COMMON SOCIALLY ACCEPTED FALSE BELIEFS ABOUT MENTAL ILLNESSES

This has been a hard one to write.  Not because of lack of clarity, but frankly, because this topic outrages me. It’s not under my skin it’s in my dang blood.  I have read a few things online which has provoked this proverbial bear and like any momma bear that feels a sense of protection over those that she considers to be hers, I am responding.  And at times in this article, aggressively so.  I don’t do so to cause an offense, but I do so to convey the depth of anger that is felt among the misunderstood.  My hope is to dispel some misconceptions by talking about common socially accepted false truths around mental illness.  For the sake of argument, I am going to mostly talk about depression as my subject matter, to keep this conversation as linear as possible.  Ok let’s get to it.

 

False information point 1.

 

‘Depression is at an all time high’.

 

Is it?  The statement above is both true and untrue.  Major Depressive Disorder was not clinically RECOGNIZED in the United States until about 1980.  Since 1980, researchers, chemists, scientists, neuroscientists and DOCTORS have been developing methods of testing to both identify and treat MDD.  To think that depression all of a sudden is a problem, is an incomplete thought.  Depression has ALWAYS been a problem.  The conversation is not that depression is at an all time high; it is rather that it is only now, in the last 40 + years it is formally recognized and treated.  In short, depression is at an all time point of recognition.   Testing, clinically, is a method only introduced in the 20^th century.  To me, common sense says, ‘of course depression will be at an all time high.’  We are only scratching the surface of what we know, can test for and treat!  Testing is still to this day progressing.  Of course numbers will rise!  We are simply at an all-time understanding of the issue and are still developing criteria to classify and diagnose what constitutes as depression (and MI’s), and to therefore treat both with lifestyle adjustments and/or medications and therapies.

 

From any article I have read online, data does not in anyway substantiate that depression only mildly existed or was non existent  ‘back then.’ Depression was as a prevalent issue ‘ back then’ (whenever ‘back then’ was) as it is now.  Depression dates back to the Ancient Greeks and the Mesopotamian Era.  As science evolves, we for sure will have more illnesses to be uncovered, more symptoms to be identified through clinical research and more therapies available.    In conclusion, yes depression is at an all time high, but that is because it is at an all time point of understanding, not because it did not exist.

 

Please do not just take my opinion for it, do your own study.  Included is some of my research at the bottom of this blog. ‘The History of Depression’

 

 

False information point 2.

 

It’s a conspiracy.  The government and pharmaceutical companies are financially invested in giving us drugs that we don’t need to continue making the billions.

 

(on the depressed or mentally ill and the topic of prescription medications)

 

**Please read the following in the tone of sarcasm.

 

Yes, absolutely true.  I know of tonnes of scientists, chemists, psychiatrists, doctors, researchers and clinicians that go into their field to find medical solutions with the end goal in mind to bamboozle and trick the general public into taking medication that they do not need in order to make a profit.  Bringing curative measures to people suffering has nothing to do with it.  In fact, they even have a test in high school that you can take which helps determine what you want to major in in college, and there it is uncovered that people truly want to drug the American and worldwide public in order to make their fortune.

 

And

 

Also, yes, absolutely, the government sits down at a big round table in a dark, creepy, secret, high security room with the medical and pharmaceutical superpowers and masterminds of the world to devise a plan to over medicate, drug and again, trick the general public into taking medication that they do not need in order to make their billions.  It’s all a conspiracy.  Probably formulated by the democrats.

 

THAT WAS COMPLETE SARCASM ON MY PART.  But I am trying to make the point of how ridiculous that sounds. 

 

I wonder, do we feel the same about the medicines and treatments of those with diabetes, cancers, heart disease, blood pressure, Alzheimer’s, arthritis, cystic fibrosis, COPD, asthma, Crohn’s disease, HIV, AIDS, MS, Parkinson disease, epilepsy, AND SO ON.  Of course not we don’t.  We instead are grateful for the medicinal treatments available that literally save and prolong people’s lives.

 

Am I saying that ALL pharmaceutical companies operate out of complete integrity?  I can’t answer that.  But to assume that pills are created to keep people hooked and in a junkie like cycle that merely keeps people buying and consuming medication is unintelligent.  Do pharmaceutical companies as a whole made a profit?  For sure.  But so does any other industry that serves the public.  I mean, how DARE the automotive companies make a profit.  How dare airline companies make billions.  How dare restaurants, agriculturalists, universities, financial institutions, Apple, real estate developers, AND ANY OTHER INDUSTRY ON THE PLANET make a profit off of people… creating a supply and demand that we cannot resist only to trap us.  My goodness, all of life is a conspiracy.

 

False information point 3.

 

Depression (and mental illness) is not chemical.

 

Actually that’s partially true.  IT’S FAR MORE than chemical.

 

‘Depression is not chemical’ …  I have heard this a lot over the course of my life.  I’ve got to say, that statement fully comprised of complete and utter horse shit.

 

If that is true, then in other words, when a war veteran is depressed or has PTSD, are we to say that he/she just feels sad, and it hasn’t affected them chemically and therefor healing is within their mental control?  That’s interesting, because any war vets that I know of cannot get themselves out of the darkness, they need various measures of help, and the train of mental and physical pain that they experience as a consequence of their mental illness is not something they can get a hold of.

 

How about mom who has just given birth, lets say it was traumatic.  She was powerless and something terrible happened.  She is now depressed.  Are we saying this doesn’t change her brain anatomically speaking?  Or how about postpartum depression.  Are we saying that the baby blues is just the traits of a weak woman who needs to get it together?  What about a victim of child abuse?  They have depression. Are you telling me that the impact of the trauma has not impacted their limbic system?  What about a child who has abandonment issues, are you telling me that their neuro reflexes aren’t chemical and they should just be able to buck up rather than shrink when someone offers them trust?  How about an man or woman who experiences trauma, something violent, a death, a job loss, something that has left them paralyzed. They are suddenly depressed because of something that they experienced..  Are you telling me that the depression hasn’t toyed with their brain make up?  What about the child of someone with a mental disorder. They are leading a successful adult life.  College degree, high functioning.  Suddenly, they start to experience mania and depressive episodes.  No apparent reason.  Are you arguing that their genetics did not pre-dispose them to a mental illness?

 

I think mental illness from what I understand to be true and have read, is partial genetics predisposition, part environmental etc.  But to me that is a chicken and egg conversation.  Regardless of how the MI got there, it will impact the brain and the body.  Treatment is required.   I could go on all day but, rather I am going to let Harvard do the scientific explaining.

 

I ask you to glance through this article (included) or scroll to my conclusion at the bottom and click the link later.

 

 

FROM HARVARD:

 

 

https://www.health.harvard.edu/mind-and-mood/what-causes-depression

 

It’s often said that depression results from a chemical imbalance, but that figure of speech doesn’t capture how complex the disease is. 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, stressful life events, medications, and medical problems. It’s believed that several of these forces interact to bring on depression.

 

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.

Researchers have learned much about the biology of depression. They’ve identified genes that make individuals more vulnerable to low moods and influence how an individual responds to drug therapy. One day, these discoveries should lead to better, more individualized treatment (see “From the lab to your medicine cabinet”), but that is likely to be years away. And while researchers know more now than ever before about how the brain regulates mood, their understanding of the biology of depression is far from complete.

What follows is an overview of the current understanding of the major factors believed to play a role in the causes of depression.

The brain’s impact on depression

Popular lore has it that emotions reside in the heart. Science, though, tracks the seat of your emotions to the brain. Certain areas of the brain help regulate mood. Researchers believe that — more important than levels of specific brain chemicals — nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression. Still, their understanding of the neurological underpinnings of mood is incomplete.

Regions that affect mood

Increasingly sophisticated forms of brain imaging — such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) — permit a much closer look at the working brain than was possible in the past. An fMRI scan, for example, can track changes that take place when a region of the brain responds during various tasks. A PET or SPECT scan can map the brain by measuring the distribution and density of neurotransmitter receptors in certain areas.

Use of this technology has led to a better understanding of which brain regions regulate mood and how other functions, such as memory, may be affected by depression. Areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus (see Figure 1).

Research shows that the hippocampus is smaller in some depressed people. For example, in one fMRI study published in The Journal of Neuroscience, investigators studied 24 women who had a history of depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with those who were not depressed. The more bouts of depression a woman had, the smaller the hippocampus. Stress, which plays a role in depression, may be a key factor here, since experts believe stress can suppress the production of new neurons (nerve cells) in the hippocampus.

Researchers are exploring possible links between sluggish production of new neurons in the hippocampus and low moods. An interesting fact about antidepressants supports this theory. These medications immediately boost the concentration of chemical messengers in the brain (neurotransmitters). Yet people typically don’t begin to feel better for several weeks or longer. Experts have long wondered why, if depression were primarily the result of low levels of neurotransmitters, people don’t feel better as soon as levels of neurotransmitters increase.

The answer may be that mood only improves as nerves grow and form new connections, a process that takes weeks. In fact, animal studies have shown that antidepressants do spur the growth and enhanced branching of nerve cells in the hippocampus. So, the theory holds, the real value of these medications may be in generating new neurons (a process called neurogenesis), strengthening nerve cell connections, and improving the exchange of information between nerve circuits. If that’s the case, depression medications could be developed that specifically promote neurogenesis, with the hope that patients would see quicker results than with current treatments.

Figure 1: Areas of the brain affected by depression   Amygdala: The amygdala is part of the limbic system, a group of structures deep in the brain that’s associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. The amygdala is activated when a person recalls emotionally charged memories, such as a frightening situation. Activity in the amygdala is higher when a person is sad or clinically depressed. This increased activity continues even after recovery from depression. Thalamus: The thalamus receives most sensory information and relays it to the appropriate part of the cerebral cortex, which directs high-level functions such as speech, behavioral reactions, movement, thinking, and learning. Some research suggests that bipolar disorder may result from problems in the thalamus, which helps link sensory input to pleasant and unpleasant feelings. Hippocampus: The hippocampus is part of the limbic system and has a central role in processing long-term memory and recollection. 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 hormone impairs the growth of nerve cells in this part of the brain.

Nerve cell communication

The ultimate goal in treating the biology of depression is to improve the brain’s ability to regulate mood. We now know that neurotransmitters are not the only important part of the machinery. But let’s not diminish their importance either. They are deeply involved in how nerve cells communicate with one another. And they are a component of brain function that we can often influence to good ends.

Neurotransmitters are chemicals that relay messages from neuron to neuron. An antidepressant medication tends to increase the concentration of these substances in the spaces between neurons (the synapses). In many cases, this shift appears to give the system enough of a nudge so that the brain can do its job better.

How the system works. If you trained a high-powered microscope on a slice of brain tissue, you might be able to see a loosely braided network of neurons that send and receive messages. While every cell in the body has the capacity to send and receive signals, neurons are specially designed for this function. Each neuron has a cell body containing the structures that any cell needs to thrive. Stretching out from the cell body are short, branchlike fibers called dendrites and one longer, more prominent fiber called the axon.

A combination of electrical and chemical signals allows communication within and between neurons. When a neuron becomes activated, it passes an electrical signal from the cell body down the axon to its end (known as the axon terminal), where chemical messengers called neurotransmitters are stored. The signal releases certain neurotransmitters into the space between that neuron and the dendrite of a neighboring neuron. That space is called a synapse. As the concentration of a neurotransmitter rises in the synapse, neurotransmitter molecules begin to bind with receptors embedded in the membranes of the two neurons (see Figure 2).

The release of a neurotransmitter from one neuron can activate or inhibit a second neuron. If the signal is activating, or excitatory, the message continues to pass farther along that particular neural pathway. If it is inhibitory, the signal will be suppressed. The neurotransmitter also affects the neuron that released it. Once the first neuron has released a certain amount of the chemical, a feedback mechanism (controlled by that neuron’s receptors) instructs the neuron to stop pumping out the neurotransmitter and start bringing it back into the cell. This process is called reabsorption or reuptake. Enzymes break down the remaining neurotransmitter molecules into smaller particles.

When the system falters. Brain cells usually produce levels of neurotransmitters that keep senses, learning, movements, and moods perking along. But in some people who are severely depressed or manic, the complex systems that accomplish this go awry. For example, receptors may be oversensitive or insensitive to a specific neurotransmitter, causing their response to its release to be excessive or inadequate. Or a message might be weakened if the originating cell pumps out too little of a neurotransmitter or if an overly efficient reuptake mops up too much before the molecules have the chance to bind to the receptors on other neurons. Any of these system faults could significantly affect mood.

Kinds of neurotransmitters. Scientists have identified many different neurotransmitters. Here is a description of a few believed to play a role in depression:

• Acetylcholine enhances memory and is involved in learning and recall.
• Serotonin helps regulate sleep, appetite, and mood and inhibits pain. Research supports the idea that some depressed people have reduced serotonin transmission. Low levels of a serotonin byproduct have been linked to a higher risk for suicide.
• Norepinephrine constricts blood vessels, raising blood pressure. It may trigger anxiety and be involved in some types of depression. It also seems to help determine motivation and reward.
• Dopamine is essential to movement. It also influences motivation and plays a role in how a person perceives reality. Problems in dopamine transmission have been associated with psychosis, a severe form of distorted thinking characterized by hallucinations or delusions. It’s also involved in the brain’s reward system, so it is thought to play a role in substance abuse.
• Glutamate is a small molecule believed to act as an excitatory neurotransmitter and to play a role in bipolar disorder and schizophrenia. Lithium carbonate, a well-known mood stabilizer used to treat bipolar disorder, helps prevent damage to neurons in the brains of rats exposed to high levels of glutamate. Other animal research suggests that lithium might stabilize glutamate reuptake, a mechanism that may explain how the drug smooths out the highs of mania and the lows of depression in the long term.
• Gamma-aminobutyric acid (GABA) is an amino acid that researchers believe acts as an inhibitory neurotransmitter. It is thought to help quell anxiety.

Figure 2: How neurons communicate   1          An electrical signal travels down the axon. 2          Chemical neurotransmitter molecules are released. 3          The neurotransmitter molecules bind to receptor sites. 4          The signal is picked up by the second neuron and is either passed along or halted. 5          The signal is also picked up by the first neuron, causing reuptake, the process by which the cell that released the neurotransmitter takes back some of the remaining molecules.

Genes’ effect on mood and depression

Every part of your body, including your brain, is controlled by genes. Genes make proteins that are involved in biological processes. Throughout life, different genes turn on and off, so that — in the best case — they make the right proteins at the right time. But if the genes get it wrong, they can alter your biology in a way that results in your mood becoming unstable. In a person who is genetically vulnerable to depression, any stress (a missed deadline at work or a medical illness, for example) can then push this system off balance.

Mood is affected by dozens of genes, and as our genetic endowments differ, so do our depressions. The hope is that as researchers pinpoint the genes involved in mood disorders and better understand their functions, depression treatment can become more individualized and more successful. Patients would receive the best medication for their type of depression.

Another goal of gene research, of course, is to understand how, exactly, biology makes certain people vulnerable to depression. For example, several genes influence the stress response, leaving us more or less likely to become depressed in response to trouble.

Perhaps the easiest way to grasp the power of genetics is to look at families. It is well known that depression and bipolar disorder run in families. The strongest evidence for this comes from the research on bipolar disorder. Half of those with bipolar disorder have a relative with a similar pattern of mood fluctuations. Studies of identical twins, who share a genetic blueprint, show that if one twin has bipolar disorder, the other has a 60% to 80% chance of developing it, too. These numbers don’t apply to fraternal twins, who — like other biological siblings — share only about half of their genes. If one fraternal twin has bipolar disorder, the other has a 20% chance of developing it.

The evidence for other types of depression is more subtle, but it is real. A person who has a first-degree relative who suffered major depression has an increase in risk for the condition of 1.5% to 3% over normal.

 

One important goal of genetics research — and this is true throughout medicine — is to learn the specific function of each gene. This kind of information will help us figure out how the interaction of biology and environment leads to depression in some people but not others.

 

Temperament shapes behavior Genetics provides one perspective on how resilient you are in the face of difficult life events. But you don’t need to be a geneticist to understand yourself. Perhaps a more intuitive way to look at resilience is by understanding your temperament. Temperament — for example, how excitable you are or whether you tend to withdraw from or engage in social situations — is determined by your genetic inheritance and by the experiences you’ve had during the course of your life. Some people are able to make better choices in life once they appreciate their habitual reactions to people and to life events. Cognitive psychologists point out that your view of the world and, in particular, your unacknowledged assumptions about how the world works also influence how you feel. You develop your viewpoint early on and learn to automatically fall back on it when loss, disappointment, or rejection occurs. For example, you may come to see yourself as unworthy of love, so you avoid getting involved with people rather than risk losing a relationship. Or you may be so self-critical that you can’t bear the slightest criticism from others, which can slow or block your career progress. Yet while temperament or world view may have a hand in depression, neither is unchangeable. Therapy and medications can shift thoughts and attitudes that have developed over time.

Stressful life events

At some point, nearly everyone encounters stressful life events: the death of a loved one, the loss of a job, an illness, or a relationship spiraling downward. Some must cope with the early loss of a parent, violence, or sexual abuse. While not everyone who faces these stresses develops a mood disorder — in fact, most do not — stress plays an important role in depression.

As the previous section explained, your genetic makeup influences how sensitive you are to stressful life events. When genetics, biology, and stressful life situations come together, depression can result.

Stress has its own physiological consequences. It triggers a chain of chemical reactions and responses in the body. If the stress is short-lived, the body usually returns to normal. But when stress is chronic or the system gets stuck in overdrive, changes in the body and brain can be long-lasting.

How stress affects the body

Stress can be defined as an automatic physical response to any stimulus that requires you to adjust to change. Every real or perceived threat to your body triggers a cascade of stress hormones that produces physiological changes. We all know the sensations: your heart pounds, muscles tense, breathing quickens, and beads of sweat appear. This is known as the stress response.

The stress response starts with a signal from the part of your brain known as the hypothalamus. The hypothalamus joins the pituitary gland and the adrenal glands to form a trio known as the hypothalamic-pituitary-adrenal (HPA) axis, which governs a multitude of hormonal activities in the body and may play a role in depression as well.

When a physical or emotional threat looms, the hypothalamus secretes corticotropin-releasing hormone (CRH), which has the job of rousing your body. Hormones are complex chemicals that carry messages to organs or groups of cells throughout the body and trigger certain responses. CRH follows a pathway to your pituitary gland, where it stimulates the secretion of adrenocorticotropic hormone (ACTH), which pulses into your bloodstream. When ACTH reaches your adrenal glands, it prompts the release of cortisol.

The boost in cortisol readies your body to fight or flee. Your heart beats faster — up to five times as quickly as normal — and your blood pressure rises. Your breath quickens as your body takes in extra oxygen. Sharpened senses, such as sight and hearing, make you more alert.

CRH also affects the cerebral cortex, part of the amygdala, and the brainstem. It is thought to play a major role in coordinating your thoughts and behaviors, emotional reactions, and involuntary responses. Working along a variety of neural pathways, it influences the concentration of neurotransmitters throughout the brain. Disturbances in hormonal systems, therefore, may well affect neurotransmitters, and vice versa.

Normally, a feedback loop allows the body to turn off “fight-or-flight” defenses when the threat passes. In some cases, though, the floodgates never close properly, and cortisol levels rise too often or simply stay high. This can contribute to problems such as high blood pressure, immune suppression, asthma, and possibly depression.

Studies have shown that people who are depressed or have dysthymia typically have increased levels of CRH. Antidepressants and electroconvulsive therapy are both known to reduce these high CRH levels. As CRH levels return to normal, depressive symptoms recede. Research also suggests that trauma during childhood can negatively affect the functioning of CRH and the HPA axis throughout life.

Early losses and trauma

Certain events can have lasting physical, as well as emotional, consequences. Researchers have found that early losses and emotional trauma may leave individuals more vulnerable to depression later in life.

Profound early losses, such as the death of a parent or the withdrawal of a loved one’s affection, may resonate throughout life, eventually expressing themselves as depression. When an individual is unaware of the wellspring of his or her illness, he or she can’t easily move past the depression. Moreover, unless the person gains a conscious understanding of the source of the condition, later losses or disappointments may trigger its return.

Traumas may also be indelibly etched on the psyche. A small but intriguing study in the Journal of the American Medical Association showed that women who were abused physically or sexually as children had more extreme stress responses than women who had not been abused. The women had higher levels of the stress hormones ACTH and cortisol, and their hearts beat faster when they performed stressful tasks, such as working out mathematical equations or speaking in front of an audience.

Many researchers believe that early trauma causes subtle changes in brain function that account for symptoms of depression and anxiety. The key brain regions involved in the stress response may be altered at the chemical or cellular level. Changes might include fluctuations in the concentration of neurotransmitters or damage to nerve cells. However, further investigation is needed to clarify the relationship between the brain, psychological trauma, and depression.

 

CONCLUSION

 

Getting transparent today,

 

People I love (including myself) have ongoing MI issues.  Since my previous blog I have had dozens of private messages that will remain private, of people attesting to their mental illness wrestles. THANK YOU FOR SHARING!  Most of all, these warriors have consistent incredible frustration at the widespread misunderstanding of depression and wider mental illnesses.  They have had little support from peers.  The three points of falsehood I made reflect collective plight.  I am simply writing what perhaps is not safe for them to write.  What is really awful about all of it, is that because people believe the above nonsense to be true, when people with mental illness or depression muster the voice and courage to disclose their struggle, because of preconceived notions, people pull away from them.

 

Collectively, the judgement.  The ‘get over it.’  The ‘you’re just lonely, moody, put your big boy/girl pants on and deal with it.’  Or ‘you’re just self absorbed’ or ‘navel gazing’ or ‘having a pity party’ and worst of all, choosing to not be happy, is all bull-to-the -shit.  For most of those people I have heard from, it is in fact a chemical, genetic and an outside of their control element that they suffer with (not environmental).   Others have endured trauma which has onset their mental illness.  Regardless of the onset/cause, MI requires treatment, it has impacted them beyond their control and has changed their physical make up, and in some cases need to take advantage of the medications that the drug pushing bastards are trying to force down their throats.  (again, sarcasm)

 

As an advocate for this community, my community, I will hold this line and bang on about it much to the discomfort of some because this is very real and is a topic worthy of wide research and respect.  I also don’t mind hanging myself out to dry on this one. What do I mean? I mean this.  I am a woman who is happily married, the momma of 4 glorious babies, and who happens to have a clinical diagnosis of PTSD, bi-polar disorder, and anxiety, some of which stems from trauma, some of which is chemical.  I used to feel shame about this.  I used to try to mind over matter my way out of this.  I tried everything.  And I mean everything.  But I am at peace with my diagnosis and if anything I am in love with it.  Why?  I get me now.  I take medicine that brings me back to me now.  Having any of those illnesses are no different than high blood pressure and needing to pop a pill for it.  Unfortunately, in the mental health community we have to combat stigma and judgement from the armchair experts to which I say:

 

if you are not qualified to speak to this and or if you are not mentally ill yourself and you consider yourself a keyboard-warrior-prophet-armchair expert,on behalf of myself and anyone else who wants to jump onboard, HUSH YOUR MOUTH. Respectfully.

 

Love,

 

Allison

 

RESOURCES

 

 

Below is the link and a portion of the article on 20^th Century History of Depression

 

https://www.verywellmind.com/who-discovered-depression-1066770

 

Excerpt:

‘Treatments for Depression in the Recent Past 

During the late 19th and early 20th centuries, treatments for severe depression were generally not enough to help patients, leading many people desperate for relief to have lobotomies, which are surgeries to destroy the frontal portion of the brain. These surgeries were reputed to have a “calming” effect. Unfortunately, lobotomies often caused personality changes, a loss of decision-making ability, poor judgment, and sometimes even led to the patient’s death.11

 

Electroconvulsive therapy (ECT), which is an electrical shock applied to the scalp in order to induce a seizure, was also sometimes used for patients with depression.

During the 1950s and 60s, doctors divided depression into subtypes of “endogenous” (originating from with the body) and “neurotic” or “reactive” (originating from some change in the environment). Endogenous depression was thought to result from genetics or some other physical defect, while the neurotic or reactive type of depression was believed to be the result of some outside problems such as a death or loss of a job.

The 1950s were an important decade in the treatment of depression thanks to the fact that doctors noticed that a tuberculosis medication called isoniazid seemed to be helpful in treating depression in some people.12 Where depression treatment had previously been focused only on psychotherapy, drug therapies now started to be developed and added to the mix.

In addition, new schools of thought, such as cognitive-behavioral and family systems theory emerged as alternatives to psychodynamic theory in depression treatment.

One of the first drugs to emerge for the treatment of depression was known as Tofranil (imipramine), which was then followed by a number of other medications categorized as tricyclic antidepressants (TCAs). Such drugs provided relief for many people with depression but were often accompanied by serious side effects that included weight gain, tiredness, and the potential for overdose.13

Other antidepressants later emerged, including Prozac (fluoxetine) in 1987, Zoloft (sertraline) in 1991, and Paxil (paroxetine) in 1992. These medications, known as selective serotonin reuptake inhibitors (SSRIs), target serotonin levels in the brain and usually have fewer side effects than their predecessors.

Newer antidepressant drugs that have emerged in the past couple of decades include atypical antidepressants such as Wellbutrin (bupropion), Trintellix (vortioxetine), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Our Understanding of Depression Today 

The term major depressive disorder (MDD) was first introduced by clinicians in the United States during the 1970s. The condition officially became part of the DSM-III in 1980. The current edition of the diagnostic manual is the DSM-5 and is one of the primary tools used in the diagnosis of depressive disorders.

While the condition is much better understood today than it was in the past, researchers are still working to learn more about the causes of depression. At the present time, doctors believe that depression arises from a combination of multiple causes including biological, psychological, and social factors.

Causes and Risk Factors of Depression

Modern views of depression incorporate an understanding of the many symptoms of this condition as well as the often cyclical effect that the symptoms can have. For example, depression can cause disturbances in sleep, appetite, and activity levels; in turn, poor sleep, diet, and exercise can exacerbate symptoms of depression.1

In addition to considering the psychological factors that contribute to depression, doctors are also aware that certain medical conditions such as hypothyroidism may cause depressive symptoms. The diagnosis of depression includes ruling out other medical conditions and other possible causes such as alcohol or substance use.

How Depression Is Diagnosed With the DSM-5

Thanks to the improved understanding of the causes of depression, effective treatments have emerged. Psychotherapy and medications that target molecules called neurotransmitters are generally the preferred treatments, although electroconvulsive therapy may be utilized in certain instances, such as in treatment-resistant depression or severe cases where immediate relief is required.

Other, newer, therapies, including transcranial magnetic stimulation and vagus nerve stimulation, have also been developed in recent years in an attempt to help those who have failed to respond to therapy and medications.

Unfortunately, the causes of depression are more complex than we yet understand, with no single treatment providing satisfactory results for everyone. Because depression is such a complex condition, mental health professionals often recommend a treatment approach that includes medications, psychotherapies, and lifestyle modifications.’