Depression... the cloud of sadness over life. Sometimes the clouds lightly shadow the joys of life but they still shines through. It’s a mild discomfort but you have learned to live with it. And even when the sun is out, you know there will be another sad day to come.
Sometimes depression is seen as dark angry clouds. Have you ever known someone to be easily angered and frustrated at the drop of a hat? That can also be an expression of depression. We think depression is always expressed through sadness but sometimes its through anger, especially for men.
For other people the clouds move in and the sunshine is just absent. The world is colored by thoughts and feelings of pain or deep numbness. The hurt can come and go in waves or stay for days or weeks at a time. Some times it feels unbearable to survive. And it is hard to see any sunshine at all.
Depression isn’t the same for everyone. But you might experience:
What happens in the brain of depression:
Historically, research studies on depression proposed that depression is caused by low levels of individual neurotransmitters - serotonin, dopamine, norepinephrine, and/or histamine - in the brain. However, we now understand that depression is caused by a complex interplay between genetics, dysfunctional systems of brain circuits, temperament/personality traits and environmental stressors.
In the brain, the most common abnormalities found on MRI are bright spots in the basal ganglia and the thalamus and reduced sizes of the hippocampus and caudate nucleus, all of which are deeper, more primitive regions of the brain with complex functions preserved across mammalian species. PET scans of depressed patients commonly show decreased metabolism/brain activity in the frontal brain regions which are responsible for attention, memory, concentration, mood regulation, and other higher-level brain functions that make humans uniquely prone to bouts of depression.
Is depression environmental or genetic?
Sometimes a life event leaves us feeling grief and loss, disappointment, mild depression. Some people have a genetic predisposition to depression which means when life gets hard they may be more susceptible to symptoms of depression than someone who does not have a genetic link for depression. When there is a genetic link you can often notice similar feelings or symptoms in other family members..
All medications are not created equal
The first-line antidepressants are selective serotonin re-uptake inhibitors (SSRIs) such as escitalopram (Lexapro) or fluoxetine (Prozac), as this class of medications has shown the most benefit in studies directly comparing the efficacy of SSRI’s vs. placebo (i.e. fake) pills in reducing symptoms of depression.
Second-line antidepressants include serotonin/norepinephrine re-uptake inhibitors (SNRI’s) such as venlafaxine (Effexor) and norepinephrine/dopamine re-uptake inhibitors such as bupropion (Wellbutrin).
The choice of medication depends on a variety of factors related to the symptoms being targeted and the side effect profiles of each medication.
In individuals with depression that persists despite engagement in talk therapy and standard first- or second-line medication treatments, it is common for psychiatrists to combine medications from multiple classes in order to improve antidepressant efficacy.
Tips to climb out:
This article was co-authored by Andre Burey, MD and Amanda Craig, PhD LMFT
Dr. Burey is a psychiatrist double board-certified by the American Board of Psychiatry and Neurology (ABPN) in Adult Psychiatry and Child & Adolescent Psychiatry. He is staff psychiatrist at Silver Hill Hospital in New Caanan and has a private practice in Darien, CT.
Dr. Craig is a American Associate of Marriage and FamilyTherapy (AAMFT) board approved supervisor and licensed marriage and family therapist (LMFT) with a doctorate in family psychology. She works primarily with issues that impact couples and parenting tweens. She has a group practice in NYC and a private practice in Darien, CT.