Causes And Treatments Of Depression
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Depression can have many causes, all of which are complex and can be difficult to understand. In some cases, feelings of depression can be clearly connected to an experience in someones life, such as a tragic loss or a violent event. Other people may be aware they have a family history of mental illness and, as a result, may not be caught off guard by a diagnosis of depression.
However, some people become depressed and dont know why. They may feel they do not have a reason to be depressedespecially if they perceive their life as being good or easy compared to others.
The pressure to explain or justify how they feel can make depression worse and may prevent people from getting necessary treatment.
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Different Types Of Depression
There are different types of depression, and there are some conditions where depression is a symptom. These conditions include:
- Bipolar disorder people with bipolar disorder, which is also known as “manic depression”, experience times of depression, where the symptoms are similar to clinical depression. They also go through phases when they have excessively high moods . Bouts of mania can include harmful behaviour like unsafe sex, spending sprees and gambling.
- Seasonal affective disorder is also called “winter depression”. It’s depression that is related to weather, usually winter, so it happens seasonally.
- Postnatal depression happens to some women after they’ve had a baby. It’s treated similarly to other types of depression, with antidepressant medication and talking therapy.
Learn more about how depression is diagnosed here.
What If My Symptoms Dont Improve
If youre not responding to treatment, you may live with treatment resistant depression. This is when your symptoms have not improved after at least 2 standard treatments. This can also be known as treatment-refractory depression.
There is currently no official criteria used to diagnose treatment resistant depression.
What treatment is available for treatment-resistant depression?There are treatment options for treatment resistant depression. Even if antidepressants have not worked already for you, your doctor may suggest a different antidepressant from a different class.
The new antidepressant you are offered will depend on the first antidepressant you were given.
Sometimes your doctor can prescribe a second type of medication to go with your antidepressant. This can sometimes help the antidepressant work better than it does by itself.
Where antidepressants have not worked, your doctor may suggest talking therapies, ECT or brain stimulation treatments. See the previous section for more information on these.
What is an implanted vagus nerve stimulator, and how is it used in treatment resistant depression?If you live with treatment resistant depression, and youve not responded to other treatments, you may be able ask for an implanted vagus nerve stimulator.
Please speak to your doctor if youre interested in this treatment and for more information. You may be able to get this treatment funded through an Individual Funding Request.
- NHS Your Rights by clicking here.
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Other Treatments And Suicide
Evidence is growing that the glutamate NMDA-receptor antagonist ketamine and its active S-enantiomer can exert rapid, short-term reduction of suicidal ideation along with rapid reduction of symptoms of depression, including in BD patients, although effects on suicidal behavior are uncertain . There is considerable uncertainty about how to continue use of racemic or S-ketamine following initial benefits, and some concern that its discontinuation may provoke adverse clinical responses . ECT often appears to be lifesaving in suicidal emergencies but lacks evidence of sustained antisuicidal efficacy . Other methods of external electrical or magnetic stimulation of brain, vagal nerve stimulation, and deep brain stimulation are being investigated or introduced for the treatment of otherwise treatment-resistant depression but remain to be tested adequately for specific effects on suicidal behavior, particularly in BD.
Additional interventions of potential value include emergency hospitalization as well as psychotherapies, in particular cognitive-behavioral, dialectic, and interpersonal methods, which can improve depressive symptoms and may reduce suicidal risk . However, results from studies of psychosocial interventions may be limited by the self-selection of patients who adhere to such prolonged treatments.
The Lived Experience Of Depression
A person who is in good physical health, is employed, has a safe home to live in, enough money to care for themselves and their family, supportive friends, and hobbies may struggle to comprehend why they feel persistently sad, angry, or irritable.
In the absence of a clear trigger such as the death of a loved one, a divorce, or the loss of a job, they may feel that it doesnt make sense for them to feel depressed.
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It Can Help You Navigate Some Big Life Choices
For some, therapy is a life-long journey. For others, therapy serves as a guide through some tough waters. Maybe you just need someone to help you weigh a decision about work, a relationship, or your health. Having an empathetic ear in these times can only help.
We all experience issues at some point in our lives, whether it be a bad breakup, a stressful work situation, or family difficulties, Sal Raichbach, a licensed social worker of the Ambrosia Treatment Center, told INSIDER. Talking to someone who is trained in handling emotions and working out problems can be extremely beneficial in these scenarios.
What If I Am Not Happy With My Treatment
If you are not happy with your treatment you can:
- talk to your doctor to see if they can suggest changes,
- get an advocate to help you speak your doctor,
- ask for a second opinion if you feel it would help,
- contact Patient Advice and Liaison Service and see whether they can help, or
- make a complaint.
There is more information about these options below.
Advocacy
An advocate is independent from the NHS. They are free to use. They can be useful if you find it difficult to get your views heard.
There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. They arent available in all areas.
You can ask an advocate to help you make a complaint. Advocates that do this are called NHS complaints advocates. They are free to use and don t work for the NHS. They re available in all areas.
You can search online to search for a local advocacy service. If you cant find a service you can call our advice service 0808 801 0525 . You can email us too at . We will look for you.
Second opinion
Talk to your doctor about your treatment to see if you can resolve the problem with them first. If you dont agree with their decisions about diagnosis or treatment, you could ask for a second opinion. You are not legally entitled to a second opinion, but your doctor might agree to it if it would help with treatment options.
‘PALS’
Complaints
- Advocacy by clicking here.
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How Do I Get Help If I Think I Have Bipolar Disorder
The usual first step to getting help is to speak to your GP.
It can help to keep a record of your moods. This can help you and your GP to understand your mood swings. Bipolar UK have a mood diary and a mood scale on their website. You can find their details in the Useful contacts section at the bottom of this page.
Your GP cant diagnose bipolar disorder. Only a psychiatrist can make a formal diagnosis. Your GP may arrange an appointment with a psychiatrist if you have:
- depression, and
- ever felt very excited or not in control of your mood or behaviour for at least 4 days in a row.
They might refer you to a psychiatrist at your local NHS community mental health team .
Your GP should make an urgent referral to the CMHT if they think that you might have mania or severe depression. Or there is a chance that you are a danger to yourself or someone else.
Your GP should refer you to your local NHS early intervention team if you have an episode of psychosis and its your first one.
Bipolar disorder can be difficult to diagnose because it affects everyone differently. Also, the symptoms of bipolar disorder can be experienced by people who have other mental illness diagnoses. It can take a long time to get a diagnosis of bipolar disorder.
You can find more information about:
- NHS mental health teams by clicking here.
Activity: Working Through Itthinking About Your Diagnosis
Writing your thoughts, concerns, questions and goals down can be a very helpful tool to help you make sense of your diagnosis and next steps. Working it out by writing can also help you describe what youre going through to loved ones or health professionals. Also, if you need to access different services and supports, various professionals may start to ask you about your diagnosis including who provided the diagnosis and when it happened. Writing things down can help you remember what youve been told. If you add your thoughts and concerns too, writing can help you see your own progress over time in your recovery journey.
Step 1
Before you can be expected to deal with your diagnosis, you need to be able to put your diagnosis into words. Answer the following questions in your journal:
What diagnosis were you given?
Who provided you with the diagnosis?
When was it given to you ?
Did anyone else confirm this diagnosis? When?
What investigations were done to arrive at the diagnosis?
In lay words, what does this diagnosis mean? What does it involve?
What questions did you ask after you were given the confirmed diagnosis? If you can remember, what answers were you given for your questions?
How much did you already know about depression? Little? Some? A lot?
What attitudes and assumptions did you have about people with depression before this?
How much do you accept this diagnosis? Fully, Unsure, Dont accept it?
How much does it make sense with what you were experiencing?
Step 2
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What Can I Do If I Have Depression
If you have symptoms of depression, see your healthcare provider. They can give you an accurate diagnosis, refer you to a specialist or suggest treatment options.
If you or someone you know is thinking of hurting themselves or taking their own life:
- Go to the emergency department of your hospital.
- Contact a healthcare provider.
- Speak to a trusted friend, family member or spiritual leader.
A note from Cleveland Clinic
Depression is a common condition that affects millions of Americans every year. Anyone can experience depression even if there doesnt seem to be a reason for it. Causes of depression include difficulties in life, brain chemistry abnormalities, some medications and physical conditions. The good news is that depression is treatable. If you have symptoms of depression, talk to your healthcare provider. The sooner you get help, the sooner you can feel better
Last reviewed by a Cleveland Clinic medical professional on 12/31/2020.
References
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It Can Allow You To Build Better Relationships
If you have relationships in your life that youd like to see improved, deepened, or altered, therapy is a great place to get the skills to do so.
The person receiving therapy is able to build trust, appropriate transparency and set boundaries in all the relationships in their lives, Kernes told INSIDER.
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Consider Seeing A Psychiatrist First
Theres a tendency for some new patients to visit a counselor or psychologist for their initial mental health evaluation rather than a psychiatrist. This can be beneficial for many people, especially if your case is not severe, but for others, its often not enough.
Only psychiatrists are also medical doctors, which means that they are able to prescribe medications.
If your depression stems from a chemical imbalance, talk therapy will not be sufficient to treat you. Its best to make your initial visit to a psychiatrist, who can both prescribe medications and offer you psychotherapy if its needed. This two-pronged approach of medication and talk therapy is often the most beneficial to patients.
Psychotherapy is a broad term for a variety of different verbal and psychological techniques that are employed to help an individual work through their mental health condition or source of underlying stress. These techniques include but are not limited to psychoanalytic therapy or psychodynamic psychotherapy, behavior therapy, cognitive therapy, and cognitive behavioral therapy . Oftentimes, other mental health professionals in the field such as counselors and social workers will draw from psychotherapeutic techniques and use them with their clients.
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Can You Be Born With Anxiety And Depression
When a person gets anxiety or depression, they are more likely to be related to it if they are younger. If you have older family members who have anxiety and depression, it can still be a genetic trait. There are new conditions in people that are over the age of 20 that can be related to life events.
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Diagnosing And Treating Depression
Theres no physical test for depression.
If you experience depression symptoms most of the day, every day, for more than two weeks, you should visit your GP. This is especially important if:
- you have symptoms of depression that arent getting any better
- you have thoughts of self-harm or suicide
- your work, relationships with friends and family, or interests are affected by your mood
It can be hard for people with depression to imagine that anything can help them but the sooner you seek help, the sooner the symptoms start to get better.
Your GP may examine you and perform blood or urine tests to make sure there isnt another condition causing your depression symptoms, like an underactive thyroid.
When you see your GP, theyll try to find out if you have depression by asking you questions. These are likely to be about your health, how youre feeling, and how that is affecting you mentally and physically.
Telling your doctor your symptoms and the affect they are having on you will help your GP to tell if you have depression, and how severe the condition is. Its important to be as open as possible.
Your conversation with your GP will be confidential. This rule can only be broken if your GP thinks there is a significant risk of harm to you or others, and that telling a family member or carer would make that risk lower.
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Talking To Your Gp About Depression
When youre depressed it can be difficult to imagine that treatment can actually help. The sooner you seek treatment, the sooner your depression will improve.
Conditions such as an underactive thyroid can cause symptoms of depression. Your GP will do a urine and blood test to rule this out. There are no physical tests for depression. Your GP will tell if you have depression by asking you lots of questions. You will be asked about your health and how it is affecting you mentally and physically.
Try to be as open and honest as you can be with your answers. Describe your symptoms and how theyre affecting you.
Any discussion you have with your GP will be confidential. If you have thoughts or urges to harm yourself or others your GP would speak to your family and friends.
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Helping A Suicidal Friend Or Relative
If you see any of the above warning signs:
- get professional help for the person
- let them know they’re not alone and that you care about them
- offer your support in finding other solutions to their problems
If you feel there is an immediate danger, stay with the person or have someone else stay with them, and remove all available means of committing suicide, such as medication.
Over-the-counter drugs such as painkillers can be just as dangerous as prescription medication.
Also, remove sharp objects and poisonous household chemicals such as bleach.
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What Are The Symptoms Of Bipolar Ii Disorder
During a hypomanic episode, elevated mood can manifest itself as either euphoria or as irritability.
Symptoms during hypomanic episodes include:
- Flying suddenly from one idea to the next
- Having exaggerated self confidence
- Rapid, pressured and loud speech
- Increased energy, with hyperactivity and a decreased need for sleep
People experiencing hypomanic episodes are often quite pleasant to be around. They can often seem like the life of the party making jokes, taking an intense interest in other people and activities, and infecting others with their positive mood.
Whats so bad about that, you might ask? Hypomania can also lead to erratic and unhealthy behavior. Hypomanic episodes can sometimes progress onward to full manias that affect a persons ability to function . In mania, people might spend money they dont have, seek out sex with people they normally wouldnt, and engage in other impulsive or risky behaviors with the potential for dangerous consequences.
The vast majority of people with bipolar II disorder experience more time with depressive than hypomanic symptoms. Depressions can occur soon after hypomania subsides, or much later. Some people cycle back and forth between hypomania and depression, while others have long periods of normal mood in between episodes.
Untreated, an episode of hypomania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months.