What you need to know about depression

What is depression?

Depression is essentially characterized by a loss of meaning in life, coupled with a lack of pleasure in living. It can lead to melancholy and suicide.

Mental health professionals define depression, or the medical term characterized depressive episode, as a "mood disorder" with common symptoms such as sadness, guilt, loss of pleasure, sleep disturbance, apathy, fatigue and social withdrawal. Characterized depressive episodes also affect cognitive functions (impaired concentration, memory, motivation) and so-called instinctual functions (appetite, sleep, libido).

Depression is an illness. It's not just an apathetic state due to a lack of willpower, or a temporary feeling of sadness and fatigue linked to the ups and downs of life. It's a medical condition with a precise clinical diagnosis that needs to be treated.

The symptoms of a characterized depressive episode are present for a minimum period of two weeks at an acute level of severity, and represent a major change from normal functioning (professional, social, family).

Depression figures

In 2004, the World Health Organization declared depression to be the fourth leading cause of human suffering and disability, behind cancer, heart disease and road accidents. In 2021, depression was declared the leading cause of human suffering and disability. In all demographic groups, the figures are rising.

Most often observed in the 25-45 age bracket, depression is growing fastest in children and adolescents. From 2015 to 2020, antidepressant prescriptions rose by 40% in adolescents, compared with 15% in adults. Emergency room visits for suicidal thoughts increased by 59% from 2016 to 2021.

In France, the Baromètre Santé survey conducted in 2021 by Santé publique France shows that 12.5% of people aged 18 to 85 have had a major depressive episode in the 12 months preceding the survey. This increase concerns all population segments analyzed. The rate is higher among women than men (15.6% vs. 9.3%), regardless of age. Depressive episodes experienced "an unprecedented acceleration between 2017 and 2021 (+36%), particularly among young adults", observes this study: they affected 1 in 5 young adults (20.8%) in 2021, an increase of almost 80% compared to 2017 (11.7%).

On average, each depressed person negatively affects at least 3 other people.

Is depression hereditary?

Depression is not a hereditary disease, nor is it genetically transmitted. However, it is estimated that a person with one parent who has suffered a major depressive episode is 2 to 4 times more likely to be depressed than the general population. This is known as predisposition.

Depression can be transmitted by depressed parents to their children largely through their interactions, i.e. the models parents unintentionally set in their values and outlook, including the way they cope with adversity, manage and solve problems, and relate to others.

What are the possible consequences of depression?

Depression is more than just a mood disorder and a set of symptoms. It affects your ability to think and make decisions. It affects job performance, concentration and the ability to function at work. It affects relationships. It's hard to be around depressed people. It ends up damaging relationships, and of course, all that leads to is more isolation and more depression.

Untreated depression can worsen, become chronic and lead to suicidal thoughts. Hospitalization may be required when a patient suffering from a depressive disorder is at high risk of suicide. Hospitalization helps prevent the patient from acting out, and allows treatment to be readjusted in the event of a recurrence.

What factors lead to depression?

There is a whole range of factors involved in the onset of mental disorders, which cannot be considered in isolation: biology (including genetics and epigenetics), psychology, environment, context, life situation, personal history and social factors. All these factors play a part in the appearance and development of disorders, and interact with each other: environmental parameters can sometimes give rise to disorders with biological consequences.

Depression is often seen as the consequence of external events. However, some people who have experienced violent trauma do not suffer from depression because they have acquired coping skills and self-organization patterns.

What counts is not so much what actually happens to us as how we interpret the events of our lives, the meaning and significance we give them.

Stress affects the way we make decisions that complicate and exacerbate depression. Unintentionally, this reflects a decline in the quality of decision-making strategies, and leads to errors of judgment.

Mood influences how we remember what happens to us and the quality of the choices we make. Our state of mind influences our perceptions and the quality of decisions, and helping patients make better decisions by modifying the mental process is one of the most important things to do in therapeutic work.

How is depression treated?

Is there a better treatment for depression? Absolutely not. Is there a better approach? Absolutely not. The best approach is the one that works for the individual.

The most common form of treatment is antidepressant medication. For around half of those taking antidepressants, symptoms diminish significantly after a few weeks. Antidepressants can help you manage vegetative symptoms, such as sleep and appetite disturbances, and they can lower the level of depression. But they are not without side effects, and should not be taken on a long-term basis and without therapeutic help.

No medication will help you develop stress management skills. No medication is going to help you establish and maintain positive relationships with other people, or develop cognitive skills that will help you think critically about experience instead of letting your emotions drive you. An antidepressant won't help you come to terms with the destructive events in your life, nor will it help you rebuild. One of the most important things in therapeutic treatment is learning to rebuild a compelling future.

Psychoanalytic or psychodynamic therapy and cognitive-behavioural therapy have proven effective in reducing the symptoms of depressive disorders.

Cognitive-behavioral therapy provides techniques for managing the symptoms of depression (sleep, stress, etc.). It also helps to correct negative thought patterns.

Psychoanalytic work on depression aims to bring about a transformation in psychic functioning, bringing about a profound change in the mental aspects that have given rise to it. Psychoanalytic therapy focuses on the unconscious phenomena of past and present life, as well as on feelings. By gaining a better understanding of their history, patients move towards self-acceptance and relief from psychological suffering.

The psychoanalyst also possesses - and this is very important in the case of depression - a unique and essential tool for assessing the depth and severity of the problem, which is absolutely original, thanks to the concept of a complex psyche, made up of three instances, with a structure, a form of thought, a defensive organization, a much greater unconscious component than the conscious one, and an inner conflict specific to each individual. In other words, psychoanalysis looks at what is needed to bring about truly lasting change.

How can I get help if I'm suffering from depression?

When you're drowning, any buoy is a good one to grab. No help should be overlooked.

Antidepressants, which a doctor can prescribe, can help you get your head above water at first and regain your ability to think and act, but they need to be combined with psychotherapy if you are to have any chance of treating the psychological causes.

It's important to get professional help. You don't know your own dark areas. The aim is not to cure depression, but to learn how to manage your moods and change the way you interpret events in your life.

One of the most important skills you can develop is reality testing. How do you get outside yourself to find out what's really going on? If you observe the times when people have the most problems, it's when they lock themselves into beliefs that are disconnected from reality. Clinicians call this cognitive rigidity. The main problem with depressed people is that they think certain things and then make the mistake of believing their own reasoning, becoming victims of the negative emotions that follow.

The role of a psychotherapist is to help the patient acquire the cognitive skills needed to gather information and make the best use of it, rather than relying on unfounded conclusions.

Depression can also have archaic causes, long repressed and exiled in the unconscious, which resurface in the form of symptoms. In this case, analytical therapy can help to identify the origins of the suffering, so that we can better understand and manage it.