What is Depression?
Depression is defined by the International (statistical) Classification of Diseases (ICD) as having a low (sad) mood, low energy, less activity, less enjoyment, less interest, loss of concentration, tiredness, poor sleep, poor appetite, low self-esteem, loss of self-confidence, loss of libido (desire), often guilt and or worthlessness, lethargy or agitation. It can be mild, moderate or severe. It can happen once, a few or several times or not stop (Otte et. al, 2016).
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM5), Major Depressive Disorder must have at least five symptoms start and last two weeks or more of: depressed mood, less interest or pleasure, weight loss, too little or too much sleep, lethargy or agitation, fatigue, worthlessness or guilt, less concentration or ability to decide, thinking of death or suicide, that significantly lowers functioning and is not caused by a substance, medical condition, other mental condition and no mania has ever occurred. It can be mild, moderate or severe (Tolentino et. al, 2018).
Common signs of depression include waking too early, sleep problems, appetite loss and high reactivity (blowing up). The biological effects usually are an increase in stress hormones (cortisol) and an overall endocrine (hormonal) disruption. Older biological theories believe it is entirely caused by a chemical imbalance in the brain but this is no longer considered valid. The current psychological theory is that negative messaging from the neocortex (higher brain areas) start and maintain these changes in the brain. Older Freudian models described it as self-directed aggression, due to lack of outlets, control, certainty, and interconnection. Other psychological theories include learned helplessness, early age parental loss or high stress.
How to Treat Depression
There are various ways to treat depression. Drug Interventions, which have an overall effective rate of 30%, include:
- Monoamine Oxidase (MAO) Inhibitors and Tricyclics, which increase norepinephrine to reduce anhedonia (pleasure loss)
- Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) that increase serotonin and norepinephrine to reduce lethargy, agitation and grief
- Norepinephrine Dopamine Reuptake Inhibitors (NDRIs) which increase norepinephrine and dopamine to reduce the loss of pleasure
Psychological interventions try to restore the capacity to see bad events in larger context and reduce the recovery time (DeRubeis et. al,). Older psychological theories may try to provide an outlet, increase control, provide more certainty, and an interconnection. Our neurocognitive approach the Neurocog™ system integrates all of the main cognitive and behavioural theories and interventions and avoids confusing terms. Instead of the terms Depression or Major Depressive Disorder a neurocognitive description addresses the specific strengths and challenges presented. Low motor and sensory awareness can also lower emotional awareness. This can then lead to difficulty in navigating thoughts and ideas which can create distorted perspectives. What is referred to as Depression is often caused by mistaking one or a few negative events as a never-ending misery.
Another misperception is that there would not be any significant negative events or difficulties so that when it occurs it is experienced as a terrible shock. This misperception can cause others, such as believing there is no way out of feeling miserable or that negative events are a deserved punishment. These false ideas then create feedback cycles of misinformation that sustain or increase the process of misery. But with neurocognitive training the ability to overcome misperceptions increases and they are less likely to feedback.
During the current COVID-19 pandemic there is a process of transition from societal norms to a different way of organising ourselves to cope with a deadly virus. Transitions can often include disruptions, loss and worse. Adapting to the “new normal” takes neurocognitive skills of emotional and cognitive awareness and self-regulation. Each of us has some level of neurocognitive capacity but for those who are struggling just taking time to practice these skills will reduce distress and improve functioning as a way of dealing with depression during COVID-19.
At our clinical office the staff of Neurocog are here to help if you feel some or all of these symptoms or other difficulties in the way you are feeling and thinking. We pioneered neurocognitive training using the Neurocog System by applying effective techniques from the most widely used methods of cognitive and behavioural science. We even developed the Neurocog app to help you build those skills more easily. Contact us directly at 02 82249670 or go to our website www.neurocogsystem.com to find out more.
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9(10), 788-796.
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., … & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2(1), 1-20.
Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 criteria and depression severity: implications for clinical practice. Frontiers in psychiatry, 9, 450.