Focusing on depression – Mental Health Week Special

It is Mental Health Week, it is also the week where I am studying `Affective disorders` in my Master`s degree, and I am reading a lot on the subject.

I chose this module as the mood disorders – especially depression – is common in society, second to heart disease amongst non-communicable diseases.

I am a psychology graduate, I had thought I knew all about depression, but it turns out that I did not.

Depression is increasing in society, and according to the World Health Organization (WHO report, 2004), it will be the number 1 cause of burden of disease by 2030.  Right now, 1 out of 4 of you is experiencing common health problems (anxiety and depression). And only a third seek help and get proper treatment and half of the ones that do get treatment experience relapse (Thase, 2006) This is interesting when you think about all these awareness activities and known antidepressants.

The reality is that so many of you are not aware of what depression is and how can you stay mentally healthy.

I think the first thing to learn is the definition of depression with it is four different levels (Cleare et al., 2008).

Major Depression according to DSM-5 needs to show five symptoms during the same two -week period and the main symptom need to be there – depressed mood or low interest or pleasure.

–         Depressed mood most of the day

–         Showing no interest or taking no pleasure in any activity

–         Weight loss or gain

–         Insomnia or hypersomnia

–         Fatigue, loss of energy

–         Feelings of worthlessness, and feeling excessive guilt

–         Finding hard to think and concentrate, being indecisive

–         Acting restless or moving/speaking slowly

Four different levels for depression is subthreshold depression – depressed mood most of the date for two years with the presence of 2 or more symptoms, mild major depression, moderate major depression, severe major depression

Below I gathered the most interesting findings that you might want to know:

–         People mistake depression with physical illness as `pain` is a symptom of depression, and they lose time because of the incorrect diagnosis.

–         Cortisol levels (stress hormone) are quite high in depressed patients. That is why there is a tendency for them to wake up early in the morning. High cortisol levels in blood wake you up.

–         Inflammation is another symptom of depression and that why there is a strong two-way relationship between heart disease and depression (Pearson et al., 2003)

–         Depression most of the times (60%) co-exist with anxiety.

–         The complete cure for depression is still to be found, as drugs proved to not to be that efficient. Antidepressants work best for moderate to severely depressed patients but with a %50 chance for relapse. And if the treatment does not start in the first 3 to 6 months, the chances of cure decreases further (Bukh et al., 2013)

–         There is some evidence that antidepressants are less effective in mild depression (Paykel et al., 1988). And this is where psychological therapies – Cognitive Behavioural Therapy is most impactful to date (Cujipers et al., 2011) – and lifestyle changes can be influential.

–         And there is so much you can do through lifestyle changes (Sarris et al., 2014). Lifestyle changes involve the changes in diet, physical activity and exercise, relaxation and sleep-wake cycles, minimisation of smoking, alcohol or illicit substances, meditation techniques and social interaction.

I want to elaborate more on lifestyle changes as I believe through these changes, not only you avoid depression and anxiety, but you have a chance to live life to it its fullest.

Let`s start with diet….

What is the evidence that diet can have an impact on a psychological disorder? A large study Spanish SUN Cohort study that followed 10,000 middle-aged professionals for four years and this study showed that sticking to Mediterranean dietary pattern reduces the risk of depression. The exact physiological mechanism is not clearly understood but we do know that Western dietary pattern is associated with inflammation and inflammation is observed in depression patients.

Supplements such as St John`s Wort (Linde et al., 2005) and Omega 3 fatty acids seem to work for mildly depressed (Freeman et al., 2006)

There have been so many studies done to show that exercise is beneficial to mental health. Also, studies show that yoga works.

The more interesting finding is how exercise can be addictive in the sense of using it as the only coping mechanism with negative emotions, for those of you who are interested, here is an article on this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210598/

Meditation, spirituality, religion…

Mindfulness (meaning `paying attention in a particular way, on purpose, in the present, and non-judgmentally `) is the one that stands out as a meditation technique. It`s as a treatment method, is called Mindfulness-Based Stress Reduction (MBSR). You can read more on this through the studies done by Hoffman (Hoffman et al., 2010) on the effect of mindfulness-based therapy on anxiety and depression.

There have been some studies done about being religious and the effect on depression. Religious involvement is associated with `hope` and Hope is inversely related to depression (Harold et al., 2019) Most of you must have read `Man`s Search for Meaning` by Viktor E. Frankl, if not I strongly advise you … It is a brilliant book that enables you to understand how `believing and hoping` can give you the resilience to survive in the most horrible circumstances.

Alcohol and substance abuse mostly accompanies depression but more interestingly, some studies on how alcohol, especially in adolescence, can predict later onset of major depressive disorder, this is quite alarming when you think alcohol and substance abuse is becoming more common in younger people (Caldwell et al., 2002)

Another interesting study on caffeine this time, consuming a moderate amount of caffeine (two or three cups a day correlated with a reduced risk of depression (Lucas et al., 2011). I am glad I can continue with my twice a day Turkish coffee 😊

Sleep disturbance is a frequent sign of depression (Roth et al., 2003). A night of good night sleep is not only good for mental health, but it is also good to avoid stroke, obesity, diabetes, coronary artery disease and myocardial infarction (Grandner et al., 2012).

Social interaction, there is overwhelming information on this, no need to say anything more on the value of family, a great circle of friends.

What was surprising for me was the studies done with pets. They can affect our wellbeing not only through their unconditional love but also through forcing us on to a routine, to be out in the open in nature. A study which I found very delightful, is the study about children`s cortisol levels in times of stress is lower for the ones who has a dog (Kertes et al., 2016).

I hope I have given you enough ammunition to go and to make changes in your life.

We have 😊 We got a dog 😊 she is in the photo with my son, is not she a beauty?

I hope for peace of mind to everybody x

References

Bukh JD, Bock C, Vinberg M, et al. (2013) The effect of prolonged duration of untreated depression on antidepressant treatment outcome. J Affect Disord 145: 42–48.

Caldwell TM, Rogers B, Jorm AF, Christensen H, Jacomb PA, Korten AE, Lynskey M: Patterns of association between alcohol consumption and syndromes of depression and anxiety in young adults. Addiction. 2002, 97: 583-594. 10.1046/j.1360-0443.2002.00092.x.

Cuijpers P, Andersson G, Donker T, et al. (2011) Psychological treatment of depression: Results of a series of meta-analyses. Nord J Psychiatry 65: 354–364.

Freeman MP, Hibbeln JR, Wisner KL, et al. (2006) Omega-3 fatty acids: Evidence basis for treatment and future research in psychiatry. J Clin Psychiatry 67: 1954–1967.

Hofmann SG, Sawyer AT, Witt AA, Oh D: The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010, 78 (2): 169-183.

Harold G Koenig, Nagy A Youssef, Zachary Smothers, John P Oliver, Nathan A Boucher, Donna Ames, Fred Volk, Ellen J Teng, Kerry Haynes: Hope, Religiosity, and Mental Health in U.S. Veterans and Active Duty Military with PTSD Symptoms. Military Medicine, usz146, https://doi.org/10.1093/milmed/usz146

Grandner MA, Jackson NJ, Pak VM, Gehrman PR: Sleep disturbance is associated with cardiovascular and metabolic disorders. J Sleep Res. 2012, 21 (4): 427-433. 10.1111/j.1365-2869.2011.00990.x.

Darlene A. Kertes, Jingwen Liu, Nathan J. Hall, Natalie A. Hadad, Clive D. L. Wynne, Samarth S. Bhatt (2016) Effect of Pet Dogs on Children’s Perceived Stress and Cortisol Stress Response. https://doi.org/10.1111/sode.12203

Linde K, Berner M, Egger M, et al. (2005) St John’s wort for depression: Meta-analysis of randomised controlled trials. Br J Psychiatry 186: 99–107.

Lucas M, Mirzaei F, Pan A, Okereke OI, Willett WC, O’Reilly EJ, Koenen K, Ascherio A: Coffee, caffeine, and risk of depression among women. Arch Intern Med. 2011, 171 (17): 1571-1578. 10.1001/archinternmed.2011.393.

Jerome Sarris, Adrienne O’Neil, Carolyn E Coulson, Isaac Schweitzer & Michael Berk: Life-style medicine for depression. BMC Psychiatry volume 14, Article number: 107 (2014) | Download Citation

Pearson, T. A. et al, 2003, Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and prevention and the American Heart Association, Circulation 107, 499-511

Roth T, Roehrs T: Insomnia: epidemiology, characteristics, and consequences. Clin Cornerstone. 2003, 5 (3): 5-15. 10.1016/S1098-3597(03)90031-7.

Paykel ES, Hollyman JA, Freeling P, et al. (1988) Predictors of therapeutic benefit from amitriptyline in mild depression: A general practice placebo-controlled trial. J Affect Disord 14: 83–95.

Thase ME. Preventing relapse and recurrence of depression: a brief review of therapeutic options, CNS Spectr 2006; 11:12-21

WHO global report, 2004, accessed from https://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/