Depression

If asked to name the serious illness that affects more people than any other in the world, what you guess? HIV-AIDS? Malaria? Tuberculosis?

Well, the answer, perhaps surprisingly, is clinical depression. “Clinical” because it is cripplingly deep and persistent and altogether different from “reactive depression,” the normal mood swings that we all experience as a result of the rebuffs of everyday life. Given time, these lift and we move on.

But wait a minute, you might protest, depression is merely a state of mind, not really a disease. Well, you’d be mistaken. Clinical depression does indeed attack the mind, or brain if you prefer, but its causes can be organic as much as psychological. And its consequences can be just as deadly as the worst infectious disease.

While depression is not fatal on its own, it has a lethal talent for perpetuating feedback loops that can maim or kill. Stress, for example, often leads to high blood pressure and heart disease, which reduces physical activity, leading to depression, which in turn ramps up stress, etc. etc. Round and round and down and down, a vortex that sucks millions of people into a black hole and death. The details vary widely – a different disease, for example, or abuse of alcohol or drugs – but it is depression that traps the victim and drives the cycle.

Causes of depression vary widely – an under-active thyroid, heavy metal poisoning, oral contraceptives, vitamin deficiencies, low blood sugar, post partum hormone imbalance, chronic disease – the list goes on and on. But the one constant factor, almost invariably present, is psychological damage, most often dating from childhood. A dysfunctional family, sexual abuse, any of many different complexes – again, the list is long.

Another constant, or nearly so, is low levels of serotonin in people with depression. Serotonin is a neurotransmitter (chemical messenger) in the brain, responsible for mood elevation. What causes this condition is not known, although psychological factors such as stress are suspected, and genetics likely plays a role.

It is this serotonin deficit that the Prozac family of drugs is designed to correct, and they have been spectacularly successful. Unfortunately, they have also been responsible for some very serious mental disorders, particularly when prescribed without benefit of parallel psychotherapy. There can also be physical side effects such as low blood pressure, rashes, headaches and sexual dysfunction.

Living as we do at a higher latitude and in a rainy climate, we should be aware of the aptly named SAD (Seasonal Affective Disorder), a very common type of depression caused by insufficient exposure to light. A week or two on a tropical beach is usually the best cure, but if that’s not possible, you may want to consult your health practitioner, rather than waiting for spring to banish the winter blues.