Depression: A Mental Disorder, Not A Choice
Trigger warning, this article talks about suicide.
Many individuals who suffer from psychological illnesses would rather not discuss them; however, psychological sickness is not something to be embarrassed about. It is an ailment, very much like any other condition in our body. Mental illness is a medical condition that requires treatment.
Would you be ashamed to seek medical attention if you were suffering from heart trouble? No, you would not. You would seek medical attention to correct any issues that exist. The heart is a vital internal organ. One cannot survive without a heart, you need your heart. The brain is also a vital organ. One cannot survive without a brain. The brain is the body’s control center. “It is the seat of all thoughts, memories, perceptions, and feelings.” If the brain is impaired due to a mental health condition, one cannot function like he or she should on most capacity. Emotions, thinking , communication are all affected and impaired.
If the brain and heart are both vital internal organs, we need both of them to survive. We cannot survive without either. We cannot continue to attend to matters of the heart and ignore the brain. If you think about it, they both carry the same measure. We treat heart conditions, but we are not eager to treat mental health conditions. Instead, we are ashamed and embarrassed to treat a brain condition that affects our psyche.
Why does society continue to behave that it is fine if one is hurting in the brain.Mental health issues are real, and it is not a choice. It is heartbreaking to hear an individual say my brain hurts. I dropped out of college due to mental health issues. I tried three times, and I failed. Mental health conditions may be invisible, but they are real. We cannot see a mental health condition, but it does not mean it does not exist. We also cannot see Air, Oxygen, Carbon dioxide, Hydrogen, Helium. As a society we need to do better as we encounter individuals with mental health issues.
Depression is a mood disorder that causes constant feelings of sadness and loss of interest in day to day activity. It is also called major depressive disorder or clinical depression. Depression causes anhedonia. Anhedonia is the inability to experience pleasure in any capacity. Anyone can experience symptoms of depression at any given point in life. Depression can be inherited. It may appear unexpectedly. All it takes sometimes is a life event that is beyond our control, such as a major crisis, grief, job loss and so on. Individuals who experience clinical depression may appear to be unmotivated, it is not by choice. Those who suffer from depression experience constant sadness, hopelessness, guilt, shame and helplessness though no fault of their own.
When depression is left untreated, it causes a serious impairment on day to day functioning. It causes a lack of motivation and concentration. “According to Kevin Caruso at suicide.org, untreated depression is the #1 cause of suicide. Over 90 percent of people who die by suicide have a mental illness at the time of their death. Depression is a leading factor in Suicide when left untreated.” Depression is a very serious mental health condition. Depression is not something that one can just shake off or snap out of. It is real. It is not a weakness. Depression comes with catatonia at times which means one is not able to respond to the world around them. “Catatonia is a syndrome — a collection of signs and symptoms — where your brain doesn’t manage muscle movement signals as it should and you behave abnormally.” Catatonia is very common in individuals who have schizophrenia.
It is not uncommon for someone who is suffering from depression to say I slept for 16 hours with no interruption. It is also not unusual for a depression patient to say I have not showered for days. I hear these comments in sessions all the time. Some people may think or say they just didn't want to or it is laziness. That is a false narrative. Depression causes serious impairment in mood, thoughts and sometimes even physical pain. In spite of depression occurring a single time during one’s life, individuals ordinarily have numerous episodes. During these episodes, side effects happen a large portion of the day.
Symptoms of depression in adults:
Sensations of sadness, sorrow, emptiness or hopelessness, emotional outbursts:
Loss of interest or delight in most or every typical activity, like sex, leisure activities.
Sleep issues such as insomnia, Sleeping too much.
Sluggishness and lack of energy, so even small tasks require extra energy
Diminished hunger and weight reduction or expanded desires for food and weight gain
Anxiety, Tension, restlessness.
Delayed in thinking, speaking even body movements
Difficulty thinking, concentrating, making decisions and recalling things
Frequent thoughts of death, self destruction, suicide attempts or suicide
Physical issues with no explanations such as headaches, and back pains
For a lot of individuals who suffer from depression, the symptoms are severe enough that they experience impairment in their daily functions such as at work, school, spending time with friends and family.
Depression symptoms in children and teens:
In younger children, symptoms of depression present as aches and pains, irritability, sadness, worry, refusal to go to school and being underweight.
In adolescents, symptoms of depression include irritability, sadness, anger, feeling misjudged, poor school performance and attendance,loss of interest in day to day activity, abusing alcohol and self destruction behaviors.
Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events.
Types of depression include:
Major depressive disorder (MDD)
Bipolar depression
Perinatal and postpartum depression
Persistent depressive disorder (PDD)
Premenstrual dysphoric disorder (PMDD)
Psychotic depression:
Seasonal affective disorder (SAD)
Causal Factors:
The exact cause of depression is not fully known. While depression is caused by genetic factors, stressful life events and chemical imbalances. It is more complicated than one may think. Based on research on depression, levels of brain chemicals are a factor, nerve cell connections, nerve cell growth is a factor and how nerve circuits function also impacts depression. There are several parts of the brain that impacts depression directly. According to harvard health:
Amygdala: The amygdala is part of a group of structures deep in the brain that’s associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. Recalling an emotionally charged memory, such as a frightening situation, activates the amygdala. Activity in the amygdala is higher when a person is sad or clinically depressed, and this continues even after recovery from depression. This increase in activity may actually cause the amygdala to enlarge.
Basal ganglia (not pictured): The basal ganglia are a related group of structures deep in the brain. They are connected to and interact with structures that are closer to the brain’s surface. They may help facilitate movement and may be involved in memorizing, thinking, and emotional processing. Some studies have found shrinkage and other structural changes in the basal ganglia in people with depression.
Hippocampus: The hippocampus plays a key role in processing long-term memory. Interplay between the hippocampus and the amygdala might account for the adage “once bitten, twice shy.” It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people, and research suggests that ongoing exposure to stress hormones impairs the growth of neurons in this part of the brain.
Ways to treat depression:
While depression may be a serious condition. It is treatable in most individuals. There are many ways to treat depression:
Counseling: Counseling or psychotherapy, involves talking to a mental health professional. One can address their issues and learn coping skills.
Medication: Prescription medication such as antidepressants. Oftentimes, they are prescribed by a psychiatrist.
Alternative Medication: This may include acupuncture, hypnosis and biofeedback.
Brain stimulation therapy: people with severe depression or psychosis tend to use this method if recommended by their psychiatrist.
Self Help: can include weekly exercise, and regular sleep habits.
Many individuals are under the notion that eating healthy and exercise is a cure for depression. It certainly helps the cause. Taking care of one’s health makes a tremendous difference as it pertains to depression. If one is suffering from clinical depression, eating healthy, and exercise is not sufficient to cure it. I am not saying every single person who suffers from depression has to have medication. It all depends on the severity of their symptoms. I have seen individuals who are so depressed that only medication and talk therapy gave them relief.
Medication is a necessity to treat depression for some individuals in conjunction with talk therapy. Talk therapy helps individuals to bring issues on the surface and it also helps with coping skills. Medication helps manage and alleviate the symptoms. Medication is not always a cure for everyone. For some people medications do not work at all, even if they change their medication periodically. I have seen clients who are medication resistant. Some individuals have taken medication for a long time and medications simply do not work for them. Some individuals simply do not respond to anti-depressants at all.
There are also several approaches that a therapist can use to treat depression in counseling. They have to find what works for each individual client. A therapist would know what approach to use and when. These are some of the approaches:
Cognitive behavioral
Acceptance and commitment therapy
Interpersonal psychotherapy
Family or marital therapy
Dialectical behavioral therapy
Group psychotherapy
Mindfulness
Behavioral activation.
What if medication and counseling does not work for a patient with depression? A patient can talk to their psychiatrist about brain stimulation therapy if they choose to go that route. There are several Brain stimulation therapy:
Repetitive transcranial magnetic stimulation (rTMS).
Ketamine
Electroconvulsive therapy (ECT)
Vagus nerve stimulation (VNS)
There are individuals who have to take medications no matter what. Unfortunately, some people simply do not have a choice. They have to take medications in conjunction with talk therapy to help manage their depression. Depression is not a one size fits all type of situation. My first line of defense as it pertains to patients is not always medication. It also depends on the severity of the depression.
I like to at least try the alternative routes first, such as yoga, acupuncture, deep breathing, biofeedback, hypnosis, lifestyle change. Medication is always a second option for me. The reason being is that there are individuals who can function using alternative medication if the depression is mild. As I stated prior, if you are in need of medication the alternative route will not work for you. I do recommend that a person take medication if it means getting through the day without a mental struggle.
There are several other measures that one can apply along with depression treatment. For example, do not not use recreational drugs, manage stress, regular exercise, sleep, a healthy diet, get a hobby. Stick to a treatment plan.
If someone you know suffers from depression, do not judge them. It is not a choice. They did not choose depression. Depression chose them. Show a little kindness and compassion. It could be you, It could be me. It could be anyone.
If you think you want to harm yourself or attempt suicide: call 911 immediately.
If you’re having suicidal thoughts: Call your doctor or mental health professional.
Contact a suicide hotline. In the call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week.
call or text 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week.
Lifeline Chat. Services are free and confidential.
U.S. veterans or service members who are in crisis can call 988 and then press “1” for the Veterans Crisis Line. Or text 838255. Or chat online.
The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1–888–628–9454 (toll-free).
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