Depression FAQ (Frequently Asked Questions)

Depression is a complex and pervasive mental health condition that affects millions of individuals worldwide. In fact, according to the NIMH (National Institute of Mental Health) more than 21 million U.S. adults had at least one major depressive episode in 2021. This represents 8.3% of the U.S. adult population. In this comprehensive exploration, we delve into how  depression works, the neurology and science, the behavioral changes on individuals, different depressive disorders, causes, age susceptibility, societal perceptions, and how to treat depression. Additionally, we provide insights on how you can support individuals experiencing depression.

What is depression?

Depression manifests on both emotional and physical levels. Emotionally, individuals experience persistent feelings of sadness, hopelessness, and a lack of interest in activities they once enjoyed. Physically, it can lead to changes in appetite, sleep disturbances, and fatigue. The impact on daily life is profound, affecting work, relationships, and overall well-being. Depressive episodes can vary in intensity and duration, making it crucial to recognize and address the symptoms. Depression isn't like a light switch where one day you don't have it and the next day you do. Rather, it is a progressive condition that takes shape over time and can vary in intensity. Major depression (a more severe form of depression) is a serious medical condition.

Most experts agree that there are two major theories explaining what causes depression - a cognitive model and a molecular model. According to a Stanford Medical article, the cognitive model "suggests that depression results from negative thoughts generated by dysfunctional beliefs. The more negative thoughts an individual experiences, the more depressed that person becomes." Whereas the molecular model describes the underlying cause as "an imbalance of chemical neurotransmitters in the brain, including serotonin, norepinephrine and dopamine".

What happens in the brain during depression?

The brain plays a central role in depression. Neurotransmitter imbalances, particularly involving serotonin and norepinephrine, contribute to mood disturbances. Depression alters the brain's neuroplasticity, that is the brain's ability to adapt and change, affecting both structure and function. Regions such as the prefrontal cortex and amygdala are implicated, influencing emotional regulation and responses to stress. Understanding these neurological aspects is vital for tailoring effective interventions.

What happens to people during a depression?

Behavioral changes are hallmark indicators of depression. Individuals may withdraw from social activities, exhibit irritability, and struggle with concentration. The impact on relationships is substantial, often leading to strained connections with family and friends. Daily activities become challenging, and the ability to find joy in previously enjoyable pursuits diminishes. Recognizing these changes is crucial for early intervention and support.

However, physical and behavioral changes are not always apparent as is evident in this Norwich Football Club commercial (it's a TV ad from the UK) during World Mental Health Day:

How does depressive disorder work?

Depressive disorders come in various forms, including:

• Depression
• Persistent depressive disorder (PDD) - persistent depressive disorder features chronic but less severe symptoms
• Major depressive disorder (MDD) - Major depressive disorder involves intense, prolonged periods of low mood
• Bipolar disorder - Bipolar disorder includes episodes of depression alongside periods of mania or hypomania

The interplay of genetic, environmental, and psychological factors contributes to the development and manifestation of these disorders. In some cases, persistent depressive disorder (PDD) and major depressive disorder (MDD) can overlap; this is called "Double depression" and it's a serious condition that can become life threatening if not treated.

Why do we go into depression?

The causes of depression are multifaceted, what medical professionals terms "multifactorial". There is no typical starting point or breaking point that causes depression, but rather most experience a progressive, downward spiral. Biological factors, such as genetics and neurotransmitter imbalances, play a role. Environmental stressors, trauma, and chronic illnesses can trigger or exacerbate depressive episodes. Additionally, personality traits and coping mechanisms influence susceptibility. Other factors could include: pregnancy, menopause, loneliness, alcohol and drug use, illness and aging.

For more information about how psychologists work to unravel the multi facets of depression, read our "How Depression Works" article.

At a higher level, depression is ultimately caused by a person's inability to find the balance between their perception to handle stress, and thus they lose hope for ever finding a solution.

Can a brain scan show depression?

Advancements in neuroimaging techniques, including functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), have provided insights into the brain's activity during depression. There's a wonderful image from the Mayo Clinic showing brain scans from the a healthy person and one with depression. [insert image] It's clear that brain activity is affected because of depression.

While these scans don't diagnose depression directly, they reveal patterns and abnormalities associated with the condition. Neuroimaging contributes to a more nuanced understanding and aids in refining treatment strategies.

Who is more prone to depression?

Depression can affect individuals across all age groups, but susceptibility varies. Adolescents and young adults are often more vulnerable due to hormonal changes, academic pressures, and identity formation. Older adults may face increased risk due to health issues, loss of loved ones, or isolation.

Here are the demographics of depression from the CDC:

• The age-standardized prevalence of depression among U.S. adults was 18.5% (crude = 18.4%) (Table 1).
• Age-specific prevalence of depression was highest among those aged 18–24 years (21.5%) and lowest among those aged ≥65 years (14.2%).
• The age-standardized prevalence of depression was higher among women (24.0%) compared with men (13.3%), higher among non-Hispanic White adults (21.9%) compared with non-Hispanic Black or African-American (16.2%), non-Hispanic Native Hawaiian or other Pacific Islander (14.6%), Hispanic or Latino (14.6%), and non-Hispanic Asian (7.3%) adults, and higher among adults who had attained less than a high school education (21.2%) compared with adults with a high school education or equivalent (18.5%) and college degree or higher (15.4%).
• Among states, the age-standardized prevalence of depression ranged from 12.7% in Hawaii to 27.5% in West Virginia (median = 19.9%) (Table 2).
• The 10 states with the highest prevalence were (in descending order) West Virginia, Kentucky, Tennessee, Arkansas, Vermont, Alabama, Louisiana, Washington, Missouri, and Montana.

What part of the brain is damaged in depression?

It's crucial to clarify that depression doesn't necessarily cause physical damage to the brain. Instead, structural and functional alterations occur. The hippocampus, involved in memory and emotion regulation, may experience changes. The prefrontal cortex, responsible for decision-making and emotional control, can also be affected. These alterations underline the complexity of depression as a neurobiological phenomenon.

Harvard Medical School has a helpful illustration of the major brain parts - https://www.health.harvard.edu/mind-and-mood/what-causes-depression

How do people with major depression act?

Individuals with major depression often exhibit a range of behaviors. They may isolate themselves, experience changes in sleep patterns, and struggle with decision-making. Fatigue and a sense of worthlessness are common. Recognizing these signs is pivotal for early intervention. Encouraging open communication and empathy is crucial in supporting individuals with major depression.

Based on research and findings from Stanford professor Randall Stafford, MD, Ph.D., " symptoms of depression are most concerning if they appear consistently for at least two weeks (multiple symptoms are common). These include:

• Marked loss of interest in daily activities (such as hobbies, sports or sex)
• Reduced appetite and significant weight loss or weight gain
• Thinking and/or moving noticeably slower
• Loss of energy
• Feelings of worthlessness or guilt, focusing on past failures, or blaming yourself for things that aren't your responsibility.

What are additional symptoms of depression?

The Mayo Clinic has these additional symptoms for people experiencing depression:

• Feelings of sadness, tearfulness, emptiness or hopelessness.
• Angry outbursts, irritability or frustration, even over small matters.
• Sleeping too little or too much.
• Physical problems that can't be explained, such as back pain or headaches.
• Anxiety, restlessness or nervousness.
• Frequent or repeated mention of not wanting to live, suicidal thoughts, suicide attempts or suicide.

Depression - How can it be treated?

According to the World Health Organization (WHO) depression can initially be treated through psychological treatments and medications. Psychological treatments can teach new ways of thinking, coping or relating to others. Psychological treatments for depression include:

• Behavioral activation
• Cognitive behavioral therapy (CBT)
• Interpersonal counseling
• Problem-solving therapy

Antidepressant medications include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, but there are many, many others and all vary based on the recommendations from medical and psychiatric professionals.

How should you support someone who is depressed?

Responding to a depressed person can be very tricky. Not all of us are trained professionals in identifying or reacting to psychological conditions. Nor have most of us been given context to that person's biological, emotional and social situation. So naturally, this is a tough ask. Supporting someone who is depressed requires empathy, patience, and understanding. Offering a listening ear without judgment, encouraging professional help, and being supportive are key. Avoiding dismissive comments and educating oneself about depression fosters a more compassionate approach.

The Mayo Clinic recommends the following actions:

• Talk to the person about what you've seen and why you're worried about it.
• Explain that depression is a health condition — not a personal flaw or weakness — and it usually gets better with treatment.
• Suggest seeking help from a professional. A health care provider is a good place to start. You also could see a mental health provider, such as a licensed counselor or psychologist.
• Offer to help prepare a list of questions to discuss in the first appointment with a health care provider or mental health provider.
• Express your willingness to help by setting up appointments, going along to them and attending family therapy sessions.

Overall, acknowledging the validity of their feelings and providing assistance in seeking appropriate treatment can make a significant difference.

Final Thoughts

We hope this Depression FAQ helped to better understand that depression is a multifaceted condition that is still being researched and studied. From its emotional and neurological dimensions to societal perceptions and emerging trends, recognizing the complexity of depression is crucial for effective support and intervention. By fostering awareness, dispelling stigma, and embracing empathy, we can collectively contribute to a more informed and compassionate approach to mental health.