Depression

By Dr. Frederick Allen Walker

Sadness, albeit unpleasant, is a normal temporary emotion. Experiencing sadness to the extent where it creates feelings of hopelessness, helplessness and worthlessness with a chronic negative impact on us, our families, friends and coworkers is abnormal and could be a sign of major depression.

Major symptoms of depression are: changes in sleep, decreased interest in activities which were formerly enjoyed, increased guilt, decreased energy, decreased concentration, changes in appetite, changes in psychological and or motor activity, and most importantly, thoughts or plans of suicide.

The medical community does not fully understand the causes of depression. However, we know that in general there are two main causes. The first cause is biologic or genetic and is evidenced by family history studies. The second cause is psychological, social, environmental or behavioral experiences.

Genetic Causes of Depression

Some individuals have internal genetic predispositions toward depression and can become depressed without external or psychological factors playing a role. It is hypothesized these individuals have malfunctioning genes causing improper production and regulation of serotonin, dopamine and norepinephrine. Some individuals may have a combination of genetic, psychological and or behavioral factors, which when combined may cause depression while others become depressed by experiencing adverse psychological and or behavioral factors alone.

Psychological, Social, Environmental or Behavioral Experiences

There are numerous psychological, social, environmental or behavioral experiences that can cause depression. And, with the holiday season just ending, that's a good place to look for examples of depression.

Family or social problems can be complex but the most common underlying theme involves loss. Whether family or friend, spouse or partner, death or dying, separation or divorce, loss is the most common factor responsible for causing depressive symptoms. During the holidays the loss of a loved one or separation from children due to divorce can dramatically magnify feelings of depression. During the holidays as individuals and as a culture we typically deny the expression of grief or depression for fear it may dampen the “holiday spirits” of those around us.

Spiritual and cultural issues may involve themes of existentialism such as the meaning of life. If from mainstream America , spiritual issues may involve what is the meaning of Christmas or how do I find meaning in a culture so strongly influenced by commercialism and Christianity? If from another country, religion, race or culture, issues may include alienation from the mainstream and what is the meaning of my life within mainstream culture?

Environmental issues can involve the changing of seasons, which produces a decrease of sunlight exposure during the winter months. Decrease in sunlight exposure has been proven to create changes in brain chemistry and in some individuals can precipitate or exacerbate feelings of depression.

Behavioral issues during the holidays surround activities of over consumption, particularly buying, eating and drinking. Overspending or increasing financial debt increases financial anxiety. Overeating increases body weight thereby decreasing self-image or esteem. Overdrinking changes brain chemistry, increasing the likelihood for depression and anxiety to take hold. Assuming exercise is a normal part of your daily routine, the tendency to avoid usual routines and replace with novel holiday activities results in decreased levels of certain brain chemicals responsible for promoting a sense of well being. Decreased exercise also promotes increased body weight thereby negatively impacting self-image. Overeating, overdrinking, overspending and decrease in exercise all combined or individually can disturb sleep. Poor sleep is proven to play a major role in the production of symptoms of depression. One can see how important a role behavior plays in how we feel before, during and after the holidays.

If you or someone you know experienced any of these feelings or symptoms during the holiday season, it may be necessary to seek treatment.

How is depression treated?

The most important first step in treatment is an accurate assessment and diagnosis. The diagnosis sets a stage for successful treatment. In my opinion the best place to begin is with your primary care physician, internist or psychiatrist. These are medical doctors who have the most extensive training and resources available to implement a treatment plan. There are other qualified professionals who are effective in the treatment of depression. However, the most comprehensive place to begin is with a board-certified medical doctor.

If you suspect someone you know is having thoughts of suicide, you should ask him or her. A common misconception is that asking someone could give them the idea or cause them to attempt or commit suicide. This has been proven to be false. If you suspect someone is having suicidal thoughts you should always ask, you could potentially save their life.

Dr. Frederick Walker is a native of Louisville and a graduate of the University of Louisville School of Medicine, Department of Psychiatry and Behavioral Sciences. He is a general psychiatrist in private practice here in Louisville and is currently accepting new patients with immediate availability and can be reached at 502-657-6070.