(Text is translated from Mikä on masennus ja minkälaisia masennuksen muotoja, sekä oireita on olemassa? -article)
Depression could be described as one way a person reacts to a critical phase in life. If a critical life phase becomes too difficult to endure, a natural coping strategy in such a situation might be depression. Depression manifests in a person holistically, affecting behavior, thoughts, the body, and socially. For some, depression almost completely immobilizes, while for others, it is more of a slowing and dreary experience without impairing functionality. In this text, we will discuss factors that can contribute to the onset of depression, how to recognize the signs of depression, and methods for treating it.
In mild depression, one is often functional and can manage daily life. However, tasks that are normally straightforward, such as work, study, and maintaining relationships, may require extra effort.
In moderate depression, functional ability is noticeably impaired, and sick leave may be necessary for recovery.
In severe depression, symptoms significantly hinder functionality, and the condition can be completely debilitating. Tasks that are usually manageable may feel overwhelmingly burdensome.
Melancholic depression is characterized by a lack of pleasure, intense feelings of guilt, decreased appetite, and physical agitation or retardation.
Atypical depression often involves reactive mood swings, where something positive momentarily improves the mood. Increased appetite and sleep needs are common in atypical depression, along with feelings of powerlessness and a tendency to feel abandoned, especially when alone.
Psychotic depression includes delusions and disturbances in reality perception, in addition to other depressive symptoms.
Seasonal affective disorder, such as winter depression, occurs during dark winter months. Symptoms typically begin in October and improve by February-March. Read more about seasonal affective disorder (SAD) from here: (Kaamosmasennus)
Postpartum depression occurs after childbirth and can involve difficulties bonding with the baby, intense anxiety, panic attacks, and a decline in functioning.
Dysthymia involves milder symptoms than major depression but persists continuously for at least two years, negatively impacting quality of life.
While the exact causes of depression are not fully understood, various factors contribute, including psychological, social, physical, biological, and genetic elements. Traumatic experiences, major life changes, suppressed emotions, unresolved grief, relationship conflicts, personality traits, low self-esteem, substance use, and physical or mental illness can all contribute to depression. Negative learned thought and behavior patterns can also predispose individuals to depression.
Depression can be triggered by numerous factors, and it's highly individual which events lead to depression. Life events such as disappointments or losses can trigger depression. Prolonged stress, burnout, unemployment, relationship problems, loneliness, addictions, financial difficulties, illness (personal or of a loved one), childbirth, hormonal changes, or being a victim of crime or violence can also be triggers. However, depression doesn't always have a clear cause, and anyone can experience it, regardless of genetic predisposition or risk factors.
Depression symptoms vary among individuals. The most apparent symptom is a depressed mood or significantly reduced interest or pleasure in activities. This mood disturbance persists for most of the day for at least two weeks. Depression also involves cognitive difficulties, emotional instability, and physical symptoms. Memory problems, forgetfulness, slowed thinking, and difficulty concentrating are common. Emotional states fluctuate from irritability and anxiety to a near-total emotional numbness. Enjoying achievements and activities becomes challenging, and feelings of loneliness and melancholy are prevalent. The regulation of emotional systems is disrupted, leading to the dominance of emotions associated with the threat system, including anxiety, sadness, lethargy, fear, anger, irritability, and disgust.
The most obvious symptom of depression is a depressed mood or significantly reduced interest or pleasure. The symptom bothers the person for most of the day for at least two weeks. In depression, the mind is depressed for most of the time, and it may be accompanied by a deep sense of hopelessness, where nothing seems to inspire or matter. However, depression is not just about a lowered mood or diminished interest. Diagnosing an actual depressive state also requires several concurrent symptoms. (Competing companies have defined the symptom picture.)
The memory of a depressed person weakens, and absent-mindedness, such as forgetting small and large things, occurs frequently. You might forget in the middle of a sentence what you were saying. Thinking becomes sluggish. If logical thinking was easy before, it may now be nearly impossible. Concentrating on reading or a prolonged conversation with another person is challenging, sometimes even impossible.
Emotional states vary from irritability to anxiety and almost total emotional numbness. Lack of joy and a lack of interest are common in depression. However, moments of well-being can still be found in the mind of a depressed person. Typically, activities like exercise and enjoyable moments with other people bring a sense of well-being and happiness. Nevertheless, the mood of a depressed person is generally more or less low.
Finding enjoyment in achievements and activities is often difficult in depression. Profound loneliness and feelings of melancholy are typical. Other people seem unreachable, and it's challenging to find the pleasant experience of belonging to a group.
From the perspective of emotional regulation systems, in depression, the so-called threat system is almost constantly activated. This is reflected in the predominance of emotions associated with this system. These emotions include:
Anger and disgust can be predominant experiences and, at their worst, turn inward—forming a vicious cycle of self-criticism that effectively diminishes vivacity and the experience of enjoyment, leading into darkness. As a remedy to self-criticism, understanding, kindness, and gentleness towards oneself help construct a path out of the darkness.
On the other hand, anger or sadness can become problematic for someone due to experiences and lessons in life. If these emotions cannot be allowed, they may become the cause of depression—often referred to as emotional blockages or mental jams. In these situations, accepting emotions and working through the difficulties in life associated with them usually alleviates depression.
The thinking of a depressed individual tends to be highly negative, and cycles of negative thinking are quite typical in a depressed mind. Negative events, interactions, and experiences are easily remembered. Positive things and states of being also occur, but in a depressed mind, they often go unnoticed or are immediately forgotten once they pass. Even a minor setback can trigger feelings of hopelessness and inadequacy.
The relationship a depressed person has with themselves is often very critical; feelings of worthlessness and dissatisfaction cast a dark shadow over life. Consequently, shame is a very common experience for a depressed individual, often being a factor that sustains and reinforces depression. Shame makes a person feel inferior and disconnected.
Thoughts about death and its relief occasionally cross the mind. Feeling burdensome to others while believing that it might be easier for everyone if one were to pass away is a common sentiment for a depressed individual. Sometimes, a person might experience suicidal thoughts and actively plan self-harm. Hence, it's important for those close to a depressed person to understand that thoughts about death and occasionally even planning are part of depression. These thoughts reflect the depressed person's profound distress. Thoughts about death might seem comforting when feeling extremely hopeless. Fortunately, the deep and strong desire to stay alive usually provides reasons even within depression to stay present and give life a chance. Talking about thoughts related to death is almost always a relieving experience. It's liberating to know that one is not alone in their despair and that others have had these thoughts but have later enjoyed life again.
Depression typically reduces a person's ability to function, making it more challenging to perform tasks that they otherwise manage well when not depressed. Activity is reduced and slowed down, initiating tasks is challenging, and there's often a lack of drive and energy. Decision-making might be difficult, and an anxious feeling pervades the body.
Investing in personal well-being often decreases for a depressed individual. Taking a shower might feel like a huge task, often postponed until the next day. Sexual desires and enjoyment may also diminish for many due to depression. Changes in sexuality are frequently associated with depression medication, but they can also be part of depression.
It's common for depression to cause changes in appetite. Some eat very little, while others tend to binge on snacks. Many notice weight gain, and managing weight can be painfully challenging. Challenges in weight management might relate to depression medication, but changes in the body's metabolism due to depression often lead to easy weight gain and difficulties in shedding pounds.
Disruption of bodily rhythms is also a significant biological factor in depression. The circadian rhythm defines the sleep-wake cycle, and when this rhythm is disturbed, falling asleep can be difficult, and waking up properly in the morning can take a long time. Additionally, the frequent early-morning awakening often associated with depression is typically a sign of rhythm disturbance. Moreover, disruptions in the circadian rhythm can affect sleep structures and even cause insomnia. Read more about disruptions in the body's circadian rhythm and chronobiological treatments from here: (Aikabiologiset hoidot eli rytmit masennuksessa) [Article is in Finnish]
Furthermore, a depressed person's behavior might, in some way, be self-destructive. This could manifest in the amount or ways they consume substances. It's also not uncommon for their behavior in traffic or hobbies to become somewhat self-threatening. This behavior reflects distress, hopelessness, and helplessness—wishing for some accident to occur to "escape from it all."
Relationships with others constitute a significant part of life; our connections with others fundamentally shape and mold us into who we are. Therefore, a lack of positive contact with others usually at least fuels depression. Difficulties in interpersonal relationships are often a contributing factor to depression.
The relationship with others almost inevitably changes to some extent when one is depressed. Often, being in the company of those with whom one can be "themselves" is energizing and uplifting. There is no need to pretend to be energetic and happy if it doesn't feel good at that moment. In such situations, mood often lightens, and a smile effortlessly appears. Conversely, being in the company where one feels the need to strongly maintain a certain role can make one feel very heavy and empty.
As a person becomes depressed, they often become highly sensitive to the negative words and gestures of others. These are perceived and interpreted strongly and may linger in one's feelings for a long time. If the self-image is already poor, such negatively charged encounters only contribute to increased self-criticism, feelings of inadequacy, and a sense of worthlessness.
If self-criticism and a shame-laden state are strong, a person may start avoiding almost all other people when depressed. It is challenging for them to experience being with others as positive because they constantly perceive themselves as inadequate or not the right kind of person to be enjoyable company.
Social situations that were previously enjoyable may feel burdensome, answering the phone can be overwhelmingly difficult, and reaching out to another person requires effort. Other people may seem like a threat. Thus, social anxiety is quite common in depression.
However, the caring and open support of others is invaluable in recovering from depression. This can also lead to a more positive relationship with oneself.
Being with a depressed person, a close one often feels the contagious helplessness and hopelessness of the depressed person, and the reaction can be a strong urge to solve the depressed person's problems to make them "cheer up." It can be challenging to just be with them and share their world, as it may be perceived – quite understandably – as dull and depressing.
It is not uncommon for a loved one to suggest simple solutions they find beneficial or have heard about – a certain supplement, exercise, waking up earlier in the morning, etc. These may have already been tried, or the energy may not be there right now. The person suffering from depression may already know that these are good things, but they alone do not solve their depression. They may feel offended and think that the other person does not understand them, while the loved one wonders why their well-intentioned advice is not being taken.
Depression is not an emotion; it is an involuntary defense against overwhelming feelings. The depressed individual has kept their emotions inside. They feel that no one can understand them. Nevertheless, expressing emotions has been proven to alleviate depression. It is, however, difficult, and expressing pent-up feelings certainly does not feel good for those close to the person. A depressed individual is often angry at family members for seemingly incomprehensible reasons and may feel guilty. It is essential, however, for the depressed person to feel that their expression of emotions does not drive people away.
It is crucial for the loved ones of a depressed person to remember that they do not have to react to every expression of distress or try to find a solution. They do not have to get involved in the depressed person's moods. Instead, what matters is to remind the other that they are important, as knowing that someone truly cares often helps the depressed person. Take a moment to listen to what your loved one is really going through. You do not have to fear the depressed person; their mind is intact, and you can talk to them just like anyone else.
Living with someone suffering from depression can be extremely challenging and frustrating. You may feel the need to help the depressed person, but everything you do seems to make the situation worse. Remember that depression gets better, even if the situation currently seems hopeless. It is crucial that, as a loved one, you take care of your own well-being.
Depression is approximately twice as common in women as in men. The typical symptoms of depression are quite similar regardless of gender: low mood, intense fatigue, and loss of the ability to experience pleasure. However, there are observed gender differences in some depression symptoms.
In men, sleep disturbances and decreased appetite occur more frequently than in women. Compulsive busyness and overachievement can also increase in men as a way to release emotions and cope with a bad mood. Some immerse themselves in gaming, while others release their emotions through physical activities. For some, overachievement occurs through work, leading to excessively long working hours. Additionally, men express depression as irritability and aggression more frequently than women. If a partner is constantly on edge, and managing daily life becomes difficult, it is essential to be aware and try to understand the root causes of this behavior.
In women, depression usually manifests as an increase in appetite and sleep needs. Seasonal symptoms, such as depression, are more common in women than in men. Women also experience anxiety more easily than men, and therefore, women feel more guilt and feelings of worthlessness than men. Additionally, women undergo hormonal changes that may explain their higher risk of developing depression. Such hormonal changes occur during adolescence, pregnancy, menopause, as well as after childbirth or miscarriage.
The diagnosis of depression is always based on a doctor's interview. During the interview, the doctor assesses the individual's life situation, and the final diagnosis is based on the symptoms observed during the interview. The number and severity of symptoms, as well as their duration and temporal prevalence, influence the confirmation of depression. Depression is not solely about reduced mood or interest; the diagnosis of actual depression requires other concurrent symptoms.
Depression screening tools can be used as aids in diagnosing depression. The result of a depression test is indicative, but alone, it is not a sufficient source of information for diagnosing depression. The diagnosis of depression is always based on a doctor's interview.
Beck Depression Inventory (BDI): Beck's Depression Inventory (BDI) is intended for individuals who suspect they are depressed and wonder if they should seek help. Based solely on the BDI score, a depression diagnosis cannot be made. A score of 0–12 is normal, 13–18 indicates mild depression, 19–29 moderate to severe depression, and ≥30 indicates severe depression.
[You can take the Beck Depression Inventory (BDI-21) test [Link to BDI-21 test] (Test is in Finnish)
DEPS Test: The DEPS Depression Test is intended for individuals who are considering whether to discuss their well-being with a doctor. DEPS is commonly used in Finland, but no single result from a depression test necessarily means that a person is suffering from depression. A doctor's examination is always needed for making a diagnosis.
[Link to DEPS test] (Test is in Finnish)
Geriatric Depression Scale (GDS): The Geriatric Depression Scale (GDS) has been developed for assessing depression in elderly individuals. GDS is a self-assessment scale, but another person can fill out the scale by reading the questions aloud to the elderly individual. Depression symptoms are assessed for the past week. A score of 0–10 is normal, 11–20 indicates mild depression, and 21–30 indicates moderate to severe depression.
Depression is often mistaken for other conditions, and without proper examination, incorrect diagnoses can easily be made. For example, a blood test can help ensure that there is no other underlying illness, such as hypothyroidism or anemia, which may be misdiagnosed as depression. Additionally, depression episodes associated with bipolar disorder are often mistakenly thought to be ordinary depression.
Bipolar disorder involves changes in mood, with elevated mood episodes, depressive episodes, and combinations of both. There may be a symptom-free period between episodes, but a person may suffer from milder depressive symptoms. Thus, it is possible that a person's mood swings characteristic of bipolar disorder are not recognized, and the symptoms are thought to be depression based on the presentation of symptoms alone. (Mieli ry)
Each person's depression is unique, influenced by several factors. Depression is a complex, systemic issue, and as such, it should be treated comprehensively. Each depressive condition should be seen as unique, and attention should be given to the whole picture before considering appropriate treatment.
Insufficient or monotonous nutrition can contribute to depression. For our nervous system to function well, it needs nutrients from food to produce nerve cells and neurotransmitters. The diet should include an adequate amount of unsaturated fat, antioxidants, folic acid, B12 vitamin, and omega-3 fatty acids.
St. John's Wort preparations have been shown to have a relieving effect on depression. Studies have revealed that St. John's Wort preparations are as effective as established antidepressants. Moreover, these preparations have fewer negative side effects than conventional antidepressants. Turmeric has been shown to have mood-lifting effects, and it may also enhance the therapeutic effects of antidepressants. Turmeric is a well-tolerated spice with no significant side effects.
Exercise develops and maintains physical, mental, and social health, reducing premature mortality. Exercise elevates mood and makes one feel more energetic. It reduces muscle tension, increases blood circulation in the brain, and decreases the secretion of the stress hormone cortisol.
Various complementary explanations have been found for the effectiveness of exercise in treating depression. Consistent with the serotonin theory, it has been observed that exercise increases the levels of pleasure-inducing neurotransmitters in the brain. Endorphin hormones not only induce happiness but also reduce pain. Additionally, exercise helps improve sleep.
Chronobiological treatments refer to the fact that our body and mind's rhythm has been disrupted, causing conditions such as seasonal affective disorder, anxiety, and depression. Chronobiological treatments aim to restore this rhythm. (Aikabiologiset hoidot eli rytmit masennuksessa) [Article is in Finnish]
Psychotherapy is a theory-based, interactional form of treatment. Psychotherapy aims to explore factors and events affecting the client's mind that are related to mental challenges. These factors usually relate to thoughts and feelings, and their connections and ways of functioning.
Psychotherapy is largely based on talking, but it differs from conversations with, for example, a friend or family member. The difference lies in the fact that psychotherapy examines mental events and their effects on the state of being using various methods and techniques.
Psychotherapy differs from other forms of depression treatment in that many patients experience gaining wisdom or maturity through it. Psychotherapy aims to support a person's activity and the sense of self-determination in life. This sets it apart from, for example, medication treatments, where the patient is a passive recipient waiting for effects.
Cognitive-Behavioral Therapy, or CBT, revolves around examining internal processes, thoughts, and feelings. In therapy, individuals learn to address immediate negative thoughts, question them with facts, and transform them to better align with the situation. CBT involves changing the immediate thoughts of the depressed person in relation to themselves, others, and the future. Additionally, it examines and changes the broad underlying assumptions behind depression. Depressed individuals tend to downplay everything good in their lives and exaggerate everything that is going poorly. For example, "If X doesn't like me, then nobody likes me."
Interpersonal Therapy, or IPT, (Link as text, Article is in Finnish) is a three-phase psychotherapy method developed specifically for the treatment of acute depression. IPT does not seek the "ultimate" cause of depression; instead, it examines social factors that trigger depression. IPT also does not aim to change the patient's personality, which is common in many other therapy forms.
Interpersonal therapy focuses, as the name suggests, on interpersonal interaction, known as "relationship therapy." Understanding the connection between depression and the preceding interpersonal issue helps in problem-solving and alleviates depression. A person heals when they learn to manage their own life and emotionally charged interpersonal relationship problems.
IPT has several advantages in treating depression, such as practicality, a relatively short duration of treatment, typically 3-5 months, and compatibility with other treatments that complement the effect of IPT.
Solution-focused psychotherapy sees the problems a person faces in a social context as part of social interaction. Clients are helped to change their perspective on their situation through therapeutic conversation. The length of solution-focused therapy varies greatly, but typically there are fewer sessions.
Long-term psychotherapies can also be useful in the treatment of depression. However, their positive effects may emerge more slowly than in short-term therapies. If a person has many other problems alongside depression, long-term therapy may be a recommended option.
Peer support is a useful tool as part of depression treatment. Individuals who have experienced depression themselves are often a great help to other depressed individuals. Group therapy for depressed individuals often combines both peer support and therapeutic work in an excellent way. Sharing common experiences increases mutual understanding. Hearing stories of others' coping is particularly crucial during moments of loneliness. Peer support helps better understand what has happened and commit to the present. Additionally, peer support provides hope for the future.
Expressive writing is a tested method for understanding and coping with personal crises, anxiety, and stressful situations. In essence, it involves personal, emotion-based writing where form, grammar, or spelling is not important. The goal is to express things on one's mind in writing and, through this, process one's own thoughts and feelings. Expressive writing is not so much about dealing with what happened but rather about addressing the emotions and feelings stirred by the past or ongoing situation.
The most commonly used antidepressants are SSRIs (Selective Serotonin Reuptake Inhibitors), which focus on increasing the levels of serotonin in the body. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) have also become prevalent. Tricyclic antidepressants, developed in the 1950s, are still used quite widely.
Serotonin plays a broad role in various regulatory functions in the body. It is involved in internal communication, primarily in the gut and sensory perception but also in the central nervous system. The purpose of SSRIs is to alleviate depression by significantly increasing the levels of serotonin in the body. The body compensates for the drug's effect by reducing its own serotonin production and serotonin receptors.
SSRI medications and the resulting permanently high serotonin levels affect various bodily functions, including intestinal activity, sleep, and sensory perception. Notable side effects of SSRIs include nausea, stomach problems, dizziness, tremors, motor restlessness, palpitations, anxiety, sexual dysfunction, seizures, and susceptibility to suicide.
When discontinuing SSRIs, the body experiences serotonin deficiency because there is no longer an excess of serotonin. Serotonin deficiency is not observed in people before starting SSRIs; it is only detected in individuals who have used SSRIs at some point.
Discontinuation of SSRIs usually causes withdrawal symptoms, and it is not precisely known why they are more severe in some individuals than in others. Withdrawal symptoms differ from depression in that they are highly physiological. A person feels painful all over, and controlling one's emotions is challenging because serotonin has previously kept emotions in check. Electrical shocks in the head are a typical but peculiar withdrawal symptom. Similarly, sensory perception can behave strangely, as if one does not feel present in the moment, and the body does not feel like one's own. Sexual dysfunction occurs in everyone using serotonin, as serotonin affects sensory perception. Many expect sexuality to return to normal after stopping antidepressant use, but some may experience a persistent loss of sexual desire or function.
Learn more about the effects of antidepressants on the body from here: (Masennuslääkeriippuvuus - Vaiettu kansantauti) [Article is in Finnish] ” Antidepressant Dependency - The Silent National Epidemic”
In self-help for depression, it is essential to try to stick to normal daily routines and enjoyable activities/hobbies while avoiding social isolation. The assistance of other people is crucial for living through depression.
Regular, basic physical exercise has been shown to be as effective as medication and psychotherapies, at least for milder depression. Therefore, any enjoyable exercise or outdoor activity is beneficial for self-help in depression.
The significance of sufficient sleep and rest is crucial for both mental and physical well-being. Consider what relaxation methods work for you and stick to them.
A varied diet is essential for overall health and well-being. Try to eat meals that contain plenty of fiber, vegetables, fruits, and berries, and opt for lean protein sources. Good sources of fat include nuts, seeds, and fatty fish like salmon.
To some extent, the development of depression can be prevented through mental health-promoting lifestyles. Factors that help prevent depressive states include good relationships with loved ones and social support, as well as healthy lifestyle habits such as regular exercise, a varied diet, sufficient sleep, and avoiding or quitting substance use.
Recovery from depression is individualized. Depressed feelings can be momentary, easing within a day or a few days. On the other hand, the alleviation of depression can sometimes take a considerable amount of time. It's generally considered a comprehensible reaction to life situations and can last from weeks to months, sometimes even longer.
There are many factors that can contribute to the recovery from depression. Alongside formal treatment, the following aspects may support the healing process:
Social Support: Social support is a significant resource in depression. Assistance from others is crucial for living through depression. When interacting with a depressed person, it's essential to remember that even a small chat or having coffee together can provide important and natural support for recovery.
Exercise: Exercise increases the levels of pleasure-inducing neurotransmitters in the brain and raises the amount of endorphins in the blood. It also enhances blood circulation in the brain, reduces muscle tension, and, most importantly, decreases the secretion of the stress hormone cortisol. Exercise also helps prevent the recurrence of depression.
Functional Approaches to Support Recovery: Writing can help organize one's thoughts, feelings, and experiences. Keeping a diary, for example, is a way to express one's state of mind and increase self-understanding. Drawing, painting, playing musical instruments, and listening to music can also promote understanding of one's emotions and thoughts.
Towards Positive Thinking: Negative and pessimistic thoughts are typical in the mind of a depressed person. Negative events, contacts, and experiences tend to stick more easily in the mind, overshadowing positive ones. However, it's possible to train the mind towards a more positive thinking pattern. It's crucial to notice when the mind is stuck in continuous cycles of negative thoughts and life feels overwhelmingly dark.
In the appointment scheduling calendar below, you can easily book a session with an expert from Mielipalvelut (Finland) who specializes in depression treatment.
For new clients, we recommend the "Ensikartoitus" service. In this initial assessment, our expert, along with you and possibly your loved ones, discusses your current situation. The first assessment is not an interview or a test but marks the beginning of active work towards your recovery. Learn more about the first assessment (Ensikartoitus) here.
Mielipalvelut toimii Helsingissä, Tampereella, Turussa sekä etäyhteyksin ympäri Suomen. Klikkaa alta:
