Understanding and handling depression

by Dr Donna Robinson

Depression is often diagnosed as a prolonged episode of severe sadness often accompanied by disinterest and disengagement in activities which once provided enjoyment. Sadness itself is a common and healthy human emotion, most often experienced after disappointment, loss or personal stress. Negative emotions may return in bouts, but in most cases they diffuse overtime. Sometimes however, this sadness can manifest into something deeper and more entrenched. This can begin to affect your overall outlook, lifestyle and relationships, indicating the onset of depression. It is important to realise that depression is not uncommon and comes in many forms, each of which can be treated through introducing positive changes into your lifestyle as well as clinical means, if needed. Remember that these negative feelings will pass and there is a wide network of support and advice which you can tap into. One common cause of depression is hormone imbalances: Changes in the balance of hormones may trigger major depression in certain people, especially during menopause or during and after pregnancy. As a doctor, I can’t help but listen to my patients, learn from them and at times in my life feel the lows.


Why should you treat depression?

Depression can last months, and the reality is we have to get on with life and work, live and interact with others even when our moods are low, so treatment is important. Not only that, depression affects brain function. There are three parts of the brain that appear to play a role in major depression: the hippocampus, amygdala, and prefrontal cortex. The hippocampus is located near the centre of the brain. It stores memories and regulates the production of a hormone called cortisol. The body releases cortisol during times of physical and mental stress, including during times of depression. Problems can occur when excessive amounts of cortisol are sent to the brain due to a stressful event or a chemical imbalance in the body. In a healthy brain, brain cells (neurons) are produced throughout a person’s adult life in a part of the hippocampus called the dentate gyrus. In people with major depression, however, the long-term exposure to increased cortisol levels can slow the production of new neurons and cause the neurons in the hippocampus to shrink. This can lead to memory problems.

The prefrontal cortex is located in the very front of the brain. It is responsible for regulating emotions, making decisions, and forming memories. When the body produces an excess amount of cortisol, the prefrontal cortex also appears to shrink.The amygdala is the part of the brain that facilitates emotional responses, such as pleasure and fear. In people with major depression, the amygdala becomes enlarged and more active as a result of constant exposure to high levels of cortisol. An enlarged and hyperactive amygdala, along with abnormal activity in other parts of the brain, can result in disturbed sleep and activity patterns. It can also cause the body to release irregular amounts of hormones and other chemicals in the body, leading to further complications. Many researchers believe high cortisol levels play the biggest role in changing the physical structure and chemical activities of the brain, triggering the onset of major depression. Normally, cortisol levels are highest in the morning and decrease at night. In people with major depression, however, cortisol levels are always elevated, even at night.


Ways to cope with depression in your daily life 

Reaching out and staying connected is an important first step in the healing process to overcome depression. Dwelling on negative thoughts by yourself can make it difficult to maintain a healthy perspective, and you can often benefit from opening up to those close to you. However, the very nature of depression makes this especially difficult, as it’s common to want to withdraw and isolate yourself from others. If you feel as though you have nobody to turn to, remember that there are always opportunities to meet new people and make new connections. Continual engagement in activities which make you happy is another way of introducing positivity into your life. Getting outside of the house and involving yourself in societies or events which you used to enjoy can greatly uplift your mood, even if you don’t feel up to it beforehand. 

Daily exercise and maintaining a balanced diet are beneficial to your physical and mental health. ‘When you exercise, your body releases chemicals called endorphins. These endorphins interact with the receptors in your brain that reduce your perception of pain.’ Endorphins also trigger a positive feeling in the body, helping to alleviate depression. Exercising in a group or with a friend can help motivate you as well as encourage you to meet new people and step outside of your comfort zone. Diet plays an essential role in emotion and mood, thus if you do not consider yours carefully, your symptoms could be exacerbated. During depressive episodes, it is not uncommon to crave sugary snacks or comfort food rich in refined sugar and carbohydrates. Consequently, excess consumption of these foods often lead to
a crash in mood and energy. Instead, try to increase your intake of citrus fruits and leafy greens, which have a high vitamin B content, as a deficiency may be linked with depression.

When to seek professional help
After taking steps towards leading a more positive lifestyle, if you notice your depression worsening it may be time to seek professional help. It is always important to remember that depression can be treated and that here are several avenues of treatment which can be recommended to you. Most treatment plans involve several different methods and adopt a holistic approach to alleviating depression. Many types of antidepressants are available to you to treat depression. The most common are Selective Serotonin Reuptake Inhibitors (SSRIs). These are often the first drugs given to patients as they generally have fewer unwanted side effects. ‘An imbalance of serotonin may play a role in depression. These drugs fight depression symptoms by decreasing serotonin reuptake in your brain.’ However there is now a range of other medicines, so I tell patients if they experience any side effects, switch to another medicine. Cognitive Behavioural Therapy (CBT) aims to help you deal with overwhelming problems or emotions through speech therapy and changing the way you think and behave. Sessions are usually arranged weekly and they aim to look for practical ways to improve your state of mind on a daily basis. During the sessions you learn how to work with your therapist to understand what changes need to be made in your lifestyle in order to counter unhelpful thoughts and behaviours. There are some online CBT courses that some of my patients have found to be really useful and they can be free.

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