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What is Depression?

  • Writer: Publicity PSYSOC
    Publicity PSYSOC
  • Oct 30, 2023
  • 8 min read

Written by: Chloe and Yi Jin


Depression is a common mental disorder, affecting over 280 million people globally (Koskie & Raypole, 2022). Despite it being widely common, it is commonly misconceived that depression stems from traumatic events in our lives. Researchers are unable to attribute depression to a sole cause as it can stem from a combination of different factors. Furthermore, not everyone who experiences a traumatic event will develop depression. For a common disorder, not many people actually know and understand depression. Therefore, this essay aims to provide a better understanding of the condition; from its symptoms to the possible causes, and treatment.


According to the DSM-5, depressive disorders are defined by mood episodes. There are different types of mood episodes such as major depressive episodes and manic episodes, but we will only be focusing on major depressive episodes. The diagnostic criteria for a major depressive episode require meeting at least 5 symptoms (out of the list of symptoms listed in DSM-5), with 1 being either a depressed mood or anhedonia. These symptoms should last for 2 weeks and cause the individual significant distress and an inability to function normally. Symptoms of depression include a depressed mood or anhedonia (inability to feel pleasure), sleep disturbances, feelings of worthlessness or guilt, recurrent thoughts of suicide, and more. 


The symptoms have a huge impact on one’s quality of life and can cause immense distress to the individual. For example, depression can lead to a lack of personal hygiene and a disorganised living environment. Depression causes a lack of motivation, making it hard for individuals to carry out their daily routines and maintain personal hygiene. They find it challenging to tidy up after themselves due to the symptoms of fatigue and feelings of worthlessness (Pattermore & Pineda, 2022). This leads to a pile-up, making the task of cleaning up increasingly difficult as days pass. It causes a negative effect on one’s quality of life and general well-being, compromising their social and personal life.


A common misconception of depression is that the individual is simply feeling sad for a long period. This is not entirely accurate as one can be diagnosed with depression without a persistent feeling of sadness. As mentioned above, depression can only be diagnosed if the individual has a depressed mood or anhedonia. Anhedonia refers to a lack of pleasure in activities that the individual previously enjoyed. It could be referred to in a social or physical sense. Social anhedonia refers to a lack of interest in social activities, such as interacting with others and attending social functions. Physical anhedonia is a lack of enjoyment in physical situations, such as eating and sex (Purdie, 2016). A withdrawal from social activities and activities that one usually enjoys is enough for one to be diagnosed with depression. According to our body’s reward system, when the individual does not feel pleasure in the activity, they have less motivation to repeat the action. This causes them to withdraw and decrease the frequency of the action. Therefore, when one suffers from anhedonia, they usually withdraw socially and stop participating in their hobbies.


Since an individual can be diagnosed with depression without having a depressed mood, this shows that depression manifests in different ways and symptoms. Depression is actually a broad category with multiple types of depressive disorder falling under this umbrella. The main types of depression are major depressive disorder and persistent depressive disorder. Other types include recurrent brief depression, seasonal-patterned depression, and premenstrual dysphoric disorder.


Although major depressive disorder (MDD) and persistent depressive episode (PDD) are different, many of the symptoms overlap. Both include symptoms of depressed mood, appetite and sleep changes, and fatigue. So what makes them so different and how can we tell the difference? The main difference between MDD and PDD lies in the duration of the depressive episodes and the number of symptoms. MDD requires the depressive episode to last for 2 weeks while PDD has a period of at least 2 years. The individual would need to be in a depressed mood for most of the time for 2 years before it can be diagnosed as PDD. MDD also requires more symptoms to be present in that short period while PDD only requires a minimum of 2 symptoms.


The differences do not mean that both depressive disorders occur independently of each other. In fact, many people with PDD also suffer from MDD, leading to ‘double depression’ (Melrose, 2017). Researchers have discovered that most who suffer from PDD develop MDD at least once in their lives (Melrose, 2017). In both disorders, the individual suffers from a depressed mood and feelings of hopelessness and fatigue. They do not believe that there is a way out from these feelings, therefore feeling hopeless and a lack of motivation. 


The fact that the depressive disorders are co-morbid with each other provides support that depression is long-lasting. One may have gotten through an MDD episode but still possess long-lasting symptoms of depression that are insufficient for the diagnosis of MDD, so they are diagnosed with PDD. They may be in remission or partial remission before relapsing due to the emergence of another depressive episode. 50% of those who previously suffered from MDD will relapse within 2 years. With each relapse, the time duration between each episode decreases. With the statistics of at least 25% of MDD cases becoming chronic and remission durations shortening, it shows that individuals may never truly recover from depression. Nevertheless, with medication and therapy, patients can learn how to deal with their stressors and triggers. in the long run, they are able to pick up solutions to cope with their depression in healthy ways. With the prevalence of long lasting depression, more needs to be done to raise awareness and improve the public’s understanding.


When it comes to the causes of depression, it is usually due to a combination of personal characteristics, life events and changes in the brain (Beyond Blue, n.d.). There are a few factors that are found to be linked to the development of depression. These factors include genetics, personality, medical illness, life events and alterations in the brain. The factors contributing to the development are categorised mainly into two groups, genetics and the environment. 


Firstly, genetics refers to how features and genes are passed down from one generation to the next (AMNH, n.d.). When put into the context of depression, genetics play a role in determining one’s risk of experiencing and developing depression. Research has shown that an individual with a family history of depression has a higher chance of experiencing depression at some point in their lives (Shadrina et al., 2018). Breen et al. (2011) identified a specific gene that appears to be prominent in several family members who suffer from depression. Genetics also decide our personality and biological sex, which also indirectly contributes to the risk of depression. Individuals with personality traits such as neuroticism and introversion are found to have a higher chance of experiencing negative thoughts which can increase one’s risk of having depression (Klein et al., 2011). Research has also found that major depressive disorder is significantly more prevalent in females as compared to males, specifically women being twice as likely to develop MDD (Salk et al., 2017). Therefore, this shows that genetics play a major role in the development of depression.


Other than genetics, environmental factors are also related to the development of depression. The environmental factors include traumatic events, parental upbringing, and poor physical environment. They change our brain structure and function, as well as affect our mental health (Lindberg, 2021). For example, when someone goes through a traumatic event such as being bullied, it affects the individual’s self-esteem, causing emotional trauma and learned helplessness (Hernandez-Puga, n.d.). These detrimental effects of bullying will negatively impact the individual’s mental health and possibly lead to depression. Research conducted on children also notes that children raised in unfavourable environments typically have delayed brain development, increasing their risk of memory impairments, learning challenges, and behavioural issues which can indirectly contribute to depressive behaviours (Lindberg, 2021).


Other than acting as individual factors that influences the risk of depression, there can be an interplay between genetics and environment as influence on the risk of depression. This is identified in epigenetic studies of depression. Epigenetics refers to the modification of gene expressions, without altering gene sequence, that are caused by the environment (Penner-Goeke & Binder, 2019). With the modification of gene expression, there is changes in the production of enzymes and growth factors such as histone deacetylase, histone methyltransferases and brain-derived neurotrophic factor (Penner-Goeke & Binder, 2019). These biological changes in one’s body can result in changes to one’s risk of depression. 


In addressing depression, various solutions have emerged, with cognitive behavioural therapy (CBT) and medication standing out as prominent approaches. Cognitive Behavioral Therapy is a psychotherapeutic approach that aims to modify negative thought patterns and behaviours contributing to depression (NHS, 2021). Through sessions with a trained therapist, individuals learn to identify their distorted thinking, challenge irrational beliefs, and develop healthier coping mechanisms. By targeting the root causes of depression, CBT equips individuals with the skills to manage the struggles they face and prevent a relapse. It focuses on the cognitive, affective, and behavioural processes while emphasizing self-monitoring. Self-monitoring is the capacity to observe, recognize, and evaluate one's own cognitive, behavioural, and emotional responses (Dowden et al., 2014).


Medication, particularly antidepressants, is another crucial tool in the treatment of depression. These medications work by regulating neurotransmitters in the brain, such as serotonin and norepinephrine, which play a pivotal role in mood regulation (Cleveland Clinic, 2023). For individuals suffering from severe or persistent depression, medication can provide the initial boost needed to engage effectively in therapeutic interventions like CBT. However, medication alone might not address the underlying issues, making it most effective when used in conjunction with other treatments (Blom et al., 2007). Medication only serves to suppress the symptoms, but it does not stop or end a depressive episode. When medication is stopped, the individual might suffer from a relapse.


In conclusion, depression is a common and long-lasting disorder which can affect individuals for their whole life. Although genetics play an important role in the development of depression, it should be noted that there is an interplay between genetics and the environment. This means that not all individuals with the gene for depression will develop depression. As mentioned above, the environment also plays an equal part in the development. A nurturing upbringing, where the social, emotional, physical and mental needs of the child is attended to, and social activities are crucial in the brain development of children, decreasing the risks of depressive behaviours and symptoms. Despite depression being a long-lasting disorder, individuals can learn to keep it at bay with CBT and medications. CBT targets the root causes of depression while medication helps to keep the symptoms at bay. Therefore, individuals with depression are highly recommended to take part in CBT and if necessary, take medication along with it.



References

AMNH. (n.d.). What is Genetics? | AMNH. American Museum of Natural History. https://www.amnh.org/explore/ology/genetics/what-is-genetics



Blom, M. B. J., Jonker, K., Dusseldorp, E., Spinhoven, P., Hoencamp, E., Haffmans, J., & van Dyck, R. (2007). Combination Treatment for Acute Depression Is Superior Only when Psychotherapy Is Added to Medication. Psychotherapy and Psychosomatics, 76(5), 289–297. https://doi.org/10.1159/000104705


Breen, G., Webb, B. T., Butler, A. W., van den Oord, E. J. C. G., Tozzi, F., Craddock, N., Gill, M., Korszun, A., Maier, W., Middleton, L., Mors, O., Owen, M. J., Cohen-Woods, S., Perry, J., Galwey, N. W., Upmanyu, R., Craig, I., Lewis, C. M., Ng, M., & Brewster, S. (2011). A Genome-Wide Significant Linkage for Severe Depression on Chromosome 3: The Depression Network Study. American Journal of Psychiatry, 168(8), 840–847. https://doi.org/10.1176/appi.ajp.2011.10091342



Dowden, A. R., Warren, J. M., & Kambui, H. (2014). Three Tiered Model Toward Improved Self-Awareness and Self-Care. VISTAS Online, 30.


Hernandez-Puga, A. M. (n.d.). Bullying and Depression: Lasting Effects On Youth | Ana HPMD. Www.toplinemd.com. https://www.toplinemd.com/ana-hpmd/bullying-and-depression-lasting-effects-on-youth/


Klein, D. N., Kotov, R., & Bufferd, S. J. (2011). Personality and Depression: Explanatory Models and Review of the Evidence. Annual Review of Clinical Psychology, 7(1), 269–295. https://doi.org/10.1146/annurev-clinpsy-032210-104540


Koskie, B., & Raypole, C. (2022, January 14). Depression Statistics: Types, Symptoms, Treatments & More. Healthline. https://www.healthline.com/health/depression/facts-statistics-infographic#prevalence


Lindberg, S. (2021). How Your Environment Affects Your Mental Health. Verywell Mind. https://www.verywellmind.com/how-your-environment-affects-your-mental-health-5093687


Melrose, S. (2017). Persistent Depressive Disorder or Dysthymia: An Overview of Assessment and Treatment Approaches. Open Journal of Depression, 06(01), 1–13. https://doi.org/10.4236/ojd.2017.61001



Pattermore, C., & Pineda, S. (2022, May 6). Messy Rooms and Depression: What’s the Link? Psych Central. https://psychcentral.com/depression/messy-room-depression#depression-and-messiness


Penner-Goeke, S., & Binder, E. (2019). Epigenetics and depression. Epigenetics, 


Purdie, J. (2016). Anhedonia: Symptoms, Treatment, and More. Healthline. https://www.healthline.com/health/depression/anhedonia


Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102


Shadrina, M., Bondarenko, E. A., & Slominsky, P. A. (2018). Genetics factors in major depression disease. Frontiers in Psychiatry, 9(334). https://doi.org/10.3389/fpsyt.2018.00334







 
 
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