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I am depressed

by Yoana Nikolova

We hear these words often, used in a variety of situations and in different contexts. The word ‘depression’ is thrown around as casually as other physical states like ‘I am sleepy or ‘I am hungry’, but the truth is that depression is one of the leading causes of serious disabilities around the world and despite that, it seems like its presence remains in the shadows. The reason for this is that mental disorders are a lot more difficult to understand and recognize than physical illnesses like heart problems or diabetes. It can be said that one of the main reasons for confusion in this subject comes from misunderstanding the difference between feeling depressed and having depression.

Almost everyone in this world has had moments or periods of time when they feel miserable or sad – a breakup, a big life change, losing someone close to you or just a rainy day can cause feelings like sorrow, apathy or pain. Sometimes there is no apparent reason for how we feel, we just wake up one day and the feelings inside are grey, but at some point the day changes and that feeling goes away.

Clinical depression is something completely different, it is a medically proven condition which lasts over two weeks and significantly affects the quality of life of those suffering from it.

The effect of depression is felt in every aspect of life – personal relationships, work, sense of self, worldview, sex drive and many others. The symptoms of depression may be: a depressed mood, reduced interest or pleasure in activities once enjoyed, changes in appetite, changes in the sleeping cycle – sleeping too much or too little, a feeling of lack of purpose, guilt, self-loathing, obsessive thoughts, difficulty concentrating, anxiety, melancholy, loss of energy and suicidal thoughts. If a person has 5 of these symptoms, according to psychiatric criteria, they could be diagnosed with depression.

It is important to note that in addition to behavioral symptoms, depression also physically affects the brain. The changes include a decrease in the volume of the frontal lobe and hippocampus (responsible for thinking and emotion), on a micro level there is abnormal transmission or sometimes lack of some neurotransmitters (serotonin, norepinephrine and dopamine), disrupted circadian rhythm (responsible for the natural rhythm of body function), disrupted REM sleep and deep sleep, as well as hormonal disruptions – high levels of cortisol (stress hormone) and disrupted regulation of the thyroid hormones. At this point, there is no clear indication of what exactly causes depression, relation between genetics and environment is observed, but there is no method of diagnosis for indicating whether and who it will affect. Because of the unclear physical dimensions, it is often hard to find out if a person who may look okay on the outside carries the burden of depression.

According to the National Institute of Mental Health (USA), it takes an average of 10 years for someone suffering from mental health issues to seek help, but the truth is that there are very efficient treatments so if there is someone in your life who is battling depression, try to gently encourage them to seek help. It is important to be aware of the fact that people who are battling this type of psychological conditions may feel a lot of guilt and shame, so it is not helpful when we approach the situation in a mean or dismissive way. If we want to be helpful, we can offer to do research and look for the appropriate therapist, book an appointment or create a list of questions for the doctor. For someone with depression, it can seem impossible to make these first steps. If they feel ashamed or guilty, we can remind them that depression is a medical condition just like asthma or diabetes, that it is not a weakness or a character trait and that it is not necessary for them to try and overcome it alone, the same way we would not try to mend a broken arm by ourselves. If you have not experienced depression before, try to avoid comparing it with merely states of sadness, this will provoke even more shame rather than show empathy. This does not mean that we must talk about the depression. On the contrary – open discussions about it reduces the feeling of isolation, we just have to remember that we do not really understand what the person in front of us is going through and it is important to listen carefully if we want to understand. Studies show that if we ask someone whether they have suicidal thoughts and they feel free enough to share that with us, it actually reduces the chance of suicide. Open discussions about mental disorders help not only one specific person, but they also help reduce the overall stigma around them, so people who do suffer from them can more easily find help.

How is depression treated?

Depression is among the most treatable of mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.

Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem or a vitamin deficiency (reversing the medical cause would alleviate the depression-like symptoms). The evaluation will identify specific symptoms and explore medical and family histories as well as cultural and environmental factors with the goal of arriving at a diagnosis and planning a course of action. It is extremely important to give the correct diagnosis and it is not right to diagnose depression with only an interview. If depression is mild, most cases can be cured with therapy only and without prescribing medication.


Brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry. These medications are not sedatives, “uppers” or tranquilizers. Generally, antidepressant medications have no stimulating effect on people not experiencing depression. The goal is to balance the brain chemistry while simultaneously examining and treating the emotional, psychological factors which are not any less important. The reason for prescribing antidepressants is to make the treatment easier. Of course, as stated above, issues with the adrenal gland, the thyroid, etc. could also cause depressive states, regardless of the individual’s psyche. It is important to note that there are many possible contraindications and medication should be taken responsibly, under strong supervision.

Antidepressants can lead to improvement within the first week or two of taking them, but that is a purely chemical improvement which always works in combination with therapy.

Antidepressants alone cannot cure a depression which is based on attitudes and perceptions of the world. The full positive benefits can be observed in two to three months. If the patient feels little to no improvement after a few weeks, their doctor can adjust the dosage of medication or add or substitute another antidepressant. In some situations, other psychotropic medications may be helpful. It is important to let your doctor know if a medication does not work or if you experience side effects. In order for the therapy to be effective, it must be done by a qualified specialist. It is extremely important to find a doctor you trust completely.

Psychiatrists usually recommend that patients continue to take medication for six or more months after the symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk. An unfortunate downside is that many people develop addictions and antidepressants can cause depressive states on their own.


Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, psychotherapy is often used along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on the problem solving in the present. CBT helps a person to recognize distorted/negative thinking with the goal of changing thoughts and behaviors to respond to challenges in a more positive manner.

Psychotherapy may involve only the individual, but it can also include other people in group or family therapy. Depressive states may be caused by dysfunctional relationships, in which case it is better for the therapy to include the family, or couple, in order to help solve the issues within these close relationships. The process is difficult because a large percentage of people in these families or relationships do not openly discuss emotional subjects and very often the person who has depression is the most sensitive member of the group. This way, the weight of not only the relationships, but also of the depression and the stigma and misunderstanding surrounding it, falls on that person.

Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions

Electroconvulsive therapy (ECT) is a medical treatment that has been most commonly reserved for patients with severe major depression who have not responded to other treatments and whose life is in danger. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. ECT has been used since the 1940s and so the many years of inspection have led to major improvements. It is usually performed by a team of trained medical professionals including a psychiatrist, an anesthesiologist and a nurse or physician assistant.

Types of depression

There are a few types of depression. Some of the most common ones are listed below.

Major depressive disorder

People with major depression are in a constant state of sadness and apathy. They may lose interest in activities they have previously enjoyed. Treatment usually includes medication and psychotherapy.

Persistent Depressive Disorder

Also known as dysthymia, persistent depressive disorder’s symptoms last for at least 2 years. A person with this disorder can have episodes of deep depression as well as less serious symptoms.

Bipolar Disorder

Depression is a common symptom of bipolar disorder and studies show that people who have that disorder can have depressive symptoms around half of the time. This can make the distinction between bipolar disorder and depression hard to make.

Psychotic Depression

Some people experience psychosis with depression. Psychosis can include delusions like false beliefs or losing touch with reality. This can include hallucinations – sensing things which do not exist in reality.

Postpartum Depression

After giving birth, many women go through postpartum depression. When hormone levels correct themselves after birth, this can lead to mood changes. There is no singular prognosis for the duration of this type of depression – it may last months or years. Anyone who experiences continuous depression after birth must seek medical help.

Major Depressive Disorder with Seasonal Pattern

Previously referred to as Seasonal affective disorder, this type of depression has to do with decreasing daylight during the fall and winter seasons. It is corrected during the rest of the year and as a response to treatment. People who live in countries with long and harsh winters are apparently more likely to be affected by this condition.

Risk factors

  • Despite the lack of methodology for early prediction of depression, there are conditions which put people at higher risk. The risk factors include:

  • Difficult life experiences like losing a loved one, issues at work, relationship changes, financial problems and medical problems

  • Intense and constant stress – stress is helpful in small quantities, however, when the body and the mind are exposed to continuous stress, changes in the neurochemistry of the brain emerge – cortisol level rise, one of the effects is on the frontal lobe (responsible for rational thinking and making decisions), another is on the adrenal glands which release adrenaline. Additionally, continuous stress shows that there are certain factors in someone’s life which harm them and their inability to escape those situations causes a feeling of powerlessness and frustration which can often lead to depression.

  • Lack of successful coping strategies – a key ingredient for our stability is strategies for coping with difficult situations. Some of these strategies come from our family and are embedded deeply and consistently, others come from our experiences and communication with others. Very often, bad strategies for coping with difficult situations can exacerbate our feelings of helplessness, pain, shame and pointlessness, while successful ones can allow us to live through pain and suffering without a complete personality breakdown. Good news is that coping strategies can be learned and altered at any stage of life and are a very good way to battle chronic depression.

  • A close relative with depression – the power of identification plays a major role in depression; people who have grown up close to a person with depression are at a risk of encountering the same condition themselves.

  • Using some prescription medication as corticosteroids, some beta-blockers and interferon – depression is as physical as it is psychological, using medication which disturbs the function of certain neurotransmitters can lead to depression.

  • Using sedatives, alcohol and amphetamines – addiction plays a huge role in developing depression.

  • Head traumas – sometimes head traumas can cause significant changes to a person’s character, senses and behavior.

  • A previous episode of major depression – when a person has gone through major depression before, the way back becomes much easier. On a purely cerebral level, the paths major depression creates are wide and well trampled, therefore, many people will find themselves in a critical situation after they have battled depression and end up in the same rut. In order to avoid severe relapses, it is important to work on developing coping strategies and leading a healthy way of life and thinking; repetition is the most powerful tool, so the more we reinforce our positive outlook and helpful coping mechanisms, the harder it is to relapse into a depressive state.

  • A chronic condition such as diabetes, chronic obstructive pulmonary disease (COPD) or cardiovascular diseases – chronic diseases often cause a feeling of limitation, a lack of choice, helplessness which are typical symptoms of depression.

  • Constant persistent pain.

Self-help and Coping

There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improves mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol and drugs (depressants) can also help reduce symptoms of depression. However, perhaps the best way to reduce the symptoms and to manage depression is with meaningful relationships, adopting a positive outlook and skills for coping with difficult situations. If we focus solely on fixing the issues, we will not become happier or more energetic. We can compare this to a garden full of weeds – if we tore all of them out, the garden would be nothing more than a muddy piece of land. Depression is often accompanied by a feeling of helplessness, loneliness and pointlessness which come from internal beliefs, traumatic experiences and who knows what else, but these things are in the past. It is important to look towards the future, to look for relationships, habits, thoughts and activities which actually make the world brighter every day. This is hard for people who are submerged in depression and so this is where the people around them – the ones they can lean on when feel are powerless – become important. These people and their words, presence and love are just as healing as any antidepressant or therapist, if they are aware enough of what the person they love is going through.

Depression is a real illness and help is available. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, a first step is to see your family physician or psychiatrist. Talk about your concerns and request a thorough evaluation. This is a start to addressing your mental health needs.


American Psychiatric Association:

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This article is part of the project Healthy, Brave, and Proud: A mental health support program for LGBTI youth, which aims at providing support and raising awareness regarding the mental health of LGBTI youth. The project is financed by the TELUS International Bulgaria Community Board.

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