Depression is a psychiatric illness. On the other hand, in everyday language depression is also often defined as the appearance of some isolated and not too serious symptoms.
It has an incidence equal to 9-20% of the general population, but it seems to be constantly increasing.
Depressive disorders are quite different from each other and both diagnosis and treatment are difficult to establish with accuracy.
A first subdivision concerns:
- Depressive disorders: major, dysthymic and not otherwise specified.
- Bipolar disorders: type I, II and cyclothymic.
There are two factors that determine depression and they are often co-present. These increase the chances of getting sick, but do not provide any clinical certainty:
- Biological factor: it is a hereditary element that implies physical predisposition. Involved are: glands, hormones, neurotransmitters and nerve receptors.
- Psychological factor: it consists of a greater vulnerability to the disease and often takes root in negative childhood experiences.
The material published is intended to allow quick access to general advice, suggestions and remedies that doctors and textbooks usually dispense for the treatment of Depression; such indications must in no way substitute the opinion of the attending physician or other health specialists in the sector who are treating the patient.
What to do
It is not always easy to distinguish a "difficult period" from actual depressive symptoms.
Early diagnosis is very often hindered by shame and rejection of this condition.
Below we will list some useful tips to recognize a depressive symptom and suggest how to intervene.
- It is necessary to prevent the consolidation of symptoms and the aggravation of the disease by making an early diagnosis.
- Depression often begins with some simple, apparently "physiological" moods, even if more intense, repeated and close together:
- Negative perception of events.
- Sadness and irritability.
- Feeling of "depression" (it is used to define it as such, but this word is used very often in an inappropriate way, while it tends to be omitted when the doubt is stronger).
- In this first phase it is very important to try to reverse the mood trend as a preventive action.
- If left untreated, these symptoms can develop into a frankly clinical condition and lead to:
- Depressed mood throughout the day and for several days.
- Inability to feel pleasure during normally fulfilling activities.
- Unmotivated or excessive irritability, negativity, and emotional pain.
- Anhedonia (tiredness, fatigue, lack of energy).
- Abnormal increase or decrease in appetite.
- Sleep disorders.
- Slowing or motor agitation.
- Lack of concentration.
- Feeling of failure, guilt (own or others) and worthlessness.
- Tendency to isolation.
- Recurring thoughts on suicide.
- The most important diagnostic aspect is the pervasiveness of the symptoms (i.e. the constancy and duration), but it is not certain that they occur all at the same time.
- If you suspect that you are suffering from a depressive disorder, it is necessary to consult a doctor immediately:
- GP for the first approach: usually prescribes mild medications to facilitate spontaneous remission.
- Specialist: psychiatrist or neurologist. It is able to more accurately identify the type of disorder and prescribe a specific therapy.
- Therapist: psychologist - psychotherapist. It identifies the psychological mechanism that causes the mood disorder and intervenes by modifying the mental pathways, the processing system, etc. He does not prescribe drugs.
- That said, some very important tips for prevention (at the first symptoms) and also for treatment are:
- Do not abandon customary activities.
- Attend the community.
- Adhere to a balanced diet.
- Practicing sports motor activity.
- Do not abuse psychotropic substances: alcoholism, drugs, smoking, binge eating desorder (compulsive eating).
- Avoid only circumstances that actually cause suffering.
- Dedicate yourself to interesting activities capable of "disconnecting the brain" from brooding (constantly thinking about the future) or rumination (constantly thinking about the past).
- Abandon clichés, try to overcome shame and seek help in times of need. By contacting a specialist early, in most cases the problem can be solved with light interventions and without leaving too significant experiences.
- Ultimately, the main remedies are:
- Pharmacological therapy.
- A combination of both.
What NOT to do
- Giving up early diagnosis by not going to the doctor.
- Interrupt the diagnostic procedure if the general practitioner recommends a specialist visit.
- Underestimate the bad mood and recurring negative attitudes.
- Give in to anhedonia and stop most activities (work, sports, hobbies, social relationships, etc.).
- Neglecting sleep and not regularizing it.
- Neglecting the diet.
- Isolate yourself.
- Rimuginare and ruminate continuously.
- Avoid or discontinue drug therapy.
- Avoid or stop psychotherapy.
- Abusing psychotropic substances.
- Tend to self-harm and strive to cope with particularly uncomfortable circumstances.
What to eat
The dietary role in depressive pathology is controversial.
There is a scientific basis that suggests a correlation, but the real impact is not always so significant (see also: Diet and Depression: preventing it at the table).
In general it is recommended to:
- Adopt a normal-calorie and balanced diet. Sometimes it requires a special effort, as some drugs used in the treatment have an anorectic effect.
- Respect a diet with the right fraction of carbohydrates.
- Hypoglycemia and possible ketoacidosis caused by fasting or a low carb diet alter mood, creating a "fluctuating" trend.
- Hyperglycemia caused by a diet that is too high in carbohydrates can lead to decreased glucose utilization by brain tissue, confusion, slowdown, and lethargy.
- If desired, take a portion of coffee when you wake up in the morning (worst time in depressed people); it can improve mood, as long as it does not interfere with pharmacological action.
- Promote the consumption of foods rich in omega 3: guarantee the integrity of neurons; hence also their functionality. They are abundant in fishery products, in certain oil seeds (flax, kiwi, grape seeds, soybeans, etc.) and related oils, krill oil, cod liver oil, etc.
What NOT to Eat
- Avoid low-calorie diets, as they increase the risk of symptoms worsening.
- Avoid excess of strongly stimulating drinks, supplements and foods such as: coffee, tea, energy drink, cocoa, dark chocolate, etc. It is especially important in bipolar pathologies, in the tendencies to abuse and in clinical pictures also characterized by anxious symptoms.
- Avoid the intake of alcoholic beverages: they increase the risk of abuse and negatively affect the pharmacological metabolism. They can make anhedonia worse.
- Avoid foods very rich in histamine: it has a stimulating action that can compromise the pharmacological action or trigger severe headaches and worsen anxiety. It is mainly present in fishery products (blue fish) and significantly increases with poor conservation.
- Avoid foods very rich in tyramine: it is a derivative of the amino acid tyrosine. Like the previous one, it is a marker of poor conservation. It stimulates the release of norepinephrine predisposing to tachycardia, headache, etc. It abounds in cheeses, preserved meats, soy sauce, fish, red wine and other spirits, bananas and chocolate.
- Avoid foods that are very rich in glutamate: it is an amino acid that acts as an exciting neurotransmitter. Widely used in the food industry as a flavor enhancer, it abounds in bouillon cube, ready-made or freeze-dried soups, etc. Excess is very difficult to achieve with the diet, but it can happen in Chinese cuisine.
- Avoid excess cholesterol and saturated or hydrogenated fats (especially in trans conformation): they do not have a direct negative effect on depression, but a diet rich in these molecules is associated with a worsening of brain function. They abound in junk foods such as fast food, packaged foods, fatty cheeses, margarines, bi-fractionated oils etc.
- Avoid excess arachidonic acid: it is an omega 6 derived from linoleic acid. It is abundant in some oilseeds and related oils (for example in peanuts and in extracted oil). Especially when associated with an omega 3 deficiency, excess arachidonic acid appears to worsen brain function.
- Do not follow diets without carbohydrates or with too many carbohydrates (see What to Eat).
Natural Cures and Remedies
Among the most effective natural remedies for mild depression we recognize:
- Regular motor physical activity: creates an endorphin release which can greatly relieve symptoms.
- Psychotherapy: see Medical Treatments below.
- Relaxing activities that allow you to interrupt the continuous cycle of brooding-aluminum, allowing the brain to "metabolize" thoughts:
- Advanced relaxation techniques: of any kind. Some are katabasis, shiatsu, watsu, maternage etc.
- Transcendental Meditation.
- Mental training: induced or autogenous.
- Yoga: Pranayama is especially useful.
- Herbal medicine: they are considered useful against mild depression: herbal teas, decoctions and lukewarm solutions enriched with essential oils that contain:
- Hypericum: is the most effective. It has an inhibitory action towards the reuptake of noadrenaline and serotonin in a manner comparable to tricyclics or to inhibitors of the reuptake of serotonin and noradrenaline.
- Tricyclic antidepressants: used mainly in the treatment of moderate and severe depression. They are the least used due to side effects:
- Amitriptyline: for example Laroxyl, Triptizol, Adepril.
- Imipramine: for example Imipra C FN, Tofranil.
- Nortriptyline: for example Dominans, Noritren.
- Others are: clomipramine, dosulepin, doxepin, trazodonelo, phepramine.
- Selective serotonin reuptake inhibitors: second generation antidepressants that have replaced tricyclics due to the minor side effects, as they lack the cholinergic action:
- Fluoxetine: for example Prozac, Azur, Flotina, Fluoxeren.
- Citalopram: for example Seropram.
- Sertraline: for example Zoloft, Tralisen.
- Norepinephrine and dopamine reuptake inhibitors:
- Bupropion: for example Elontril, Wellbutrin, Zyban.
- Serotonin and norepinephrine reuptake inhibitors:
- Duloxetina: ad esempio Xeristar, Yentreve, Ariclaim, Cymbalta.
- Venlafaxine: for example Efexor.
- Monoamine oxidase inhibitors (MAOIs): these are second choice drugs due to the side effects they can generate.
- Phenelzine: for example Margyl.
- Isocarboxazide: for example Marplan.
- Tranylcypromine: for example Parmodalin.
Depression prevention can be adopted in special circumstances:
- Familiarity with the disease: recognition of biological and / or psychological factors.
- Positive clinical history: those who have already suffered from depression are prone to relapses.
- Particularly traumatic negative events: they are very subjective and should not be underestimated, even if from an external point of view they may seem negligible.
The basic rules for preventing and reducing depressive symptoms can be summarized as follows:
- Strive to maintain a normal lifestyle and carry on customary activities.
- Attend the community and not isolate yourself.
- Remember that rumination and brooding DO NOT lead to any solution; on the contrary, they tend to aggravate the symptoms.
- Rationalize your condition and always act for your own good, putting aside guilt, shame and resentment.
- Respect a balanced diet avoiding fasting, overeating and attitudes that can introduce any eating disorders (anorexia, bulimia, binge eating desorder, grignottage).
- Practicing sports motor activity, but avoiding it becoming a stressful activity.
- Set aside time for activities that can be rewarding and mood-enhancing.
- Totally avoid psychotropic substances (alcohol, drugs, nicotine, etc.).
- If possible, eliminate all uncomfortable circumstances.
- Consult a specialist.
All forms of psychotherapy fall into this category. The most used is the Cognitive-Behavioral Psychotherapy (TCC): It is quite effective, although it sometimes requires antidepressant drug support or mood regulator. It consists in becoming aware of the vicious circles that cause the disease, eliminating them with the reactivation of behavior, thinking and thanks to more suitable behaviors. In addition, he works a lot on relapse prevention.