Depression content

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Depression can be the result of dramatic experiences, such as the loss of a loved one, job, or social status. In such cases, we are talking about reactive (psychogenic) depression[8]. It develops as a reaction to an external event or situation. According to some theories, depression sometimes occurs when the brain is overloaded as a result of stress, which can be based on both physiological and psychosocial factors.
A risk factor for developing depression in adults may also be severe experiences in childhood: for example, child abuse may be a prerequisite for the occurrence of depression in the future[9]. A meta-analysis of epidemiological studies involving 23,544 people surveyed found that child abuse increases the risk of recurrent and prolonged depressive episodes. There is also some evidence that childhood abuse and violence experienced in childhood reduce the likelihood of remission of depressive disorder. However, according to a meta-analysis by Infurna et al. (2016), relatively "silent" forms of child abuse (psychological abuse, neglect) are more strongly associated with the subsequent development of depression than explicit physical and sexual abuse[10].
It was suggested (M. Kovack, 1976) that factors such as the loss of a father or mother in childhood, the presence of a parent who is confident in his inferiority or has excessively rigid, rigid beliefs, lack of social experience or social skills, and the negative experience of communication between the child and his peers or brothers may be involved in the development and strengthening of depressogenic beliefs/ sisters; the presence of a physical defect in the child[11].
Depression can be predisposed to certain personal characteristics of a person — for example, perfectionism.
But if the psychological, iatrogenic or somatic (see below) causes of depression are absent or not obvious, such depression is called endogenous, that is, as if "originating from within" (the body, psyche). In approximately one-third (about 35 %) of cases, manifest depressions occur autochthonously, that is, without any external influences. Structurally, such depressions are endogenous from the very beginning[13].
Currently, there is no clear understanding of the neurobiological causes of clinical depression (major depressive disorder). There are a number of hypotheses in the scientific community on this subject, none of which has yet received convincing evidence. It is obvious that depression is a clinically and etiologically heterogeneous disorder[14]. The monoamine theory links the development of depression to a deficiency of biogenic amines, namely serotonin, norepinephrine, and dopamine[15]. Some researchers conclude that this theory is not sufficiently broad, since it does not explain the limitations in the effectiveness of antidepressants and the slow development of their therapeutic effect[16]. Although the serotonin hypothesis is widely accepted, there is no strong support for this hypothesis: modern neuroscience studies have not been able to confirm the assumption that depression is based on serotonin deficiency in the central nervous system[17]. A systematic umbrella review published in Molecular Psychiatry 2022 found that there is no evidence for a link between serotonin levels and depression18].
For many people in sunless weather or those who are in darkened rooms, depression can occur due to the lack of bright light. This type is called seasonal depression or seasonal affective disorder, because it is most often observed in patients in autumn and winter [19] [20]. Seasonal depression can be treated with sunny walks or light therapy. However, in a study conducted on a large sample of 34,294 people, it was not possible to find a relationship between depression and the time of year. Depression was not associated with either the latitude at which a person lives or the amount of sunlight[21]. However, this study has important drawbacks — in particular, the survey of these 34,294 people was conducted by phone, which makes it impossible to diagnose the presence or absence of clinical depression in respondents[22].
Depression can result from the side effects of many medications (for example, levodopa, corticosteroids, benzodiazepines [23]) — the so-called iatrogenic or pharmacogenic depression. Most often, such depression passes quickly on its own or is cured after the appropriate drug is discontinued. Neuroleptic depressions (resulting from taking neuroleptics) can last from several months to 1.5 years and often have a vital character[24]. The cause of depression in some cases is also the abuse of sedatives or sleeping pills, alcohol, cocaine and other psychostimulants [23], opiates[25]. Also, depression can be somatic or, more precisely, somatogenic, that is, manifest as a consequence of somatic diseases (for example, Alzheimer's disease, atherosclerosis of the arteries of the brain, traumatic brain injury, or even the usual flu). In addition, the risk factors for depression are pregnancy and childbirth — up to 10% of women experience depression during pregnancy, postpartum depression is observed in 12-16% of women who gave birth[26].
Scientists also see depression as an evolutionarily fixed mechanism of thinking. According to the hypothesis of analytical reflection, depression has become fixed in the process of evolution as a mechanism that allows an individual to focus on solving complex problems[27]. Avoidant behavior in depression, first, circumvents the process by which people learn to tolerate the painful feelings that persist when they adopt a slow, analytical approach to problem solving and arise as a result of considering and making compromises. Secondly, it is a poorly adapted byproduct of a developed propensity for action that quickly reduces pain. Third, it occurs in those social environments where there are means to implement avoidant behavior[28].
Existential analysis offers an ontological interpretation of mental suffering in depression. This interpretation says that depression is associated with a disappointing exposure of the insignificance of human existence, and in ordinary life a person leads an inauthentic life (authentic and inauthentic life are defined in Heidegger's philosophical anthropology). The experience of depressive emotional suffering is viewed as a disappointing encounter with the reality of existence[29].
In clinical practice, there are often cases of incorrect diagnosis and inadequate treatment of depression in people with somatic diseases, when the cause of depression, that is, the somatic disease itself or its therapy, is not taken into account[31].
In patients with neurological disorders, the incidence of depression reaches 40-50 %; depression is often found in patients with medical conditions that directly affect the central nervous system (for example, in Itsenko — Cushing's disease, depression develops in 60 % of cases).[31].
Patients with hypothyroidism are very prone to developing depression. The prevalence of depression in patients with insufficient thyroid function reaches 50 %, and the risk of developing depressive disorders during life in patients with hypothyroidism is 7 times higher than in healthy people. Symptoms of depression often come to the fore, appearing several years before the development of a clear clinical picture of hypothyroidism, and dominate the complaints of patients. In individuals with therapeutically resistant depression, the prevalence of hypothyroidism is particularly high and reaches 50 %[45].
According to proponents of cognitive psychotherapy, depression in many cases is caused and supported by dysfunctional beliefs that usually arise in childhood and are activated in an adult as a result of a particular life event that caused the development of depression. These dysfunctional beliefs predispose patients to the characteristic distortions of thinking that underlie the "cognitive triad of depression": a person suffering from depression tends to have a low opinion of themselves, their environment, and the future. Depressive patients systematically distort their perception of events, finding in them confirmation of their ideas about their worthlessness, negative views on the surrounding reality and their future. There may be such characteristic distortions of thinking as randomness of inferences, "all-or-nothing" thinking, excessive generalization, selective abstraction, and exaggeration.
In addition to the" negative triad " — a negative view of themselves, their future, and the world — people with depression have a fixed focus on the topic of loss, real or imaginary (thoughts about the death of loved ones, the breakup of relationships, the collapse of hopes, the inability to achieve significant goals). Also, depressed patients are characterized by rigid, imperative beliefs with more frequent use of the speech forms "should" and "should" than healthy people: such beliefs are called the "tyranny of obligations" by the creator of cognitive psychotherapy, Aaron Beck (for example, a depressed patient may believe that he " should quickly and without anyone's help find a solution to any problem", "must understand everything, know everything and foresee", "must never suffer, always be happy and serene", etc.) [11].
According to the cognitive model, in depressive disorders, both beliefs and behaviors are equally important — as well as biochemical processes-these components reflect different levels of analysis, and none of them is a priority. Each therapeutic approach has its own point of application: the pharmacologist intervenes at the biochemical level, and the cognitive psychotherapist intervenes at the cognitive, affective, and behavioral levels. At the same time, changes in depressive beliefs are associated with changes in the prevailing mood, behavior, and, as confirmed by some data, the biochemistry of depression[46]:
According to a 2011 study[47], it is difficult for general practitioners to identify cases of depression because in almost half of cases, patients try to keep silent about the symptoms of depression. Many people are afraid of prescribing antidepressants and their side effects; some believe that keeping their emotions under control is their own business, and not the concern of the doctor; there are also fears that the mention of a case of depression will get into the medical record and somehow become known to the employer; finally, some are afraid of being referred to a psychiatrist for treatment. This suggests that therapists should make more use of screening tools, including short questionnaires, in cases that do not exclude depression. It is advisable to conduct such screening for all pregnant women[48].
The Zang Scale[49][50] and the Major Depression Questionnaire[51] are often used for screening and determining the severity of depression.
In the diagnosis of depression, there are several fundamentally different tasks: screening for the presence of depression, clinical assessment of depression (test and medical), and measurement of individual symptoms associated with depression, such as anxiety, anhedonia, suicidal activity, etc.
Today, diagnostic capabilities that largely determine the choice of treatment (antidepressants, psychotherapy, etc.) are based more on medical experience and the use of questionnaires (not an instrumental method) than on objective, quantifiable criteria[52].
In all patients with mood disorders, it is advisable to conduct an examination to exclude somatic causes of depression, in particular, an assessment of thyroid function, which can detect hypo - or hyperthyroidism[45].