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Depression - A Silent Disease

About 1.9 million Kenyans suffers from depression. How is depression defined and what are its triggers?

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Depression is a mental illness with severe effects. An early diagnosis of the disease and therapy are essential in order to lead a joyful and balanced life as soon as possible. Those who suffer from depression suffer from a state of persistent low mood which they are unable to overcome. This state is different from "normal" feelings of exhaustion, despondency and sadness which arise as a reaction to concrete problems. Everyone experiences such lows, and they tend to pass as soon as the events that triggered them have been dealt with. 

Untreated depression, on the other hand, does not usually get better by itself. It can arise due to a variety of different causes and can also manifest itself no matter what the external circumstances are. 

A combination of several causes leads to depression

In most cases, depression has several causes. Physical and genetic factors interact with psychological and psychosocial triggers and reinforce one another. Due to the very complex nature of these interactions, there is neither a "typical depression" nor a "typical person suffering from depression". 

The biological causes of depression include first and foremost hereditary factors: in other words, the presence of certain genes which are associated with a slightly increased risk of depression. Someone who has inherited such a gene is more likely to develop depression during his or her life than someone who has inherited a more robust make-up. 

Other factors include physical triggers, such as one’s brain metabolism. When the latter gets out of control, the messenger substances serotonin and/or noradrenalin are thereafter no longer present in optimal concentrations in the brain. As a result, impulses can no longer be transmitted properly between brain cells resulting in an improper processing of stimuli, and the feelings and thoughts of those affected change, sometimes in drastic ways. 

Disease as a trigger of depression

Diseases such as tumours, brain injuries, strokes or severe hormonal disorders can also cause depression. It such circumstances, it can often be difficult to ascertain whether it is the illness causing the depression or vice-versa. As before, many factors of different natures (physical, psychological, psychosocial) interact in complex ways. Physical symptoms such as headaches, fatigue and sleep disturbance are also common and so are such phenomena as gastrointestinal discomfort, loss of appetite or skin issues. 

Another aspect to this interaction is the organism’s reaction to stress. Research shows that during chronic stress, acute psychological trauma or while one suffers from an infectious disease, the steroid hormone cortisol is released at an increased rate. This increased amount of cortisol due to stress can cause behavioural changes such as impaired concentration, sleep and appetite, loss of sexual desire and an increased anxiety response. All of these behavioural changes are also typical of depression. According to experts, a person's predisposition plays an important role in how imbalances of steroid hormones are formed and how strong their effects are. It thus remains to be clarified whether dealing with stress, crisis or experiences of loss is simply a mechanism which has not been successfully learned by some individuals or whether some hereditary factors do indeed interact in a certain way and thus create circumstances which are favourable to the disease.  

Changed life circumstances can promote depression

Drastic changes in one’s life involving a change in employment or the death of a relative or friend can increase the risk of depression. Other factors which may also have the same effect include traumatic childhood experiences, the loss of close carers, abuse, violence, and emotional neglect.  

Retirement (especially forced or early retirement), the birth of a child, bullying at work or the loss of social contacts after accidents or migration, as well as conflicts within one’s family and social circle can also play a role.  Personal characteristics such as being highly achievement-focused, feeling a sense of responsibility and being very self-critical (perfectionist tendencies in particular) are often aggravating factors.  

Metabolic diseases and depression

Certain metabolic diseases such as diabetes or thyroid dysfunction and neurological diseases such as Parkinson's disease or dementia are often accompanied by a low mood and sometimes depression. Infectious diseases such as pneumonia and heart disease can also elicit a similar effect on one’s mental health.

Older people are also particularly susceptible to depressive moods. Drastic life changes, illnesses and medication often affect the mind in various different ways as one gets older. Medication such as cardiovascular drugs, sleeping pills or medicines for allergies in particular can also result in a marked low mood. Finally, alcohol dependence or substance abuse can also have the same effects. 

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