From the Editor’s Keyboard

Depression versus variations in human behavior

8 March 2016 at 00:59 | 1916 views

By Dr. Nanah Sheriff Fofanah-Sesay, Guest Writer, Virginia, USA.

It is often impossible to determine why human behavior varies from individuals to individuals. Although genetics, environment, culture, religious background, education, socio-economic status and ethnic background play significant roles in ways human sees, perceive and react, the vast variations in human behavior cannot be clearly identified.

The purpose of this article is to discuss depression in relation to variations in human behaviors and to outline causes, symptoms, myths, and treatments of this emerging pandemic.

Depression is characterized by a diminished or sad mood manifested by decreased interest in activities which used to be pleasurable, weight gain or loss, psychomotor agitation or retardation, fatigue, inappropriate guilt, difficulties concentrating, as well as recurrent thoughts of self-harm, harming others or death. These symptoms must be present for a continuous period of at least two weeks in order for a diagnosis of clinical depression is established (American Psychiatric Association, 2013).

Depression can be caused by a combination of genetics, chemical, biological, psychological, social, and environmental factors. This disease is often a signal that certain mental, emotional, and physical aspects of a person’s life are out of balance.

Chronic and serious illnesses such as heart disease, HIV/Aids, cancer may be accompanied by depression. Other causes of depression include major life stressors such as death of a loved one, loss of a job, a divorce, loss of a treasured item, inability to accomplish a goal and other more subtle factors that lead to loss of self-esteem or self-identity.

In some situations, the circumstances involved in depression are ones over which an individual has little or no control. In other situations however, depression occurs when people are unable to see that they actually have choices that can bring about change in their lives (American Psychological Association, 2010).

Life events leading to adversity in childhood such as grief, neglect, mental abuse, unequal parental treatment of siblings can contribute to depression in adulthood. In addition, childhood physical or sexual abuse in particular significantly increases the likelihood of experiencing depression in adulthood (American Psychological Association, 2010).

Depression differs from occasional sadness in that while everyone occasionally feels sad or blue, these feelings tend to dissipate rather quickly. In contrast, someone with depression experiences extreme sadness or despair that lasts for at least two weeks or longer. Depressed individuals tend to feel helpless and hopeless; moreover, they tend to blame themselves for having these feelings.

Depression interferes with activities of daily living such as working, or concentrating on tasks, eating and sleeping. Somatic symptoms such as chronic pain, headaches, stomach aches, and shortness of breath can be a manifestation of depression. Some individuals may feel angry, revengeful, and malicious for prolonged periods (American Psychological Association, 2010).

The symptoms of depression vary based upon the level of the disease and the individual coping mechanisms. However, most people with depression experience one or more of these symptoms: decreased mood, withdrawal, especially from loved ones and favorite activities, feelings of irritability, anxiety, emptiness, hopelessness, helplessness, worthlessness, being ashamed of one’s self, insomnia or excessive sleeping, and suicidal ideation.

According to the World Health Organization (2015), depression affects an estimated 350 million people of all ages. It is the leading cause of disability and a major contributor to the global burden of other diseases.

In addition, more women are affected by depression than men. In the United States, depression affects 10 percent of Americans (National Institute of Mental Health, 2015). Despite these grim evidence-based epidemiology on depression, certain myths persists about the disease.

Some of the myths about depression are: 1) depression doesn’t affect me, 2) depression is not a real medical problem, 3) depression is something that does not affect strong people and if it does, they can easily snap out of it, 4) depression only happens when something bad occurs in your life, such as a breakup, death of a loved one, or failing an examination, 5) taking anti-depressants will change one’s personality, and 6) talking about depression only makes it worse.

Prior to initiating treatment for depression, a comprehensive psychiatric assessment must be implemented. This assessment must include the history of present illness and current symptoms, psychiatric history, general medical history, medications including over-the-counter agents and supplements, history of substance use and treatment for substance disorder, personal history, social history, and family history.

For individuals suffering from mild depression, your provider may initially recommend cognitive behavior therapy (CBT) which focuses on identifying problems with an individual’s behavior and thinking, then teaches evidence-based skills for coping more effectively (Bilsker, 2009). Further management for mild depression include treatment of the underlying physiological problems such as chronic pain and group psychological interventions targeting people with depression.

Moderate to major depression is usually managed with the use of pharmacologic agents. Since multiple agents are available on the market, the decision for the most appropriate agent is based on findings from the psychiatric assessment. The most commonly use anti-depressants today are tricyclic (TCA) which act by blocking norepinephrine reuptake pump and, to a varying degree serotonin reuptake pump. Changing in the balance of these chemicals in the brain is being noted to help brain cells send and receive chemical messages, which in turn improve mood. Examples of TCA’s on the market are Nortriptyline (Pamelor), Desipramine (Norpramine), and Imipramine (Tofranil).

Selective Serotonin Reuptake Inhibitors (SSRI’s) and Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s) are the most commonly used treatment for depression in the U.S. since the introduction of Fluoxetin (Prozac) in 1986. SSRI’s act by inhibiting presynaptic serotonin reuptake where as SNRI’s inhibit serotonin and norepinephrine reuptake at higher doses. Examples of SNRI’s agents are Venlafaxine (Effexor) and Duloxetine (Cymbalta).

Other anti-depressants such as Bupropion (Wellbutrin) inhibits the synaptic reuptake of norepinephrine and dopamine. One of the most commonly used anti-depressant agent especially in the elderly population is Mirtazapine (Remeron) which act by selectively blocking the 5-HT2A and 5-HT2C serotonin receptors. Its pharmacologic effect in treating mood, poor appetite, and insomnia simultaneously makes it superior to other agents in the management of depression.

In instances where depression remain non-responsive to pharmacologic and non-pharmacologic managements, electroconvulsive therapy (ECT) is used. During ECT, an electric current is briefly applied through the scalp to the brain while the person is asleep under general anesthesia, inducing a seizure (Adams et al., 2008). Adverse reactions of anti-depressants and ECT are always a consideration in the management of depression however, this discussion is deferred in this article.

Depression is a serious illness that can manifests in abnormal behaviors; however, most people attain symptoms resolution with adequate management. To find out more about depression and where to get help, contact your local mental health affiliate or call 1-800-969-6642 in U.S.A.