Depression and its reality
Depression is a phenomenon that takes the individual by surprise throughout their existence and that can change their daily life. It actually represents the moment where the mood changes and becomes negative. It is the perception itself about life, and the events that take place, that becomes dark, sad and essentially pessimistic.
Depression can really turn life upside down, with consequences that can profoundly affect one’s destiny. Its “victims” end up feeling lost and need to fight to get their life back. This struggle can seem difficult, impossible even. In reality, many people never find a way out and become loyal visitors of psychiatry, which accompanies them in its labyrinth in order to gain their loyalty.
At first, and despite their depression, the sufferers keep their optimism and hope and seem very open to the promises of psychiatry offering them the perspective of helping them get their lives back. And this is oftentimes the case. Too often in fact!
A large number of people are still lost in the maze of psychiatry that slowly exhausts its promises or its solutions. What’s more, depressed individuals apply the suggested solutions, with treatments that augment or change, but oftentimes with modest or pessimistic results. It is these weak results that cause them to lose hope, followed by a phase of despair and resignation.
In the face of this obvious failure, the classical psychiatry admits to having done everything, what was needed and all that was required and maintains that with a bit of courage, the path will become successful. The patients often, or too often, after years of therapy and treatment, end up accepting or “accommodating” their unresolved situation. Hence, the discouraged patients are frequently demobilised, less and less involved in the struggle to survive and thus become victims of DEPRESSION.
Furthermore, psychotherapy sessions are sequenced one after the other, viewed as the only means to recognize and appease the depressed suffering, yet in a climate of endless disappointment. Psychotherapists, by the very nature of their profession and their empathic personality, provide support and reassurance. This process can thus foster embracing depression as a heavy, chronic illness that is difficult to overcome.
Moreover, psychotherapy often aims to assess the problems that are likely at the origin of depression. This instils the impression that life is full of issues, leading patients to make sense of their ever-present depression.
The depressed patients generally take antidepressants yet continue to be depressed. One simple question could be asked: what would be the point of continuing a treatment based on antidepressants if they cannot stop the depression? The answer is always the same: antidepressants appear to help and avoid the worse. Many patients have in vain tried to stop them… In reality, they are often afraid that giving up the medication would worsen their states. Antidepressants accompany depression and the patients despite side effects such as loss of sex drive, disruption of sleep, weight gain, or background anxiety etc.
The reality of depression can be summarized in the following way:
- It remains a difficult and chronic disease that needs to be accepted with resignation
- Current psychiatry prescribes antidepressants that do not manage to stop the disease, but only accompany it
- Depression shakes up the lives of patients, becoming sad, pessimistic without ever returning to the way it used to be.
The NEOPsy approach aims to change the reality of depression, but in order to do so, it is important to acknowledge its specific phenomena.
The specific phenomena of depression
It is not difficult to recognize a depression. It is described equally everywhere, in books and on homepages. From a NEOPsy standpoint, depression is a REGIMEN of the body and the soul, generating changes on these levels. Thus, understanding the phenomena and mechanisms of depression constitutes a crucial step on which its healing depends.
In our vision, this body and soul regimen changes four spheres in a depressed person:
- The biological or organic sphere concerning the body, with an energy drop, fatigue, sleep disorder, appetite and weight disruptions, etc.
- The sphere of perception meaning the way the world is perceived, with sadness, pessimism, fear, less joy
- The sphere of action abilities with a reduction in the ability to work, concentrate, solve problems, etc.
- The behaviour sphere, with inhibited conduct, diminished social relationships, hobbies, sexuality etc.
This represents a novel definition of depression stemming from our original approach of the phenomenon, based on a question of lifestyle, that a person is to adopt.
Instead of creating descriptive lists of symptoms and manifestations, as can be seen in many places, we believe that it is necessary to understand the mechanisms that create them.
Hence, we can better understand and acknowledge how to treat it, as opposed to accepting it in a spirit of resignation. Here we talk about the fight against depression.
The fight against depression
In order to fight depression, we need to approach it in a thorough and logical manner so as to find an effective solution, tailored to each patient. We do not believe that a sole, unique solution needs to be applied to all patients: psychotherapy and/or antidepressants.
The treatment of depression must convey good results, otherwise it is likely that the therapeutic process was not correctly assessed.
In this case, how can we explain the situation of somebody who after years of psychiatric care and treatment still does not manage to recover? What is wrong with the treatment or therapy? Many people are entitled to ask themselves this question, including the patients’ loved ones.
Fighting depression entails three simple and logical steps: understanding depression, acting against it and attaining favourable results.
Understanding is an essential and necessary step preparing and organizing the therapeutic intervention in order to attain good results.
UNDERSTANDING depression means understanding the mood regulation system and mechanisms and the causes that can distort them.
The mood system comprises three mechanisms:
- A psychological mechanism or emotional reaction
- A personality mechanism
- A biological mechanism containing all the elements of the body (the glands, neurons, hormones, etc).
An accurate understanding of the phenomena of depression facilitates the assessment of its causes and the search for specific solutions.
Types of depression
1. Psychological or reactionary depression
The causes of the psychological or reactionary depression are negative life events affecting us. The most difficult causes of the psychological depression are unemployment, emotional separation, the death of a loved one or divorce.
The psychological mood system manages the emotional adaptation to these events.
The depression due to these unfavourable events is simply a normal reaction. Everyone will sooner or later be confronted with negative events throughout their lives and experience this type of depression, which despite its painful appearance, remains natural and legitimate.
The intensity and duration of the psychological (or reactionary) depression are proportional to the severity of the event (the cause) engendering them. The more serious the event, the higher the intensity of depression.
2. Personality-based depression
Personality is innate, representing our way of functioning. We are different according to our way of acting and reacting. When personality presents exaggerated traits, such as being overly suspicious, obstinate, distrusting or naïve etc., adapting in life generates suffering.
This type of depression remains triggered by life events, even harmless ones, but which are “processed roughly”, due to problematic personality traits.
“Processed roughly” means that life events generate amplified emotional reactions.
Such amplified types of reactions can be found for instance in the borderline personality disorder, where depression is a dominant trait. We have encountered many depressed patients with a personality disorder that had not been diagnosed.
3. Biological depression
The biological mood system comprises all the elements of the body that can influence mood: glands, neurons, hormones, the vascular system, the brain etc. The biological mood system can be distorted due to various internal and external causes. Therefore, if an element (such as the thyroid) of the biological mood system is disrupted, this can engender a biological type of depression. For instance, in the case of hypothyroidism, a lower hormonal secretion of the thyroid is one of the internal causes of biological depression.
Other factors can cause a biological depression, such as medication, traumatic brain injury, genetical elements, toxic substance intake (alcohol, cannabis, cocaine, ecstasy, heroin etc.), sleep disruption, various illnesses, the menstrual cycle or menopause etc.
Even a trivial drug (such as ibuprofen) can disturb the biological mood system and trigger a depression. Reading the package insert to acknowledge a relative risk of depression is enough.
The disruption of the biological mood system reacts through a permanent exacerbation of emotional responses. These patients acknowledge that their reactions are sometimes exaggerated and that it does not take much to affect them.
Biological depression is generally not diagnosed or considered a potential cause of depression, as there is no complete description of the mood system in psychiatry textbooks.
4. Mixed depression (psychological and biological)
Oftentimes depression is mixed, psychological and/or biological, and/or personality-based at once. Mixed depression is the result of a simultaneous disruption of the psychological, personality, or biological mood system, as in the case of a young person undergoing an emotional breakup (psychological cause), who is also borderline (personality-based) and who additionally smokes cannabis (biological cause).
Mixed depression has a less known trait: the disproportional amplification of the intensity and duration of emotional reactions relative to life events (this may appear strange).
This disproportionate amplification of emotional reactions is the mark of mixed depression, as if the biological mood system interfered with the psychological mood system or a personality disorder. This interference in the mood system gives the impression of an internal blockage that many patients complain about.
It is the reason why the main difficulty of depression treatment resides in correctly identifying its causes. This will decide the course and the treatment which can be adapted and effective or not.
The influence of the biological or personality component on mood can affect the entire life, block the person’s potential to evolve throughout their life, and hence this can ruin their life.
In our reasoning, if the cause for depression is psychological, the solution needs to be a treatment of the same nature, as in psychological. A so-called psychological solution would mean starting psychotherapy.
Psychotherapy needs to be carried out intelligently and be exclusively centred on the causes of depression. Childhood-centred psychotherapy is a waste of time if it did not mark the beginning of the depression.
For instance, if a patient falls into depression due to work problems (mobbing or burnout), psychotherapy needs to be focused on work-related issues and not on problems during childhood.
On the other hand, if the cause of the depression is biological, its therapeutic solution needs to be of the same nature, as in biological.
A biological solution requires treatment that works on the biological system in order to improve and balance its functioning.
There are two types of biological treatment (solutions):
- Adequate medication
- Adequate behaviour that modifies harmful conduct from where a disruption of the biological system originates. For example, if the cause of biological depression is cannabis, the solution would be to cease it.
In the case of mixed depression, the solutions are mixed: psychological (psychotherapy) and biological (medications and/or adequate conduct).
The value of our therapeutic intervention is explained by the results we attain. Persistence of depression despite treatment indicates lack of effectiveness and should be questioned.
When treatment is started, the mood parameters need to be measured by means of specific tools. Treatment leading to favourable results ought to be maintained.
Treatment that does not engender positive results needs to be stopped.
It is the main reason that validates the employment of specific tools recording progress and measuring results.
Good results confirm good treatment, whereas bad results should render the treatment doubtful.
Moreover, treatment needs to be adjusted according to various other aspects, such as medication tolerance, side effects, patient preferences etc.
Treatment needs to evolve with clinical progress, by means of a chain of therapeutic interventions which are periodically tailored to the results.
In the therapeutic action, there are two parties making a pact – a rigorous convention, involving commitment and assignments. Without such a convention, results remain random.
Making use of NEOPsy tools is part of the therapeutic effort that the patients and their loved ones are to provide. Caregiver and caretaker alike commit to a process which involves hard work in order to succeed.
The NEOPsy approach organizes its steps in this fashion and focuses its efforts.
Why should the patient, their loved ones and the caregiver mobilize long-term efforts? In order to obtain favourable result or in other words, fight and win against depression.
The results we attain confirm or validate the utility and effectiveness of our effort.
The main obstacle of current psychiatry stems from the fact that results are validated by the caregivers and not by patients and their loved ones. The message that today’s psychiatry conveys is that patients benefited from the best possible treatment and the results are the best they could obtain.
In patients’ and their loved one’s reality, these results engender loss of hope and resignation. And they have no arguments to fight against this resignation.
Measuring and recording results by patients or their loved ones appear to be objective solutions in order to assess the evolution of depression, potential improvement or deterioration, its healing.
From this perspective, we have compiled specific tools to measure mood starting from the treatment onset.
Another important factor, if the patient arrives with a treatment already started, we need to evaluate it with respect to their state, considered to be the direct result of former or current treatment.
If the treatment is adequate, the patient’s state would be favourable. Effective treatment produces lasting positive results, marked by long-term remission of depression and improvement of associated symptoms (anxiety, sleep etc.).
On the other hand, if the person still suffers from a recent or chronic depression despite treatment, we need to analyse it and call it into question, followed by implementing another treatment capable of improving results.
According to the diagnostic handbooks ICD 10 or DSM V, the diagnosis of depression relies on the assessment of 5 symptoms among 9:
- depressed mood,
- lowered interest for activities and lack of joy for pleasurable activities,
- a change in appetite or weight,
- sleep disruption,
- a psychomotor decrease or agitation,
- feelings of lack of value,
- attention or concentration difficulties,
- suicidal ideation.
This diagnosis is very restrictive and does not take the causes into account. However, the key to the problem of depression resides in correctly identifying the causes and their nature. It is as if diagnosing a car problem were to limit itself to a simple acknowledgment that the car broke down, whereas an accurate diagnosis ought to find the cause of the breakdown.
There is no need for this list of 9 manifestation in order to assess a person with depression, while understanding that the mechanisms and the causes for depression remain a priority.
Present day psychiatry does not have a useful model, capable of simply explaining the mechanisms of depression, in order to correctly identify its causes.
It is thus necessary to explore, analyse and disassemble all the potential causes of the depression in order to determine its origins. For instance, mixed depressions have a mixed causality with one or more psychological causes and one or more biological causes, not to mention personality.
Hence, each patient’s depression remains unique, despite a similar appearance, but with different causes.
In order to effectively treat each depression, we need to correctly identify the causes so that each treatment is tailored and cause-specific.
In conclusion, when diagnosing a depression, it is important to determine if the depression is psychological, if it is due to personality, if it is strictly biological or if it is mixed.
It is thus wrong to use the same treatment (psychotherapy and/or antidepressants) for all types of depression.