Depression is not a disease with concrete symptoms, unlike physical diseases, and since it cannot be shown by routine laboratory tests, it is difficult for both the depressed person and those around him to perceive this situation as a disease. However, research shows that people experiencing depression have certain chemical disorders in their nervous systems and this causes the symptoms. For example, fatigue, sleep disturbance, loss of life energy, etc. The symptoms are the result of a problem in the secretions of serotonin, noradrenaline and dopamine in the brain. Usually, this chemical problem in the brain is triggered by stress and sadness. Because intense stress disrupts the hormonal balance in our body and causes the deterioration of many biological systems in a chain reaction with a domino effect.
It should not be forgotten that although these symptoms are due to stress, they are not natural and normal. To make an analogy: the condition of the leg of a person whose leg is broken as a result of being hit by a car is not natural and normal. This leg needs treatment. Trying to walk with that leg without treatment will make the leg worse. Just like this, a person in a depressed mood makes his problems even more difficult while trying to solve them.
Depression is not weakness and lack of will. Anyone can get depressed. However, some people are biologically and psychologically more prone to depression. Depression is more common in people who are seen as ideal people by the public, who are perfectionists, meticulous, and strictly adherent to their values. Childhood traumas and current distress also increase the risk of depression. However, even before the current problem is over, the person can come out of depression and cope better with the problem he is experiencing with treatment.
Depression is not a simple state of sadness. A person who experiences normal sadness due to some situations in his life may desire and enjoy beautiful things. A depressed person, on the other hand, has reluctance, pessimism, and lack of self-confidence, not only in the area that causes sadness, but in every aspect of his life. For example, a person who has problems with his/her spouse or whose studies are going badly should feel relieved and good when he/she chats with his/her friends and is interested in the things he/she loves. This is the exact t If he does not want to meet people or does not even enjoy watching TV programs that he followed before, depression should be suspected.
Simple sadness is not permanent. Sometimes a person feels good, depending on the situation. However, there is continuity in depression. The depressive mood, even if it waxes and wanes, never goes away, at least for weeks.
Depression is definitely not a mental illness or insanity. Unfortunately, there are people who are afraid of being stigmatized and hesitate to consult a doctor. The patient's relatives should be aware of this issue and encourage the patient to receive treatment. Mental illnesses such as schizophrenia, in which the ability to evaluate reality is impaired, and depression are separate conditions. Although psychotic symptoms such as auditory hallucinations and delusions are observed in rare cases of very severe depression, these are temporary. Cases of depression resolve completely.
The pessimism in depression is not like perceiving things that do not exist, but like “constantly seeing the glass half empty.” In the mind of a depressed person, only the bad things that happened in the past, what is happening now and what may happen in the future are at the forefront; he cannot even think about the good things. Even if he is reminded of good things, he cannot find solace.
Troubles are a natural part of life, everyone has their own troubles. Having a problem does not mean being depressed. Just as not everyone who suffers from the same problem has depression, a person may not become depressed in another period when he or she experiences greater troubles. So, troubles are not the cause of depression, they are just a triggering factor in people with a hereditary predisposition.
It is often impossible to eliminate troubles, and depression often continues even if the troubles disappear. For example, a depressed person who has problems with his spouse may no longer feel good even if his spouse starts to treat him well. The emergence of depression associated with stress is similar to a fuse blowing due to an increase in electrical voltage. Even if normal electric current is supplied, the lamps in the house no longer work and the fuse must be repaired. Disruption of some secretions in the brain of a person experiencing stress is like blowing a fuse. Medicines repair this.
Most of the time, troubles and depression are higher in terms of cause-effect relationship. They form a cycle similar to murta and chicken. In other words, troubles and depression increase each other in a vicious circle, and it is often difficult to distinguish which one starts first.
Although stress factors affecting the general population increase the frequency of depression, depression in the sense of a disease is not an inevitable condition and is not found in everyone. The sadness of those who are depressed is not like that of others. For example, economic problems upset and upset many people, but not all of these are depression.
The depressed person constantly feels unhappy, sad, hopeless and helpless; takes no pleasure in anything; sleep and appetite are disturbed; cannot concentrate and becomes forgetful; his energy has decreased; is stagnant or restless; may feel guilty or worthless; He may think about dying.
A person who experiences at least 5 of these 9 symptoms continuously for more than 2 weeks is depressed. The presence and severity of depression are two different things. For example, if a person with a problem may cry for days but does not experience other symptoms, he/she is not depressed and does not need medical treatment. However, another person may constantly experience many of the above symptoms, albeit mildly, and may not show this to those around them and may not cry at all. But this person needs treatment.
At least half of the depression cases can resolve spontaneously, but if left untreated, some of them become permanent, and even if some of them partially improve, some of their symptoms may fluctuate and continue in a milder degree throughout life.
Untreated. The depression period lasts an average of 9 months, even if it passes at the end of its natural course. Experiencing the symptoms of depression listed above during this period causes significant losses in the person's life. For example, a person's success at work or school decreases as his concentration, sleep and energy decrease. Symptoms such as restlessness, lack of sexual reluctance, irritability, and inability to work disrupt their relationships with their spouse. On the other hand, with appropriate medical treatment, the vast majority of cases of depression begin to improve within a few weeks; Unnecessary loss of work/power and deterioration in relationships are prevented. Therefore, trying to overcome depression without medication or treatment is not an admirable attitude.
Almost all cases of depression improve with appropriate treatment. D The most common reason for not getting better is non-compliance with treatment. Those who expect to get better by taking a box of medicine as if using antibiotics, or those who think that their doctor will fix them with a meeting, as if touching them with a magic wand, may desperately go from doctor to doctor. One should avoid giving simple suggestions such as ”that anyone can think of. A patient of mine said to his relatives in the face of such insistence: “I am depressed, I am not retarded. I also know how to travel. “If I could, I would have done it.” The depressed person has lost his life energy. He has neither the strength nor the will to do anything. In this situation, it is pointless to force that person. In fact, this attitude will harm Him even more. Because the more he cannot push himself and succeed, or the more he sees that the things he loved to do before no longer have any meaning or even become boring for him, the more hopeless he will become. So, instead of useless struggles, the patient should reduce his expectations and put his life on "idle" in the first weeks of treatment. Those around the patient should also accept this situation for the first few weeks. Psychiatrists report a severely depressed patient and ask him to rest, or they try to isolate him from the environment and therefore stress by hospitalizing him.
After the depressed patient starts to recover within a few weeks with the help of treatment, especially running and other sports will help him overcome depression more quickly. After this period, social activities should be increased gradually. Depression is seen in all socio-economic layers. It is also common in rich people and in affluent societies such as Scandinavian countries. In fact, interestingly, the countries where suicide occurs most frequently are rich countries such as Scandinavian countries and Japan. On the other hand, depression is not uncommon in more religious countries and communities.
Medicines given for depression are not drugs, they do not cause permanent damage to the body. Modern depression medications have almost no sleep-inducing side effects. Other side effects are generally mild and temporary. It is not severe enough to disrupt daily life. These drugs help people with mild depression to function better. It does not prevent them from driving, driving, or studying. Depression medications are absolutely not addictive. Drugs that may cause addiction are subject to special control in our country; They are sold with green and red prescriptions. Antidepressants are not in this category.
An ideal treatment should include psychotherapy along with medication. Psychotherapy and drug therapy are not alternatives but complements to each other. The best results can be achieved by doing both together.
Prof. Dr. İlhan Judge
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