By Suchetana Ray Chaudhuri and Srijita Bannerjee
Why are we so hesitant to talk about depression? Is it some kind of a hoax? Well, we don’t think so. Falling down is an accident but staying down is a choice. And we don’t want that choice to rule our minds, do we? We have all endured pain and loss, we have felt broken, we have known hardships and felt the loss all alone, but here we are, still standing upright, to move forward like a warrior. We are all survivors fighting an amazing battle between life and death. Depression, anxiety, panic attacks, are not signs of weaknesses but signs of trying to stay strong.
Talking about depression, the first phrase thing that comes in mind is that, “Leave me alone, I want to spend time with myself!” Of course, you need to. But, staying alone and persistently thinking about negativism will not help you come out of it. There can be various issues where one faces depression, be it any kind of abuse, low self-esteem, conflicts, death or loss, being incompetent, feeling left alone and so on. Yet, we overcome them all in the due course of time.
Globally more than 264 million people of all ages suffer from depression. Our identity and esteem become reflections of external markers of achievement which often lead to depression.
Depression should not be viewed as a single disease but a heterogenous syndrome comprised of numerous diseases of distinct causes and pathophysiologies. Attempts have been made to establish subtypes of depression defined by certain sets of symptoms:
- Melancholic Depression – severe symptoms and prominent neurovegetative abnormalities.
- Reactive Depression – Moderate symptoms in response to external factors
- Psychotic Depression – Severe Symptoms with psychosis including delusion and hallucination.
- Atypical Depression – Associated with labile mood, hypersomnia, increased appetite, weight gain
- Dysthymia – Mild symptoms but with a more protracted course
It is likely that many brain regions mediate the diverse symptoms of depression. This is supported by human brain imaging studies (still in relatively early stages) which have demonstrated changes in blood flow in several brain areas including regions of prefrontal and cingulate cortex, hippocampus, striatum, amygdala and thalamus to name a few. Similarly, anatomic studies of brains of depressed patients obtained at autopsy have reported abnormalities in many of these same brain regions. Knowledge of the function of these brain regions under normal conditions suggests the aspects of depression to which they may contribute.
The hippocampus, vital for the storage of memories, appears to be smaller in people with a history of depression than in those who have never been depressed. A smaller hippocampus has lower number of serotonin receptors (One of the neurotransmitters that allow communication across different brain regions involved in processing emotions). Hence the hippocampus may mediate cognitive aspects of depression such as memory impairments, feeling of worthlessness, hopelessness, guilt, doom and suicidality.
Studies have shown that people with depression have higher amygdala reactivity and their amygdala stays active longer than people without depression. This means that a depressed brain reacts stronger and fixates longer on emotionally charged information making it harder to remain calm and rational. A calmer amygdala means a calmer, happier you. Hence the striatum and amygdala and related regions could mediate the anxiety and reduced motivation that is seen in many patients.
Difficulty concentrating and hyper-focusing on the negative, both symptoms of depression, are controlled by the cingulate cortex. Elevated stress is both a cause and a symptom of depression. The hypothalamus regulates several hormones and controls the body’s stress response. Hence the hypothalamus can mediate the neurovegetative symptoms of depression including too much or too little sleep, appetite, energy as well as loss of interest in pleasurable activities.
We should always feel free to contact any doctor if we are facing any of the symptoms of depression. The large majority of people suffering from depression show some improvement with any of the several antidepressant medications or electroconvulsive seizures (ECS). In addition, several forms of psychotherapy can be effective for patients. Drugs along with psychotherapy have been shown to exert a synergistic effect on the patients. The acute mechanism of action of antidepressant medications are inhibition of serotonin or nor epinephrine reuptake transporters.
A dominant theme in our society is that you should be happy and if you are not so there is something wrong with you. Life can be difficult at times. It is in the labelling of people as depressed that the greatest injustice is done. It is essential to treat the person not the depression. We must come to understand how the depressed person struggles contextually in their lives and to appreciate their particular struggles. We must at all costs refrain from reducing them to a clinical compilation of symptoms.
We know it’s not easy to feel free and talk about depression, but we can always get in the right path to deal with it by sharing and talking. Love yourself, admire yourself, nurture yourself and most importantly be your first priority.
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 Nestler, E. J., Barrot, M., DiLeone, R. J., Eisch, A. J., Gold, S. J., & Monteggia, L. M. (2002). Neurobiology of depression. Neuron, 34(1), 13-25.
 Jowit J. 2018. ‘What is Depression and why is it Rising?’. The Guardian.
 Schwartz M. 2012. ‘Is our Society Manufacturing Depressed People?’. Psychology Today.