What is depression?

When most people talk about depression, they are referring to what professionals call "mood disorders" or "depressive disorders". These include many different types of depression, including for example major depressive disorder (also known as major depression), persistent depressive disorder (often referred to as dysthymia or as chronic major depression), seasonal affective disorder, post-partum depression (after giving birth), or premenstrual dysphoric disorder.  Other conditions, such as adjustment disorder (also referred to as a "stress-response syndrome"), can be associated with depressive symptoms. Major depressive disorder is without doubt the most prevalent of these forms of depression.

What is major depressive disorder?

Major depressive disorder, or major depression, is a psychophysiological disorder that is associated with a number of important changes in feelings, in thinking and in behavior that occur over a period of at least two weeks. The condition affects how people think, feel and behave and is associated with intense feelings of sadness and loss of interest in things that the person normally enjoys. Other symptoms may include impaired functioning at work, with friends and family, or at school; irritability; feelings of sadness or of emptiness; loss of interest; significant weight change or change in appetite; fatigue or low energy; feelings of guilt or worthlessness; unexplained physical pains in joints, or headaches or stomach pains; difficulty concentrating and focusing; or thoughts of death or suicide.

What is not depression?

Depression is not just feeling blue a day or two, and it certainly is NOT a character flaw or a sign of weakness or of laziness. Anyone can develop a mood disorder, including major depression; it has ABSOLUTELY nothing to do with intelligence or with one's level of education. 

What causes depression?

There is no one explanation of depression, as it may be caused by biological, environmental and psychological factors, either acting alone or interacting with each other. Unfortunately, many people, including many so-called experts, have overly simplistic explanations for depression. Some of these might be that depression is caused by distorted thinking or a chemical imbalance. There is to date no evidence that any one of these actually causes depression. Indeed, it is not unusual for people, including health professionals, to confuse cause and process. For example, a chemical imbalance might be found in individuals who are depressed, as many researchers have found. This is not however evidence that this imbalance is the original cause of the depression; indeed, it may be the process through which depression operates, or the chemical process that modulates how we respond to a stressor, or even the consequence of how we deal with a situation that is stressful or difficult. Taking an antidepressant does have an effect on our brain; but this also true of many experiences we can have in a day. When our first child is born, or when we experience our first significant break-up, our brain changes. Symptoms of depression can go away because we take an antidepressant, or because we experience a significant, positive event, or because we change the way we live our lives. This is not evidence that the depression was caused by a chemical imbalance, just like the success of aspirin in getting rid of a headache is not evidence that a lack of aspirin caused the headache. But the brain, and its chemistry, can never be removed from the equation. Many professionals, still today, tend to oppose mind and body, and approach these as if they were independent systems. But they are not.  When we are disappointed because we fail at a task, or feel hurt because someone has rejected us, the information is processed in our brain, not in our foot. Everything we think, believe, and feel, at any moment of the day, happens in the brain.  

Biological Causes

Changes in brain functioning are associated with depression. Neurotransmitters are substances that are present naturally in every brain. Serotonin and norepinephrine are examples of neurotransmitters that appear to be implicated in the symptoms of depression. Most pharmaceutical treatments influence one or both of these neurotransmitters.

Best practices normally involve getting blood tests done to rule out some of the possible physical causes for the depression (for example, thyroid problems). Oftentimes, a psychologist or psychotherapist will initiate treatment before you get the results of these tests. That is perfectly fine: the likelihood of thyroid problems in routine practice tends to be somewhat low, and it is always best to begin treatment, including psychological treatment, as soon as possible. Your mental health professional should however ask you to get blood tests done - a formal diagnosis cannot be given before some possible physical causes for the change in mood are ruled out.

Environmental Causes

Depression can be triggered by events that are stressful. the loss of a job or a stress work environment; a divorce or serious relationship conflict; chronic pain or serious illness; the death or illness of a loved one; isolation from friends or family.

Psychological Causes

Depression can be caused by the way we understand and react. Each of us responds to life differently. How we think and respond to situations can be related to or even affect whether or not we become depressed. Our childhood has a strong influence on us as adults. An overly strict, abusive, hopeless, or negative upbringing can shape how we view the world and make it easier to become depressed.

Stifling emotional reactions or alternatively over-reacting emotionally can influence the development of depression. Sometimes depression itself is the cause of more depression as depressed people stop doing the very things that might help them to get better.

Depression can be treated

Major depression can be labeled as "light", "moderate" or "severe", based on the intensity of the symptoms. For milder forms of depression, medication is generally not recommended. Psychotherapy is not necessarily needed for milder forms of depression either. Lighter forms of depression can be successfully treated with behavioral activation, coached bibliotherapy, or coached self-help, often using a stepped-care approach. Self-help and bibliotherapy alone do not usually work; it is important to have someone coach you through the process and motivate you with specific forms of intervention (for example, Motivational Interviewing) in order to get you, then keep you on the right track. The advantage of these lower-intensity therapies is that they require less time, and are less expensive than psychotherapy. If these fail, or if you have a more severe form of depression, then you should consider psychotherapy and/or medication, alone or in combination. Studies have shown that both psychotherapy and antidepressant medication can be effective in treating more severe forms of depression. Most of this research indicates that the effects of both types of treatment are generally equivalent, although the effects of psychotherapy appear to be longer-lasting than those of medication. For the most severe forms of depression, a combined treatment -medication and psychotherapy- should be given serious consideration.

Depression should be treated

Do not wait for depression to go away on its own. In the vast majority of cases, individuals recover from depression much faster if treated than if not treated. Keep in mind that approximately 50% of individuals who have had a single major depressive episode may have another. Close to 70% of those who have had two episodes may have a third, and 90% who have had three may have a fourth. Depression should always be taken seriously, and treated quickly and effectively. The earlier a treatment begins, the more effective it is.  

Always make sure you are working with the right professional. There are many professionals who can help in treating your depression. But there are also professionals who are not quite up to date with the research. Worse, there are charlatans. Always ask your family doctor why he recommends one treatment over another and ask him if there is research supporting his recommendation. Unfortunately, not all health professionals, including family doctors, are up to date on the research; more disturbing is that studies have shown that health professionals do not sufficiently follow best-practice guidelines when prescribing or delivering a treatment. On this website, you will information on what you should ask your mental health professional if you are considering psychotherapy. It is always worth spending the time to meet different professionals and to find the one that is right for you.

Don't forget: this is about you. You have the right to ask questions.

Information for friends & family

If you think that a good friend or family member is suffering from depression, you may feel helpless. Although you may not be a health care professional, there are things you can do.

10 Ways to Help

1. Recognize the signs. Information is power. Knowing what you are dealing with or helping your depressed friend or relative to know can make a difference.

2Talk about it. Someone with depression may be unable or unwilling to broach the subject. Just saying the word or opening the conversation may be helpful. Be reassured that this is not an easy conversation, so don’t feel bad because if you don’t want to do it.

3. Choose your time. Not all moments for talking are equal. Choosing a place or time that is better for your loved one. Places that they love or times when they are less overwhelmed are probably best.

4. Offer to be there. Just knowing that you are there and that you care can sometimes allow your depressed relative or friend to reach out. Offer to have coffee or call them each night.

5. Help to build a network of support. You might not be able to do this alone. Find a good professional to help, like a psychologist or your family doctor.

6. Offer help (in getting help). Making an appointment, accompanying your loved one to their first appointment, or babysitting for your friend’s children can make the difference between them getting help or not getting help.

7. Talk openly about suicide. Many people who are depressed have thoughts of suicide. Ask about this directly and be firm about accompanying someone who is actively considering suicide to the emergency room of a hospital.

8. Take care of yourself. Remember that a helper who burns out is no help at all. Make sure that you eat well, sleep well, exercise, see your own friends, and do the things that keep you well while you are trying to help.

9. Learn about treatment options. There are a number of treatments for people suffering those suffering from depression. Asking questions to a mental health professional is a great place to start.

10. Keep at it. Remember that different things will help different people. If your first initiative fails, try other things on this list.

Different groups also offer help and support to individuals suffering from depression or to their family members. Some organizations such as NIHM offer information on depression, its symptoms, and treatment options. You may also wish to visit the websites of the Canadian Mental Health Commission, or of specialized programs such as Beyond Blue. Medipsy Psychological Services also has brochures on different mental problems, including depression.

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The information provided here is for informational purposes only. Always consult with a mental health professional for advice and recommendations. All images on this website are used courtesy of Stuart Miles at FreeDigitalPhotos.net.

More on: Psychologist Montreal;  Neuropsychologist Montreal; Child psychologist Montreal; Sex therapist Montreal; Psychological test, diagnosis, assessments; Anxiety; ADHD (Attention Deficit Disorder); Phobia; FearMedipsy Psychological Services is located at 4610 Ste Catherine Ouest, Westmount, Quebec / 514-419-3005 / info@medipsy.ca; For services in the Vancouver area, visit the website of APEX Psychological Services.