Depression is the leading cause of disability in the world. In the United States, close to 10% of adults struggle with depression. But because it's a mental illness, it can be a lot harder to understand than, say, high cholesterol. One major source of confusion is the difference between having depression and just feeling depressed. Almost everyone feels down from time to time. Getting a bad grade, losing a job, having an argument, even a rainy day can bring on feelings of sadness. Sometimes there's no trigger at all. It just pops up out of the blue. Then circumstances change, and those sad feelings disappear. Clinical depression is different. It's a medical disorder, and it won't go away just because you want it to. It lingers for at least two consecutive weeks, and significantly interferes with one's ability to work, play, or love. Depression can have a lot of different symptoms: a low mood, loss of interest in things you'd normally enjoy, changes in appetite, feeling worthless or excessively guilty, sleeping either too much or too little, poor concentration, restlessness or slowness, loss of energy, or recurrent thoughts of suicide. If you have at least five of those symptoms, according to psychiatric guidelines, you qualify for a diagnosis of depression. And it's not just behavioral symptoms. Depression has physical manifestations inside the brain. First of all, there are changes that could be seen with the naked eye and X-ray vision. These include smaller frontal lobes and hippocampal volumes. On a more microscale, depression is associated with a few things: the abnormal transmission or depletion of certain neurotransmitters, especially serotonin, norepinephrine, and dopamine, blunted circadian rhythms, or specific changes in the REM and slow-wave parts of your sleep cycle, and hormone abnormalities, such as high cortisol and deregulation of thyroid hormones. But neuroscientists still don't have a complete picture of what causes depression. It seems to have to do with a complex interaction between genes and environment, but we don't have a diagnostic tool that can accurately predict where or when it will show up. And because depression symptoms are intangible, it's hard to know who might look fine but is actually struggling. According to the National Institute of Mental Health, it takes the average person suffering with a mental illness over ten years to ask for help. But there are very effective treatments. Medications and therapy complement each other to boost brain chemicals. In extreme cases, electroconvulsive therapy, which is like a controlled seizure in the patient's brain, is also very helpful. Other promising treatments, like transcranial magnetic stimulation, are being investigated, too. So, if you know someone struggling with depression, encourage them, gently, to seek out some of these options. You might even offer to help with specific tasks, like looking up therapists in the area, or making a list of questions to ask a doctor. To someone with depression, these first steps can seem insurmountable. If they feel guilty or ashamed, point out that depression is a medical condition, just like asthma or diabetes. It's not a weakness or a personality trait, and they shouldn't expect themselves to just get over it anymore than they could will themselves to get over a broken arm. If you haven't experienced depression yourself, avoid comparing it to times you've felt down. Comparing what they're experiencing to normal, temporary feelings of sadness can make them feel guilty for struggling. Even just talking about depression openly can help. For example, research shows that asking someone about suicidal thoughts actually reduces their suicide risk. Open conversations about mental illness help erode stigma and make it easier for people to ask for help. And the more patients seek treatment, the more scientists will learn about depression, and the better the treatments will get.
Depresija je vodeći uzrok invaliditeta na svetu. U Sjedinjenim Državama, približno 10% odraslih vodi borbu sa depresijom. Međutim, zato što je to mentalna bolest, može biti mnogo teža za razumevanje nego, recimo, visok holesterol. Jedan od većih izvora zabune je razlika između bolovanja od depresije i depresivnog osećanja. Skoro svako se oseća potišteno s vremena na vreme. Loša ocena, gubitak posla, svađa, čak i kišni dan mogu doneti osećanje tuge. Ponekad uopšte nema pokretača. Prosto naiđe niotkuda. Zatim se okolnosti promene i ta tužna osećanja nestanu. Klinička depresija je drugačija. To je medicinski poremećaj i neće tek tako otići samo zato što vi tako želite. Ostaje prisutan najmanje dve uzastopne nedelje i značajno ometa sposobnost osobe da radi, igra se ili voli. Depresija može imati mnogo različitih simptoma: loše raspoloženje, gubitak interesovanja za stvari u kojima inače uživate, promene apetita, osećanje bezvrednosti ili preterana krivica, previše ili premalo spavanja, loša koncentracija, nemir ili sporost, gubitak energije ili misli o samoubistvu koje se ponavljaju. Ako imate bar pet od ovih simptoma, prema psihijatrijskim normama, kvalifikujete se za dijagnozu depresije. To nisu samo simptomi vezani za ponašanje. Depresija se fizički manifestuje u mozgu. Pre svega, postoje promene koje se mogu videti golim okom i putem rendgena. To obuhvata smanjenu veličinu frontalnog režnja mozga i hipokampusa. Na nižem nivou, depresija se vezuje za nekoliko stvari: abnormalno prenošenje ili istrošenost određenih neurotrasmitera, naročito serotonina, norepinefrina i dopamina, izmenjeni cirkadijalni ritmovi, ili specifične promene REM i sporotalasnih delova ciklusa spavanja, kao i hormonalne abnormalnosti, kao što je visoki kortizol i deregulacija tiroidnih hormona. Međutim, neuronaučnici još nemaju celu sliku o tome šta izaziva depresiju. Izgleda da ima veze sa složenom interakcijom između gena i sredine, ali nemamo dijagnostičko sredstvo koje može precizno predvideti gde će se i kada pojaviti. Budući da simptome depresije nije lako uočiti, teško je reći da li neko izgleda dobro, a zapravo se bori. Prema Nacionalnom institutu za mentalno zdravlje, prosečnoj osobi koja pati od mentalne bolesti potrebno je preko deset godina da zatraži pomoć. Međutim, postoje vrlo delotvorni tretmani. Lekovi i terapija se međusobno dopunjuju da bi podržali hemijske materije u mozgu. U ekstremnim slučajevima, elektrokonvulzivna terapija, a to je neka vrsta kontrolisanog napada u mozgu pacijenta, takođe veoma pomaže. Drugi tretmani koji obećavaju, kao što je transkranijalna magnetna stimulacija, takođe se ispituju. Stoga, ako poznajete nekoga ko se bori sa depresijom, nežno ih podstaknite da potraže neku od ovih opcija. Možda biste mogli i da pomognete oko određenih stvari kao što je traganje za terapeutima u blizini, ili sastavljanje spiska pitanja za doktora. Osobi sa depresijom ti prvi koraci mogu delovati nedostižno. Ako osećaju krivicu ili sramotu, istaknite da je depresija medicinsko stanje, baš kao astma ili dijabetes. To nije slabost ili osobina ličnosti i ne treba da očekuju da će to jednostavno prevazići, baš kao što ne bi mogli da snagom volje prebole prelom ruke. Ako vi sami niste doživeli depresiju, izbegavajte da je poredite sa situacijama kada ste osećali tužno. Poređenje onoga što osoba doživljava sa normalnim, privremenim osećanjem tuge može učiniti da osete krivicu zbog svoje borbe. Čak i sam otvoren razgovor o depresiji može pomoći. Na primer, istraživanja pokazuju da, kada nekoga upitate o suicidnim mislima, to zapravo umanjuje rizik od samoubistva za tu osobu. Otvoreni razgovori o mentalnoj bolesti pomažu u rušenju stigme i olakšavaju ljudima da zatraže pomoć, a što više pacijenata zatraži lečenje, utoliko će naučnici više saznati o depresiji i utoliko će dobiti bolje lečenje.