In order to begin any explanation of the nature of depression, it is advisable to begin by establishing some common terms, distinctions, and popular definitions.
But most of all what must be stressed are the meanings and differences between them.
The volume of misconceptions, stereotypes and prejudices that the vast majority of people have concerning the topic of depression in the medical sense is truly astounding.
To begin, we must make a very clear distinction between Depression and Clinical/Bipolar Depression.
Colloquially, they are used indiscriminately.
Anyone who has experienced Clinical/Bipolar Depression will tell you that the two are absolutely nothing alike.
- "Depression" (used in a non medico-legal sense) as the word is commonly used in day to day jargon refers to momentary bouts of the blues or melancholy.
(and this meaning/understanding is not for any form of medico-legal related fields.)
- Every human being experiences this from time to time, it is completely normal and after a little while without need of medical intervention you will be back to normal.
- Unipolar/Bipolar Depression (using as in medico-legal sense) is not anything remotely similar to plain old "Depression."
Clinical/Bipolar Depression is a medical condition as true as diabetes (DM Type-II) or cancer (e.g. breast cancer, testicular cancer etc.).
"Normal" depression is psychological whereas Clinical/Bipolar Depression is both psychological and physiological, it is well documented that drastic alterations occur in the brain as well as other changes occur in the rest of the body.
The importance of these distinctions is paramount (most important), you cannot gain an understanding of these conditions without it.
I will urge people who are reading this and who are fortunate not to have experienced clinical/bipolar depression, to keep this distinction clear in your minds while reading the rest of this book, any related material, and most of all when interacting with those who are diagnosed.
Please pay Attention!
For the remainder of this document for the sake of simplicity when the word "depression" is used it will refer to the medical condition of Clinical or Bipolar Depression, and the term "normal depression" will refer to the everyday non diagnosed human experience.
Now that the most important distinction and definitions are out of the way lets establish some others.
There are two major types of medical depression
- Clinical Depression
- Bipolar Disorder
Clinical Depression is an outdated term but is still commonly used. Similarly Bipolar Disorder(BD) was formerly referred to as Manic Depression, but Manic Depression is still widely used to refer to it.
The correct terms to use as accepted by the medical community are:
Major Depressive Disorder(MDD) or Unipolar Depression instead of Clinical Depression, and Bipolar disorder instead of Manic Depression.
As I said before there are two major kinds of medical Depression, MDD and Bipolar Disorder.
What's the Difference?
In a nut shell Bipolar Disorder is the same as MDD except that it has two alternating phases; Depression and Mania.
The experiences are usually the same symptoms that occur with MDD, except that they alternate with Manic Symptoms.
Without going into too much detail at the moment, for our purposes now just think of Mania as the opposite of Depression or an extremely good mood.
The phrase extreme highs and lows sums it up quite nicely for our purposes. We'll go into a little bit more detail about mania later but I don't want to leave you thinking the Mania is all fun and games. Even though you do have an elevated mood there are some very negative symptoms that also come along with Manic periods which will be explained latter.
While there are some documented differences between MDD and the depressive phase of Bipolar Disorder, for our understanding they are not relevant and will not be addressed in this book. Both MDD and Bipolar depression are more similar than not, have the same basic symptoms and are usually treated in a similar fashion. Unless otherwise specified when the term depression is used it refers to both Major Depressive Disorder and the Depressive phase of Bipolar Disorder.
If you've noticed I said that MDD and BP are the two major kinds of medical depression. There is another milder but still medically relevant form of depression known as dystimia which we'll touch upon briefly later.
Perhaps then some assume that:
Statistics point out that approximately one out of every six people will have a depression (with varying degrees of seriousness) at least once in their lifetime. The magnitude of this number is all the more shocking if one confronts it with the general ignorance about the problem. Even people well-informed about other health issues will often be caught totally by surprise by a depression. I know, I was one of them. Since our early school years we get tons of information about healthy eating, on the perils of smoking and heavy drinking, on avoiding sunburn, etc., etc. But mental health, largely because of the prejudice surrounding any kind of mental illness, is to a large extent ignored. This is more of a tragedy if one realises how far-reaching are the implications for a person's life and productivity, and most importantly, how depression could be avoided altogether if only people knew how to recognize the early symptoms.
As you read through this document, please always bear in mind that whenever the term depression is used it refers specifically to the physical illness more properly described as clinical depression. One also finds the very same word depression used in the context of other mental disorders (such as manic depression ) of which this document does not cover. It is very important to keep this distinction in mind. As an example, consider the people who suffer from bouts of melancholy all through their lives. They often describe their subjective feeling as that of being depressed. However, when one takes a closer look at more objective indicators, they may not show the symptoms of a clinical depression. This document does not apply to them.
One of the enduring myths about clinical depression is that you can cure it simply by convincing a depressed person that life is good and worth living. Likewise, a depressed person will not be magically cured if all of their problems are suddenly solved. In fact, it was my experience (and that of many others) that the factors which contributed to the depression were long past and resolved. However, they had their physical toll in the brain, and that could not be suddenly undone.
Our misuse of language compounds the problem. All too often a perfectly healthy person (brain-wise, of course)will say that they feel depressed when really all they're experiencing is a passing case of the blues. It is far from my intention to dictate how people should use language, but this example illustrates my case. Curiously, one of the tell-tale symptoms of clinical depression is the inability to have strong emotions, including sadness and the blues.
Another important aspect to remember about depression is that it is not an on/off condition. There is a continuum between a perfectly healthy brain and one from a severely depressed person. I estimate that in modern society, those who could be classified as in perfect mental health are probably the minority. Moreover, just like physical fitness goes through ups and downs throughout a lifetime, the mental health of a typical individual will also fluctuate. It is only when the fluctuation dips significantly low for an extended period that the diagnosis of a depression is typically made. Elaborating further on this note, the good news is that a very large number of people who strictly speaking are not depressed and have largely satisfactory lives, could still feel better and happier if they took better care of their brains. The advice herein contained is also for them.
You may wonder why I have bothered to write such a lengthy description of depression if I advise people to seek professional help anyway. In a sense, you are asking for a rationale for this document. Well, I would not have written it if I thought it was irrelevant, dangerous, or simply superfluous- Quite the contrary. I see good reasons that justify it, as follows.
- The focus of the document is an objective description of clinical depression, explaining the physical illness which progressively takes its toll on the brain. If more people were aware of this fact, they would not be as complacent when the first symptoms appear. Moreover, they would feel less stigmatised and reluctant about seeking professional help.
- By being better informed, people would realise the importance of seeking competent help. Many General Practitioners and even Psychologists are not properly informed about depression, and they can even inadvertently give their patients plenty of bad advice. Worst of all, the situation can worsen dramatically before the patient even realises what is wrong with the advice they are given. This happens frequently, believe it or not. The only solution is for people to be better informed and able to spot whether or not their GP is competent enough to treat them.
- The enormous cost of health care in affluent societies often translates into health insurers pressuring for the cheaper solution of relying solely on antidepressants. In countries where the GP stands as the gate-keeper for specialised treatment, people may find it difficult to convince their GP to send them to a specialist. The result is treatment based largely on medication, with little or no coaching.
- Lifestyle plays a large role in the development of depression. Again, by better understanding the problem from an objective perspective, people will more easily assimilate the need to take good care of their sleep and to avoid overloading their brains.
The remainder of this instalment is structured as follows. I will begin by explaining what exactly is a depression and how the problem develops in the first place. Special attention will be given to a description of the most typical symptoms which accompany each stage of the illness. The next step is more personal: it describes the lifestyle changes I had to make to help my brain recover instead of sinking deeper into the illness.
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