One thing we often don’t recognize about mental health issues is that they affect so much more than the mind. Depression is no exception.
From sleep and eating to cognition and motivation, depression can affect most aspects of someone’s life.
Why depression is serious
There are many types of depression, including major depression, persistent depressive disorder (also called dysthymia), as well as situational types such as seasonal affective disorder and postpartum depression.
“Our understanding of depression is really evolving in medicine. We used to lump everyone into the category of major depression, but within the past 10 years or so we’ve realized that not everyone falls into that bucket,” says Patricia Areán, a clinical psychologist and professor of Psychiatry and Behavioral Sciences at the UW School of Medicine.
Anyone of any age, gender, race, ability or cultural background can develop depression. And it’s a serious problem: Over the past decades, suicides have increased in the United States, according to data from the National Institute of Mental Health.
Additionally, The World Health Organization lists depression as a leading cause of disability worldwide.
“Depression doesn’t just cause absenteeism, but presenteeism, where you’re present but you can’t function well, you’re having a hard time focusing and the quality of work isn’t good, but you still show up because you don’t feel comfortable calling in sick,” Areán says.
Brain chemical imbalance
There are many things that can contribute to the development of depression. One well-known hypothesis involves an imbalance of brain chemicals, called neurotransmitters.
Neurotransmitters, such as dopamine, serotonin and norepinephrine, all have somewhat different functions but all deliver chemical messages between neurons within the brain. The messages they send play a role in what someone’s mood is at any given moment.
There are several ways imbalance can occur. The cells receiving the chemical messages may not be receptive to them, or the brain may produce fewer amounts of certain neurotransmitters than is optimal.
Neurotransmitters regularly get absorbed into neurons during a process called reuptake, which stops neurotransmitters from transmitting their messages. Imbalance may also occur if the brain essentially “cleans up” neurotransmitters too quickly.
These different types of imbalances could partially explain why depression is different in every person and why some people respond better to certain types of treatment, Areán says.
Brain areas involved in depression
Several brain areas in particular seem to play a major role in the development of depression symptoms.
The amygdala, located deep in the center of the brain, is involved in many emotional responses including activating the brain and body’s fear response. This area tends to have increased activity in people with depression.
Research has also shown that some areas of the brain appear to shrink — and thus function less well — in people with chronic depression. These areas include the hippocampus, which is involved in long-term memory, and the thalamus, which regulates sleep and wake cycles and handles sensory and motor input.
It’s important to note that, while chemical imbalances and other brain mechanisms are involved in depression, they alone don’t cause depression. Genetics, traumatic experiences, medical conditions, chronic stress and even personal characteristics can make someone more likely to develop depression.
“Some people are more emotionally reactive and feel their feelings more strongly,” says Areán. “That alone doesn’t necessarily mean they will develop a mental illness, but they may be at higher risk in situations where they don’t have much control.”
How depression affects the body
There are, of course, mental symptoms of depression, such as feeling sad or down. Anhedonia, the inability to feel pleasure in things that usually bring joy, is also common.
“Some people have one of those two symptoms, but some people don’t,” Areán says.
In fact, many depression symptoms are felt not in the mind but in the body.
Physical depression symptoms can be polar opposites depending on the person. Hypersomnia, or excessive sleepiness, is common, as is insomnia. Appetite can also be affected, either by not having one or by overeating or eating without thinking. Some people feel a complete lack of energy or motivation; others feel restless or on edge.
“One aspect to depression that is not in the diagnostic criteria is that it can make you feel sick, achy and tired all the time. It’s not that you’re being lazy, it’s that you don’t have energy and your brain and muscles feel tired. That makes it challenging because the thing you need to do is the thing you don’t feel like doing, so you have to push yourself,” Areán says.
How someone’s symptoms manifest can depend on their age, too. Children and teens are more likely to be restless or irritable, whereas older adults may have things like stomach problems and insomnia.
The most serious symptom is a preoccupation with death or dying, either with a wish to die or actively trying to figure out how to die. Suicidal thoughts are serious. Suicide is a leading cause of death in the United States and is the second-most cause of death among children, teens and younger adults, from age 10 to 34.
Depression is treatable
While the data about suicide is grim, depression doesn’t have to be. The good news is that depression is treatable.
One common misconception to clear up first: While healing and feeling better is more than possible, there is no such thing as a “cure” for mental illness.
“We don’t have cures. We can prevent future episodes of depression, but if you need to come back to therapy or get healthcare, that’s OK. It’s not like you would ignore an illness like diabetes or heart disease,” Areán says.
There are several ways to treat depression, including medications, therapy and specialized practices for people who have treatment-resistant depression.
The most commonly prescribed medications for depression are called selective serotonin reuptake inhibitors, or SSRIs. They are thought to work by preventing excessive reuptake of the neurotransmitter serotonin.
Cognitive behavioral therapy (CBT), is one of the most scientifically effective forms of therapy for depression, as is dialectical behavior therapy (DBT). Interpersonal psychotherapy, behavioral activation or problem-solving treatment are other good options depending on someone’s particular needs, Areán says. Even therapy apps can be helpful for some people, or at least a starting point as they explore treatment options.
For people who have depression that doesn’t respond to these types of treatment, electroconvulsive therapy (ECT), sometimes called shock therapy, is an option. It sounds severe, but it’s been proven to be helpful for people who have exhausted all other options.
“Depression is not your fault. No one should ever feel guilty for it. Don’t feel like you have to pull yourself up by your bootstraps, because it’s not easy. Depression is a neurological condition, and you’ll need support and that’s OK,” Areán says.