Depression, as recognized by experts in the field of mental health, has caused more human suffering than any other single sickness that has afflicted humanity (Beck & Alford, 2009). According to the World Health Organisation (WHO) (2017), depression is the second most vexatious disease in the world, impacting more than 300 million people. Despite the ubiquitous nature of the disorder, there are huge gaps in depression literacy, even among those who have experienced the condition (Mamun, et al. 2020). “I got detention for not doing my homework, ugh, I’m so depressed!” “I hate when the store runs out of my favorite ice cream, it gives me depression!” “Why are you so silent today? Are you depressed?” These are phrases that most of us have either come across or even enunciated ourselves.
What is Depression?
Depression might be just a term to some, however, it’s a reality for others. Therefore, in anticipation of the distinction between experiencing ordinary human emotions and having a clinically diagnosed disorder becoming too blurry, comprehending the rudimentary concepts of depression becomes essential.
Depression, according to the Diagnostic and Statistical Manual of Mental disorders- 5 (DSM-5), is a widespread and severe mood disorder that marks the far end of the sadness continuum. Intense and persistent melancholy, disinterest in most activities, changes in appetite, sleep disturbances, fatigue, psychomotor retardation, lack of concentration, negative feelings about oneself, along with frequent thoughts of self-harm or suicide constitutes depressive symptomatology. To be considered a major depressive episode, a person must experience 5 or more of these symptoms for 2 weeks or more, whereas a minor depressive episode is defined as having 2-4 of these symptoms for 2 weeks or more (Kearney & Trull, 2011).
Depression also comes in various forms like Major Depressive Disorder (MDD), Dysthymia, Perinatal/Postpartum Depression (PPD), Seasonal Affective Disorder (SAD), etc. (Wright, 2019). However, due to concerns of brevity, this essay will not be focusing on the specific symptoms and triggers of each of these forms of depression.
An Anecdote of Depression: Karen Gormandy’s Story
Over the years, people of all ages, from young children to older adults, have been documented to be susceptible to depression (Wagner, et. al., 2020). However, the symptoms of depression are not the same for everyone; in fact, they can differ significantly from one individual to the next (Wagner, et.al., 2020). Karen Gormandy’s story is a personal narrative of depressive episodes that played out through different phases in her life.
Karen, who was renowned as the "Queen of Play" as a child, began to withdraw inwards when she experienced her first depressive episode when she was twelve. Her family had just moved to New York from Trinidad and her mother had left without leaving any details of her return. Karen was suffering from crippling depressive symptoms by the time she was fifteen, despite the fact that there were no warning signs or clues. It began with feeling numb and inattentive at school and soon she couldn’t get herself out of bed. Karen had spent virtually her whole sophomore year at home before she realised it. At seventeen, her mother returned. “I don’t remember how I came to get up and out and back to school”, she recalls.
Karen’s fall into her second depressive episode was slow but steady. Her husband was working in a different state and her adolescent son was drifting away from her. Karen, who was expectantly enrolled as an architecture student in a college at the time, saw her identity as a wife and mother dwindling. Within a short span of time, her absorption with academics started to decline and she felt flustered, irritable, and completely dejected. “I started to cry. I cried a lot. I cried in front of the university bursar when he asked me why I hadn’t paid the rent”, Karen says as she recollects her memories of being unsure about her marriage and motherhood (Kearney & Trull, 2011).
Karen was recommended to a university therapist, and since then she has been in talk therapy along with taking appropriate medication occasionally. Although her sadness feels omnipresent to her, she views therapy as a secure space where she can express her raw emotions and work through internal conflicts. According to Karen Gormandy, “the inclination not to give up and to shut down is like fighting a powerful force of nature that is as strong and as unyielding as gravity” (Kearney & Trull, 2011).
Etiology of Depression
When we turn our concentration towards the factors that give rise to this debilitating disorder, it not only serves the purpose of increasing depression literacy among people but also helps in identifying the plausible causes and ways of preventing critical symptoms such as self-harm and suicidal ideation. The environment that one grows up in, including their culture and family, along with psychological factors such as response to life hassles, substance abuse, cognitions, personality coefficients, and vulnerabilities formulate a significant part of one’s predisposition to depression. Besides these risk factors, let’s dive into some widely observed biological characteristics that might lead to depression.
Genetics and Depression
Although no single gene or collection of genes appears to be linked to mood disorders, certain people appear to be genetically predisposed to them (Kearney & Trull, 2011). According to a scientific study, the mother's depression and anxiety during pregnancy can be inherited, and persons with depressed first-degree relatives are 1.5 to 3 times more likely to acquire depression (Bembnowska & Jośko-Ochojska, 2015).
How Depression Works; the Brain, Neurochemicals & Hormones
The biochemical roots of depressive symptomatology are interconnected to problems with brain neurotransmission, which includes neurotransmitters like serotonin, norepinephrine, dopamine, etc., and these neurotransmitters, particularly serotonin, are found in decreased concentrations in those who suffer from depression (Bembnowska & Jośko-Ochojska, 2015).
The University of Pisa conducted a series of studies which discovered that by boosting the expression of "tryptophan kynurenine," kynurenine also has a significant impact on the central nervous system and hence determines serotonin inadequacy (Bembnowska & Jośko-Ochojska, 2015). The kynurenine pathway of tryptophan metabolism produces a number of active metabolites. To create kynurenine, the amino alkanoic acid is first digested. During this reaction, two enzymes are involved: 2,3 tryptophan TDO, which is triggered by stress hormones, and indoleamine 2,3 dioxygenase, which is activated by pro-inflammatory cytokines. At the hormonal level, environmental stimuli activate the TDO circuit, and the increased appearance of genes that produce cytokines may characterise a hereditary predisposition to depression (Marazziti, et al. 2013, as cited in Bembnowska & Jośko-Ochojska, 2015).
Parts of the brain like the amygdala, hippocampus, caudate nucleus, anterior and cingulate cortex, are all affected by mood disorders, particularly depression. Besides, it also leads to decreased activity in the prefrontal and other cortical areas (leading to a reduction in serotonin levels) and may also cause damage to white matter, basal ganglia, and the pons (Kearney & Trull, 2011). These are areas that are concerned with regulating attention, emotions, and motor activity. These changes in brain activity can be caused by certain hormonal alterations such as increased cortisol levels, onerous circumstances, or even old age.
Circadian rhythms, or one's internal sleep-wake clock, are disrupted in 45 to 83 percent of patients with depression (Thase, 2006, as cited in Kearney & Trull, 2011). Depression causes people to enter rapid-eye-movement (REM) sleep faster and sleep less deeply than usual (Riemann, 2007, as cited in Kearney & Trull, 2011). Due to the absence of accessible sunshine to regulate a person's internal clock, a disrupted circadian rhythm might also cause depression during the winter months (Avery et al., 2001, as cited in Kearney & Trull, 2011).
Depression & Nootropics
Mental health specialists propose and administer a variety of treatments based on each individual's specific diagnosis of depression, including psychotherapy, electroconvulsive therapy (ECT), yoga, meditation, and medication. While medication such as antidepressants address the mood symptoms and manipulate brain chemicals, the brain’s cognitive functioning is targeted by nootropics (Wright, 2019). There is an indubitable link between mood disorders like depression and brain health. Nootropics are cognitive enhancers that improve motivation and concentration, boost one’s artistry, and ameliorate sleep (Zana, 2021). Nootropics aid in the improvement of brain blood circulation and in the regulation of chemical activity, the enhancement of brain energy, and the reduction of toxin resistance (Zana, 2021) Nootropics can help with stress and depression as they not only boost your brain's stress tolerance, but they also aid in brain regeneration and the removal of stress-related pollutants (Zana, 2021). Let’s look at some of the most commonly prescribed nootropics for depression.
1. Citicoline facilitates the modulation of acetylcholine, dopamine, and glutamate which has been demonstrated to help patients with their memory. It also helps to maintain the integrity of neuronal membranes (Talih & Ajaltouni, 2015). Citicoline is one of the greatest nootropics for depression, according to Muza (2021).
2. L-theanine induces relaxation by inhibiting excitatory neurotransmitters including dopamine and serotonin and regulating brain alpha wave activity (Wright, 2019). Improved mood, inventiveness, and relaxed focus have all been linked to increased alpha waves (Muza, 2021).
3. According to a study, Rhodiola is very effective in people experiencing mild to moderate depression, and its benefits are similar to those of the antidepressant drug Zoloft (Muza, 2021). It operates within the brain by modifying neurotransmitters and buffering cortisol, the stress hormone (Wright, 2019).
There are also other infamous nootropics that are used to maintain mental execution and balancing moods, such as Lion Mane Mushroom, Vitamin B6, B9 and B12, Bacopa Monnieri, etc. Although nootropics have been found to be advantageous for some patients, it comes with certain after-effects that cannot be neglected. Nootropics, depending on who it is prescribed to, can cause gastrointestinal discomfort, headaches, quivering, weakness, and vertigo, and therefore, it’s crucial to not self-diagnose or get a hold of these nootropics without a proper prescription from a verified doctor. Online merchants that seem as pharmacy websites frequently feature photographs of physicians praising the items and marketing nootropic pharmaceutical products, making nootropics widely available on the internet (Talih & Ajaltouni, 2015). However, it is important to beware and abstain from obtaining nootropics from unregulated sources.
Despite assimilating all this information about how depression manifests itself as a disorder, it could be challenging to accurately sense what it feels like to be on a journey of battling depression. “The point is, I don’t understand how people live. It’s amazing to me that people wake up and say, "Yeah! Another day, let’s do it!’ How do they do it? I don’t know”, exclaims Bojack Horseman, a fictional character representing the embodiment of different symptoms of depression (Bulkley, et. al., 2014-2020). Although mental health is an intricate concept to grasp, educating oneself about prevalent mental illnesses, like depression, will never be a futile exercise. As mentioned before, acquiring knowledge about the manifold symptoms, roots, and treatment strategies along with sensitising oneself to the strenuous experiences of others will not only facilitate awareness about depression among lay-persons but also aid in people looking out for pivotal signs of the disorder and eradicating the stigma around depression. These small efforts in the right direction could ultimately save several lives in the future.
Unwired India is a neurotech-startup that aims at integrating state-of-the-art research and developments in STEM, for catalyzing the transition of Neuroscience to Neurotechnology. We develop avant-garde non-invasive neurostimulation products used to solve some of the world’s most critical global issues and challenges. Our mission is to take cutting-edge brain research directly into the lives and homes of people, thereby fostering a unique culture of sustainable neuroscience and scientific literacy in India.
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A friendly reminder: We've done our research, but you should too! Check our sources against your own and always exercise sound judgment.
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About The Author
Content Writer for The Hope Project
Anagha Srinivasan is an undergraduate student from India, who is an avid learner and holds a fervent interest in the field of Psychology. Over the last few years, she has developed a passion for psychological research and content writing. As a young woman from India, she holds strong opinions about several social issues such as inequality, discrimination, prejudice, and mental health, and aims to incite dialogue and discussion through her work.