Depression is Real and Not All Depression is the Same

Dr. Amanda Craig, Ph.D, LMFT

Dr. Andre Burey, MD

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: 

• Feeling weighted down in cement blocks

 

• Trouble getting out of bed and often feeling like a nap

 

• Feeling hungry but nothing sounds good to eat

 

• Eating brings comfort

 

• People are talking so fast

 

• The world is moving so fast

 

• Blah

 

• Feeling an emptiness you just can’t explain

 

• Feeling aches and pains in the body. Literal physical discomfort from emotional hurt

 

• Irritation that leads you to fly off the handle in a way you can not control

 
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:

• Keep it simple. When we expect too much of ourselves when we are struggling with depression we feel disappointed when we don’t do it and guess what? Feel more depressed. Baby steps build to big steps.

 

• If you have a history of depression, know your first signs and symptoms of depression. This will help to catch it early and feel better faster.

 

• Basic life skills like eating well, getting enough sleep and moving your body are essential for staying balanced and feeling better. When you are well rested and not hungry you have more strength to fight depression. A little goes a long way.

 

• Sleep hygiene is understanding what your sleep patterns are in order to find ways to combat insomnia. Some people are always tired and some people can’t sleep. Know your symptoms so you know what to solve through sleep hygiene.

 

• The negative thoughts exacerbate the feelings of sadness or depression. Remind yourself daily- you matter to your family and friends, you add value to the world around you. There is a special and unique path meant just for you. Be specific with how you contribute to other people’s happiness and why you matter to the world. Find even the small ones.

 

• Notice a negative thought and reframe to other important thoughts that are more positive or even neutral. Negative thoughts lead to a downward spiral if left alone.

 

• Have your people that support and encourage you. Put distance between you and people that bring hurt to you. 

 

• Share your hurts with others. Keeping pain and depression a secret only gives it oxygen to get worse and hurt more.

 

• Seek therapy and psychiatry to get medical support that will help you develop a plan that includes life change and improving brain functions.

 

• Find things that bring you joy and make time for them. You deserve time for yourself and it will make you a better caregiver, employee, friend and mostly importantly you will feel better. 

 

• If someone you know is struggling with depression take them seriously. Remind them why they matter to you, offer to find them a therapist and psychiatrist and don’t hesitate to call 911 and ask for a wellness check if you fear they are contemplating suicide.
  

 
 
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.