you've probably come out of a
particularly sad movie and said
something like man that was depressing
in this case you're talking about how at
that moment the movie made you feel sad
discouraged hopeless or anxious you
probably wouldn't say something like man
that movie was clinically depressing the
latter expression refers to a much
different state of depression clinical
depression which is sometimes called
major depressive disorder or unipolar
depression is a serious mental disorder
that has a lifetime incidence of up to
20 percent in women and 12 percent in
men making it one of the most common
reasons people seek out mental health
services that being said as well as
being relatively common clinical
depression is in fact very serious it's
so serious that it interferes with
someone's day-to-day life like working
studying eating and sleeping essentially
leading to this overall feeling that
life isn't enjoyable but what causes
someone to feel this way well we don't
exactly know what specifically causes
clinical depression especially since it
could be so different between patients
it's probably a combination of factors
though like genetic factors biological
factors environmental factors and
psychological factors it's been shown
that people with family members who have
depression are three times more likely
to have it themselves and this link
seems to increase with how closely
related family members are biologically
though most medications focused
specifically on neurotransmitters
neurotransmitters are signaling
molecules in the brain that are released
by one neuron and received by receptors
of another neuron when that happens
essentially a message is relayed from
one neuron to the next regulation of how
many of these neurotransmitters are
being sent between neurons at any given
time is thought to play a super
important role in the development of
symptoms of depression since they're
likely involved in regulating a lot of
brain functions like mood attention
sleep appetite and cognition the three
main neurotransmitters that we focus on
for depression are serotonin
norepinephrine and dopamine why do we
focus on these three well
because medications that cause there to
be more of these neurotransmitters in
the synaptic cleft this space between
the neurons are shown to be effective
antidepressants and this finding led
researchers to develop the mono amine
deficiency theory which says that the
underlying basis of depression is low
levels of serotonin norepinephrine or
dopamine which are all called mono
amines because they have one amine group
additionally it's thought that each of
these might have an impact on certain
sets of symptoms with depression like
norepinephrine on anxiety or attention
or serotonin on obsessions and
compulsions or dopamine on attention
motivation and pleasure so if one of
these is down then that could lead to a
set of specific symptoms being felt by
the patient serotonin in particular is
thought to be a major player some
theories suggest it's even capable of
regulating the other neurotransmitter
systems although evidence supporting
this theory is still pretty limited some
hard evidence implicating serotonin in
depression has to do a tryptophan
depletion which is the amino acid the
body uses to make serotonin so if you
take it away you can't make as much
serotonin and it's been shown that when
the body can't make as much serotonin
patients start getting symptoms of
depression so that's all well and good
but unfortunately the reasons why
serotonin or other neurotransmitters
might be lost or decreased in depressed
patients in the first place isn't well
known and research remains ongoing
ultimately development of depression is
complicated right it involves these
biological components in combination
with the genetic components as well as
environmental factors which could be
specific events like a death or a loss
or sexual and physical abuse in order to
diagnose clinical depression patients
must meet certain criteria that are
outlined in the Diagnostic and
Statistical Manual for mental disorders
the fifth edition first they must be
affected by at least five of the
following nine symptoms most of the day
nearly every day depressed mood
diminished interest or pleasure in
activities significant weight loss or
gain inability to sleep or over sleeping
psychomotor agitation like
pacing or ringing one's hands or
psychomotor impairment like this overall
slowing of thought and movements fatigue
feelings of worthlessness or guilt
lowered ability to think or concentrate
and finally recurrent thoughts of death
or suicide ality including suicidal
thoughts with or without a specific plan
as well as suicide attempts and these
symptoms must cause significant distress
to the patient's daily life also the
depressive episode can't be due to a
substance or other medical condition the
symptoms can't be better explained by
another mental disorder like
schizoaffective disorder and finally the
patient can't have had a manic or
hypomanic episode at any point
additionally sometimes major depressive
disorder can be divided into subtypes or
closely related conditions postpartum
depression is a subtype that can happen
following childbirth although studies
have shown that in many cases onset of
depression occurs prior to childbirth as
well so it's now diagnosed as depressive
disorder with peripartum onset in other
words the onset happens during pregnancy
or four weeks following delivery it's
not quite understood why this happens
although hormonal changes likely play a
role especially estrogen and
progesterone also though an abrupt
change in lifestyle might be an
important causal factor especially
because this can happen in men as well
as women atypical depression is another
important subtype that's characterized
by an improved mood when exposed to
pleasurable or positive events called
mood reactivity and this is in contrast
to other subtypes like melancholic
depression even during what used to be
pleasurable events also atypical
depression often includes symptoms like
weight gain or increased appetite over
sleeping heavy feeling limbs also known
as leaden paralysis and rejection
sensitivity essentially feeling anxiety
at the slightest evidence of rejection
finally dysthymia now known as
persistent depressive disorder is
sometimes used to describe milder
symptoms of depression that happen over
longer periods of time specifically two
or more years with two or more of the
following
symptoms a change in appetite a change
in sleep fatigue or low energy reduced
self-esteem decreased concentration or
difficulty making decisions and feelings
of hopelessness or pessimism knowing
that so many factors are probably
involved in depression it can be a
challenge to treat although with the
right treatment seventy to eighty
percent of patients with clinical
depression can significantly reduce
their symptoms treatment can come in
many forms and are most commonly grouped
into one of two major categories one
nonpharmacologic approaches in other
words things other than medications and
two pharmacologic approaches either a
single medication or combinations of
medications starting with an on
medication approach a number of studies
have shown the benefits of physical
activity in helping with depression
there are various reasons why it's
thought to work ranging from the release
of neurotransmitters endorphins and
endocannabinoids to raising the body
temperature and relaxing tense muscles
regardless of the exact mechanisms data
suggests that exercising for 20 minutes
three times a week can help alleviate
depression symptoms there's also a lot
of research exploring the relationship
between diet and depression and although
there are no silver bullet foods many
experts suggest healthy eating habits
like more fruits and veggies beyond
physical activity and healthy eating
which is more helpful for a number of
reasons
another major nonpharmacologic approach
is psychotherapy or talk therapy which
is definitely preferred for young
patients and for those with milder
symptoms there are a few popular
approaches including cognitive
behavioral therapy and interpersonal
therapy and the most important thing
here is that these approaches depend
heavily on the relationship between the
patient and the therapist as well as the
clinical skills of the therapist if
patients have more severe depression or
mild depression for a longer period of
time then antidepressant medication
might be prescribed along with the
therapy the most commonly prescribed
medications are selective serotonin
reuptake inhibitors or SSRIs in the
synaptic cleft
after neurotransmitters get released
those neurotransmitters are normally
reabsorbed
SSRIs block the reabsorption or inhibit
the reuptake of serotonin which means
that there's going to be more serotonin
in the synaptic cleft other classes of
antidepressants that are less commonly
prescribed are mono amine oxidase
inhibitors or Mao is and tricyclics as a
final last line treatment for severe
depression ECT might be performed under
written concent EC T stands for electro
convulsive therapy and is when a small
and controlled amount of electric
current is passed through the brain
while patients are under general
anesthesia and this induces a brief
seizure
although ECT has been used for decades
and actually does seem to be effective
for about 50% of patients the reason why
electrically induced seizures seem to
improve symptoms is not well understood
alright clinical depression is tough
right both for those experiencing it and
for those trying to help treat it unlike
many other illnesses depression carries
with it a lot of social stigma and can
lead to moral judgments that can make a
person with depression feel even worse
love and support from friends and family
helps tremendously and having a strong
social support network has been proven
to lead to better outcomes
thanks for watching you can help support
us by donating on patreon or subscribing
to our channel or telling your friends
about us on social media
you