The Depression Trap

The word depression is used to describe feeling a bit sad for a day or two and a medical condition that can result in death. We seem to lack the language to really express the range of negative feelings that we suffer from. Does this really matter? I think it does for a number of reasons.

Firstly it can lead to a lot of misunderstandings. We all have periods in our life when we are unhappy, perhaps due to bereavement, or a relationship break up. It is natural in such circumstances to go through a period of feeling really down. We may feel as though things will never get better, our life is over or just incredible sadness. In such circumstance we may well describe ourselves as depressed, but most of us are not actually clinically depressed. We are going through a natural, healthy period of sadness or mourning and we will recover on our own in due course. However, if we think of this as depression and call it depression then this can lead to us misunderstanding true clinical depression. This can be very painful for those who are clinically depressed.

Many people with clinical depression suffer from well meaning friends and relatives telling them to snap out of it, think positive, or try taking up a new hobby. These tactics may have worked for people who were just feeling down, but they don’t work for those who are truly depressed. If we had different words to express feeling deeply sad and being clinically depressed then we might avoid some of these misunderstandings.

As a counsellor I try not to ‘misuse’ the word depression, but then I sometimes find myself struggling to describe how I’m feeling. Sometimes when I’ve been going through difficult periods in my life I have felt tremendously sad, as though my life had no purpose and I was just waiting to die. In the moment I can see no purpose, no reason to go on and it feels as though the sun will never shine again. However, I don’t feel that I can say I feel depressed because I know I’m not clinically depressed. These bouts don’t last long enough for me to qualify, plus I usually only have 3 or 4 rather than 5 of the required symptoms (see below for DSM4 definition of depression). So I am left feeling that I must in some way minimise the importance of my feelings, as I can’t use the only word I know that ‘feels’ right.

So do we need to invent a new vocabulary? There is already enough confusion about clinical depression, non clinical depression, major depression, atypical depression, dysthymia, weepy depression, anxious depression etc. This ever increasing list of types of depression seems to me to have more to do with the human obsession with categorising things than with the condition itself. What I’m thinking of here is new word for the type of ‘depression’ that doesn’t need clinical intervention. The sort that we all go through, that’s a natural part of being human. So that we can express how bad we feel without stepping on the toes of those who are clinically depressed. What do you think? Any suggestions?

The official definition of clinical depression is given in the Diagnostic and Statistics Manual-IV (DS4), as:

‘Five or more of the following symptoms present during a two week period (at least one of the symptoms is either depressed mood or loss of interest or pleasure):

• depressed mood
• loss of interest or pleasure
• poor or increased appetite/weight loss or gain
• insomnia or hypersomnia
• psychomotor agitation or retardation
• loss of energy/fatigue
• feelings of worthlessness, guilt or self reproach
• poor concentration/indecisiveness
• thoughts of death or suicide attempts’

Could the number of receptors in your brain determine whether or not you are depressed and how depressed you are? A recent study by the University of Michigan Depression Center suggest that there may indeed be a link.

They took brain scans of patients diagnosed with major depression and compared them to scans of control subjects who were not depressed. One group was tested for 5HT1 receptors which respond to serotonin and a second group were tested for mu-opioid receptors which respond to endorphins (’feel good’ hormones involved in stress responses, pain control and reinforcing rewarding experiences). The test group selected had not previously taken antidepressants.

In both cases they found:

a) Those with depression had fewer receptors.

b) The fewer receptors the more serious the depression.

c) The number of receptors was a good indicator of whether or not antidepressant treatment would be effective.

This suggests that how we respond to life events may be at least in part determined by the receptors in our brain. Whether or not we become depressed, how severe and long lasting our depression is and whether or not we respond to antidepressants may be linked to the number of receptors we have.

So what determines the number of receptors found in the brain? Is it genetic, are we born with it? Is it a result of early childhood experiences? In her book ‘Why Love Matters’ Sue Gerhardt explains how early experiences can have a significant impact on how a child’s brain develops including how many receptors of various types develop.

Equally importantly, can we change the number of receptors in our brain, or are we stuck with what we’ve got? If the number of receptors can change then this might be a possible cure. The scientist don’t specifically cover this in their press release. However, the reason they give for selecting test subjects who had not taken antidepressants was that the antidepressants might have led to more receptors being produced. So this does seem to suggest that the creation and destruction of receptors is possible.

If receptors can be created and destroyed then this also means that the low numbers of receptors may be a symptom of depression rather than a cause. Although once the number of receptors has decreased it seems likely that this would work to re-enforce the depression and perhaps make it worse.

As is so often the case the study raises many new questions. The Michigan team plan to carry out further research and hope that their work will help us to better understand depression. They aim to recruit depressed volunteers who are not taking medication for more brain-imaging studies. You can find out more at www.umengage.org.

What do you think? Post a comment to have your say.

Depression may be linked to low levels of selenium according to the latest study on vitamin and mineral deficiencies. The study was carried out in a nursing home, where elderly residents were given micronutrient supplements for 8 weeks. Significant decreases in reported depression and increases in serum selenium levels were noted.

This is just the latest study to link some sort of deficiency to depression. Other supplements that have been linked to improvements in depression include omega 3, most of the B Vitamins, Vitamin C, Vitamin D, magnesium, iron, zinc and potassium. (Although interestingly this latest study did not show any improvement with Vitamin C or folic acid.) It is possible that being deficient in a whole range of vitamins and minerals could be a contributory factor in depression.

It certainly seems sensible to make sure that you eat a healthy balanced diet and take a multivitamin and mineral supplement. If the deficiency theories are correct then this could help you overcome your depression. In any case it will help to ensure you are in good general physical health and that in turn may help you to feel a little better.

However, many people who feel depressed find healthy eating difficult. They may loose their appetite, or ‘comfort eat’. If you are finding it difficult to eat healthily then it may help to speak to a nutritionist for advice on what to eat, and/or a counsellor for help with the emotional side of eating. A long list of dietary changes can be very intimidating and it’s not surprising that many people give up before they start. Try taking small steps, perhaps one a week or one a month. Don’t worry if you slip up, just keep going.

You might like to try some of the following small steps to get you started.

1. Start by taking a basic multivitamin and mineral supplement. Make sure that it contains at least the RDA (Recommended Daily Amount) of all the vitamins and minerals listed above.
2. Add fresh fruit and vegetables to your diet. Eat as much of these as you can.
3. Enlist the help of friends and family to support you in making the changes. Perhaps eating with someone else if you have problems eating and usually eat alone or asking people not to eat ‘forbidden’ foods in front of you. Maybe the whole family could start to improve their diet.
4. You could try keeping a food diary to track your progress. This could include how you feel about the changes you make as well as what you eat and drink.
5. Try to cut down on coffee or switch to decaffeinated – caffeine promotes anxiety and disrupts sleep patterns.
6. Try to cut down on sugary foods. Sugar gives you an artificial ‘high’ making you feel better, but this is then followed by an artificial ‘low’. You can become stuck in this cycle needing more and more sugar just to feel ok.
7. Try to cut out alcohol or at least cut down. It is a depressant and destroys some vitamins in the body.

If you have found ways to help support yourself eating a more healthy diet then please share them.

Vitamin D deficiency may be linked to depression according to a recent study. The study looked at 1282 people aged 65-95 and showed that those with low blood levels of Vitamin D and high blood levels of a hormone called parathyroid were more likely to be depressed. Vitamin D levels were 14% lower for the group suffering from mild or severe depression compared to the non depressed group.

Levels of parathyroid increase as a result of Vitamin D deficiency. In this study levels were found to be 5% higher in those with mild depression and 33 % higher for those with severe depression (compared to the non depressed group).

It is not possible to tell from this study whether the deficiency actually causes the depression. It could be that Vitamin D deficiency is a side effect of depression. However, it is not unreasonable to suggest that a lack of Vitamin D could have an impact on mood as it plays a key role in a number of hormonal and neurological processes.

Further study is needed, but it could be that supplements of Vitamin D and exposure to sunlight could be helpful. What do you think?

Source: Archives of General Psychiatry