What you should know about depression

Is vacation a good time to write about depression? It's as good as any other time because depression doesn't go away just because it's summer. Yes, the sun and less pressure at work can ease depressive tendencies, just like rest and a change of surroundings often increase motivation and energy. On the other hand, some people feel more isolated during their holidays because they have no exciting plans or company. Some people, even in the most beautiful summer scenery, cannot find joy in themselves, although they pressure themselves that they should. Others, distracted from their responsibilities, look at their lives and feel that something is wrong – for them, the lack of a daily routine brings about anxiety rather than relaxation. It happens that we wait for holidays hoping that they will let us gain strength, and then it does not happen at all – we feel tense and irritated from day one instead. Holidays do not make difficult issues disappear – there is no point in avoiding them.

Depression is among the top most common mental disorders. According to the World Health Organization, 1 in 8 people worldwide experienced mental health disorders in 2019. 280 million people struggled with depression, including 23 million children and teenagers. These are very high numbers, and the pandemic has caused them to rise sharply, estimated at as much as 25%. Even if such a growth dynamics turns out to be temporary, the fact is that there are more and more cases of depression and it has become almost impossible not to somehow come across depression related issues. Perhaps you have experienced depression or are suffering from it. Perhaps someone you relate to, friends, neighbours or co-workers suffer from it. It's quite possible you don't even know. You or another person may also be in an at-risk group – if so, your own actions and the received support will determine whether or not depression develops.

Realising what depression is is often difficult for those who have not experienced it: usually, when trying to understand a phenomenon that is new to us, we look for references to something we are already familiar with. We compare depression to sadness and we cannot understand why what helps us to cope effectively with 'feeling blue' does not work at all this time. Meanwhile, depression takes place in the other person's inner world to which we have limited access. It doesn't help either that the colloquial word "depression" is used to describe situations that make us somewhat sad but have little to do with actual depression. Therefore, even if it seems tempting to say dramatically: "This weather is really depressing", it is better to refrain from it.

Sadness often doesn't mean depression. On the other hand, depression often means sadness, but there is more to it. Sadness usually has a tangible cause and its intensity is commensurate with the events that triggered it – someone may be slightly sad about a misunderstanding and very sad about a breakup. Depression often cannot be linked to a single, tangible cause and manifests itself disproportionately strong in the context of what has happened or is happening in a person's life. Sadness is temporary and passes fairly quickly – it goes away when the situation changes, the person starts to think differently, or takes action to deal with the problem. A sad person is rather easy to cheer up. Depression lasts longer, regardless of changes in the situation and opportunities to cope with it. Also, it resists simple attempts to improve the mood. Sadness leaves room for feeling other positive emotions – a person who is sad over losing their job may still find joy in meeting friends or reading books. Depression permeates all areas of life and makes its every aspect seemingly less important and valuable – it is accompanied by anhedonia, i.e. the inability to experience joy.

From a medical point of view, the term "depression" includes a variety of disorders with specific names and symptoms. It is certainly not a uniform phenomenon, which makes it all the more difficult to understand it. The image of a person who does not get out of bed and completely loses interest in the world, known from the movies, corresponds best to the diagnosis of a severe depressive episode. But many people with depression function so well that when they start talking about what they feel inside, they often hear, "You? I would never have guessed". Sometimes pain or sleep disorders come to the fore in depression. When the actual problem "hides" behind other symptoms, it is called masked depression. We have postpartum and seasonal depression associated with diseases and addictions. Therefore, it is better to leave the diagnosis to specialists and not announce: "You are depressed, you need to get treatment" or "You're okay, get over it".

Even though depression is a mental disorder, it has many physical symptoms. These include insomnia or excessive sleepiness, decreased or increased appetite, significant weight changes, fatigue, slowness of movement, pain, low libido, but also rarer, lesser-known symptoms such as unexplained constipation and diarrhoea, menstrual disorders, and itchy skin. We know that depression is accompanied by changes in the levels of neurotransmitters and pro-inflammatory substances, as well as changes in the brain and gut microbiota. The relationship between the psyche and the body is two-sided and in the case of disorders it is often difficult to say what is the cause and what is the effect. Most likely, various unfavourable changes stimulate each other. For example, negative emotions keep you from falling asleep, and sleep deprivation, in turn, causes further deterioration of a mental condition. The other side of the coin – the more optimistic one – is that it is also possible to launch a positive cascade of changes that will serve us.

While we know more and more about depression, we are not entirely sure what causes it. Genes explain it in part, but they are not the only factor. It is possible to inherit a greater susceptibility to depression, but we do not 'get' it directly from our ancestors – as we inherit blue eyes, for example. The fact that a parent suffered from depression does not automatically precondition their offspring – to say that someone "has depression after their mother" is too simplistic. It should also be noted that what may appear as hereditary may be in fact rooted in early childhood experiences. Being a child of a depressed person is not easy – children often feel guilty about their parent's condition, experience loss as a result of their inaccessibility or absence, or become their emotional caregivers. It is more difficult for them to form a positive image of themselves and the surrounding world, and this in many cases affects their future fate.

When you research the causes of depression, you will find many different hypotheses. None of them, however, rules out the others as 'not true'. Rather, it could be said that each hypothesis sheds light on some truth about depression. It is now accepted that whether depression develops depends on a configuration of a number of factors:

• biological (neurotransmitters, hormones, diseases and medications taken);
• psychological (beliefs, sense of control, personality traits);
• social (support, cultural patterns);
• economic (life situation);
• as well as environment (nature, peace, sun);
• lifestyle (rest, diet, activity);
• events that make up our individual stories.

Today, the omnipresent chronic stress in many ways corrodes both the body and the psyche. This is easy to understand when we think that, inherently, stress response consists in focusing all our energies on something negative, because that is the most urgent – whereas the positive distracts. From an evolutionary point of view, if a lion was chasing you, it was better not to think about how nice the flowers smelled. This makes sense when stress occurs from time to time, when we have to deal with an occasional challenge. But it doesn't work at all when we live under stress all the time and face problems that have neither an expiry date nor a solution. The thoughts: "I have to try harder", "Why did they treat me like this?" can torment us endlessly. Then the system cracks. Non-stop hyped alertness and no time to renew depletes both the body and the brain. Exhausted neurons become less plastic, i.e. they lose the ability to properly adapt and react adequately to the situation – as a consequence, shaking off sadness can become extremely difficult.

Good relationships promote mental health, and bad relationships contribute to the development of mental disorders. But although support is one of the key healing factors in depression, unfortunately this disease is often destructive to personal relationships, mainly due to the impaired communication. So, a lot depends on the awareness of relatives. It is also worth remembering the importance of relationships with yourself. Being kind to ourselves can protect us from mental suffering. It requires nurturing good contact with yourself – being mindful of your feelings, desires, doubts and fears, fully experiencing your emotions and satisfying your personal needs. We ought to pay attention to what we often put aside or postpone as in the rush of day-to-day affairs some matters may seem less urgent or important. However, abandoning oneself can turn out to be a source of deep inner sadness, hard to soothe after many years of depletion.

Usually, depression doesn't go down like a bolt out of the blue. Difficult, traumatic experiences may (although do not have to) be the "trigger" of a full-blown disorder, but usually the tendency builds up slowly over the years. Sometimes, what we see as a sudden depressive episode does not seem so unexpected after zooming in on someone's life. Susceptibility to depression can also change over time, as some factors disappear, others emerge, and some we learn to control. Most often, depression is preceded by warning signals, for example, there is only one symptom at first – often the situation can still be changed at that point. The same is true for depression relapses. Experiencing one episode increases the likelihood that more will occur, but many other factors also affect that.

Dysthymia is similar to depression, but milder. It does not take its toll so extensively and seems quite bearable. It allows you to function without major problems. For a dysthymic person, reality seems grey, but not black. Even a little colour may pop up from time to time. Someone with dysthymia, when answering the question: "Is your life okay?", will ponder for a long time or say, "Yes, but …" and will not be able to specify what is wrong. Dysthymia can reduce the quality of life for years and still be ignored – people suffering from it often find that it is not so bad, that they do not need to seek help. They sadly acknowledge that "it has to be this way", which is not true.

Depression is experienced by people of different sexes, ages, education, marital and economic status, undertaking various professional activities, belonging to different cultures, believing in different religions and representing different views. It can affect people whose life seems hard and those who seemingly lack nothing and can only be happy. No one group in society is completely immune to depression, although some may be particularly vulnerable. It's good to remember about that and not underestimate serious situations by stating: "She is too young to be depressed", "There is no depression. He just makes it all up because life is too good for him". It is also important that we do not contribute to increasing the risk by excluding or isolating certain categories of people who do not fit our image of the world.

According to statistics, depression affects women twice as often as men. However, it is difficult to say whether the numbers reflect reality – it may be that women simply ask for help more often. After all, culture gives women more permission to talk about what they are going through, while men are forbidden to admit any "weakness". Perhaps it is also cultural patterns that are at least partly responsible for different experiencing of depression as suffered by men and women. Women are more prone to torment themselves with negative thoughts, to cry and blame themselves, and they may feel anxious or have eating disorders. Whereas men rather show irritability and anger, take refuge in work, or abuse alcohol. So, the same darkness that lies inside takes on a form more consistent with the accepted image of a given gender.

In children and adolescents, signs of depression can include withdrawal from social contacts, deterioration in school performance, irritability, arguments with household members and slamming doors, getting lost in their emotions, feeling guilty about everything or feeling that they cannot do anything right, frequent complaints about headache or abdominal pain, also acts of auto-aggression. However, in the elderly, symptoms of depression are sometimes confused with symptoms of diseases such as Alzheimer's and dementia, or are considered a natural sign of ageing. Often times, it is not sadness that dominates, but physical symptoms – sleep disorders and pain. There is also low motivation, giving up interests and activities, neglecting self-care and excessive thinking about the impending death.

We can prevent the occurrence and recurrence of depression. Among effective factors are those that benefit us in many other ways as well: good sleep, physical activity, healthy diet, rest, supportive relationships, self-esteem, sense of purpose, having goals and practicing problem coping skills. However, while your own influence is significant here, it is a mistake to blame yourself or someone else for depression. Sometimes, looking from the side, we think that someone could have managed their life differently and – actually – "got into it" at one's own request (we, on the other hand, would certainly not let that happen, would we?). It is not that simple because depression is also determined by factors that one cannot influence. For example, cultural patterns hostile to diversity or covid that enforced isolation on a massive scale. Moreover, if a person could act differently, they would probably do so. Meanwhile, the very realisation that our own thoughts, emotions and behaviours are damaging us may take years, or not happen at all. Not to mention changes..

Currently, the most effective depression treatment includes a combination of drugs and psychotherapy. Antidepressants (drugs from the SSRI, SNRI, TLPD, and MAOI groups) work because they increase the level of neurotransmitters, such as serotonin and noradrenaline, and increase the level of neuronal stimulation. Psychotherapy is effective because it teaches more beneficial ways of thinking and acting, and prompts us to strengthen and use new neural pathways. However, specific drugs and methods of psychotherapy may affect different people differently, so the therapy is always adjusted individually. Electromagnetic stimulation and electroconvulsive therapy (infamous for historical reasons, but now applied safely and effectively) are also used to treat depression. Correction of vitamin D deficiency may act as a supportive stimulant. Research is being conducted on the effectiveness of anti-inflammatory agents or melatonin supplementation. There are also more and more reports of the positive effects of ketamine and psilocybin use. When discussing depression treatment, it's important to keep in mind its complex causes – just as there is no one simple explanation for depression, there is no one universal and magical remedy. While this may not always be easy to accept and apply, managing depression may require significant changes in various areas of life.

Employees of companies covered by the ICAS EAP Employee Assistance Program and their relatives can use confidential psychological support available 24/7 to deal with symptoms of depression or to help others with it.