The Latin root of the word depression is ‘depressus’. Pressing down means pulling, exhausted, sad, sad.
Depression is usually symptomatized by a pessimistic view of life and the future, feelings of hopelessness and worthlessness, slowing down in thoughts and actions, feelings of emptiness, and in some cases preoccupation with thoughts of death and suicide.
Depressive disorder is a condition that affects the whole body. It affects the body, mood and thoughts. Nutrition and sleep patterns, self-perception, and thought functions are affected.
If a person has four or more of the following symptoms, cannot get out of this situation on their own, and the symptoms persist for more than two weeks, a specialist should be consulted.
In general, we can collect the symptoms of depression in 4 areas:
1. Mood domain: Depressed, sad, sad and painful emotions are dominant. These feelings can be verbalized by the patient himself. It can be understood from his facial appearance, tone of voice and behavior or his relatives tell that he is sad and unhappy. Lack of interest and desire, not being able to enjoy the activities and life (anhedonia) is evident.
2. Psychomotor activity: More often, psychomotor slowing is evident. Slowing of movements, fatigue, exhaustion, slowing of speech, slow passage of time are observed. There may also be psychomotor agitation.
3. Cognitive domain: Thought content includes thoughts of loss, hopelessness, pessimism, inadequacy, worthlessness, guilt, and death. There may be dealing with past mistakes, thoughts of punishment, and depressive-themed delusions.
4. Vegetative area: Sleep and appetite disorders, menstrual irregularity, sexual reluctance are observed.
In masked depression, which is a type of depression in which the symptoms of depression are in the background or not observed at all and there is no deterioration in interpersonal relations, patients often deny or underestimate their psychological symptoms and life problems. Instead of these, the physician; They apply with complaints of physical symptoms (sleep disorders – often difficulty falling asleep, waking up frequently at night, waking up early in the morning, appetite disorders, frequent decrease in appetite and weight loss), sexual reluctance, menstrual irregularity, loss of energy and fatigue. In addition, physical symptoms such as long-term pain, constipation-diarrhea, nausea and vomiting may occur, and alcohol-substance abuse may occur.
Most people with clinical depression feel lonely. They think that they are the only ones suffering from this disease. In fact, clinical depression is a fairly common illness.
Clinical depression dramatically changes your emotions, your relationships with family and friends, your job, and your outlook on life. If neglected, it can disrupt marriage, friendships, professional career. If left untreated, it can lead to hopelessness and a feeling that life is not worth living. It can even lead to suicide in some patients.
It is a serious and common disease with a lifetime prevalence of 15% overall and 25% for women. The general observation is that this disease is twice as common in women as in men, regardless of country or cultural differences. It is thought that this situation may develop due to hormonal differences, giving birth, exposure to various psychosocial stressors. Hormonal factors such as menstrual cycle changes, pregnancy, miscarriage, postpartum period, premenopausal and menopause may play a role in the higher prevalence of depression in women. Many women also face additional stressors such as responsibilities at both home and work, being a single parent, caring for children and their aging parents.
Although the age of onset varies between 20-50, the average age of onset is 40. 50% occur before the age of 40, and 10% after the age of 60. It peaks between the ages of 35-45 in women and between the ages of 55-70 in men. There is no racial difference. Sociocultural factors; The risk is higher in those with a family history of alcoholism, depression, loss of a parent before the age of 13, and those with a low socioeconomic status. The risk in first-degree relatives is approximately 10-13%. An increased risk was also found in identical twins.
According to the studies conducted in our country; Depression is more common over the age of 40 (most common between the ages of 40-50). Somatization (somatization) is common (about 20% of cases). Prevalence: It varies between 8-20%. It was found that endogenous depression recurs more frequently than reactive depression. The prognosis is better in middle and elderly patients with good social support. The prognosis was worse in depression accompanied by physical illness.
Depression usually occurs after a traumatic event. To briefly list traumatic events:
loss of a loved one
Serious problems at home or at work
Long-standing or chronic diseases
Use of trachylizan, antihypertensive, steroid (prednisone), codeine and indomenthacin type drugs
Substance use
The phase of withdrawal from substance use
The causes of depression can be grouped under two main headings: biological and psychosocial. Neurochemically, there is decreased biogenic amine (serotonin, norepinephrine, dopamine) activity. Irregularities in the direction of cholinergic dominance are seen in the adrenergic-cholinergic system. The hypothalamo-pituitary-adrenal axis is hyperactive in depression and cortisol hypersecretion is observed. In addition, the TSH response becomes blunted in depression, and GH, FSH, LH and testosterone levels decrease. Immune functions are reduced in depression. Sleep is abnormal in 60-65% of patients with mood disorders. REM intensity and overall REM duration increase in depression. After falling asleep, the time to the onset of the first REM period (REM latency) and stage 4 sleep decreases. Although the genetic relationship is not always confirmed, if one of the parents has major depression, the risk for the child is 10-13%. This risk is 50% in identical twins and 10-25% in fraternal twins. The concept of neuronal plasticity is also an important concept in the etiology of depression. Neuronal plasticity is the fundamental process by which the brain acquires information and adapts this information to relevant stimuli and the environment. Under stress, atrophy is observed in pyramidal neurons, especially in the hippocampus.
Antidepressants prevent the decrease in cell proliferation and this atrophy.
Considering the psychosocial dimension; The symbolic or real loss of a loved one is perceived as rejection. Depression is explained by the return of anger and aggression towards the lost object. Ambivalence against the lost object is important. Returning anger is the best-known formulation in the dynamic explanation of depression. This formulation also explains the need for self-blame, low self-esteem, and punishment.
Depression is a condition that can be treated with success. Various drug treatments and accompanying psychotherapy give good results in many patients. When these two methods are applied together, the best answer is obtained.
After all the symptoms of the disease have passed, the thing to do is to use medication for at least 6 more months and to see your therapist at certain intervals. Remember, having depression once is a sign that the second one will come easier.
Dr.phil. R. Meltem KAVCAR SIRALI
