World Day to Combat Depression: the other pandemic

Following the outbreak of the coronavirus and the subsequent confinement we were forced to endure, the number of people suffering from mental illness has skyrocketed, especially among young people.

Today, January 13, is World Day for the Fight against Depression, a date that many people celebrate with the main objective of raising awareness, guiding and warning all citizens about this disease.

It progresses silently and is sometimes underestimated, but depression is the third cause of disability in the world and affects, according to the WHO, more than 300 million people. Leticia Pérez del Tío, a health psychologist with expertise in psychogerontology and clinical neuropsychology, also points out that depression has a high recurrence rate, specifically between 40 and 60% after a first episode and 90% after the third episode.

For all these reasons, its approach must be global and special attention must be paid to preventive strategies. Furthermore, it is essential to understand that in order to prevent depression it is necessary to understand its causes and the mechanisms involved in its onset.

What is depression?

Leticia Pérez refers to depression as a broad and heterogeneous disorder, but as stated in the Diagnostic and Statistical Manual of Mental Disorders DSM5, major depressive disorder (MDD) is characterized by the presence of at least one of these symptoms:

  1. Depressed mood or loss of interest or pleasure coupled with significant weight loss without dieting or weight gain (eg. more than 5% body weight)
  2. Insomnia or hypersomnia on most days
  3. Agitation or psychomotor retardation almost every day
  4. Fatigue or loss of energy almost every day
  5. Excessive or inappropriate feelings of worthlessness or guilt
  6. Decreased ability to think or concentrate, or to make decisions, almost every day
  7. Recurrent thoughts of death
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To establish a diagnosis of depression, these symptoms must be present for a period of two weeks, represent a change from previous functioning, and cause clinically significant distress or impairment in social, occupational, or other important areas of the person’s functioning and not be due to a medical illness (e.g., hypothyroidism) or substance (e.g., medication).

As can be inferred from reading the above paragraph, it is not a passing sadness or an understandable low mood following a negative life event, depression does not equate to the usual mood swings or short-lived emotional reactions that can arise in response to the challenges of everyday life.

Depression is a serious health condition, especially if it is long-lasting and, in the most severe cases, can lead to suicide. The good news, as the psychologist points out, is that this disease is treatable.

Mechanisms involved in depression

To understand how depression appears and is maintained, the interdependence of all the systems that make up human beings and underlie their behavior must be taken into account. A broad, transdisciplinary approach is needed to address depression, as well as the rest of the so-called psychiatric or neurological disorders.

Although depression is usually related primarily to emotional state, depressed individuals may show deficits in different domains of cognitive functioning, specifically in executive function, attention, memory and psychomotor speed.

Specifically, with regard to executive function, they show deficits in the planning, initiation and monitoring of complex goal-directed behaviors. In addition, they also show difficulties in the ability to selectively attend to relevant stimuli and goals and inhibit processing or responding to non-relevant stimuli, which is called cognitive control.

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All these cognitive deficits imply that, in addition to assessing and treating the emotional symptoms themselves, it is also necessary to assess and treat the cognitive alterations that appear and maintain depression, given the interdependence between emotion-cognition and behavior.

Assessment and treatment of depression

The complete evaluation of a person with major depression should include the following phases:

  1. Conducting a workup by the family physician or internal medicine physician to rule out organic medical or pharmacological causes that explain the condition, paying particular attention to personal and family history of depression.
  2. Psychological/neuropsychological and/or psychiatric evaluation depending on each particular case.
  3. Consultation with specialists in those cases in which it is necessary (e.g. drug-resistant sleep disorders).

In terms of treatment, the approach to depression includes psychological and pharmacological (antidepressant) treatments. The decision as to which type of treatment is necessary to receive will depend on the person’s preference and other factors, such as:

  • Previous treatments and their outcome
  • Side effects
  • Level of severity (whether your depression is mild, moderate or severe)
  • Time of evolution

As far as psychological treatments are concerned, the most widespread is cognitive-behavioral therapy (CBT). This treatment is based on the hypothesis that the way we feel is affected by our thoughts and beliefs and how we behave. This therapy uses techniques such as emotional regulation, recognition and transformation of cognitive biases and behavioral activation.

Therefore, depression is a mental illness that we should pay attention to and not underestimate, but above all devote the necessary time to treat it.