venlafaxine or Citalopram)

More information about treatments for Depression can also be found under treatment of depression.

rTMS as treatment option