Research question about depression

Contents

10 Key Questions About Depression

What Is Depression?

Depression may be described as feeling sad, blue, unhappy, miserable or down in the dumps. Most of us feel this way at one time or another for short periods. But true clinical depression is a mood disorder in which feelings of sadness, loss, anger or frustration interfere with everyday life for an extended time.

Depression is a common condition. The National Institute of Mental Health (NIMH) estimates that about 10 percent of American adults experience some form of depression. For people with chronic illnesses, the number can be higher. For example, NIMH estimates that about 25 percent of people with cancer have depression, and one study of people with multiple sclerosis found that 41.8 percent had significant symptoms of depression.

The symptoms of depression can be mild, moderate or severe. But even when symptoms are mild, the condition is not the same as temporarily having the blues. People cannot snap out of depression by force of their will. And while practicing healthy habits may help, getting regular exercise, eating right or taking a vacation may not completely alleviate depression.

Depression is more common in women than men and is especially common during the teen years. Men seem to seek help for feelings of depression less often than women. Therefore, women may only have more documented cases of depression.

What Causes Depression?

Depression often runs in families and may be due to heredity, learned behavior or both. Even with a genetic predisposition, it is usually a stressful or unhappy life event that triggers the onset of a depressive episode. While the exact causes of depression are unknown, several factors appear to affect its onset:

  • Biochemistry: Nerve cells in the brain send and receive messages that control your emotions and feelings, with the help of chemicals called neurotransmitters. Scientists believe that depression symptoms occur when some of these neurotransmitters, including serotonin and norepinephrene, are not delivered correctly, causing a chemical imbalance.
  • Genetics: A family history of depressive disorder puts people at greater risk, but depression also strikes people who have no family members with the illness. Depression that results from a person’s biology or genetic inheritance is sometimes referred to as endogenous depression.
  • Personality: People who are pessimistic or have low self-esteem or low tolerance for stress are more likely to develop depression.
  • Difficult life situations: Depression may be more likely in people who are facing serious problems in their lives, such as abuse, violence or poverty. Difficult times, such as divorce, the death of a loved one, financial problems or moving from your home can also contribute to depression. This type of depression is sometimes referred to as reactive depression.
  • Other illnesses: People who have certain other medical conditions – such as cancer, heart disease, stroke, diabetes, Parkinson’s disease and hormonal disorders – are more likely to develop depression.

Depression may also be brought on by:

  • Disappointment at home, work, or school (in teens, this may be breaking up with a boyfriend or girlfriend, failing a class or parents divorcing)
  • Drugs such as sedatives and high blood pressure medications
  • Alcohol or drug abuse
  • Chronic stress
  • Childhood events like abuse or neglect
  • Social isolation (common in the elderly)
  • Nutritional deficiencies (such as folate and omega-3 fatty acids)
  • Sleeping problems

What Are the Symptoms of Depression?

Not everyone who is diagnosed with depression has the same symptoms. Some experience only a few symptoms, others have most of them. How severe the symptoms are and how long they last also varies from person to person. To be diagnosed with major depression, a person must have at least five of the following symptoms nearly every day for at least two weeks:

  • Feeling sad or empty
  • Decreased interest or pleasure in activities
  • Appetite change with weight loss or weight gain
  • Decreased or increased sleeping
  • Fatigue or loss of energy
  • Feeling worthless or guilty
  • Being either agitated or slowed down
  • Difficulty thinking or concentrating
  • Recurrent thoughts of death or suicide

Low self-esteem is common with depression, so are sudden bursts of anger and lack of pleasure from activities that normally make you happy, including sex.

Depressed children may not have the classic symptoms of adult depression. Watch especially for changes in school performance, sleep and behavior. If you wonder whether your child might be depressed, it’s worth bringing to a doctor’s attention.

Are There Different Types of Depression?

As with other types of illness, depression takes different forms. Some of the most common depressive disorders are:

  • Major depression is characterized by symptoms that affect a person’s work, sleep, eating habits, and interest in activities he or she once enjoyed. Episodes of major depression can last for six months or more. To be diagnosed with major depression, a person must have several of the symptoms noted in question 3 LINK on most days for at least two weeks. People with major depression may have just one episode of the illness, but more often the symptoms return several times during their lifetime.
  • Dysthymia is a low-intensity mood disorder characterized by similar but less severe symptoms than major depression, but the condition is longer-lasting (the symptoms must be present for two years to receive the diagnosis). While not totally disabling, dysthymia makes it difficult for a person to feel good or function normally. Many people who have dysthymia also have periods of major depression.
  • Bipolar disorder, which is sometimes called manic-depressive illness, is much less common than other types of depressive disorders. It is marked by cycles of intense highs, called manias, followed by intense lows, or depressions.

Other common forms of depression include:

  • Postpartum depression is depression after the birth of a baby. Between 10 and 15 percent of women who give birth are clinically diagnosed with this form of depression. (Postpartum psychosis, which is sometimes confused with postpartum depression in the media, is a rarer and much more serious mood disorder that requires immediate medical care.)
  • Premenstrual dysphoric disorder (PMDD) refers to depressive symptoms that occur about one week prior to menstruation and disappear after you menstruate.
  • Seasonal affective disorder (SAD) occurs during the fall-winter season and disappears during the spring-summer season. It’s likely due to lack of sunlight.

How Do I Get Help for Depression?

Without treatment, depression can be extremely serious, and even life-threatening if a person has thoughts of suicide, so it’s extremely important to seek help if you are having depression symptoms. Effective treatments are available, and the National Institute of Mental Health estimates that more than 80 percent of people who seek treatment find relief from their symptoms.

If you are depressed for two weeks or longer, contact your doctor about treatment options or referral to a professional who is knowledgeable about depression, such as a psychotherapist or a psychiatrist.

If you have thoughts of suicide, a suicidal plan or thoughts of harming yourself or others, call 911 or a suicide hotline, or go to a nearby emergency room.

Call your doctor right away if:

  • You hear voices that are not there.
  • You have frequent crying spells with little or no provocation.
  • You have had feelings of depression that disrupt work, school or family life for longer than two weeks.
  • You have three or more depressive symptoms.
  • You think that one of your current medications may be making you feel depressed. DO NOT change or stop any medications without consulting your doctor.
  • You believe that you should cut back on drinking or drugs, a family member or friend has asked you to cut back, you feel guilty about the amount of alcohol or drugs you use, or you drink alcohol or use drugs first thing in the morning.

How Is Depression Diagnosed?

Because some medicines and medical conditions can cause the same symptoms as depression, the first step in diagnosis is a complete medical history and a thorough physical examination. The exam may include an interview and laboratory tests to rule out other causes for the symptoms. If no other cause is found, people with symptoms of depression usually undergo a psychological evaluation performed by their physician or by a psychologist or psychiatrist.

During a diagnostic psychological examination, the doctor asks a series of questions, including:

  • What are your symptoms?
  • How long have you had these symptoms?
  • How severe are the symptoms?
  • Have you had these symptoms before?
  • If so, were you treated for depression?
  • What treatments did you have and which worked best?
  • Do you have any relatives who have had depression?
  • If so, were the relatives treated for depression, and which treatments worked best?
  • Do you use drugs or drink alcohol?
  • Have you thought about death or suicide?
  • Whether speech or thought patterns or memory have been affected.
  • Other associated symptoms (sleep, appetite, concentration, energy).
  • Possible stressors in your life, and support systems in place.

If your answers to these questions indicate that you have depression, your doctor will work with you on a treatment plan.

What Medications Are Used to Treat Depression?

Doctors can choose from several different types of anti-depressants (sometimes combined with psychotherapy) based on a person’s symptoms and tolerance for the medication. Because they are unable to tell how well a person will respond to an anti-depressant in advance, a person may need to try several different medications or combinations of medications to alleviate symptoms.

It takes six to eight weeks for most people to feel the full effect of anti-depressant medication, and most are prescribed for six months to a year, and sometimes longer. People with chronic major depression may need to take anti-depressants indefinitely. A person with depression should never stop taking anti-depressants without first talking to a doctor.

The major types of anti-depressant medications are:

  • Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs): The newest types of anti-depressants work by acting on two chemical messengers in the brain linked to depression, norepinephrine and serotonin. Medications in this category include Cymbalta (duloxetine), Effexor (venlafaxine) and Serzone (nefazodone).
  • Selective serotonin reuptake inhibitors (SSRIs): SSRIs work by increasing the activity of serotonin in the brain. They include Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine), Paxil(paroxetine), Celexa (citalopram) and Lexapro (escitalopram).
  • Tricyclics: Like SSNRIs, tricyclic anti-depressants work on norepinephrine and serotonin. They are as effective in treating depression as the newer drugs, but their side effects are usually more severe. As a result, doctors do not often prescribe them as a first choice. Tricyclic medications include Tofranil (imipramine), Elavil ( amitriptyline), Pamelor (nortriptyline) and Norpramin (desipramine).
  • Monoamine oxidase inhibitors (MAOIs): MAOIs work by blocking the action of a chemical substance called monoamine oxidase (MAO) in the nervous system. Doctors sometimes prescribe these medications when people do not respond to other types of anti-depressants. They are also prescribed for panic disorder and bipolar disorder. Medications in this group include Nardil ( phenelzine), Parnate (tranylcypromine) and Marplan (isocarboxazid).

What Other Treatments Are Available for Depression?

Depression is treated in a variety of ways.

Psychotherapy

People with mild depression may only need psychotherapy (talk) to improve their symptoms, though doctors often advise therapy in conjunction with medication. Psychotherapy attempts to help people work through their problems by talking regularly with a therapist. Depending on the situation, a person may undergo psychotherapy one-on-one with a therapist, take part with a spouse or family or try group therapy with people who have similar problems.

Research has shown that some one-on-one short-term therapies, lasting 10 to 20 weeks, can help with depression. They are:

  • Interpersonal therapy, which focuses on improving personal relationships that help cause depression or make it worse.
  • Cognitive or behavioral therapy, which focuses on changing negative thinking and behavior that may be linked to depression.

Hospitalization

For people who are so severely depressed as to be unable to function, or who are suicidal and cannot be safely cared for in the community, psychiatric hospitalization may be necessary.

Electroconvulsive therapy (ECT)

Doctors may suggest ECT for people with severe depression, and for those who either cannot take anti-depressants or for whom anti-depressants do not work. ECT is performed under sedation and muscular paralysis to eliminate discomfort, and uses a brief electrical shock to cause a short seizure – about 30 seconds – in the brain. Doctors think it works for depression because the seizure releases chemical messengers in the brain, such as norepinephrine and serotonin. Usually, a person needs 12 or fewer treatments.

Herbal treatments

One such herbal remedy is St. John’s wort (Hypericum perforatum). In Germany, St. John’s wort has long been used to treat mild to moderate depression. Studies on its use there, however, have been short-term and have not usually used uniform doses.

The U.S. National Institutes of Health conducted a three-year study of St. John’s wort and major depression of moderate severity. The study found no significant difference in rate of response for depression among groups receiving St. John’s wort, taking an SSRI anti-depressant or those getting a placebo. People who took the anti-depressant, however, reported better overall functioning than those who took either the St. John’s wort or the placebo.

If you are using herbal treatments for depression or other conditions, you should always tell your doctor what you are taking since the herbal treatments may interact with other medications.

Can Depression Be Prevented?

Healthy lifestyle habits can help prevent depression, or lessen the chances of it happening again. Regardless of whether you have mild or major depression, the following self-care steps are recommended:

  • Get enough sleep.
  • Follow a healthy, nutritious diet.
  • Exercise regularly.
  • Avoid alcohol, marijuana and other recreational drugs.
  • Get involved in activities that make you happy, even if you don”t feel like it.
  • Spend time with family and friends.
  • Try talking to clergy or spiritual advisors who may help give meaning to painful experiences.
  • Consider prayer, meditation, tai chi or biofeedback as ways to relax or draw on your inner strengths.
  • Add omega-3 fatty acids to your diet, which you can get from cold-water fish like tuna, salmon or mackerel.
  • Take folate (vitamin B9) in the form of a multivitamin (400 to 800 micrograms).
  • Try light therapy using a special lamp that mimics the sun for seasonal affective disorder.
  • Get counseling during times of grief, stress or low mood. Family therapy may be particularly important for teens who feel blue.

Where Can I Get More Information on Depression?

You can find the latest news about depression and bipolar disorder on these Everyday Health pages:

  • Depression Center
  • Depression Ask the Doctor
  • Bipolar Disorder Community

In the 1970s, a truth was accidentally discovered about depression – one that was quickly swept aside, because its implications were too inconvenient, and too explosive. American psychiatrists had produced a book that would lay out, in detail, all the symptoms of different mental illnesses, so they could be identified and treated in the same way across the United States. It was called the Diagnostic and Statistical Manual. In the latest edition, they laid out nine symptoms that a patient has to show to be diagnosed with depression – like, for example, decreased interest in pleasure or persistent low mood. For a doctor to conclude you were depressed, you had to show five of these symptoms over several weeks.

The manual was sent out to doctors across the US and they began to use it to diagnose people. However, after a while they came back to the authors and pointed out something that was bothering them. If they followed this guide, they had to diagnose every grieving person who came to them as depressed and start giving them medical treatment. If you lose someone, it turns out that these symptoms will come to you automatically. So, the doctors wanted to know, are we supposed to start drugging all the bereaved people in America?

The authors conferred, and they decided that there would be a special clause added to the list of symptoms of depression. None of this applies, they said, if you have lost somebody you love in the past year. In that situation, all these symptoms are natural, and not a disorder. It was called “the grief exception”, and it seemed to resolve the problem.

Then, as the years and decades passed, doctors on the frontline started to come back with another question. All over the world, they were being encouraged to tell patients that depression is, in fact, just the result of a spontaneous chemical imbalance in your brain – it is produced by low serotonin, or a natural lack of some other chemical. It’s not caused by your life – it’s caused by your broken brain. Some of the doctors began to ask how this fitted with the grief exception. If you agree that the symptoms of depression are a logical and understandable response to one set of life circumstances – losing a loved one – might they not be an understandable response to other situations? What about if you lose your job? What if you are stuck in a job that you hate for the next 40 years? What about if you are alone and friendless?

The grief exception seemed to have blasted a hole in the claim that the causes of depression are sealed away in your skull. It suggested that there are causes out here, in the world, and they needed to be investigated and solved there. This was a debate that mainstream psychiatry (with some exceptions) did not want to have. So, they responded in a simple way – by whittling away the grief exception. With each new edition of the manual they reduced the period of grief that you were allowed before being labelled mentally ill – down to a few months and then, finally, to nothing at all. Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.

Dr Joanne Cacciatore, of Arizona State University, became a leading expert on the grief exception after her own baby, Cheyenne, died during childbirth. She had seen many grieving people being told that they were mentally ill for showing distress. She told me this debate reveals a key problem with how we talk about depression, anxiety and other forms of suffering: we don’t, she said, “consider context”. We act like human distress can be assessed solely on a checklist that can be separated out from our lives, and labelled as brain diseases. If we started to take people’s actual lives into account when we treat depression and anxiety, Joanne explained, it would require “an entire system overhaul”. She told me that when “you have a person with extreme human distress, stop treating the symptoms. The symptoms are a messenger of a deeper problem. Let’s get to the deeper problem.”

*****

I was a teenager when I swallowed my first antidepressant. I was standing in the weak English sunshine, outside a pharmacy in a shopping centre in London. The tablet was white and small, and as I swallowed, it felt like a chemical kiss. That morning I had gone to see my doctor and I had told him – crouched, embarrassed – that pain was leaking out of me uncontrollably, like a bad smell, and I had felt this way for several years. In reply, he told me a story. There is a chemical called serotonin that makes people feel good, he said, and some people are naturally lacking it in their brains. You are clearly one of those people. There are now, thankfully, new drugs that will restore your serotonin level to that of a normal person. Take them, and you will be well. At last, I understood what had been happening to me, and why.

However, a few months into my drugging, something odd happened. The pain started to seep through again. Before long, I felt as bad as I had at the start. I went back to my doctor, and he told me that I was clearly on too low a dose. And so, 20 milligrams became 30 milligrams; the white pill became blue. I felt better for several months. And then the pain came back through once more. My dose kept being jacked up, until I was on 80mg, where it stayed for many years, with only a few short breaks. And still the pain broke back through.

I started to research my book, Lost Connections: Uncovering The Real Causes of Depression – and the Unexpected Solutions, because I was puzzled by two mysteries. Why was I still depressed when I was doing everything I had been told to do? I had identified the low serotonin in my brain, and I was boosting my serotonin levels – yet I still felt awful. But there was a deeper mystery still. Why were so many other people across the western world feeling like me? Around one in five US adults are taking at least one drug for a psychiatric problem. In Britain, antidepressant prescriptions have doubled in a decade, to the point where now one in 11 of us drug ourselves to deal with these feelings. What has been causing depression and its twin, anxiety, to spiral in this way? I began to ask myself: could it really be that in our separate heads, all of us had brain chemistries that were spontaneously malfunctioning at the same time?

To find the answers, I ended up going on a 40,000-mile journey across the world and back. I talked to the leading social scientists investigating these questions, and to people who have been overcoming depression in unexpected ways – from an Amish village in Indiana, to a Brazilian city that banned advertising and a laboratory in Baltimore conducting a startling wave of experiments. From these people, I learned the best scientific evidence about what really causes depression and anxiety. They taught me that it is not what we have been told it is up to now. I found there is evidence that seven specific factors in the way we are living today are causing depression and anxiety to rise – alongside two real biological factors (such as your genes) that can combine with these forces to make it worse.

Once I learned this, I was able to see that a very different set of solutions to my depression – and to our depression – had been waiting for me all along.

To understand this different way of thinking, though, I had to first investigate the old story, the one that had given me so much relief at first. Professor Irving Kirsch at Harvard University is the Sherlock Holmes of chemical antidepressants – the man who has scrutinised the evidence about giving drugs to depressed and anxious people most closely in the world. In the 1990s, he prescribed chemical antidepressants to his patients with confidence. He knew the published scientific evidence, and it was clear: it showed that 70% of people who took them got significantly better. He began to investigate this further, and put in a freedom of information request to get the data that the drug companies had been privately gathering into these drugs. He was confident that he would find all sorts of other positive effects – but then he bumped into something peculiar.

Illustration by Michael Driver.

We all know that when you take selfies, you take 30 pictures, throw away the 29 where you look bleary-eyed or double-chinned, and pick out the best one to be your Tinder profile picture. It turned out that the drug companies – who fund almost all the research into these drugs – were taking this approach to studying chemical antidepressants. They would fund huge numbers of studies, throw away all the ones that suggested the drugs had very limited effects, and then only release the ones that showed success. To give one example: in one trial, the drug was given to 245 patients, but the drug company published the results for only 27 of them. Those 27 patients happened to be the ones the drug seemed to work for. Suddenly, Professor Kirsch realised that the 70% figure couldn’t be right.

It turns out that between 65 and 80% of people on antidepressants are depressed again within a year. I had thought that I was freakish for remaining depressed while on these drugs. In fact, Kirsch explained to me in Massachusetts, I was totally typical. These drugs are having a positive effect for some people – but they clearly can’t be the main solution for the majority of us, because we’re still depressed even when we take them. At the moment, we offer depressed people a menu with only one option on it. I certainly don’t want to take anything off the menu – but I realised, as I spent time with him, that we would have to expand the menu.

This led Professor Kirsch to ask a more basic question, one he was surprised to be asking. How do we know depression is even caused by low serotonin at all? When he began to dig, it turned out that the evidence was strikingly shaky. Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is “deeply misleading and unscientific”. Dr David Healy told me: “There was never any basis for it, ever. It was just marketing copy.”

I didn’t want to hear this. Once you settle into a story about your pain, you are extremely reluctant to challenge it. It was like a leash I had put on my distress to keep it under some control. I feared that if I messed with the story I had lived with for so long, the pain would run wild, like an unchained animal. Yet the scientific evidence was showing me something clear, and I couldn’t ignore it.

*****

So, what is really going on? When I interviewed social scientists all over the world – from São Paulo to Sydney, from Los Angeles to London – I started to see an unexpected picture emerge. We all know that every human being has basic physical needs: for food, for water, for shelter, for clean air. It turns out that, in the same way, all humans have certain basic psychological needs. We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most – people. I kept learning that, in very different ways, we have become disconnected from things we really need, and this deep disconnection is driving this epidemic of depression and anxiety all around us.

Let’s look at one of those causes, and one of the solutions we can begin to see if we understand it differently. There is strong evidence that human beings need to feel their lives are meaningful – that they are doing something with purpose that makes a difference. It’s a natural psychological need. But between 2011 and 2012, the polling company Gallup conducted the most detailed study ever carried out of how people feel about the thing we spend most of our waking lives doing – our paid work. They found that 13% of people say they are “engaged” in their work – they find it meaningful and look forward to it. Some 63% say they are “not engaged”, which is defined as “sleepwalking through their workday”. And 24% are “actively disengaged”: they hate it.

Antidepressant prescriptions have doubled over the last decade. Photograph: Anthony Devlin/PA

Most of the depressed and anxious people I know, I realised, are in the 87% who don’t like their work. I started to dig around to see if there is any evidence that this might be related to depression. It turned out that a breakthrough had been made in answering this question in the 1970s, by an Australian scientist called Michael Marmot. He wanted to investigate what causes stress in the workplace and believed he’d found the perfect lab in which to discover the answer: the British civil service, based in Whitehall. This small army of bureaucrats was divided into 19 different layers, from the permanent secretary at the top, down to the typists. What he wanted to know, at first, was: who’s more likely to have a stress-related heart attack – the big boss at the top, or somebody below him?

Everybody told him: you’re wasting your time. Obviously, the boss is going to be more stressed because he’s got more responsibility. But when Marmot published his results, he revealed the truth to be the exact opposite. The lower an employee ranked in the hierarchy, the higher their stress levels and likelihood of having a heart attack. Now he wanted to know: why?

And that’s when, after two more years studying civil servants, he discovered the biggest factor. It turns out if you have no control over your work, you are far more likely to become stressed – and, crucially, depressed. Humans have an innate need to feel that what we are doing, day-to-day, is meaningful. When you are controlled, you can’t create meaning out of your work.

Suddenly, the depression of many of my friends, even those in fancy jobs – who spend most of their waking hours feeling controlled and unappreciated – started to look not like a problem with their brains, but a problem with their environments. There are, I discovered, many causes of depression like this. However, my journey was not simply about finding the reasons why we feel so bad. The core was about finding out how we can feel better – how we can find real and lasting antidepressants that work for most of us, beyond only the packs of pills we have been offered as often the sole item on the menu for the depressed and anxious. I kept thinking about what Dr Cacciatore had taught me – we have to deal with the deeper problems that are causing all this distress.

I found the beginnings of an answer to the epidemic of meaningless work – in Baltimore. Meredith Mitchell used to wake up every morning with her heart racing with anxiety. She dreaded her office job. So she took a bold step – one that lots of people thought was crazy. Her husband, Josh, and their friends had worked for years in a bike store, where they were ordered around and constantly felt insecure, Most of them were depressed. One day, they decided to set up their own bike store, but they wanted to run it differently. Instead of having one guy at the top giving orders, they would run it as a democratic co-operative. This meant they would make decisions collectively, they would share out the best and worst jobs and they would all, together, be the boss. It would be like a busy democratic tribe. When I went to their store – Baltimore Bicycle Works – the staff explained how, in this different environment, their persistent depression and anxiety had largely lifted.

It’s not that their individual tasks had changed much. They fixed bikes before; they fix bikes now. But they had dealt with the unmet psychological needs that were making them feel so bad – by giving themselves autonomy and control over their work. Josh had seen for himself that depressions are very often, as he put it, “rational reactions to the situation, not some kind of biological break”. He told me there is no need to run businesses anywhere in the old humiliating, depressing way – we could move together, as a culture, to workers controlling their own workplaces.

*****

With each of the nine causes of depression and anxiety I learned about, I kept being taught startling facts and arguments like this that forced me to think differently. Professor John Cacioppo of the University of Chicago taught me that being acutely lonely is as stressful as being punched in the face by a stranger – and massively increases your risk of depression. Dr Vincent Felitti in San Diego showed me that surviving severe childhood trauma makes you 3,100% more likely to attempt suicide as an adult. Professor Michael Chandler in Vancouver explained to me that if a community feels it has no control over the big decisions affecting it, the suicide rate will shoot up.

This new evidence forces us to seek out a very different kind of solution to our despair crisis. One person in particular helped me to unlock how to think about this. In the early days of the 21st century, a South African psychiatrist named Derek Summerfeld went to Cambodia, at a time when antidepressants were first being introduced there. He began to explain the concept to the doctors he met. They listened patiently and then told him they didn’t need these new antidepressants, because they already had anti-depressants that work. He assumed they were talking about some kind of herbal remedy.

He asked them to explain, and they told him about a rice farmer they knew whose left leg was blown off by a landmine. He was fitted with a new limb, but he felt constantly anxious about the future, and was filled with despair. The doctors sat with him, and talked through his troubles. They realised that even with his new artificial limb, his old job—working in the rice paddies—was leaving him constantly stressed and in physical pain, and that was making him want to just stop living. So they had an idea. They believed that if he became a dairy farmer, he could live differently. So they bought him a cow. In the months and years that followed, his life changed. His depression—which had been profound—went away. “You see, doctor,” they told him, the cow was an “antidepressant”.

To them, finding an antidepressant didn’t mean finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place. We can do the same. Some of these solutions are things we can do as individuals, in our private lives. Some require bigger social shifts, which we can only achieve together, as citizens. But all of them require us to change our understanding of what depression and anxiety really are.

This is radical, but it is not, I discovered, a maverick position. In its official statement for World Health Day in 2017, the United Nations reviewed the best evidence and concluded that “the dominant biomedical narrative of depression” is based on “biased and selective use of research outcomes” that “must be abandoned”. We need to move from “focusing on ‘chemical imbalances’”, they said, to focusing more on “power imbalances”.

After I learned all this, and what it means for us all, I started to long for the power to go back in time and speak to my teenage self on the day he was told a story about his depression that was going to send him off in the wrong direction for so many years. I wanted to tell him: “This pain you are feeling is not a pathology. It’s not crazy. It is a signal that your natural psychological needs are not being met. It is a form of grief – for yourself, and for the culture you live in going so wrong. I know how much it hurts. I know how deeply it cuts you. But you need to listen to this signal. We all need to listen to the people around us sending out this signal. It is telling you what is going wrong. It is telling you that you need to be connected in so many deep and stirring ways that you aren’t yet – but you can be, one day.”

If you are depressed and anxious, you are not a machine with malfunctioning parts. You are a human being with unmet needs. The only real way out of our epidemic of despair is for all of us, together, to begin to meet those human needs – for deep connection, to the things that really matter in life.

• This is an edited extract from Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions by Johann Hari, published by Bloomsbury on 11 January (£16.99). To order a copy for £14.44 go to guardianbookshop.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99. It will be available in audio at audible.co.uk

If you are affected by depression or suicidal thoughts, there are places you can turn to. In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

• Note by readers’ editor, Paul Chadwick, added 7 February 2018: After publication, I considered a complaint relating to Guardian and Observer coverage of the book: this extract; Q&A with the author; review; blogpost on 8 January; and blogpost on 24 January. I concluded that the book’s author, Johann Hari, and his critic in the blogposts, Dean Burnett, were entitled to their differing views, and that the Guardian and Observer editorial standards had been met. Due to the sensitivity of the issue involved – namely, the causes and treatment of mental illness – I also concluded that it was appropriate to emphasise for readers that the author and his critic have both expressed the view that people taking anti-depressants should not stop taking their medication abruptly or without seeking professional advice.

Depression: Frequently Asked Questions

Print out these questions and answers to discuss with your health care provider.

Is depression a mental illness?

Yes. Depression is a serious but treatable mental illness. It is a medical problem, not a personal weakness. It also is very common. All people, at one point or another, will feel sadness as a reaction to loss, grief, or injured self-esteem. However, clinical depression—called “major depressive disorder” by medical providers—is a serious illness that needs professional diagnosis and treatment. About 6.7% of adults in the United States experience major depressive disorder each year.

Do children get depression?

Yes. Children are subject to the same factors that cause depression in adults. These include: changes in physical health, life events, heredity, environment, and chemical disturbances in the brain. It is estimated that 2% of U.S. children in the age group of 6 to 12 have depression. The rate of overall major depression rises at puberty to about 4% in the U.S.

Depression in children is different from the “normal” blues and everyday emotions that are typical in children of various ages. Children who are depressed experience changes in their behavior that are persistent and disruptive to their normal lifestyles, usually interfering with relationships with friends, schoolwork, special interests, and family life. It may also occur at the same time as (or be hidden by) attention deficit hyperactivity disorder (ADHD) obsessive-compulsive disorder (OCD), or conduct disorder (CD).

Can lack of sleep cause depression?

No. Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep resulting from another medical illness or the presence of personal problems can intensify depression. Chronic inability to sleep also is an important clue that someone may be depressed.

Common triggers of depression include:

  • Family history of depression
  • Grief over the loss of a loved one through death, divorce, or separation
  • Interpersonal disputes
  • Physical, sexual, or emotional abuse
  • Major life events such as moving, graduating, retiring, etc.
  • Serious illness: Major, chronic (long-term), and terminal illnesses often contribute to depression. These include cancer, heart disease, stroke, HIV, Parkinson’s disease, and others
  • Substance abuse
  • Being socially isolated or excluded from family, friends, or other social groups

Are there any alternatives to the traditional treatments for depression that I can try?

Alternative therapy describes any treatment or technique that has not been scientifically documented or identified as safe or effective for a specific condition. Alternative therapy involves a variety of disciplines that include everything from diet and exercise to mental conditioning and lifestyle changes. Some of these have been found to be effective for treating depression.

Examples of alternative therapies include acupuncture, guided imagery, chiropractic, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others. If you are interested in trying any of these options, talk with your doctor.

How can you determine if an illness is causing depression or depression is causing an illness?

Illnesses that can lead to depression are usually major, chronic, and/or terminal. When an illness is causing depression, there often is long-term pain present or a sudden change in lifestyle.

Depression causes illness in a different way. Like psychological stress, it can weaken the immune system (cells involved in fighting disease and keeping you healthy), allowing a person to get more colds or the flu. There often is a notable presence of “aches and pains” with no particular cause. While having depression may cause an illness to last longer and intensify its symptoms, the true relationship of depression-induced illness, in terms of major disease, has not been thoroughly defined.

It is important to seek the advice of your doctor if you think you or someone you know may have depression.

I’ve heard lots of warnings about drug interactions with certain depression medicines. What are they?

MAOIs, or monoamine oxidase inhibitors, are effective antidepressant medicines that have been used for years. Typically prescribed for people with severe depression, MAOIs improve mood by increasing the number of chemicals in the brain that pass messages between brain cells. MAOIs have been proven to work just as well as other antidepressant drugs, but they have more possible food and drug interactions.

Medicines to avoid when taking MAOIs include all SSRIs (a group of antidepressants that includes Prozac and Paxil) and certain pain medicines, including Demerol. There also are some cough medicines and blood pressure medicines that must not be taken with MAOIs.

Foods to avoid when taking MAOIs include aged cheeses and meats, avocado, pickled or smoked foods like sauerkraut or meat, and foods that include yeast extracts. Beer and wine also contain yeast extracts. It is important to tell your doctor about any medicines you are currently taking. Be sure to discuss the limitations, interactions, and possible side effects of MAOIs.

Why are women more likely to get depression?

Women develop depression twice as often as men. One reason may be the various changes in hormone levels that women experience. For example, depression is common during pregnancy and menopause, as well as after giving birth, suffering a miscarriage, or having a hysterectomy. These are all times when women experience huge fluctuations in hormones. Premenstrual worsening of depression can occur in a subgroup of women.

Do most people with depression commit suicide?

No. Most people who have depression do not attempt suicide. However, about 90% of people who have committed suicide had mental illness and substance abuse problems. This figure demonstrates the importance of seeking professional treatment for yourself or someone you love if you suspect depression.

Will someone who has had depression get it again?

Having experienced an episode of depression puts a person at greater risk for future episodes. However, not everyone who has recovered from depression will experience it again. Sometimes depression is triggered by a major life event or illness, or a combination of factors particular to a certain place and time. Getting the proper treatment for the correct amount of time is crucial to recovery and in helping prevent or identify any future depression.

How long does depression last?

If left untreated, various types of depressive disorders can last for years. A major depressive episode is characterized by a set of symptoms that last for more than two weeks and may last for months. Seasonal depression, or SAD, usually extends throughout the winter months and continues to improve during spring and summer. Bipolar disorder is characterized as “ups” (periods of mania) and “downs” (periods of extreme depression). Although these phases may change rapidly or slowly, bipolar depression may last until an effective treatment is found.

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Screening for Depression: Two Questions to Ask Patients

Screening for depression can be problematic, since most screening instruments are long and time-consuming. The main features of depression, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), are a two-week history of depressed mood and loss of interest in most activities. Whooley and colleagues evaluated a two-question instrument to determine its adequacy in identifying patients with major depression.

The two questions asked were as follows: (1) “During the past month, have you often been bothered by feeling down, depressed or hopeless?” and (2) “During the past month, have you often been bothered by little interest or pleasure in doing things?” The results of this two-question test were compared with those of other tests that have been substantiated to screen for depression.

Patients attending an urgent care clinic were asked to participate in the study. A self-report questionnaire and a structured interview were administered. Demographic information and any history of depression were obtained in each patient. The two questions were then asked. Subsequently, the other six validated tests were administered. A blinded review of medical records was conducted to determine whether the physician who saw the patient recognized depression in the patient.

A total of 536 patients participated in the study. The prevalence of major depression in this patient population was 18.1 percent, as determined by the National Institute of Mental Health Diagnostic Interview Schedule (a structured interview based on DSM-IV criteria). The physicians identified depression in only 8.8 percent of the patients. The two-question test had a sensitivity of 96 percent and a negative predictive value of 98 percent. The positive predictive value was 33 percent. The two-question test found 17 true positives and one false negative for every 100 patients tested.

The authors conclude that this two-question screening tool for depression is as effective as other instruments in detecting depression. If a patient answers “no” to both questions, he or she is very unlikely to have depression.

Depressed people feel useless in this life. Such patients tend to turn overwhelmed with this life without any good reasons; it prevents them from taking part in various everyday duties. These people start withdrawing from their beloved ones no matter how others try. The final stage is when a person starts thinking about suicide. It is important to consult a professional before making any final conclusions and stating the final diagnosis: depressed or not.

Many doctors hesitate about the primary causes of this mental problem. Most of the time, depressions are the result of the modifications in the human body’s chemistry that impact the mood and thinking processes. Doctors name biological factors. To make the definition short, a disorder refers to the absence of balance between the mental & emotional aspects in the life of an individual. In the majority of cases, highly stressful situations like a death of a close person lead to the long-lasting depressive moods. The problem is more dangerous when it appears without a good reason.

The top secret question is whether it is possible to recover from depression completely. A patient’s mental health condition is treatable if he/she obtains on-time professional help based on the individual approach. Such people need to feel special love & care. If one of the family members/friends notices depressive moods in a close person, it is critical to provide immediate support. Show the individual to the healthcare professional to identify the causes and diagnosis properly – it is important not to waste time on the wrong treatment. The person’s close people should make sure he/she obtains help from the licensed mental health expert to avoid the progress of the situation. Family members should keep in mind that unexpressed emotions followed by a sense of isolation lead to the worse consequences instead of recovery.”

Psychotherapy is the most popular approach to treating various forms of depression at any stage of the illness, which requires the support of specific medication. A single therapist should work with the same patient. By combining the best practices and patient’s will, it is possible to tackle individual problems that may provoke the condition. It is important to tell the truth during the treatment sessions. The result of the proper therapy is a better understanding of self and new ideas on how a patient may overcome different stressful life situations. New hobbies and relations often assist in reducing the level of depression. One of the most known therapies, cognitive behavioral therapy, offers several effective methods to resist and fight depressive attacks without any help.”

15 Interesting Depression Research Paper Topics

Before listing the best depression research topics, it is important to mention that by contacting a healthcare practitioner it is possible to collect necessary information and top ideas to implement in your study. It is time to explore the top ideas.

  1. Neurocognitive impairment in people who suffer from the type II diabetes combined with depression
  2. A systemic mental disease
  3. The structure of personality disorders
  4. Implications for individual treatment
  5. Withdrawal signs after the disruption of a noradrenergic & particular serotonergic antidepressive medication
  6. Customizing the selection of antidepressants based on gender, weight, ethnicity, and other individual features
  7. Deep brain stimulation and its effects
  8. The correlation between homelessness, poverty, and depression levels
  9. The consequences of depression on the female organism
  10. The problem of mental health in the correctional system
  11. Are asylums effectively treating various mental disorders?
  12. Do VA hospitals have the ability to treat PTSD?
  13. What can institutions do to educate the community on the mental issues?
  14. The influence of domestic violence on children suffering from PTSD
  15. Warning symptoms of depression in young boys

It is time to choose the topic and conduct a study. After writing an assignment, do not forget to edit it. Another great idea is to submit the draft to the professional proofreading, editing, & writing services to carry out the top-quality essay worth of A+!

Major Depression, also known as clinical or unipolar depression, is one of the most common mental illnesses. Over 9 million American adults suffer from clinical depression each year. This estimate is likely to be higher since depression commonly remains undiagnosed and untreated in a large percentage of the U.S. population. Major Depression is more than a temporary state of feeling sad; rather, it is a persistent state that can significantly impair an individual’s thoughts, behavior, daily activities, and physical health.

Major Depressive Disorder impacts all racial, ethnic, and socioeconomic groups and can occur at any age. The average lifetime prevalence of depression is 17%: 26% for women and 12% for men. The mean age for a first episode is in the thirties. Demographic differences show that rates are higher in urban rather than in rural areas. No racial significance has been noted. Along gender lines, women suffer from depression at twice the rate of men. Statistics have shown that one out of every seven women will experience at least one depressive episode in their lifetime. This gender difference is best explained by looking at the interplay between biological, genetic, psychological, social, and environmental factors.

Classified as mood disorders, major depression, along with other depressive disorders such as dysthymia (a chronic less severe form of depression), and bipolar disorder (manic depression) fall along a spectrum. On one end of the spectrum is unipolar or major depression and on the opposite is bipolar disorder or manic depression, both with varying degrees of severity and duration. Along this spectrum, there are several categories of mood disorders, such as postpartum depression, seasonal affective disorder (SAD) and psychotic depression, as well as variants of bipolar disorder. Bipolar disorder is characterized by severe and disabling cycles of depression and mania.

Mood disorders are highly treatable conditions, with each type requiring different treatment approaches and modalities. Antidepressant medications and psychotherapies offer useful treatment approaches and are commonly employed in treating the debilitating effects of depression. However, if mood disorders are left untreated for long periods of time, the debilitating effects of depression can lead to suicide.

SYMPTOMS OF MAJOR DEPRESSIVE DISORDER

Symptoms of Major Depression represent a significant change from the individual’s normal level of functioning. Together the symptoms cause significant distress or impairment in the individual’s life and his/her ability to function. Depression symptoms can occur with either a sudden onset or in a more gradual fashion, with the severity of symptoms ranging from mild to severe.

A Major Depressive Episode is defined as having five or more of the following symptoms present for the same two-week period, and represents a change from the individual’s normal level of functioning when well. At least one of the five required symptoms must be (1) depressed mood or (2) loss of interest.

1. depressed mood experienced most of the day, nearly every day;

2. diminished interest or pleasure in all or almost all activities most of the day, nearly every day;

3. significant change in appetite (increase or decrease) or weight (loss or gain);

4. insomnia or hypersomnia nearly every day;

5. observable psychomotor agitation (feeling restless or fidgety) or retardation (feeling slowed down) nearly every day;

6. loss of energy or fatigue nearly every day;

7. feelings of worthlessness, or excessive or inappropriate guilt, nearly every day (not merely self reproach about being sick);

8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either subjective account or observed by others);

9. recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

As a student who’s taking a psychology class in college, you’ll get to explore complex and common mental health issue called depression. In order to assess your understanding of the subject, a teacher may assign you to a depression research paper. Such type of academic work aims to detect and discuss the symptoms, significance, diagnosis, treatment, and consequences of this mental disorder. To score the top grade, you’ll need to choose an interesting research topic, plan out your essay, and refer to relevant sources of data.

This post provides you with some useful writing tips and helps you choose the best topic for a research paper on depression.

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How to Choose Depression Topics for Research Paper?

To begin with, you need to choose a topic of your future essay. Here’re a few recommendations to consider:

  • Write about a subject you’re interested in.
  • Consider the assumed length of your paper and make sure you find enough data for it.
  • Make background research, choose a back-up topic.
  • Limit the scope of research, avoid overly generic topics.
  • Refer only to legit and credible sources of information.
  • Present the information in the essay objectively.

Now it’s time to write a depression research paper outline. Just like other types of academic works, it should consist of:

  1. Introduction (with a thesis statement);
  2. Body part (with key arguments);
  3. Conclusion;
  4. Reference page.

Don’t stop researching, add more details to the outline and write the final draft. Revise, edit and correct your paper several times before submitting it. Take care of the formatting (it can be APA, MLA, Chicago or other styles).

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Common Topics for a Research Paper About Depression

Unless you’re pursuing a degree in psychology, studying depression will come only as a part of your psychology class, and most likely will be somewhat generic. Thus, when assigned to a depression academic essay, you don’t have to choose a controversial, a challenging or a narrow topic with little research data on it. It’s best to stick to one of the common general topics with plenty of material to study and refer to. You can write:

  • a research paper on depression and anxiety;
  • psychological reasons for depression research paper;
  • postpartum depression research papers;
  • research paper on depression in children;
  • teen depression research paper;
  • research paper on depression in college students;
  • depression in women research paper;
  • drugs in the treatment of depression & anxiety research papers;

In your essay, you can write about the reasons, symptoms, and common ways of treatments of these depression types.

Ideas for the great depression research paper that will score high

Here are a few examples of good depression research topics; while being generic and widely-discussed, they will let you write an excellent academic essay.

  • How parents can help young people cope with depression.
  • Signs and symptoms of “masked depression” in children.
  • What causes postpartum depression in women?
  • The reasons for depression in women in developed countries.
  • What are the key symptoms of major depression in adults?
  • Can regular physical exercising help to overcome depression?
  • Ways to come out of depression in a short period of time.
  • At what stage is it crucial to request a depression & anxiety-related sick leave?

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Advanced Topics for Top-Grade Depression Research Papers

If the amount of scientific data available on the common topics seems to be overwhelming, you can narrow down your choice to one particular aspect of depression. An in-depth research and thorough planning will help you in completing a sold, A-worthy paper. The following topics suggested by the writing experts are divided into several categories.

Teenage depression research paper topics

  • How manifestation of adolescent depression differs from one of adult depression?
  • Which warning signs should parents look for, to detect depression in their teenage children?
  • Can peer bullying and internet bullying cause depression in teenagers?
  • The risks of adolescent depression causing self-harm and suicide, and the ways to prevent it.

Diagnose and treatment of depression essay ideas

  • Treatment of depression: do teenagers react to medication in the same way as adults?
  • What are the ways of diagnosing depression at the early stage?
  • Are there any effective natural alternatives that could replace drugs in depression treatment?
  • What signs signify that a person is ready to stop taking depression and anxiety drugs?

Postpartum depression research paper topics

  • The causes and early signs of postpartum depression.
  • An outlook on postpartum depression: can it be prevented and in what ways?
  • The role of the families’ social support in helping new moms to withstand postpartum depression.
  • Which assessments can measure the risks of postpartum depression?

Ideas for a research paper on depression and social behavior

  • The ways to differentiate a person caught by depression based on their social behavior.
  • The consequences of a long-lasting untreated depression on a person’s mental health.
  • What steps can a person’s surrounding (family, social group) take to help them come out of anxiety and depression?
  • How do the symptoms of depression and autism differ?

Depression & human psychology essay topics

  • What psychological behavior reflects that a person is caught by depression?
  • Can clinical psychology help in depression treatment?
  • Different stages a person with depression goes through, and which one of them is the most dangerous?
  • Which symptoms point that a person is being drained to the roots with depression?

Preparing an academic essay on depression isn’t the easiest task. If you experience difficulties, you can order research paper from a professional writing company. The experts working for the best research paper service can handle virtually any topic, even such strange as research papers on the Great Depression and its impact on mass psychology. Moreover, they will gladly help you at any stage of crafting a paper – from choosing a topic to writing and proofreading. All you need to do is place an online order, wait for your piece to be completed, and download a PDF or Word file on your device.

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