Depression: Your Questions Answered
Q1. Is depression an illness of the brain or a psychological problem?
A. In psychiatric illnesses there are indisputably both biological and psychological causes. However, when evaluating a depression it is not helpful to search for biological or psychological causes exclusively but to consider both. This gives a broader understanding of patients, their psychological life, the onset and development of their disorder.
Q2. What is the relationship between life events and depression?
A. Any "unpleasant" life event can cause worry, sadness, anxiety or physical malaise in any person. In these cases, within certain limits, depression can be considered a normal and comprehensible reaction. However when the depression lasts much longer than it would be logical to expect, when the capacity to work, study, carry on family and social relations is hindered, we are looking at a depressive disorder that must be treated.
Q3. Can a disorderly lifestyle cause depression?
A. An "intemperate" lifestyle cannot be considered a direct cause of depression, though in some cases, especially in young people, it might signal the start of depression or a mood disorder.
Q4. Is it true that certain people tend to become more depressed in certain seasons?
A. Studies on the inheritability of psychiatric illnesses are more problematic than studies on the inheritability of medical illnesses. Some forms of depression have a large "acquired" component, in other words they depend on the external environment, life events. In other forms of depression, such as the bipolar disorder, the genetic component prevails. Some people manifest depressive disturbances only in certain seasons (spring and autumn). So far the most credited theory to explain seasonal depression is that there is an alteration of the biological rhythms ("internal clocks"), regulated the variations in the external environment.
Q5. Are more women depressed than men, and if so, why?
A. All the epidemiological studies show that women are depressed twice as often as men and the reasons could be the following: - cultural reasons, because women more easily admit their malaise; - social reasons, related to the frustrations and the considerable difficulty that many women still have finding fulfillment and/or recognition in their jobs; - biological reasons, related to the hormonal ‘eruptions’ in the female body (menstrual flow, pregnancies, menopause) that may promote the development of depression.
(See also: Depression In Men and Depression In Women)
Q6. What age group is most affected by depression?
A. Depression can occur in any age group. However there are certain phases of life that are more at risk, when changes occur that generally involve the need for the person to readapt themselves and their role in their love, social and work relationships.
Q6. What age group is most affected by depression?
A. Depression can occur in any age group. However there are certain phases of life that are more at risk, when changes occur that generally involve the need for the person to readapt themselves and their role in their love, social and work relationships.
Q7. Can nursing and puerperium cause depression?
A. From the psychological point of view all events related to reproduction in women are associated with how they view their role and their own capabilities.
From the physical and biological point of view the female reproductive functions are regulated by a delicate hormonal balance that undergoes radical changes in the course of pregnancy and childbirth. A particularly frequent syndrome is that which is called postpartum depression. It usually lasts a few weeks, after which it completely passes.
Q8. Can climacterium cause depression?
A. The period between age 45 and 55 can be a phase of crises for both sexes. In women this transition occurs at menopause; in men it does not necessarily coincide with a precise physiological event. For both sexes the convergence of physical and psychological factors may be a source of risk for the onset of a depressive condition.
Q9. What are the symptoms of depression?
A. The main symptoms are sadness, a feeling of despondency and the incapability of feeling pleasant emotions. Generally, there is also a loss of interest in habitual activities and the incapacity to undertake any sort of initiative or decision.
Depressed patients stop making decisions, everything seems problematic and unsolvable and they progressively develop a sense of failure and personal inadequacy.
Generally they feel guilty because they are no longer able to carry out their tasks and they feel they are the only one to blame for family problems. An outside observer can see how severely depressed people appear to be fatigued and their movements are slowed down, their facial expression shows sadness or indifference and the expression hardly ever changes.
Often they report difficulty concentrating and memory loss, sleep disorders, decrease in appetite, gastrointestinal disturbances, a loss of sexual desire and pleasure. The appetite is generally decreased, depressed persons eat little or not at all, and sometimes lose a noticeable amount of weight. Sleep alterations can be of various types: terminal insomnia, initial insomnia, inversion of sleep-wake patterns.
Q10. Are there different types of depression?
A. Depressions are not all the same: the following types of depression can be distinguished according to their course, symptomatology and connection with external events, which can either improve or aggravate the depression:
Major depression: this term indicates a disturbance characterized by severe depressive symptoms that last for a distinct period of time. It is helpful to point out that major depression (also called clinical depression) is rarely influenced by external events, whether they be positive or negative;
Dysthymia: patients afflicted with dysthymia manifest depressive symptoms that are substantially similar to those of the major depression but less severe, more persistent throughout time and more variable. This form of depression is often affected by external events;
Unipolar depressions: these characterize patients who have had several episodes of only depression throughout their life;
Bipolar depressions: these are found in cases where the course of the illness has been characterized by episodes of depression and episodes of mania.
Read here in details: Different Types of Depression and Their Symptoms
Q11. What are the symptoms of anxiety (accompanied by depression)?
A. Anxiety accompanies depression quite frequently. The psychological symptoms are feelings of danger or menace: the patient perceives the fear of something undefined.
This causes unmotivated worry regarding every area of the patient’s life. Generally, patients with anxiety report difficulty concentrating and a vague sense of ‘empty-headedness’ or ‘confusion’ that reduce their performance capacity and they are easily fatigued.
The somatic symptoms appear in all the body’s systems: tachycardia, palpitations, extrasystole, variations in blood pressure, chest pains, respiratory difficulty, gastrointestinal disturbances, perspiration, sensations of cold and hot, dry mouth, dizziness or veering.
Patients with anxiety almost always report sleep problems, including difficulty falling asleep or frequent wakening in the night and eating problems, with appetite decrease or increase.
Q12. Can anxiety and depression be present simultaneously?
A. It occurs often that numerous symptoms of anxiety are associated with symptoms of depression. Patients having the typical symptoms of depression, i.e. sadness, apathy, indifference, pessimism and loss of hope, can also manifest anxiety, tension, worrying, somatic anxiety symptoms and fear of having an organic illness.
In some cases it is acknowledged that patients may have developed a secondary depression subsequent to the presence of a set of anxiety symptoms. In other cases it is preferable to consider the coexistence of two types of independent disturbances. Quite often an attentive observation of the symptomology and the reconstruction of its trend throughout time give us the answer to this question.
Read also: Anxiety And Depression
Q13. How does panic attack disorder manifest?
A. Sometimes anxiety can manifest in a critical and sudden form without an obviously justifiable stimulus. These are panic attacks and they are characterized by acute terror, a sense of threat or imminent death and intense physical disturbances.
Panic attacks last a few minutes generally, but are almost always followed by agoraphobia, in other words, the fear of going out alone, or of leaving a more or less restricted "safety area". Other times anxiety might manifest intensely only in the presence of certain stimuli (objects, situations, persons, animals). These forms of anxiety are referred to as phobias.
Q14. Does depression always manifest with the same symptoms?
A. The psychological pictures of depression are extremely variable and numerous clinical varieties are distinguished depending on the prevalence of some types of symptoms over others. Along with the symptoms typical of depression, patients may also manifest agitation, anxiety, delirium, alterations of cognitive abilities, disturbances of the state of consciousness and so on.
Q15. Do depressed people feel better in the evening or the morning?
A. One of the characteristics of depression is the fluctuation in mood throughout the day. In major depression it is common, and sometimes habitual, that patients feel particularly distressed or depressed in the morning right after waking up. As the day proceeds, in the afternoon or evening, they feel a progressive improvement in their mood with an increase in energy and initiative.
In other forms of depression patients feel relatively well in the morning, and sometimes are able to carry out a few activities or work commitments. But as the day wears on they feel progressively more depressed and apathetic.
Q16. Is it true that depressed patients always have sleep disorders?
A. Sleep disorders are very frequent in all psychiatric illnesses and in particular depression. After all, sleep is a bodily function affected by various stimuli, both internal and external, that can easily alter its complex balance.
There are various ways in which sleep alterations manifest in depression. Most frequently patients report terminal insomnia: they fall asleep more or less at the same time but wake up very early in the morning and are able to sleep for only a brief interval (2-4 hours per night).
Sometimes early awakening is associated with continuous interruptions of sleep and wakening during the night (central insomnia). In more severe cases there is a manifestation of complete insomnia.
Particularly in cases of depression associated with anxiety the initial phases of sleep are altered, in other words the falling asleep phase.
Q17. During depression does body weight increase or decrease?
A. Some of the symptoms that manifest frequently in depression affect the gastrointestinal tract and appetite. These disturbances however are quite variable and manifest in different forms in each individual, though affected by the same type of depression. Sometimes there is weight loss of as much as 4-5 kilos in a few weeks. Other times, after a bulimic phase, there is an increase in body weight.
Q18. Can patients with depression have a decrease in memory?
A. Quite often patients in the course of depression notice memory disturbances and report difficulty in their work, studies or various other commitments. Patients may be unable to remember things that happened the day before or forget having said or done something they consider important.
Often they report considerable difficulty in maintaining concentration on what they are doing.
Other times depressed patients are unable to follow their train of thought; they forget what they were about to say or don't completely follow what other people are saying. This reduction of normal intellectual (cognitive) functions is entirely transitory and reversible.
Often they report considerable difficulty in maintaining concentration on what they are doing.
Other times depressed patients are unable to follow their train of thought; they forget what they were about to say or don't completely follow what other people are saying. This reduction of normal intellectual (cognitive) functions is entirely transitory and reversible.
Q19. Can sexual disturbances occur during depression?
In addition to a reduction in desire there may also be alterations of sexual functions. Men may start having precocious ejaculation or difficulty having an erection, to the point of impotency; in women frigidity is common.
Q20. Are depressed patients always apathetic and inactive or can they also be restless and agitated?
A. They are generally apathetic. They do not visit friends or acquaintances.
They are inactive and progressively reduce their social activity and outings, preferring not to go out and not drive a car.
On the other hand, some patients behave quite the opposite. They are restless, continuously busy, agitated and irritable.
A. The beginning of a depressive disturbance is variable: it can develop slowly or it can manifest from one day to the next.
In most cases the onset is slow and progressive. Quite frequently the first symptom is insomnia. Sometimes patients feel fatigued and lose interest in their daily activities or start noticing a loss of concentration.
The symptoms progressively become more complicated: the patients start feeling sadness, indifference, insomnia and the depression takes on its typical characteristics. In some cases the onset symptoms are physical problems, such as headaches, joint pain, muscle weakness.
In other cases, though seldom, the onset of the depressive episode is sudden.
When patients speak about the onset of depression, they speak about a sort of "switch that suddenly gets turned off" and from one day to the next they feel sad, apathetic, desperate. A timely diagnoses makes it possible to undertake appropriate treatment.
Read here → Most Common Treatments for Depression
A. A depressive episode has variable duration depending on the type of depression, the presence of pharmacological treatment and the phase of illness in which the episode occurs. With medication we can reduce the duration of each episode, obtain improvements after 15-20 days and remission after 2-4 months.
If an earlier treatment has not given the hoped-for results, the symptoms resist longer and it is necessary to undertake a different type of treatment. In other cases the duration is variable.
Q23. After treatment, can patients have another depressive episode?
A. The risk of a depressive episode manifesting in a person who has already had one is greater than in persons who have never had one; moreover, the larger the number of previous episodes, the greater the chance of a relapse.
This it is important for patients or their family members to turn to a specialist if previous symptoms reoccur. If the first episode has been completely cured, it is necessary to continue the medication for a few months and stop taking it gradually according to a precise plan. If there are external triggering events and ongoing stressful situations, it may be helpful to recommend psychotherapy.
Q24. Is it true that one can become chronically depressed?
A. The term "chronic" should not be interpreted in the case of depression as an ongoing incurable condition, but as a condition that is always potentially reversible with the appropriate treatments available today.
There is no such thing as an unremitting and irreversible depression; there are, however, depressions that have not been diagnosed and treated properly. In general, chronic depression refers to depressions that have lasted more than two years. [Read more about Dysthymia (Mild, Chronic Depression)]
Q25. Is it possible for women to have depression only during the menstrual cycle?
A. The various terms for this disturbance, i.e. ‘premenstrual tension’ or ‘premenstrual syndrome’, focus on the fact that it is a relatively brief disturbance that manifests during the 7–10 days before menstruation. It includes irritability, emotional instability, frequent mood swings.
Among the physical symptoms are headaches, bloating, weight increase, etc.
As regards behavior, it is often observed that there is a decrease in concentration and working efficiency, a tendency to stay in bed longer and difficulty sleeping.
As regards the cause, there can be psychological factors, such as conflicting feelings about one's femininity, sexuality or the mother figure, or cultural factors such as considering menstruation a negative phase or a phase of illness.
Among the biological factors there is a fluctuation in hormones, in particular a decrease in estrogen levels.
Q26. What's the difference between a nervous breakdown and depression?
A. “Nervous breakdown” is a colloquial term, but has no scientific foundation. In everyday language the term "nervous breakdown" is nonetheless used aspecifically to indicate any type of psychiatric disorder (and this causes confusion), though it is more often associated with depression.
Q27. How can one tell if a depression should be considered an illness or a normal state?
A. There are three criteria that can serve as a guide for patients as well as their family members:
- Reason for the depression: if the depression is not related in a comprehensible way to a cause that can explain it, it might be a condition with pathological implications.
- Duration of the depression: it is excessively long (two weeks).
- Severity of the depression: the more the depression interferes with and makes daily activities difficult, the more severe it is.
Q28. How do antidepressants work?
A. It has been observed in depressions that the symptoms are associated with a decrease in certain types of neurotransmitters (chemical messengers) such as serotonin, norepinephrine, dopamine and a variation in the sensitivity of the corresponding receptors.
It is important to bear in mind that these chemical alterations of the brain can have "biological" causes or "psychological" causes.
The principal function of antidepressants is to restore and re-establish the normal balance between neurotransmitters and receptors.
Q29. What medications are used to treat depression?
A. Today there are numerous drugs being sold, all of them considered effective in the treatment of depression.
Among these are the monoamine oxidase inhibitors (MAO) and tricyclic antidepressants (amitriptyline, chlorimipramine, etc.).
In the 1980s SSRIs (serotonin reuptake inhibitors) were introduced on the market.
More recently SNRIs (serotonin and norepinephrine reuptake inhibitors) have been introduced and in the past few years we have seen the introduction of RIMA (reversible inhibitors of the monoamine oxidase) for the treatment of depressed patients.
Q30. How effective are antidepressants?
A. All the medications available today have proven efficacy in treating depressions in 60% to 80% of cases.
If patients do not respond effectively to a certain medication, they often respond well to a different medication or to a combination of medications.
On the whole it can be said that today almost all forms of depression can be cured adequately by using the right drug at the appropriate dosage and for a sufficient amount of time.
Q31. How long does it take for an antidepressant treatment to start working?
A. One of the characteristics of antidepressants is that they start having their first effects only after 10-20 days of treatment. This is due to the complex mechanism of action of these medications.
Q32. How long does one need to take antidepressants?
A. Treatments of psychiatric disturbances are different from those of physical illnesses and require much more time for patients to improve or get well.
From the time the patients go to the psychiatrist and start taking the antidepressants it will take from two to four weeks for the symptoms to start abating. Generally in 2-4 months we can achieve total remission of the depressive episode, in other words complete disappearance of the symptoms.
It is important for the medication to be administered until the symptoms have disappeared entirely (treatment of the acute phase) and extended for at least 4-6 months after recovery (maintenance therapy).
Q33. How are the drugs administered to the depressed patients?
A. When the depression is mild, there is an awareness of one's illness and a good reason to abide by the cure.
These patients can tranquilly manage the times and ways of taking the drugs according to the prescription written by the psychiatrist.
It is different for more severe depressions where often patients are indifferent towards the chance of a pharmacological cure and tend to neglect the ways and times for administration of the antidepressants. In these cases the family members need to check to make sure the doctor's prescriptions are being implemented.
Q34. What happens if some antidepressant dosages are missed?
A. If a few tablets are missed throughout the day or the treatment is interrupted for two or three days, the therapeutic process will not stop but only be delayed.
Q35. Why is it important to avoid suddenly stopping antidepressant treatment?
A. In the short-term the sudden stopping of antidepressant treatment can lead to the manifestation of nausea, diarrhea, perspiration, headaches, chills and sleep disorders, especially if the dosage being taken is relatively high.
When, in association with the antidepressants, tranquilizers (benzodiazepines) are being taken, the picture can become more complicated with symptoms of anxiety, agitation, dizziness, tremors and insomnia.
The long-term consequences are the risk of relapse.
Q36. Can people become addicted to antidepressants?
A. Generally antidepressants do not cause physical or psychological addiction.
Q37. Do antidepressants change one's personality?
A. No, they do not modify the basic brain structure or functions which determine the characteristics of the personality but act only in cases where there is an "abnormal and ill" condition on the level of brain neurotransmitters.
Q38. Can antidepressants make you less lucid?
A. In some cases, after the administration of the first few doses there is an effect that patients fear: excessive sedation, sleepiness and a decrease in "mental lucidity".
This can occur when the medication has not been adequately chosen as a function of the type of depression and the patient’s clinical history.
These initial episodes tend to decrease progressively within the first few weeks of treatment.
Q39. Can antidepressants be taken during pregnancy or nursing?
A. As regards pregnancy, different events may occur. For example the patient might develop a depression in the first trimester of the pregnancy.
In this case it is advisable to avoid taking any type of drug to avoid the danger of a malformed fetus; moreover, the patient should be attentively monitored, possibly with psychotherapeutic support. Even in the case of depression of medium severity in the second or third trimester of pregnancy, it is advisable to avoid taking antidepressants.
It may also occur that women being treated for a previous depressive episode wish to become pregnant. In this case it is necessary to progressively stop all treatment and make sure the patient comes in for checkups regularly.
In the case of depression of any degree of severity, it is advisable for the mother to stop nursing so she can take the antidepressants without harming the child.
Q40. What foods or drinks should be avoided when taking antidepressants?
A. It is advisable in the course of taking antidepressants to avoid alcohol because it can favor symptoms such as fatigue, asthenia, apathy and therefore worsen the depressive picture.
In general it is also advisable to not drink too much coffee and or tea because these could increase one’s level of anxiety, restlessness, irritability, and aggravate insomnia.
With the exception of MAO inhibitors, antidepressants do not require particular restrictions regarding foods.
Q41. Can tranquilizers and sleeping pills be helpful in the treatment of depression?
A. Benzodiazepines are prescribed to depressed patients frequently, even when there is not a real necessity. There are however some conditions in which they can be useful as part of a specific treatment plan. Anxiety medication is frequently prescribed for depressed patients and especially family doctors consider benzodiazepines as the first drug to use in these patients.
Q42. Are lithium salts useful in depression?
A. Lithium salts are not actually antidepressants in the strict sense of the word but belong to the class of drugs defined as "mood stabilizers".
Their efficacy has been shown in particular in the treatment of mania episodes and they are extremely important for patients affected with bipolar disorder.
Q43. Can psychotherapy be helpful in treating depression?
A. Psychotherapy is certainly useful when there is reason to believe that the depression is caused by personal problems or conflicts, difficulty in relationships (family, school, work environment), an excessive reaction to stressful events or situations and, in general, difficulty accepting oneself and one's environment.
Q44. Can "tonics" be helpful in treating depression?
A. It should be clarified right away that there are no substances with an energizing effect that strengthen body organs or systems weakened by a depressive condition and those which are prescribed for "reconstituting" depressed people are always useless and sometimes harmful.
Q45. Is "sleep treatment" useful in treating depression?
A. "Sleep treatment" does not exist. Some treatments might temporarily increase the total hours of sleep, but sleep induced in this way has no therapeutic significance and represents a secondary effect of the prescribed treatment.
Q46. Should patients read the "illustrative leaflets" found in the medicine prescribed?
A. The main problem with these "illustrative leaflets" is that, according to a provision of the Ministry of Health, all of the negative effects a medication might cause, even the ones that are extremely rare and therefore improbable, must be stated.
This can lead to an unjustified fear of the danger of a medication which in actuality is useful and necessary.
Q47. How can the onset of a depression in an elderly person be recognized?
A. In the elderly, depression can manifest initially with symptoms typical of depressive disorder (sadness, loss of interest, loss of pleasure for daily activities, sleep disorders and appetite disorders) and/or with unusual signs and symptoms (physical pain without any somatic explanation, obstinate constipation, urinary disturbances, anxiety, irritability, aggressiveness, loss of control, unmotivated conviction of being damaged or unjustly hindered by others).
Q48. How does one understand if memory disturbances are related to aging of the brain or depression?
A. In cerebral aging there is an alteration in short-term memories, to a greater or lesser degree, that are lost without any possibility of recalling them in anyway. In depression, on the contrary, there is not an actual memory loss, neither short or long term, but rather a difficulty in recalling events. These disturbances diminish as the depressive symptoms improve.
Q49. Do the elderly suffer from depression more often than young people?
A. The increase in the average lifespan in all Western countries has led to a widespread increase in the diagnoses of depression in the elderly.
The risk of the elderly being afflicted by depression increases with the concomitant action of various causes: faltering physical health, loss of functioning and end of working life, solitude.
Q50. Can depression be cured in people who are very old?
A. There's no age limit for effectively curing a depression, though in the elderly it can be more difficult due to their general physical condition.
Q51. Does it take longer to cure a depression in an elderly person?
A. Yes, for two reasons:
- The dosing of anti-depressants requires a longer time to be optimally adapted to the sensitivity of each individual elderly patient;
- The brain of an elderly person reacts more slowly to chemical stimuli.
Q52. What should one do about a depressed person who "spends their day between the bed and the armchair"?
A. 1. Conserve the routine of daily life;
2. Make sure the person’s basic needs are taken care and encourage grooming to help improve their self-image, which is typically poor in depression;
3. Try to involve the depressed person in shared activities and take into account their propensity for mood swings;
4. Try to involve the depressed person in personal relationship scenarios that include affection.
Q53. What should one do when the depressed person loses or gains weight?
A. The collaboration of the family members is very important to prevent and manage variations in the weight of patients. It is necessary to pay special attention to the variations in diet compared to previous habits and urge the depressed person to participate in the normal routine of family meals.
Q54. What should one do if a depressed person believes they have a serious physical illness without any reason?
A. It is necessary to have a complete medical examination done to exclude all forms of somatic illness and refer all evaluations and decisions in this regard to the patient’s psychiatrist.
Moreover, family members should not reinforce the worries of the patients with their own anxiety but by the same token they should not systematically ignore the requests of the patient.
Q55. What should one do if the depressed person sleeps too much?
A. It is a good rule to not interfere with the adaptive and defensive rhythms of the depressed person, except in some cases in which you can use one or more of the following expedients:
- Provide the depressed person with a series of stimuli during the day that maintain his/her level of vigilance high and allow him him/her to continue their work activity even though they work less efficiently;
- Avoid and discourage the patient from taking naps in the afternoon;
- Make sure they drink a certain amount of coffee or tea.
Q56. What should one do if a depressed person does not sleep enough?
A. Since insomnia is a symptom of depression, theoretically if the patient is prescribed the proper medication, they should not have to take sleeping pills to overcome the symptom.
Q57. Is it better to urge the depressed person to continue their job or quit?
A. Depressed people tend to reduce their external stimuli more and more, so holding down a job or going back to work can contribute to making the depressive condition more bearable.
In the case of severe depression in which the effort required by work is a source of deep suffering, it is advisable for them to quit the job.
Q58. What should one do if the patient says they want to die or they want to kill themselves?
A. In a situation of medium risk (an occasional and negligible death wish), it is advisable for the patient to not be left alone at home and that the medication not be left at their complete disposal.
In high-risk situations (in which there is little or no desire to get well, deliria of guilt and ruin), the patient should be attentively watched and never left alone, and instruments that the patient might use to attempt suicide should be eliminated from the environment.
Q59. Could a depressed person be dangerous to others?
A. Depressed patients should never be considered a source of danger to the people close to them except in very rare conditions that are usually foreseeable.
Q60. What should one do if the depressed person wants to undertake an action that might have serious consequences for themselves or their family?
A. Depressed patients should be discouraged from taking actions that can in any way lead to consequences they will later regret, because their choices may be heavily influenced by the emotions typical of depression (sadness, pessimism and hopelessness).
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