Depression?

Depression? Depressed?

Depression? Depressed? Sad? Empty? Do you feel drained? Both physically and psychologically? Do you hardly ever feel rested? Do certain thoughts keep running through your mind? Then the article below might bring you some clarity! It is possible that depression is the cause.

What is depression?

Depression is a mood disorder. Therefore, it will mainly ‘attack’ your mood. Your emotional state is stuck in a vicious cycle. Your zest for life is reduced and you feel low-spirited. Most people therefore see depression as a consistent, unhappy state of mind. Because of this we hardly, if at all, enjoy anything anymore. This is correct. What most people do not know, however, is that depression involves more than only this consistent unhappiness. Depression is more complex than just going through a difficult time. More complex than one would initially think.

When can we speak of depression?

What is the difference between depression asend feeling down? Depression has a much larger impact on one’s daily life. You will experience more and more severe symptoms in a depression than you do when you are just feeling down. When you are down, this only lasts a short while, but you will still be able to enjoy fun moments. A depression will make it so that you feel down and unhappy all the time during extended periods of time. Nothing can make you laugh anymore. These symptoms must be present for at least two weeks.

A depression will also have a larger influence on your daily life than when you just feel down. A depression will lead to headaches, worrying, not wanting to leave the house,…. Feeling down does not have such a large impact. You will also notice that your work, eventual relationships, … might be impacted by your depressed feelings. When you are just ‘feeling unhappy’, this does not tend to happen like that.

Sometimes people with depression get to hear:

  • ‘Stop being so dramatic.’
  • ‘It will probably get better soon.’
  • ‘We all have difficult periods sometimes.’

These are of course reactions which do not acknowledge the person with depression. While these reactions might come from people who mean well, they can sometimes break you down even further because you think you are overreacting. If you have depression, it is useful to pay as little attention as possible to such reactions, because it is important to look for help. Once you have had a depression, especially when it has gone untreated, chances are larger that you will have another one.

Later on in the article, the symptoms of depression are explained and the criteria for a diagnosis depression are given according to the DSM (Diagnostic and Statistical Manual of Mental Disorders).

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The prevalence of depression?

Numerous studies have been done on the prevalence of depression. We want to know how often depression occurs. Does depression only exist in our Western society, or is it found in all cultures around the world?

Research by the World Health Organization (WHO) found the following statistics on depression:

  •  350 million people suffer from depression worldwide. Millions suffer indirectly because of depression of family members and loved ones.
  • 1 million people ended their life with suicide during a depression.
  • 1 to 2 mothers out of 10 suffer from pregnancy depression, with negative consequences regarding the care and love for her child as a result hereof. This in its turn has negative consequences for the development of the child.

We can thus conclude that depression is a common problem. Not only in Belgium or the Netherlands, but around the world. Depression is something that occurs in any culture. This does not seem to be so when first looking at it, because in some cultures there is no space for expressing depression.

What these numbers mainly want to show, is that there are more people with depression than one would initially think. In this society it is not uncommon to succumb to daily stress and pressure. If you have a depression, it does not mean that you are ‘weak’ or that you ‘cannot handle anything’. It has to do with other factors, which we will mention later on in the article.

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Science and depression? How do body and mind work together?

Body and mind are in a continuous connection with each other. You will often notice that, for example, psychological vulnerability shows itself in your body and vice versa.

Body                               <=>                              Mind

Depression is connected to certain hormones in the body, namely serotonin, dopamine, noradrenaline, endorphin and cortisol. If these hormones are deregulated, they can cause a depression. Below, we explain the way in which these hormones work and what influence they can have on our body and mind.

The sleep and feel-good hormone serotonin

Serotonin helps us sleep well and makes us feel good. That is why serotonin is sometimes called the ‘feel-good’ hormone. Serotonin does not only ensure a good mood and a proper sleeping pattern, it also makes us feel content, helps our memory and improves our blood pressure. We even find serotonin in certain types of food. The most common example of foodstuff in which serotonin can be found is probably chocolate.

In the following situations an irregulation, with a consequential lack of serotonin, occurs:

  • Constant stress
  • Pre-menstrual syndrome
  • Depression.

If this hormone is off-balance, this can cause binge-eating, headaches, problems concentrating, and a depressed mood. As you can see, it can even lead to the development of symptoms of a depression:

  • Binge-eating
  • Problems concentrating
  • Headache.

As a result, the hormone serotonin can have a large influence on our body and mind and it can cause depression to develop.

Pain disappears and euphoria appears thanks to the hormone endorphin

Endorphins have a pain-killing effect. They make it so that we feel less pain if we were to, for example, bump into something. Endorphins even give us a wonderful, euphoric feeling. Think of an orgasm. The wonderful and relaxed feeling is created by the secretion of endorphins. that an orgasm gives is caused by endorphins. Even when doing sports, endorphins are released.

Just like morphine, endorphins are slightly addictive. That is why you can see sex, or even sport, as slightly rewarding after some time. If many endorphins are secreted at once, you will consider the behavior you were doing at that point to be positive, meaning you start doing it more. That is how some behavior can become addictive.

If this hormone is deregulated, it can cause depressive feelings, pain and depression. A deficit of endorphins means you experience more pain, which is not good for your body nor for your mind. You become more vulnerable.

Reward and stimulation thanks to the hormones dopamine and noradrenaline

These two hormones help with the acquisition and stimulation of habits. Humans are designed to do things that give a reward and they like habits. People keep doing the same things again and again even if it no longer is rewarding after some time, simply because it is a habit.

Dopamine makes it so that certain habits are stimulated and rewarded. That is why it even has a motivational function. Just like endorphins, certain behavior will be rewarded, meaning you will enforce this behavior more often. Together with endorphins, noradrenaline and dopamine help create habits. Here is also the key to your recovery. Habits which you have learned can also be un-learned. This will not always be easy, because breaking the cycle is not seen as rewarding.

Furthermore, dopamine has a close relation with your body. It takes care of motor functions and makes sure that, if too much information is provided, you can still function normally. Your body then filters information, because dopamine reduces certain signals. Dopamine also makes it so that you do not become exhausted when you have to do two things at the same time for short amounts of time.

If there is a dopamine deficit, this can eventually stimulate addictions:

  • Drugs
  • Alcohol
  • Cigarettes

In all these substances, dopamine and noradrenaline are present. This way the addiction is rewarded and stimulated. Except for reward and stimulation, dopamine and noradrenaline also are connected to:

  • Good memory
  • Better performance
  • Euphoria

If too much of these hormones is excreted, you can experience the following symptoms:

  • Heart palpitations
  • Tension
  • Anxiety

That is why the balance of these hormones is extremely important. Both excess and deficits of dopamine and noradrenaline can cause depression. Either you cannot relax, or you become somber. Here, too, we find certain symptoms which are linked to depression:

  • Memory
  • Euphoria
  • Tension

So, you can see that certain hormones are linked to certain depression symptoms.

The stress-hormone cortisol

Learned helplessness explains why our brain ends up in a ‘depression’ at a certain point. What is learned helplessness? Learned helplessness means that you have learned to feel helpless. During a certain time you have learned that you cannot solve your problems. You learned that your efforts are useless. After a while, you then give up, because there is nothing you can do anyway. This forms the basis of depression. Our body reacts to this learned helplessness, worsening the depression.

By feeling learned helplessness for an extended period of time, production of the stress-hormone cortisol in the adrenocortical increases. This was shown by researcher Robert Sapolsky from Stanford University in his lecture at Washington State University on the 10th of October, 2001.

Cortisol also lies at the basis of a burnout. Yet, there is still a difference between depression and burnout, namely that the burnout stage shows an exhaustion of the cortisol production. The values of cortisol in the blood have gone down, there where they often are heightened during a depression.

Cortisol will damage about 25 percent of the cells in the hippocampus. Exactly those 25 percent of the neurons are the ones that contain the cortisol-receptors. The hippocampus is responsible for:

  • Concentration
  • Memory

These functions are therefore affected first. This is the first stage of depression.

In a later stage, the left prefrontal cortex will also start to be affected. This stands for:

  • Positive thoughts
  • Happy feelings

If you do not treat depression, it gets even worse. Then you will already experience the following symptoms:

  • Somber mood
  • No zest of life
  • No more happiness
  • Memory issues
  • Focus issues

If your depression continues even beyond this, the right prefrontal cortex will also be affected. This is responsible for:

  • Negative thoughts
  • Negative feelings
  • Negative experiences

In this last stage, the client becomes apathetic, and they will feel less or even nothing at all. Almost all future-oriented thoughts will have disappeared by then.

We know that learned helplessness is one of the main causes of depression. To work against this learned helplessness, it is important to re-gain your power. Because you feel helpless, you no longer do anything. This habit needs to be turned around. This is the reason why the therapist chooses intervention, where the client re-discovers that they can help themselves.

We want to build up ‘learned optimism’. This principle was described in the book by Martine Seligman.

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 Causes of depression

Depression can be caused by different factors. A depression can therefore have different causes. Because of this, depression will not always require the same type of treatment. It can be so that you know someone with a depression, but that this person gets a different treatment than you do.

To ’cause’ a depression, we also assume that there is an interaction between certain factors present.

Genetic causes                      <=>              Situational causes

Genetic causes make is to that you are more vulnerable to developing certain illnesses. Genes have already been identified, which are linked to the development of depression. So, at birth you can already have vulnerability to the development of certain diseases.

Psychology states, however, that this alone is not enough to get a depression. These genetic causes must be combined with situational causes which occur in our environment, and depression can then develop depending on how you respond to these. An example could be a divorce, loss of job, a fight, …. ‘Situational causes’ regard both your mental and physical response to these situations. Both body and mind are namely constantly developing and cannot be seen to be separate from one another. Your reactions, too, are constantly developing. Depression will develop if something major happens and your do not respond adequately to this, meaning you develop undesirable habits.

Psychological causes can therefore interact with physical causes, which in turn interact with genetic causes.

Are genetic causes always necessary to lead to a depression?

No. Genetic causes are not always at play when a depression is developed. The values which we attach to each type of cause in this article are different per depression. The model above is simply a general model. Your personal situation can therefore deviate from this. What you should keep in mind is that there at least is an interaction between body and mind. If you are depressed, your body and mind will constantly interact with each other and this way it can be so that your body pulls in your mind into a depression, or the other way around. It is important to be aware of this, so that you can get more out of treatment.

To gain more insight into the dynamics which can cause depression, we explain all possible causes more detailed here.

Situational causes? Psychological causes of depression?

Our mind and psychological wellbeing are under ‘situational causes’. Situational causes namely contain an interaction between body and mind and how our mind responds to situations outside of the body. Depression is most often caused by a long-term excess use of the brain and our immune system. This overuse is caused because you experience something extreme and your mind does not know how to adequately respond to it. When speaking of a major happening, we think of situations which you personally experience to be extremely negative. Some examples which could be considered extreme would be:

  • Strongly increased pressure at work
  • Financial difficulties
  • Family issues

Not everyone will experience these situations in the same way, but we are speaking of subjective experiences rather than objective experiences. This means that situations can be considered very negative because that is what you feel regarding it. It can be so, for example, that your job means everything to you. Then you will find your dismissal much more difficult to deal with than someone who does not care about their job.

Except for the experience, it is important how you deal with it. Your mind picks, from past experiences and belief in your own capacities, the reaction which it deems most suitable. If you develop a depression, it often means that you have chosen for the reaction ‘learned helplessness’. This means that your mind does not quite know what a suitable reaction would be, meaning it develops the feeling that it cannot do anything about it. To give a practical example, you will be likely to stay in bed and worry about what you could possibly do.

So are you weak if you have a depression?

We want to make it clear that this is not a typical reaction in people who are ‘weak’. That has nothing to do with it. A depression is caused by a shocking event and a ‘non-suitable reaction’ to this. This reaction is formed by your prior experiences and your ability to solve things. It can be so that you are so shocked by the experience that you no longer believe in your own capacities. This will affect your ability to find solutions and can bring you to worrying. This state of worrying pushes thoughts through your mind in such a speed that the part where solutions are made and action is taken is simply skipped. This way you end up in a vicious cycle, because you exhaust your brain so that it no longer can find efficient solutions. This of course then has a detrimental effect on the belief in your own capacities.

The development of a depression therefore has nothing to do with a ‘weak reaction’ but rather with a ‘non-useful reaction’. Everybody happens to have a less useful reaction to some major event at some point. It then is your responsibility to pull yourself back together and to calm down your mind, so that you can look for a suitable reaction. With this, we can help you.

Situational causes? Physical causes of depression?

Physical causes are part of the category ‘situational causes’. As seen earlier, they can interact with psychological factors and genetic factors and then lead to a depression.

What is the role which physical causes play? The body can have quite a large influence on the development of depression. Psychological factors can namely be found in your body after a while. That which we experience in our mind, can influence our body. For example, stress can make our immune system decrease its use, meaning we get ill more easily.

Physical factors can thus be a result of that which our mind experiences, but it can also trigger problems in our mind. Examples could be found in the excess of certain chemicals or the deficit of certain chemicals.

  • Specific medication
  • Hormonal changes (after pregnancy)
  • Long-term deficit of sunlight on the cornea
  • Deficit of Vitamin D or Omega 3 fatty acids (EPA and DHA)

The list above shows common problems, which are experienced by people with a depression.

What we have not yet talked about in this article is how an illness can affect our mind in a depression. People with chronic pain or a chronic illness have increased chances of experiencing depression. Their body is namely exhausted which makes it difficult to integrate your new body image in what you want to do. People with migraine, for example, find it difficult to accept that migraines can sometimes suddenly appear, causing them to have to cancel their plans. After a while you can then start to feel like your illness stops you from having fun. You have the feeling that it controls your life. For some people this can be so overwhelming that they experience symptoms of depression.

Genetic causes of depression?

In some forms of depression, the main cause is hereditary/genetic. What do we mean by this? As mentioned earlier on in the article, research has been done and ‘depression genes‘ have been identified. This means that, if you inherit a certain ‘depression gene’ from your parents or eventually your grandparents at birth, you have an increased risk of developing depression. This is something that should be diagnosed by a doctor or psychiatrist. You may not speak of genetic causes in depression with no real reason. You namely need to be certain about whether genetics could be a cause, as this has an impact on your treatment.

If you are diagnosed with a ‘depression gene’, the rule in general is to administer both psychopharmaceuticals (antidepressants + Lithium) and follow intensive therapy. This is also a general rule. Your personal situation might deviate from this. If you have been diagnosed with a ‘depression gene’, you can speak about your treatment with a doctor or psychiatrist for the most useful answers.

Recent research has shown that about 50% of the population could have some variety of the ‘depression gene’. This makes them more vulnerable to depression than the other 50% of the population. Yet, not all these people have a depression or the same type of depression. With this we want to let you know that a gene does not necessarily mean that a depression will be led to. If you have a ‘depression gene’, your environment will also have a large influence.

Am I doomed to develop depression with genetic causes?

Oftentimes, people who read the paragraphs above believe that they are doomed to develop a depression. Genes can cause vulnerability, but they cannot doom anyone to developing certain diseases.

“Genes are rarely about inevitability, especially when it comes to humans, the brain, or behavior. They’re about vulnerability, propensities, tendencies.”

– Robert Sapolsky, Why zebra’s don’t get ulcers.

This quote wants to show that a genetic predisposition for a certain disease, even for a depression, will not mean that the gene will actually be expressed. He even says that you need to work hard in order to develop a depression. Work? It namely costs a lot of effort to keep up the habits which stimulate a depression, in order for the depression to remain present.

Do you think you might have a depression? Then consider the following question:

‘Do you feel fatigued and exhausted? Do you feel like you are mentally empty?’

For many people, the answer to this question will be ‘yes’. The effort you put in keeping depression stimulating habits going is tiring and exhausting. Some of these habits can be:

  • Worrying
  • Constantly blaming yourself
  • Thinking that you cannot change anything about a situation

These thoughts require a lot from our brain and self-image. It is thus tiring and exhausting to work that hard to keep a depression up. This ‘work experience’ is put into words by the professor as follows:

“If I had to define a major depression in a single sentence, I would describe it as a genetic/neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets.”

-Robert Sapolsky, Why zebra’s don’t get ulcers.

If you need to work that hard in order to keep up your depression, you can also take your depression into your own hands and heal it. You can learn to oppose ‘learned helplessness’ and to change depression stimulating habits into happiness stimulating habits. How you can do this exactly, you will read at the end of this article.

The only exception as to when you do not have full control over your own depression without needing medication to cure your depression entirely, is generally bipolar depression. All other people with other types of depression are capable of taking care of their own depression and to choose healing.

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The symptoms of depression

Except for somber feelings there can be many more symptoms that point at a depression. As mentioned earlier, a depression can influence both your mind and your body. Thus, we can divide up the symptoms of depression into two categories: psychological symptoms and physical symptoms.

Psychological symptoms of depression

  • Irritability in depression: Everybody is irritable at times. But with depression, this occurs more often than usual. You can get annoyed about anything. For example, a television commercial. This irritability is sometimes referred to as ‘psychological discomfort’. The irritability seems to become a habit. There is a deeper cause of this irritability, namely depression.
  • Guilt and scaredness in depression: Everyone feels guilty sometimes after having done something bad. A depression makes it so that you believe that ‘anything that goes wrong’ is your fault. You no longer see anything positively. People are scared sometimes, too, but then there is a reason for this. In a depression, one experiences fears, for which there is no clear reason. Others do not find there to be a reason for this scaredness. For example, going grocery shopping.
  • Having fewer feelings in a depression: It sometimes seems as if you have fewer emotions. Things do no longer seem to get to you when you have a depression. For example a fight with friends. Sometimes it makes you feel like you are a bad person, because you no longer feel like you care. This means you might start avoiding people.
  • Thinking negatively about yourself in depression: Nobody thinks that they are perfect. Everyone wants to change something. Yet still, most are pleased with themselves. With a depression you think very negatively about yourself. You feel worthless. You can find yourself ugly, unattractive, stupid, uninteresting, … for example.
  • Insecurity in depression: Because you think so negatively of yourself, you become insecure. If you find yourself ugly, it is hard to go places. You feel like all eyes are on you. In other situations you also avoid attention when you have depression. For example, in class you do not dare to raise your hand. You are scared of making a fool out of yourself.
  • Thinking that everything is meaningless in depression: When you have depression, you feel like everything is meaningless. For example your job, hobbies, or even your relationships with others. You find life in itself meaningless. The thought often goes: “Why does it matter, it is all meaningless anyway”. As a result you feel unmotivated and do not do anything.
  • Trouble concentrating in depression: With a depression, it can be hard to stay focused. For example, you cannot read a book or watch a program on television. Having a conversation can also be hard when depressed. That which is said is forgotten immediately. You do not retain any information. This means that you can seem absent when with company.
  • Guilty thoughts in depression: With depression, you feel like you are not good enough and that you therefore will often fail. For example, at work. These thoughts can also be about the past. You can, for example, feel guilty about forgetting a birthday of a friend.
  • Worrying in depression: You can think of a certain problem or situation for a very long time if you have a depression. Even about small things. You cannot stop this and keep thinking about it. Your mind goes in circles. This often happens at night, but it can also happen during daytime. Worrying can be about anything in depression. Different thoughts and problems then intertwine. This causes a confusing storm of unhappy thoughts, which is hard to get out of. This is what we call worrying.
  • Putting off making decisions in depression: When you have a depression, you have a hard time making decisions. These can be about simple things, such as what groceries to buy. Making important decisions is even harder. This is why you put off making them, meaning they are often not made at all.
  • Slow thinking in depression: Your thoughts move slowly or even stay completely still when you have a depression. You stop thinking. When someone asks you: “What are you thinking about?” the answer often is nothing. That seems odd, but it still is an honest answer when you have a depression. It can go as far as that you live in a type of thoughtlessness. You then no longer have any thoughts.
  • Doubting the meaning of life in depression: When depressed you can feel less happy about living. You think: “It does not change anything, my life is useless.” Sometimes, these thoughts lead to suicidal ideation.

Physical symptoms of depression

  • Headaches and other complaints of pain in depression: Headaches are a very common symptom of depression. Usually, it is because you are very tense when you have a depression. Other complaints can be a feeling of pressure in the chest region, the feeling of having a stone on your heart, a knotted stomach, heart palpitations or hyperventilating.
  • Problems with sleeping in depression: People with a depression can have trouble sleeping. You can have a hard time falling asleep, because you lie awake worrying, tossing and turning instead. When you do fall asleep, you sleep lightly and keep waking up. You do not feel rested. It can also be so that you can easily go to sleep, but wake up too early. This means you sleep short nights.
  • Problems with eating in depression: With depression, you lose your appetite or food loses its flavour. This causes weight loss. Eating less is not the only way to go. In some cases, people with depression eat more. Through eating, they often feel better. This feeling disappears quickly. By eating more, you will gain weight, and this can lead to even more unhappiness. This worsens the depression.
  • Tension in depression: When depressed, some people can feel very tense or stressed. Even when you are alone, you can feel like you are under pressure. Your hands are cold, your heartbeat is speeded and you feel anxious. When other people are around, this feeling often worsens. Especially when something has to be achieved. This tenseness can lead to complaints such as headaches, stomach aches or a feeling of pressure on the chest.
  • Loss of energy with depression: Loss of energy, too, is a symptom of depression. You feel apathetic, weak, and do not feel like doing activities which you used to like. This feeling starts upon getting up. You want to stay in bed all day and not do anything.
  • Slowness or unrest in depression: With depression, it is possible that you think, speak, or react more slowly. Sometimes you can spend time silently stare at nothing. It can also be the other way around. You can be very restless, being unable to sit still, speaking fast, being confused, and moving hangs and legs. This is also called ‘agitation’.
  • Less or no need of sex in depression: You do not feel fit, and get tired and listless easily in a depression. This means you have a lesser need for sex.

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When do we speak of a depression?

To diagnose depression according to American insurance companies, so that there are financial consequences, the DSM uses the following guidelines:

  • At least five of the symptoms above of depression must be present.
  • For at least two weeks.
  • The symptoms must cause significant suffering.
  • Symptoms may not be caused by a medical issue, grief, or an addiction. For example, you can experience symptoms of depression with the use of certain medication. The cause is then not depression, but rather the medicines.

If the above criteria are all checked off, we can speak of a depression.

Symptoms for at least two weeks?

A depression and its symptoms cannot easily be solved. It seems like they just will not go away. Depression takes much longer than other unhappy or negative moments which you have had. It will also fully consume you. If something funny happens, you will no longer have the energy to laugh about it. As mentioned before, depression is more complex than simply feeling unhappy. Because depression is difficult to get rid of, there are certain consequences. THe depression will have a larger and larger influence on our daily lives.

We can give an example to clarify this. It can be so that you enjoy going out with friends. A depression might make it so that you isolate yourself more and more. You no longer want to go out. The depression starts to limit you. It blocks you from going out with friends.

Significant suffering in depression?

According to the DSM guidelines, depression should cause significant suffering. What is meant by that? To speak of significant suffering, you are no longer able to do things which you used to do. Here we do not only talk about things which you liked doing, but also about daily tasks. Examples are:

  • Work tasks
  • Cleaning
  • Buying groceries

If you are depressed, you will often forget things or no longer have the energy to do these things.

To speak of a significant suffering, depression must also influence more than one part of your life. Such areas of life include:

  • Work environment
  • Family
  • Hobbies
  • School
  • Friends

More than one of these areas of life needs to ‘suffer’ from your depression. That means that you no longer do the tasks or even the fun things that are part of these areas of life. You stop putting effort into your job, or stop going to play tennis. In the end it is so that you want to be home alone as much as you can be, due to your depression.

Significant suffering with fewer than 5 depression symptoms?

Is it possible to significantly suffer in a depression without having 5 of the depression symptoms mentioned earlier? Definitely. The DSM has this rule, but that does not mean that you cannot suffer significantly with fewer symptoms. When looking for treatment or a cure, it is useful not to look for a diagnosis but rather for what it is that you need. Diagnosis can be different from manual to manual, but that does not increase or decrease your suffering.

Even without a diagnosis you can choose to deal with your suffering. You can choose to win back your joy of life by breaking out of unwanted habits.

Symptoms cannot be caused by medical illness, grief, or addiction?

It is useful in a ‘diagnosis’ of depression to keep this rule in mind. Certain medication or even certain illness can namely trigger depression symptoms. This we may not confuse with a depression which can be caused by chronic pains. In that last case it might be so that you become depressed after a while due to the influence which chronic pains have on your life and body. When speaking of medical illnesses of which the symptoms may not be confused, we consider the medical symptoms of the disease. For example: a medical issue can cause the following symptoms:

  • Issues focusing
  • Memory problems
  • Thinking slowly
  • Being agitated

You see that these technically are symptoms of a depression as well, but yet we may not consider a depression here. The symptoms are namely not caused by how we feel about the illness, but instead it is the illness itself which causes the symptoms.

Certain types of medication, too, can cause the symptoms above. In that case we may not speak of a depression either, because it is the medication which triggers the symptoms. However, something that could indicate a depression is that you become depressed by taking the medication, because you dislike taking it. Think about people who must take a lot of medication each day. By taking in this medication they find it difficult that there are certain things they can no longer do, things they did want to. This is a psychological consequence of the medication and is therefore not a side-effect of the medication.

Grief and depression? Are you not always depressed in grief? No. It is important to differentiate between these two. In grief we speak of natural symptoms which someone experiences after losing a loved one. Everyone experiences grief when they lose someone who meant a lot to them. Thus we may not simplify this, because otherwise everyone would have had a depression at some point in life. Natural consequences of losing a loved one are not under the diagnosis depression.

What does a depression have to do with addictions? Addictions can cause feelings of depression. For example, if you are a heavy drinker and you want to stop with this but you do not ‘feel strong enough’ or have the feeling that ‘you cannot change anything with it anyway’. In spite of these being depressed feelings, we do not speak of a depression here, as the main problem is the addiction. The addiction causes these feelings, not a depression. A depression can, for example, cause an addiction, but we do not speak of a depression that is caused by an addiction. If an addiction is at play, the addiction should be treated first. Once the effects of this addiction have been removed completely, the situation can be evaluated again.

Is this difference important?

No. This is a differentiation that is used in a certain manual in order to set a diagnosis. Does this say anything about the suffering which you experience, or your options to heal yourself? No. You, yourself, can change something about the situation in which you are. It does not matter whether this situation consists of depression, grief, addiction,…. The most important thing is that you acknowledge your suffering ad look to find out how you can cure yourself.

Take the free depression test.

What are the different types of depression? Forms of depression?

There are different types of depression. We will list the most important ones here below.

A minor depression?

To have minor symptoms, at least 2 of the depression symptoms above must be present and control your life for at least 2 weeks. A minor depression is a known and less severe form of depression. In this form of depression, too, suffering is experienced.

A major depression?

In a major depression, you need to experience at least 5 depression symptoms. These symptoms must, just like in a minor depression, be present for at least 2 weeks. A major depression is less well-known than a minor depression is, yet a large amount of people do experience a major depression.

One prerequisite of a major depression is that you may only experience one depressed episode. If you experience more than one episode, however, there is another form of depression at play.

A chronic depression?

In the case of a chronic depression, the depression symptoms above occur more than once. This means that people experience more than one depressed period, when speaking of a chronic depression. Between these depressed episode, there must be an interval of at least 2 weeks. During this interval period, you may not experience any depressed symptoms.

A dysthymic disorder?

This type of depression is generally experienced as one of the less invasive types of depression. A dysthymic disorder namely is a type of depression where the somber mood needs not be present. That means that you can still experience happiness with a dysthymic depression, as opposed to other sorts of depression. The depressed mood, however, must be present more often than the experiencing of happy moments While the depressed mood is not constant, we do still consider suffering. Here, too, treatment can help you in order to deal with your symptoms.

A manic depression?

To have a manic depression, the depressed episodes will be in between manic episodes. During these manic episodes you can experience euphoria or a lot of agitation. During these manic periods you feel like you can rule the world and that nothing can hurt you. However, the depressed episodes last longer than the manic episodes do. During these depressed episodes, you will experience depression symptoms.

A treatment for a manic depression can look different than a standard depression treatment does.

Other types of depression?

There are also other forms of depression, which could involve hormones or physical processes. Examples of such depressions are:

  • Postnatal depression
  • Seasonal depression, such as a winter depression
  • Depression linked to menstruation

Take the free depression test.

Depression in children? Can depression also occur in children?

Unfortunately, depression is also common among children. Depression in children is characterized by many of the same symptoms as depression in adults is. Yet, there are important differences that can be seen in depression in children.

Aggressive behavior or isolating themselves?

Depression in children will not only manifest itself with a general sad mood. Children namely do not always know how to deal with certain emotions and therefore depressed behavior can be different in children from how it si in adults. Boys, for example, will show more aggressive behavior in depression. Girls will isolate themselves and hardly communicate any longer.

Somatic complaints in children?

Because children are more vulnerable than adults are, depression can have a large influence on the body of the child. For example, the child can experience stomach complaints caused by depression. This occurs more often in children than in adults, because children are more physically vulnerable.

Playing with a depressed child?

Playing is a sort of outlet for children. At the hand of playing they get to know themselves and their environment. Children also use games to sort out certain thoughts and feelings. If your child is depressed, it will not play as much as it used to. Children with depression namely lose the will to do anything and do no longer feel safe enough to discover themselves and their environment.

How can I help my child as a parent?

As a parent you of course want the best for your child and you want to help your child to deal with difficult situations. In depression, too, parents often want to help, but they most often are unsure as to how to do so. Depression is namely a delicate topic and it makes children more sensitive to certain ways of handling it.

Generally, people think that listening to their child helps. In many cases this is true. Open communication is important and give the child the feeling that they are being supported. Sometimes, however, parents can get too involved and get angry or sad about what their child has to tell them. In that case it can be so that the child no longer tells the parents about these types of things, because they do not want to upset their parents.

Some parents punish their child if it shows aggressive behavior. It is a good idea to clarify to one’s child that inappropriate behavior is not condoned. However, punishment does not work in a depression. That way, you namely only treat the symptoms rather than the depression itself.

Also, some parents think that if they cannot change the cause of the depression, that there is nothing they can do to help the child. In treatment there is generally a focus on the treatment of the problem as well as on the acceptance of the problem. With acceptance we do not mea that the depression should not be treated, but we would rather want to point out that it is okay to feel that way. From this experience, caregivers then try to formulate a ‘plan of attack’ regarding how to handle these feelings and how to once again find happiness.

Depression in children: treatment?

Just like in adults, a child is welcome at a psychiatrist or psychologist for dealing with the depression. Parents generally are important supporting figures in this progress. Except for these traditional forms of care giving, a child can also follow the online self-help program. This program was developed by doctors and psychologists in order to help children from their home in dealing with their depression. Children from 13 years of age upward with a large vocabulary can follow the online program, with some help now and then for eventually difficult vocabulary.

Take the free depression test.

Depression in seniors? Does depression also occur in seniors?

Depression in seniors can most definitely occur. People at a later age namely have to deal with many changes. The children move out, they start their pension, they lose their partner. In short, these changes are not always easy to deal with. Many seniors also notice that they cannot do as much as they used to be able to do, which can sometimes also have a large influence on their general wellbeing.

Symptoms of depression in seniors?

Symptoms of depression in seniors are very similar to the symptoms of depression in adults. Just like the latter category, at least 5 symptoms of depression must be present during at least a 2 week period before the diagnosis ‘depression’ can be made.

Seniors are, on top of that, in a category which is more vulnerable physically. It can often be so that seniors with depression experience more pain and more physical complaints.

Dementia or depression?

Just like how burnout and depression are very much alike each other, the symptoms of depression and dementia have a lot in common. Often the problems are said to be dementia, while there really is a depression at hand. Not every center has the option of taking specialized tests which show the difference between depression and dementia. However, sometimes it is seen that when the depression is treated, the dementia also suddenly disappears.

Depression in seniors: treatment?

Just like depression in adults, there are different ways of treating a depression in seniors. There is traditional treatment, such as the help of a psychiatrist or a psychologist, but there also are newer types of treatment, such as the online self-help program on “15Minutes4Me.com”. This program can be followed daily from home, so that the patient do not need to move. Still, they will work on themselves on a daily basis in order to treat the depression.

Click here to take the free depression test.

How can I treat a depression? How do I deal with a depression?

If you feel like the mentioned depression symptoms apply to you, then it is possible that you actually do have a depression. You are then not supposed to just put the label of depression on someone just because they are having a difficult time. For that reason it is necessary to get professional help, when looking for a depression diagnosis. Only a psychiatrist has the power to set a diagnosis.

What can be done about depression? How is it treated and where do we start? Many people do not know where to start. It is difficult to put one’s finger on a depression. An additional problem is that you have no will to do anything when you are depressed because the depression whispers in your ear: “You will fail anyway.”. Treating depression is therefore not always easy.

It is often difficult to take the first step toward treating depression. Yet, it has been shown that looking for help is important in a depression, because there is a large chance of relapse. After a first depression, there is a 30% chance of relapsing. After a second depression, this chance increases to 75%. After a third depressed episode, the chances have risen to 90%. Treating depression is therefore useful, in order to reduce the chance of relapse.

Despite these numbers, people often do not find their way to care. Research from the KULeuven shows that only 14% of people with depression without any procrastinating behavior ended up in care in the same year in which the disorder first showed up (Bruffaerst, Bonnewym & Demyttenaere, 2008). All the others did not look for help at all or only years later. In short, treating depression sometimes is easier said than done.

We can help you to take a step toward care provision and to break out of the vicious cycle of depression. Together we find a solution for depression. Together we look at how to treat depression.

Below we give possible forms of care giving for the treatment of depression, with the general pros and cons for certain forms of depression.

Treating depression? Can I be helped by a psychiatrist?

You can ask for the help of a psychiatrist if you believe that you suffer from a depression. They are also the only person who can and is allowed to set a diagnosis. So, if you are looking for a diagnosis, a psychiatrist is definitely a good idea. Furthermore, a psychiatrist has mainly had a medical education. That is why many psychiatrists prefer to pick medication as treatment rather than eventual psychotherapy. Unless they have also done a therapy course, psychological help needs to be found elsewhere.

Some forms of depression are also treatable with the help of medication. In some types of depression this can take longer than in other types. If the cause of your depression is generally based on genetic and physical causes, medication is difficult to exclude from the treatment. A treatment without medication in physical and genetic forms is depression is hardly effective at all.

Antidepressants? What are possible antidepressants in treatment of depression?

Psychiatrists ar allowed to prescribe antidepressants.

In treatment for depression, there are many different types of antidepressants, which can help you. Which type of antidepressant you should take, depends on which form of depression you have and how the antidepressant will work together with other forms of treatment.

To give an overview of the types of antidepressants which can be found on the Dutch market, you find the names of the antidepressants below as well as the dosage in which they are generally prescribed.

Specific serotonin re-uptake inhibitors (SSRIs)

Naam Dosage
Citalopram up to 50 mg per day in one dosage
Escitalopram up to 20 mg per day in one dosage
Fluoxetine up to 60 mg per day in one dosage
Fluvoxamine up to 300 mg per day in one or several dosages
Paroxetine up to 50 mg per day in one dosage
Sertraline up to 200 mg per day in one dosage

Selective noradrenaline re-uptake inhibitors (SNRIs)

Naam Dosage
Reboxetine up to 10 mg per day in 2 dosages

Tricyclic antidepressants (TCAs)

Name Dosage
Amitriptyline up to 150 mg per day in 3 dosages
Clomipramine up to 150 mg per day in 2 or 3 dosages
Dosulepine up to 150 mg per day in 1 to 3 dosages
Doxepine up to 150 mg per day in 1 or several dosages
Imipramine up to 200 mg per day in 3 dosages
Maprotiline up to 150 mg per day in one or several dosages
Nortriptyline up to 150 mg per day in 2 or 3 dosages; in seniors up to 50 mg per day

Non-selective serotonin and noradrenaline re-uptake inhibitors (SNRIs)

Name Dosage
Duloxetine up to 60 mg per day in 1 dosage
Venlafaxine up to 225 mg per day in 1 dosage

 Non-selective dopamine and noradrenaline re-uptake inhibitors (SNRIs)

Name Dosage
Bupropion up to 300 mg per day in 1 dosage

Depression: treatment? Can I be helped by a psychologist or psychotherapist?

A psychologist or psychotherapist can help you in the treatment of your depression. They cannot diagnose anything, but they can select a suitable therapeutic treatment based on your symptoms. Therapy forms which are often used in depression are forms linked to cognitive behavioral therapy. Here you learn to re-structure your thoughts regarding depression and to clear out space for thoughts which can help you move forward.

A treatment with a psychologist or psychotherapist is very useful for psychological causes and some physical causes. From research it has been shown that psychotherapy is a very effective form of care provision in major depressions and a good supplement in the case of genetic forms of depression.

Depression: treatment? Can I be helped by an online self-help program?

People often believe that an empathetic conversation with a doctor or therapist is the only way to get out of a depression. For a long time this was also believed to be true in scientific circles, as all studies were focused on the importance of the role of empathy in therapy. New research, including that my American researcher Scott Miller, show that empathy is mainly used to get commitment from a client. This way the client makes it clear to themselves that they want to change something about the situation in which they are in.

When this decision of getting help has been made, the client must be guided with the right questions. Less important is whether this guidance comes from a person or a computer. From results we have namely found that depression reduces by up to 50% after the first three weeks of usage of “15Minutes4Me.com”.

We based the development of the online self-help program “15Minutes4Me.com” on therapeutic techniques. This program has a cognitive and solution focused type of techniques at the basis in order to bend undesirable habits in depression, stress, and burnout into happiness stimulating habits. The program and the free self-test cannot set any diagnosis. The program works easier than some forms of psychotherapy so that people with minor forms of depression, who find the step to finding help difficult to take, also have a chance of getting treatment. To work on getting better more quickly, you are welcome at our online program. From current statistics, it has namely been shown that it takes just as long to find a psychologist and make an appointment as it does to feel 50% better at the hand of the program.

This program does not have the goal of replacing psychotherapy, but rather is an alternative and eventual complement to current psychotherapy. You can also follow this program combined with psychotherapy or treatment from a psychiatrist, to work each day on your positive improvements. If you follow more than one type of care, you should let your treating psychiatrist, psychologist, doctor, or psychotherapist know, so that they kan keep a full picture of your treatment.

You can also invite family members into the program to support you. We teach them how to support you. We also help them to understand you better. However, you do not have to invite them. The program simply offers the option so you can eventually work on your recovery together with your family members.

Take the free depression test.

Depression: treatment? Do the depression test!

There exist different possible types of depression tests. Would you like to know to what extent you experience certain symptoms of depression or to what extent symptoms of depression influence your life? Then you can fill out our free depression test here. This test consists of about twenty questions and takes 5 minutes to fill out. After the test you integrally are sent to a page with your personal scores, which will then help you to construct the following steps into treatment.