When we talk about depression, for all of us, quickly, a series of images come to mind in which we visualize someone with sad expression, crying heartbrokenly and isolated from others, but then what is the difference between a major depression and a depression?Deep sadness?
It is a big mistake to confuse the two concepts because, although intimately related, they are part of a sequence where the major depression is the farthest and most disabling extreme, an extreme where the suffering person is in a dark, tortuous and desperate underworld. .
- We know that emotions have a great adaptive role and that.
- Be they positive or negative.
- They are all necessary for the proper functioning of our environment.
- So sadness.
- Although it falls into the category of “negative emotions”.
- Is a healthy emotion and adaptive.
- Through which.
- In part.
- We have managed to survive.
We feel sad when we realize that we have lost something that was extremely positive for us, and the way the body must drain that wound to heal it is through the expression of sadness.
If, for example, we lose a loved one, sadness will inevitably blossom within us and lead us to a state of mourning where the healthy will be to go through some or all of the phases that usually make up it. once finished, return to the pre-loss state, except that we will always remember with love and nostalgia this being that was part of our life.
In this sense, the feeling of sadness is healthy, necessary and useful, so the most logical thing is that each of us experience it in situations equal to or similar to those we mention, so when sadness invades us, the most sensible thing is to live it, not deny it, or combat it, until it gradually disappears.
As we mentioned, major depression implies going much beyond sadness, it is classified as a disorder and, therefore, it is necessary to treat it with the seriousness and respect that it means, before explaining the possible causes, let’s define what the disorder consists of.
Major depression is defined by the simultaneous presence of a number of important symptoms, and its presence is expected to last two weeks, for diagnosis it is necessary that at least one of these symptoms be a sad and depressive mood, or a loss of pleasure (anhedonia) with the activities you used to practice.
But these symptoms are not enough, these symptoms should involve significant interference in the daily life of the person with them.
On the other hand, the diagnosis of major depression requires meeting additional exclusion criteria: that symptoms are not caused by disease or ingestion of any substance; that symptoms are not the result of a normal mourning response to the death of a loved one, there is a subtype, called melancholy, in which a number of symptoms appear, such as very marked loss of pleasure, lack of emotional reaction or inhibition.
In addition, to diagnose major depressive disorder, the person should not have had any episodes of mania or hypomania or if it is a case of schizophrenia or another psychotic disorder.
There is no single cause that determines that a person will suffer from a major depressive disorder, but in the scientific literature we can identify how several explanatory theories coexist which, as the name suggests, may or may not explain a particular case.
At the biological level, it is believed that chemical imbalances in the brain, especially anything of the well-known Serotonin neurotransmitter, are responsible for the person’s entry into this marked state of sadness and anhedonia. Currently, it is not scientifically known whether these biochemical imbalances are a cause or consequence of depression, so we cannot conclude that low Serotonin levels in the brain are responsible for depression in the person.
On the other hand, there are theories with a more psychological profile: currently the most informed, the best known theory is that of Aaron Beck, his popularity is based on facts: it is a theory that fully encompasses theoretical assumptions and methodology of information processing; Secondly, did it lead to any kind of treatment?Cognitive therapy?that has been shown to be as effective or effective as pharmacological therapy, with the added benefit of further reducing the risk of relapses and side effects.
For Beck, after the loss of reward (positive consequence of the behavior) and the natural emotion resulting from sadness, a series of cognitive errors will appear in the person: failures in the processing of external information, which would be responsible for the onset and maintenance of the disorder over time. Suppose that the depressed person cannot be objective in perceiving the information around him and therefore distorts reality in a negative way.
Some of these distortions that most often occur in depressed people are, for example, magnifying negative events that occur in their lives, minimizing positive events that occur, exaggerating the consequences of these negative events, and excessive generalization. or to think that it will be like this and that nothing will change.
In this way, the person is immersed in the so-called negative cognitive triad, which is nothing more than a permanent negative view of himself, of his own experience and, worse, of the future.
Is this distorted cognitive treatment the one that, according to the author, would lead to emotional symptoms?Deep sadness, lack of appetite, feeling empty ??behavioral?inhibition, collapsed? These emotional and behavioral symptoms, in turn, will strengthen negative thoughts, causing them to consolidate and perpetuate the disorder.
However, Beck does not rule out that this type of treatment also involves genetic, personal, hormonal factors, etc.
In general, there is a clear difference between the pharmacological treatments responsible for restoring the brain biochemical imbalance that we discussed above, and the psychological treatments, those aimed at improving the mood of the patient, as well as their existential functioning, as the case may be, mental. health professionals choose to use one or the other, or both combined.
In the context of pharmacological treatment, the most widely used drugs are selective serotonin reuptake inhibitors (SSRIs). They are used more often because they have fewer side effects than tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs). Everyone has heard of Prozac (fluoxetine), which belongs to this group.
The intention of these drugs, as the name suggests, is to prevent the rapid reabsorption of Serotonin and, therefore, that its effect on the brain is not lost so quickly when released into the small space that exists between neurons. a first impulse that would make the patient feel more enthusiastic to act.
Is depression cured with medication? No, as we said, the drug helps the person who is not able to take that first step to be better prepared in terms of mind to move forward, and it is precisely this first step that will improve their depression. .
On the other hand, within psychological treatments, those that have proven to be most effective are those that integrate into the cognitive-behavioral current, assuming that the cause of depression is that the patient has a distorted perception, towards the negative pole, of one’s own. reality and that as a consequence he feels and acts, the purpose of this treatment will be for the person to change this cognitive orientation.
Following this logic, therapy aims to change the patient’s thinking, providing him with tools to identify and modify these trends, then, thanks to a change in the way he thinks, the patient will begin to perform the activities that he has left behind and that previously provided him with pleasure, as well as incorporate new ones that can be beneficial and pleasant to him.
In this sense, we do not have to start by modifying the thoughts and beliefs of the patient, but we can start directly with behavioral activation, if this option is chosen, the patient will be able to establish a daily schedule in which various tasks will be performed. that it is committed to making.
What is the point? That the person who lost, due to her lack of activity, the existential stimuli that she had before and that made her happier, return and recover them through action.
The weekly plan should include both mastery tasks and fun tasks, control tasks are those that will help the patient feel competent and not be considered a failure or unnecessary, an example could be to resume or start taking English courses, pleasure tasks are those that involve leisure and pleasure, such as shopping, walking, calling a friend Etc.
What usually happens is that the depressed person will say that he is not motivated to perform any task, that he does not find meaning, that he does not believe that it is his problem or that he has no energy or will. you have a drawer full of excuses for not performing these tasks. As a therapist, you should know that this attitude and excuses are part of the disorder and make you understand that you need to fight this inertia.
The cognitive techniques we will use to modify negative thoughts and beliefs will be cognitive restructuring and behavioral experiences. Through restructuring, what is a person’s intention to change their negative thinking to a more adapted view of reality?Not positive? And that he realizes that he is capable of enduring it and that, moreover, it is not as terrible as he thinks.
On the other hand, behavioral experiences will help the patient realize how distorted some of their thoughts are. The therapist will suggest that the patient perform an activity or action. The patient should write down what he thinks will happen to him, and when he finishes, in the next session, the therapist and the patient will discuss what actually happened.
Finally, and according to the patient, can other more emotional techniques be used, such as rational emotional imagination?Do you see doing an activity and changing your emotions in your imagination?Mindfulness? Focus here and now, without letting your attention change Fully accept the surrounding reality: self-affirmation training or problem solving training.
References
Ortiz-Tallo, M (2004). Psychological disorders. Aljibe Editions.
Forjan, M (2010). Treat depression. Therapeutic resources Piraeus Psychology.
Bosh, M. J. (2009). The dance of emotions. Mr. Edaf.