Feeling down at different times of our lives is normal. Stress, relationship struggles, and upsetting events happen to everyone. But, if you’re feeling down or hopeless on a regular basis, you could be dealing with clinical Depression. Depression is one of the most common types of mental illnesses and impacts between 15-20% of people. This disorder affects how you feel, think and behave and can lead to a variety of emotional and physical problems.

Clinical Depression is considered a serious medical condition. It isn't a sign of weakness and you can't simply "snap out" of it. But don't get discouraged. Many people with Depression start feeling better in just a few weeks by implementing lifestyle changes, counselling, and maybe even medications.

A concerning symptom of Major Depression Disorder is feeling like you “want to die”, “for this to end”, or that “you can’t take it anymore”. If you think you may hurt yourself or attempt suicide, call 911. Also consider these options if you're having suicidal thoughts:

• Call your doctor or Depression Counsellor.
• Call a suicide/crisis hotline.
  • Anywhere in BC 1-800-SUICIDE: 1-800-784-2433
  • Fraser Valley crisis line 604 951-8855
• Reach out to a close friend or loved one.

How Depression Affects the Brain

No one knows for sure what causes Depression. However, studies have uncovered how differences in the brain’s structure and chemicals may contribute to this disorder. In addition it also seems that having Depression changes your brain:

• Cortisol and memory. Part of the brain called the hippocampus releases the hormone cortisol when you’re stressed or Depressed. When your brain gets flooded with cortisol for long periods of time, it can slow or stop the growth of new neurons in the hippocampus. This results in the hippocampus shrinking in size, which in turn leads to memory problems.
• Cortisol and the amygdala. The influx of cortisol triggered by Depression also causes the amygdala to enlarge. This is a part of the brain associated with emotional responses. When it becomes larger and more active, it causes sleep disturbances, changes in activity levels, and changes in other hormones.
• Brain inflammation. It isn’t yet clear whether inflammation is a trigger for Depression or Depression causes inflammation. But, studies clearly show that people with Depression have more inflammation in the brain. Brain inflammation can worsen Depression symptoms, interfere with neurotransmitters that regulate mood, and negatively impact learning and memory.
• Hypoxia. Hypoxia, or oxygen deficiency has also been linked with Depression. Inflammation, injury to and death of brain cells are the result. In turn, these changes in the brain impact learning, memory, and mood.

Types of Depression

Depression can be broken into categories depending on the severity and duration of symptoms.

Major Depressive disorder (MDD)- For many people with MDD, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. It is characterized by persistent feelings of sadness, hopelessness, and worthlessness that don’t go away on their own. In order to be diagnosed with MDD , you must experience 5 or more of the following symptoms over a 2-week period:

• Feeling Depressed or Depression with anxiety most of the day
• Anhedonia- a loss of interest in things that would normally bring pleasure
• Significant changes in weight or appetite
• Sleep disturbance and fatigue
• Physical feelings of being slowed down or restlessness, jumpiness and edginess
• Excessive feelings of guilt or worthlessness
• Diminished concentration and inability to think clearly and/or make decisions.
• Recurrent thoughts of death or suicide
• Unexplained physical pain/problems, such as back pain or headaches

Men versus Women

The symptoms of Depression can be experienced differently among men and women. Depression is more common in women, though the gender difference diminishes with age in Canada. Many hormonal factors may contribute to the increased rate of Depression in women, particularly during times such as menstrual cycle changes, pregnancy and postpartum, miscarriage, pre-menopause and menopause.

Men with Depression typically have a higher rate of feeling irritable, angry and discouraged. This can make it harder to recognize Depression in men. The rate of completed suicide in men is four times that in women, although more women attempt suicide.

Persistent Depressive disorder (PDD)- used to be called dysthymia. It’s a milder, but chronic, form of Depression. In order for the diagnosis to be made, Depression symptoms must last for at least 2 years.

Major Depressive Disorder with seasonal pattern (SAD)- is a type of depression that occurs during the same season each year. It usually happens in the fall or winter, but some people may experience season-linked symptoms in the summer. This disorder is more common for women and people who live either far North or South of the equator.

SAD appears to be triggered by changes in the amount of sunlight. Changes in light are hypothesized to upset a person's biological clock, which controls sleep-wake patterns and/or disturb neurotransmitter (e.g., serotonin, dopamine) functions.

Postpartum Depression (PPD)-is different from the “baby blues,” which begins within the first three or four days of giving birth, requires no treatment and lifts within a few hours or days. PPD is a deeper Depression that lasts much longer. It usually starts within the first month after childbirth (although it can occur any time within the first year) and can last weeks to months. In more serious cases, it can develop into chronic episodes of depression.

Signs of depression are often missed in new mothers because significant changes in sleeping patterns, interests, cognitions, energy levels, moods and body weight are a normal part of new Motherhood. New Mothers often resist acknowledging these signs even to themselves because of the pressure to meet societal expectations of what it means to be a “good Mother,” including how she should be feeling, thinking and behaving.

Bipolar depression- People with Bipolar Disorder may experience significant mood swings. Individuals with Bipolar 2 typically experience a varying range of high energy (manic) episodes to low energy episodes. In Bipolar 1 the individual only has the presence of mania. If Bipolar Disorder is treated, many will experience fewer and less severe symptoms of depression.

Broadly speaking, Bipolar mania can be characterized by some or all of the following features:

• Changes in thought patterns
• Development of psychosis
• Impaired judgment
• Mood changes3
• Speech disruptions
• Sudden changes in energy and activity

Depression and Anxiety

Almost 70% of individuals struggling with Depression experience anxiety. Depression and anxiety often go hand in hand. Though they’re thought to be caused by different things, Depression and anxiety share some common treatments. They can also produce several similar symptoms, which can include:

• irritability 
• difficulty with memory or concentration 
• sleep problems
• social withdrawal
• ruminative, rigid catastrophic thinking 

What causes Depression?

Many factors can influence feelings of Depression. The causes of Depression are often tied to other elements of your health.

• Family history. You’re at a higher risk for developing MDD if you have a family history of Depression or another mood disorder.
• Early childhood trauma. Traumatic events affect the way your body reacts to fear and stressful situations.
• Brain structure. There’s a greater risk for Depression if the frontal lobe of your brain is less active. Chemical deficiencies are also a major contributor.
• Medical conditions. Certain conditions may put you at higher risk. These illnesses may include insomnia, chronic pain, endocrine deficienceies, or attention-deficit hyperactivity disorder (ADHD). Neurological changes and reactivity to chronic illnesses may also be important factors.
• Substance use- About 21% of people who have a substance use problem also experience Depression.
• Major stress and or change- Chronic stress has a way of wearing a person down. Also sudden and drastic changes/loss can leave someone feeling destabilized and overwhelmed. A lack of healthy self care routines and support network plays a role in how a person manages in these difficult times.

How do you get tested for Depression?

There isn’t a single test to diagnose Depression. But your Doctor or Psychiatrist can make a diagnosis based on your symptoms and a psychological evaluation. They will ask you questions about your mood, physical functioning (ie. appetite, sleep pattern, activities), and thoughts.

Because Depression can be linked to other health problems, your healthcare provider may also conduct a physical examination and order blood work. Sometimes issues such as thyroid imbalances or a vitamin deficiency can trigger symptoms of Depression.

Counselling for Depression

Talk Therapy by a qualified Depression counsellor is an effective treatment for Depression. Depression can affect a person's ability to solve problems. It impacts concentration, makes it difficult to see problems realistically, lowers energy levels, and is so overwhelming in itself that other aspects of life are often ignored. Working with a Depression therapist can help you to problem-solve during this difficult time. Research shows that people with depression feel better faster when treatment includes both medication and counselling. This is because antidepressants change your brain chemistry in a way that makes you more receptive to talk therapy.

Studies also indicate that Depression counselling can alter brain structure and help relieve Depressive symptoms. Specifically, counselling appears to strengthen the prefrontal cortex. Here are some of the benefits of working with a counsellor:

• Helps ease everyday stressors
• Provides education about the causes of Depression and helps create a plan to decrease the chances of another Depressive episode.
• Offers new perspectives on problems.
• Identifies Depressive thinking patterns, so that you can counter negative thoughts and think more realistically.
• Helps with treatment and medication compliance.
• Increases understanding of medication side effects and how to manage them.
• Reconnects you to healthy life activities that have helped improve your mood in the past.
• Identifies destructive patterns of coping such as isolation, drugs, and alcohol.
• Aids in developing effective strategies for how to share your experience with people in your life.
• Encourages connection and decreases isolation.
• Helps catch early signs that your Depression is worsening.

Medical Therapy for Depression

Living with Depression can be difficult, but treatment can help improve your quality of life. You may successfully manage symptoms with one form of intervention, or you may find that a combination of medical treatments and lifestyle therapies works best.Talk to your Doctor or a Depression counsellor about possible options.

Doctors may prescribe medications that can fight the negative effects of Depression by helping to balance the chemicals in the brain. These include:

• Selective serotonin uptake inhibitors (SSRIs): These drugs can help alleviate symptoms of Depression by changing the levels of a chemical called serotonin in the brain. Common examples of SSRIs include Fluoxetine (Prozac), Paroxetine (Paxil), and Citalopram (Celexa).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants: When used together, these medications can relieve Depression symptoms by altering the amounts of serotonin and norepinephrine in the brain. These chemicals help boost mood and energy levels. Common examples of SNRIs include Duloxetine (Cymbalta) and Venlafaxine (Effexor XR). Imipramine (Tofranil), Nortriptyline (Pamelor), and Trimipramine (Surmontil) are examples of tricyclic antidepressants. 
• Norepinephrine-dopamine reuptake inhibitors (NDRIs): These medications aid people with Depression by increasing levels of the mood-boosting chemicals norepinephrine and dopamine in the brain. Bupropion (Wellbutrin) is a type of NDRI that may be used.
• Monoamine oxidase inhibitors (MAOIs): These drugs help ease symptoms of Depression by increasing the amount of norepinephrine, serotonin, and dopamine in the brain. They can also improve brain cell communication
• Atypical antidepressants: This group of medications includes tranquilizers, mood stabilizers, and antipsychotics. These drugs can block brain cell communication in order to relax the body.

Besides medications, certain medical procedures can also affect the brain to help ease symptoms of MDD. These include:

• Electroconvulsive therapy (ECT), which involves passing electrical currents through the brain to boost communication between brain cells 
• Transcranial magnetic stimulation (TMS), which involves sending electrical pulses into the brain cells that regulate mood 

Alternative treatments for Depression

Many people will try alternative therapies before considering counselling or medications. The research for some of these treatments are controversial and should be discussed with your Doctor before considering.

• Meditation/Mindfulness- Mindfulness practice allows people to be more intentionally aware of the present moment. Increased awareness provides space to pause before reacting automatically to others and minimizes being swept up in escalating negative emotions. Individuals who practice relaxation skills consistently report having more energy, feeling less overwhelmed by negative emotion, and being in a better position to cope with and support others.
• Exercise- 30 minutes of physical activity 3 to 5 days a week can increase your body’s production of hormones that improve your mood.
• Avoid alcohol and drugs- Drinking and/or using drugs may alleviate symptoms for a short time but in the long run often make Depression and anxiety symptoms worse.
• Set boundaries- Saying No to others may help reduce feelings of being overwhelmed and resentful.
• Pour some care into yourself- Self care can improve symptoms of Depression. This may include getting plenty of sleep, eating a healthy balanced diet, avoiding negative people, and participating in enjoyable activities.
• Light therapy- Exposure to white light may help regulate your mood and improve symptoms of depression. This therapy is commonly used for Major Depressive Disorder with seasonal pattern (SAD).
• Acupuncture- A acupuncturist will insert needles into certain points of your body that are thought to connect to the negative emotions that you are having. The needles are thought to fix blocked energy or imbalances in your body, which will also influence your mind.
• Supplements- Talk with your Doctor or psychiatrist before taking a supplement or combining a supplement with prescription medication to avoid negative interactions.
  • St. John’s wort- used in Europe as an antidepressant medication.
  • S-adenosyl-L-methionine (SAMe)-This compound has shown in limited studies to possibly ease symptoms of depression. The effects were best seen in people already taking antidepressants (SSRI).
  • 5-hydroxytryptophan (5-HTP)-may raise serotonin levels in the brain, which could ease symptoms. Your body makes this chemical when you consume tryptophan, a protein building block.
  • Omega-3 fatty acids- These essential fats are important to neurological development and brain health.
• Essential oils are a popular natural remedy for many conditions
  • Wild ginger: Inhaling this strong scent may activate serotonin receptors in your brain. This may slow the release of stress-inducing hormones.
  • Bergamot: This citrusy essential oil has been shown to reduce anxiety in patients awaiting surgery.
• Vitamins- Vitamins are important to many bodily functions.
  • Vitamin B: B-12 and B-6 are vital to brain health. When your Vitamin B levels are low, your risk for developing Depression may be higher.