What is depression and why does it occur more often?

This disease hits the news pages almost daily. Juliet Jovit asks questions about what causes depression, who is prone to it and how best to cope with it

What is depression?

People suffering from depression do not necessarily go everywhere with stretched faces, or cry at the first opportunity. On the US mental health website, MentalHealth.gov, this disease is defined as “loss of interest in important aspects of life.” Symptoms include an excess or lack of food and sleep; distance from people and ordinary activities; lack of energy; feeling of no meaning, numbness; unusually strong inconsistency and forgetfulness; feeling like you are on the verge of, angry, upset, worried or afraid; thoughts of hurting yourself or others.

An intuitive description is cited by the British Mind Foundation : “It starts like a sadness, then I feel that I am shutting down and less and less cope with reality. In the end, I feel numbness and emptiness. "

Depression is often mixed with other health problems: for example, long-term illness, irritability, obsessive-compulsive disorder, or schizophrenia.

The term " dysthymia " is used to describe long-term and less severe depression - it usually lasts for two years or more.

Ancient disease

I don't know why I'm so sad.
To me this is a burden; I hear you too.
But where I caught the sadness, found Il got.
What makes up what will give birth to her, - I would like to know!

- says Antonio in the play "The Merchant of Venice ". However, he was not the only character of Shakespeare who was experiencing depression: if Hamlet or Macbeth went to a modern doctor, they would have been prescribed antidepressants. And also Faust, Madame Bovary and Raskolnikov. Dante begins the Divine Comedy like this:

After half
my earthly life, I found myself in a gloomy forest,
Losing the right path in the darkness of the valley.

And he really groped for something like that.

Clinical depression is not a 21st century problem. It is as old as humanity. New became only its scale. But in this sense it is hard to say whether more people are really depressed today than in the past, or simply they talk about it more.

How many people suffer from depression?

Clinical depression has developed to the scale of the epidemic in recent decades, and has evolved from a rarely mentioned scourge from the outskirts of society into a phenomenon that rarely leaves the news. It has spread in schools and commercial companies, in refugee camps and cities, on farms and in the suburbs.

It is estimated that 300 million people are suffering from depression at any given time — about 4% of the global population. This follows from the 2015 World Health Organization report. Women are more prone to depression than men.

Depression is the leading global problem, and unipolar depression (as opposed to bipolar) is the 10th on the list of leading causes of early death. The link between suicide, the second most common cause of death for young people aged 15-29, and depression is obvious, and around the world every two minutes two people complete their lives.

And although in the world the figures for depression and other common health problems vary widely, the United States is the “most depressed” country in the world, closely followed by Colombia, Ukraine, the Netherlands and France. At the other end of the scale are Japan, Nigeria and China.

Where does this scatter come from?

A striking contrast between countries led to the appearance of depression as a “first world problem” or a “luxury”. The logic is this - if a gun is aimed at your head or you don’t know where you’ll get the money for the next meal, you don’t have time for such self-digging.

Recent studies indicate a whole sea of ​​causes, many of which overlap: in particular, less developed countries often lack the infrastructure to collect data on depression, and there it is less likely to recognize this condition as a disease. Also in these countries, society does not encourage people to talk about their feelings and their residents are less willing to turn to professionals for help.

Statistics are also not so simple to claim that the rich are depressed, and the poor are not.

One work in the journal Plos Medicine claims that, if we reject the extreme cases, in most countries the number of cases of depression is about the same. It is also argued that depression suffers most in Eastern Europe, North Africa and the Middle East; and most years of disability due to depression lost in Afghanistan, and least of all in Japan.

What causes depression?

Since then, when it was thought that the devil had infiltrated people with mental problems, and when such people were expelled from the community or hung up for witchcraft, the situation had greatly improved. But until now, the understanding of this disease remains extremely distorted, especially the idea that people suffering from depression simply need to “pull themselves together” or “leave the house more”.



A psychiatrist Tim Kantofer is expressing a completely different opinion in his book Depressive Illness: The Curse of the Strong [Depressive Illness: The Curse of the Strong].

He claims there is a site in the brain called the limbic system"[in fact, it is a combination of several brain structures / approx. transl.], working as a thermostat that controls various functions of the body - including mood - and restores balance after inherent descents and lifts. The limbic system is a circuit of nerves that transmit signals each other through two chemicals, serotonin and norepinephrine , which people with depression do not have. According to this description, a depressive illness is mainly physical, not psychological.

Kantofer says that under the influence of stress, weak or lazy people give up very quickly; strong people continue to move forward, doubling their efforts, struggle with any pressure that forces them to surrender, and bring the limbic system to the point of failure. However, there is no scientific evidence for this theory, since it is impossible to conduct experiments on the living brain.

It is also accepted that the disease is initiated by the resulting injuries or ill-treatment; genetic predisposition, which may or may not coincide with the history of diseases in the family; life stress, including financial problems or heavy losses; chronic pain or illness; drug use, including marijuana, ecstasy and heroin.

There is, though actively contested, the view that extreme stress or certain diseases can cause an overly strong immune response that causes inflammation in the brain, which leads to depression.

Treatment

WHO estimates that less than half of people suffering from depression are treated for it. Many receive inadequate assistance, often focused on medications, with a lack of speech therapy, which is considered a critical ally.

Among the pharmacological agents for depression, antidepressants of the group of selective serotonin reuptake inhibitors , which decrease serotonin absorption and increase its overall level, are most often prescribed . Another popular class of drugs is selective serotonin and norepinephrine reuptake inhibitors , which work simultaneously with serotonin and norepinephrine. Cognitive-behavioral psychotherapy is

most commonly used among the methods of treatment.that breaks a person’s overwhelming problems into situations, thoughts, emotions, physical sensations and actions aimed at uncovering the vicious circle of negative thoughts.

Other types are interpersonal therapy, behavioral activation, psychodynamic psychotherapy and pair therapy. All types of speech therapy can be used alone, or in combination with medications.

In addition to the medical approach, doctors may prescribe physical activity or artistic therapy, while some patients choose alternative or supportive therapies, the most popular of which are Hypericum, meditation, and yoga.

Trends

The number of types of treatment for depression increases, but the problem is not solved, but grows. From 2005 to 2015, the number of cases of depression increased by almost one fifth. The probability of getting this disease in people born after 1945 has increased tenfold. According to WHO, this reflects both the growth of the population and the proportional increase in the number of cases of depression among the most susceptible age groups.

However, in the whole world, the number of suicides has decreased by about a quarter. In 1990, their number was 14.55 people per 100,000 people, in 2016 it is already 11.16 per 100,000. The

key reason for the increase in depression is that medications do not necessarily cure the patient, and other treatment methods that can turn the tide often lacking.

Other causes of growth are an aging population (in the 60–74 year age group, the likelihood of depression is higher than in others), and an increase in stress and isolation.

What's next?

Over the past 25 years, not a single new antidepressant has been developed, forcing psychiatrists to seek help in other areas.

Were conducted positive experiments with ketamine and psilocybin , the active ingredient of the " magic mushrooms ". Hopes for a new generation of treatment methods appeared after the discovery of 44 mutations, which, according to scientists, increase the risk of depression. Another controversial area of ​​research is the treatment of depressed immunity and the controversial link between depression and inflammatory processes.

Different countries increasingly understand the need to increase the number of psychologists as a replacement or supplement to drug treatment.

Probably the most important thing is a cultural shift that makes it easier for people to seek help and talk about their illness.

Among the celebrities at the head of this shift are the British princes William and Harry, who founded the charity foundation Heads Together, and spoke publicly about their problems. Also recently, the wrestler and actor Duane Johnson spoke about his depression, and the singer Mariah Carey - about bipolar disorder.