Abnormal psychology is all around us, if we just care enough to look.

It’s in the media, the news, and this thing called the real life. We see examples of abnormal behavior on our TV screens, on the subway or in the streets at 2AM (or 8 AM, at the height of rush hour) and maybe in our own living rooms. Maybe we even experience it in our own bodies and brains.

So let’s talk psychopathology.

And for the first of this MHMD (Mental Health & Mood Disorders) series, let’s talk about depression.

As you may or may not know, depression is one of the most common, and certainly the most well-known mental/mood disorder. Globally, it affects more than 350 million people, and roughly 20 million people in the United States suffer from depression each year. Depression is also responsible for 10% of disability worldwide, and about 1 in 4 young adults will suffer an episode of depression before the age of 24, although the average age of onset is 32.

Ironically, it’s rather scary that depression does not discriminate – it affects people of all ages, geographic locations, demographics, and social positions…

[divider]

Disclaimers:

Before I go on with this post, I want to say that:

1. I am not an expert in this field; I was only a Psychology minor in college.
2. The sole purpose of this post is to inform. I used my notes from a class I took as an undergrad– “Abnormal Psychology”– to compose this article.
3. I’m not encouraging you to “diagnose” yourself or others based on the information provided here – rather, my intent is that you learn about it, talk about it, and if needed, seek counseling and get help.

[divider]

So now… let’s FIRST talk about the hard facts of Major Depressive Disorder.

[divider]

Common Symptoms of Depression:

➳ Everyone experiences depression differently and uniquely, but here are the 7 main (common) symptoms:

1. Depressed mood/irritability OR loss of interest/pleasure for most of the day, nearly every day, for two weeks
2. Weight gain due to increased appetite OR weight loss due to poor appetite
3. Insomnia (habitual sleeplessness; inability to sleep) OR hypersomnia (excessive sleepiness) nearly every day; fatigue or lethargy nearly every day
4. Psychomotor agitation or retardation as observed by others
5. Feelings of worthlessness and guilt
6. Poor concentration or indecisiveness
7. Recurrent thoughts of death or suicide with or without a specific plan

According to DSM-5, a person who is diagnosed with Major Depressive Disorder experiences symptom #1 plus four or more of the other symptoms (from #2 – #7). These symptoms must cause clinically significant distress or impairments in social, occupational, or other important areas of functioning, and the episode(s) must not be attributable to the physiological effects of a substance or to another medical condition.

[divider]

Frequency & Prevalence of Depression:

➳ As noted above, 10% of all disability worldwide can be attributed to Major Depressive Disorder.

Here are some other statistics:

• The lifetime prevalence of depression is 16%, which means that 16% of people in a given population have been affected by the disorder at some point during their lives.
• Women are twice as likely to be diagnosed with MDD than men (3x for the impoverished).
• The average age of onset is 32 (middle-aged adults), and risk decreases with age.
• 60% of those with Major Depressive Disorder also qualify for anxiety disorder; 40% of those who are alcoholic have experienced major depression.

[divider]

Common Causes of Depression:

➳ Depression has different triggers, no surprise there.

Here are some of the social triggers & causes of depression:

• Interpersonal loss (breakups, layoffs, termination of roles, etc.), which can lead to the lowering of self-esteem and feelings of humiliation, entrapment, and defeat.
• Environmental stress & difficult circumstances, which can increase the level of stress and vulnerability to depression.

➳ Depression can develop over time due to pervasive and persistent negative thoughts about the self and the environment, and not necessarily due to a sudden, stressful life event.

Here are some psychological/cognitive theories explaining the causes of depression:

• Beck’s Theory – holds that since the individual has a negative view of self, the world, and the future, he/she processes information in negative ways, leading to distorted views and cognitive biases.
• Hopelessness Theory – holds that because the individual believes that he/she does not have the power to change or control the environment, the individual often makes untrue causal attributions and responds to feelings of depression in one of two ways: 1) turn their attention inward (ruminative style, more common among women), which leads to longer, more severe episodes of depression; or 2) divert from unpleasant mood by engaging in other, more pleasurable activities (distracting style, more common among men), which is a healthier coping mechanism but still does not solve the problem.
• Seligman’s Learned Helplessness – holds that the perceived absence of control over the outcome of a situation leads to complacency.

➳ Environment plays a huge role for depressive disorders, but genetics also plays a big role (40-50% heritability).

Here are some biological triggers:

• High levels of cortisol – induces stress
• Elevation of amygdala –  sends distress signal to hypothalamus
• Malfunction in the serotonin pathway – increases vulnerability to depression when a stressful life event occurs
• Changes (lowering) in the concentration of norepinephrine, serotonin, and dopamine – affects mood

[divider]

Treatments Methods for Depression:

➳ There is no single “best” way to treat depression. Each individual is different and every method has pros and cons. 

Here are some treatment methods that focus on the psychological and/or social aspects, rather than biological/medical:

• Interpersonal Psychotherapy (IPT) – focuses on unresolved grief, interpersonal disputes, role transitions, and skills/deficits by exploring affect, behavior change techniques, and reality testing of perception.
• Cognitive Therapy (CT) – focuses on automatic thoughts and maladaptive behaviors by promoting self-monitoring, challenging and replacing negative thoughts with more neutral or realistic ones.
• Behavioral Activation (BA) – focuses on withdrawal and avoidance behaviors and encourages participation in positively reinforcing and pleasant activities.
• Mindfulness-Based Cognitive Therapy (MBCT) – focuses on prevention of relapse by practicing mindfulness and employing meditative techniques.

[divider]

➳ Real Life Applications 

Okay, enough hard facts. Let’s now get to what you can actually do if you have a friend or a family member who is in pain.

How can you reach out to those who are suffering?

First, it is extremely important to realize that the pain your loved one is going through is very real. The feelings of hopelessness and entrapment is not something they can “snap out of.” What you need is empathy, and a lot of it. Here are 4 ways you can respond to those who are feeling depressed and alone:

1. Just listen. Resist the urge to impart your “wisdom” by offering tips and advice. Instead, offer your time, care and attention. Show them that they are not alone; let them know that you care, and listen to their stories with an open and non-judgmental heart.
2. Speak hope. And I am not just talking about positive talk – there’s a limit to that. I’m talking about real hope, which truly believes in transformation. Did you know that words have the power to kill or save people? Gracious words are sweet to the soul and healing to the bones. Let your words speak hope.
3. Be consistent. Busyness is a sure condition of life, but it is never a good-enough excuse to not reach out to those you care about, if you do indeed care about them. If meeting up is impossible, a simple text or a phone call will do. Consistently reach out to them, even if they don’t seemingly acknowledge your efforts or return the love. Your intentionality can be the very key to their recuperation.
4. Serve humbly. This goes hand in hand with consistency, but there’s no better way to show your love and support than by offering up your time and talent to serve those who feel unloved and unworthy. Depending on your talents, this could be: cooking a meal and inviting them over for dinner (or, if they can’t get out of their bed, delivering food straight to their bed!), doing their laundry for them, or simply sending a bouquet of flowers or a heart-felt, hand-written letter to their house.

What if YOU are the one suffering from depression?

Did you know that your school has a Counseling and Psychological Services? Please, take advantage of it and get help if needed. Don’t minimize your pains and don’t silence your feelings. Not only are you doing yourself a favor, but you’re actually helping others by breaking the social stigma associated with mental disorders. Be brave and vocalize your problems, as they aren’t unique to you!