We’re well on our way to eradicating measles, polio, the Guinea worm, mumps, rubella, and river blindness. Despite being one of the deadliest viruses in human history, antiviral medication and treatment for AIDS has evolved to the point that someone who is diagnosed HIV positive in 2018 and seeks treatment is more likely to die of other causes, enjoying a lifespan just as long as an uninfected person. Meanwhile, we’re making strides in finding solutions to global issues such as malnourishment, obesity, and antibiotic-resistant bacteria.
But the brain is one of the last great mysteries of the human body. There’s a lot about the brain we don’t fully understand, and many of the diseases that we’ve traced back largely to the organic computer in our skull are still mostly misunderstood. Still, we’ve come a long way in the last century or so, especially over the last few decades, in the creation of several therapeutic methods for treating common mental disorders. These include generalized anxiety, major depression, autism spectrum, obsessive-compulsive disorder, bipolar disorder, and more. Among these, the most common mental disorders are mood disorders, also known as depressive disorders. But where do depressions come from?
It Can Have Many Causes
Depression is understood as a low mood and becomes a disorder when said mood continues to persist for a period of time without a reasonable or logical cause. Depression is different from sadness, which is not a mental disorder. Despite being sadness being an emotion we generally seek to avoid, thoughts of sorrow and melancholy are very human, and healthy. It’s natural to feel sad after any number of things, from tragic events to mild inconveniences. Our sorrow is amplified by the degree of suffering we endure – by any standard, missing out on a book sale is nowhere near as tragic as the abrupt loss of a loved one.
Depression is when sadness is no longer a response, but a state of mind. The first criteria for a mood disorder is a consistently low mood lasting longer than two weeks. This does not include low mood caused by grief, which can often last longer. Depression is usually most recognizable when it comes out of nowhere – but it always has at least one cause.
The first cause is a bad draw in the genetic lottery. While sadness is universal for humans, depression is rare, and occurs in only about 6.7 percent of adult Americans. Many studies note that there may be a genetic link between depressed people, meaning some people have a higher chance of getting depressed than others, and that that chance increases the more depressed people you’re related to.
Another factor to consider is emotional stress. Accumulative and/or acute stress greatly contributes to the development of depression, with or without the genetic risk. This can either mean having a really hard time at work while facing a series of other pressures (leading to a condition commonly referred to as “burnout”), or it could be stress caused by a single extreme event, leading to a trauma. Post-traumatic stress is not always the first diagnosis after a traumatic event – some people experience symptoms of depression and eventually develop a mood disorder many weeks, months, or even years after their trauma.
Then, there’s the human body. A series of different other physical illnesses can cause depression or greatly contribute to the development of a mood disorder, including hypothyroidism, multiple sclerosis, chronic pain caused by an injury or arthritis, and metabolic syndromes that often indicate an unhealthy lifestyle, which can be both a mental and physical source of stress.
Sometimes It’s Complicated
One cause rarely explains a depression. It’s not uncommon for someone diagnosed with depression to struggle with different risk factors, including pressures at home and from work, relationship problems, biological factors, and a history of mental health issues.
This is why both diagnosis and treatment require an understanding of a patient’s whole history and condition, as well as a multimodal approach. Because the human brain is still a mystery, we don’t have anything resembling a “perfect cure” for depression. Instead, we know that certain chemicals play a role in the development and possible treatment of depression, and by working with or influencing those chemicals, or by targeting specific portions of the brain, we can often alleviate, control, and even completely eliminate the symptoms of depression for a period of time.
Some people respond well to antidepressants and psychotherapy, while others do better on a healthy diet and exercise. Others yet are at a great risk of suicide despite treatment and need the constant love and supervision of their friends and family to lead a stable life.
Depression also comes in many different forms, and there is more than just one way a person can be depressed. For example, major depressive disorder is the most common form of depression and involves being depressed for more than two weeks for no discernable reason. Persistent depression characterizes the same disorder, but with symptoms lasting for several years, although people with persistent depression may also experience milder symptoms. Premenstrual dysphoric disorder is a form of depression that only occurs in the premenstrual phase of a woman’s menstrual cycle. Bipolar disorder is a form of depression coupled with mania, wherein a person experiences one or both in intermittent cycles lasting several weeks or months.
What might look like MDD (major depressive disorder) might later be reevaluated to be PMDD (premenstrual dysphoric disorder), and so on. It takes time to properly diagnose a patient and find the right treatment. And sometimes, treatments don’t work as they should.
TMS and Depression
The first line of treatment for many going through a mood disorder is a class of drug called antidepressants. These drugs are divided further into different types or subclasses, based on their exact functions in the brain. Of these, selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed, and generally the safest.
SSRIs increase the amount of available serotonin in the gaps between brain cells, helping patients better regulate their mood. However, this can have side effects based on the individual. Loss of sex drive, weight gain, and nausea are common possible side effects. Psychiatrists work with patients to try out different brands of drugs, each with a different formulation, to find an alternative without intrusive side effects. Most of the time, patients find a drug that works for them. But sometimes, they don’t.
Treatment-resistant depression does not respond well to antidepressants – but it can respond to other treatments. Transcranial magnetic stimulation, for example, affects a part of the brain responsible for mood regulation in such a way that, over the course of several sessions, the symptoms of depression in patients who don’t respond to antidepressants often regress, or even go away entirely for a while, without any lasting side effects. More research is being done to identify why this treatment works so well, but until then, it remains a useful alternative for thousands of Americans struggling to find hope through the usual avenues.