16. What causes postpartum depression?
While cases of mothers killing their children due to postpartum psychiatric problems are mercifully rare, well-known examples reported in the news have made us more aware of how vulnerable some women can be to problems such as depression after giving birth. Up until relatively recently, however, women have been afraid to talk about their postpartum symptoms for fear of being thought of as crazy or that they might pose a danger to their children. This often leads to needless suffering and a sense of shame that might prevent women from seeking help until it is too late in many cases.
In reality, postpartum or postnatal depression affects around 15 percent of new mothers and can also affect new fathers as well. Symptoms of postpartum depression can include:
Persistent sadness or a sense of feeling “empty”
Feelings of hopelessness or helplessness
Mood swings
A sense of worthlessness or poor self-esteem
Exhaustion
Difficulty bonding with the baby
Lacking confidence in maternal or paternal instincts
Many other familiar symptoms of depression also appear including loss of libido, appetite changes, lack of energy, loss of interest in activities that used to be enjoyed, social withdrawal, and insomnia. People suffering from postpartum depression can also develop cognitive problems such as poor concentration, impaired decision-making ability, and distractibility. Persistent worries can develop, including an overwhelming fear of becoming violent or suicidal. Along with worrying about possibly harming their children, people with postpartum depression may also worrying about injuring a spouse or other family member, or even committing suicide.
While postpartum depression can become life threatening if the symptoms persist long enough, there is also a more severe form known as postpartum psychosis. This means, along with symptoms of depression, sufferers can also develop psychotic symptoms such as visual or auditory hallucinations (i.e., hearing voices ordering them to kill their baby or commit some other violent act), delusions, or grossly distorted thinking patterns. While postpartum psychosis is relatively rare (occurring in about one out of every thousand pregnancies), it can be especially dangerous, as it can often appear even in women with no prior history of mental health problems.
Still, there can be warning signs that might indicate that some women are at risk for postpartum depression. One of the strongest of these is prenatal depression, which can occur in 7 to 20 percent of all pregnancies. Symptoms for prenatal depression are very similar to those seen in postpartum depression and can be triggered by pregnancy stress, relationship problems, financial worries, medical complications, or trauma.
There are also milder forms of postpartum depression such as the “baby blues,” which occurs in 80 percent of all pregnancies and usually goes away on its own after a week or two. While women who experience baby blues may be at risk of developing more severe postpartum depression in future pregnancies, the symptoms are usually not that severe in themselves so long as they don’t last longer than a couple of weeks.
While the American College of Obstetricians and Gynecologists recommends that all women be screened for symptoms of depression during pregnancy and in the months following birth, this often doesn’t happen unless the women themselves report problems. Though universal screening for depression is happening in some places, including parts of Canada, many other jurisdictions have been slow to follow suit.
As we come to understand more about prenatal and postpartum depression, better treatment options are becoming available. But not all women suffering from symptoms of depression linked to pregnancy are willing to admit what they are feeling and are delaying treatment as a result. If you are dealing with prenatal/postpartum depression, or if someone close to you is, don’t hesitate to discuss these symptoms with a health care professional as soon as possible.
17. What causes seasonal affective disorder?
While many people experience the “blues” during the autumn and winter months, the different ways that our bodies change from one season to the next can be profound. Even though you might not be aware of it, your mood and behavior often change depending on where you are living as well as the amount of sunlight you take in on a daily basis. For example, many people living in northern countries often report feeling much more depressed and apathetic during winter months, something that is much less common in people living in more southern climates.
Back in the 1980s, medical researcher Norman E. Rosenthal and his colleagues at the NIMH first identified a condition he referred to as seasonal affective disorder (SAD). In his 1993 book, Seasons of the Mind, Dr. Rosenthal suggested that the seasonal changes in depression experienced by him and many others were likely linked to not getting enough sunlight in winter months. Symptoms of SAD are very similar to those of other mood disorders: sadness, lethargy, appetite and sleep changes, and a difficulty waking up in the morning.
Women and children are far more likely to experience these symptoms and, as expected, they are much more common in northern latitudes than in places closer to the equator. People with SAD also report sleeping more hours during winter months than they do during the summer (as much as two or three hours longer in many cases). Also, for reasons that are still unclear, SAD symptoms are most apparent around the age of twenty- seven and decrease over time as people grow older.
Though not formally listed in the DSM as a distinct mood disorder, people are considered to be suffering from SAD if their depression has a clear seasonal pattern (more severe at some times of the year than others) and last for two years or more. While it’s hard to say how common SAD really is, Rosenthal reported in his book that fourteen million American suffer from SAD while another fourteen million suffer from a milder form known as the “winter blues.”
Studies looking at the physiology of SAD suggest that symptoms are related to the circadian rhythms that are found in all living organisms. These are the day-night rhythms that regulate our sleeping and waking periods and which are controlled by the master biological clock located in the supra-chiasmic nucleus (SCN) of the brain’s hypothalamus. This master clock is directly affected by light and darkness due to the neurological pathway linking ganglion cells in the retinas to the SCN. As these retinal ganglion cells are activated by optimum light levels, the SCN triggers the brain’s pineal gland to suppress the production of melatonin.
Melatonin is a specialized hormone produced by the pineal gland that cues the body to prepare for sleep. Over the course of the average day, melatonin levels remain low and only rise in the evening to prepare the body for sleep. We become drowsier and less alert, and most of our normal physical processes begin to shut down. Over the next twelve hours, melatonin levels remain high until exposure to increasing light returns them to daytime lows.
While our bodies evolved to the natural day-night light cycle, artificial lighting and electronic devices have had a serious disruptive effect on this cycle over the past two generations. Add to that our dependence on electronic devices such as cell phones and computers, and it hardly becomes surprising that young people in particular have become much more prone to insomnia and related problems such as SAD.
For people suffering from SAD symptoms, there are a range of potential treatments that can be effective. One of the most well known of these treatments is light therapy (also known as phototherapy). This basically involves the use of a bright light to simulate natural outdoor light during the first hour of waking up each day. For people suffering from fall-onset SAD, regular use of light therapy can relieve symptoms after just a few days in many cases. While light therapy devices can be purchased online, it is essential to get proper medical advice to avoid buying one of the many low-quality devices that are often advertised.
While light therapy isn’t the right solution for everyone, there are also medications that can help, though it can often take weeks before the medication takes effect. People who want to try medication to handle
SAD symptoms should be aware of possible side effects as well as the possibility that they may have to try different medications before finding one that works.
Anyone who thinks they might be suffering from SAD should see their family doctor to investigate their symptoms and to discuss the different treatment options available. While there are any number of websites offering treatments and promising quick relief, much like other kinds of depression, nobody should try diagnosing and treating themselves by relying on Dr. Google. No matter how distressing symptoms can be, it is essential to make the right choices when looking for help.
18. Is depression caused by a brain disorder?
While we are still learning about all the complex processes that allow our brains to function the way they do, numerous research studies have already linked different forms of depression to biochemical and anatomical changes in the brain. For example, key neurotransmitters such as serotonin, noradrenaline, and dopamine help the brain regulate biological processes through the body as well as in those regions of the brain controlling different emotions such as fear and anger.
Serotonin, in particular, helps control mood, appetite, and sleep, and researchers have long known that reduced serotonin levels in key brain regions result in clinical symptoms of depression. This has led to what researchers refer to as the serotonin model of depression and has inspired the development of numerous antidepressant drugs that work by reinforcing serotonin activity in different ways.
While the role that dopamine and noradrenaline play in depression are not as well understood, new research suggests that all three neurotransmitters can contribute to different symptoms of depression. It also suggests that new medications can be developed that can treat cases of depression that don’t respond to medications that work on serotonin levels alone.
But researchers have also identified other biological markers linked to depression, though it is still unclear what role they are playing in mood disorders. For example, cortisol, produced in the adrenal glands, is a critical part of the body’s resistance to stress and trauma. People experiencing the usual “fight or flight” reaction to stress are more prone to exhaustion afterward and may also be vulnerable to depression as their cortisol levels, and often their serotonin levels, drop below normal.
Ironically enough, even positive stressful events such as the birth of a new baby or a wedding can have the same effect on the body’s cortisol levels. As you can see in the section on postpartum depression, new mothers can be particularly vulnerable to symptoms of depression though, in most cases, they tend not to be that serious.
For that matter, chronic depression itself could become a stressor given the mental strain involved in trying to cope. The nervous system becomes overstimulated with the stress of coping, and this is followed by the exhaustion stage as the body tries to recover. Not surprisingly, many people suffering from depressive episodes can report feeling exhausted, though, given that their original depression is still there, they often become despondent as well as lose hope of getting better.
Research also shows that depressed people often have significantly elevated levels of cortisol in their bloodstreams. The greater the emotional distress, the higher the cortisol levels become as well, not to mention other hormones linked to stress.
But studies have also found significant differences in brain structure between people with severe depression and control subjects. For example, people suffering from depression appear to have a hippocampus that is 15 percent smaller than in people without depression. The amygdala is also much larger than normal. Both the hippocampus and amygdala are critical components of the brain’s limbic system, which regulates our ability to regulate emotion.
While these results may also be the result of stress (e.g., the amygdala also regulates cortisol levels), the link between brain anatomy and depression seems to be very real. Other brain differences linked to depression include abnormally small neurons and fewer glial cells in the brain’s prefrontal cortex; research, though, is still ongoing.
Despite all the research showing biological markers linked to depression, the question of cause and effect still hasn’t been answered. Are these different biological factors causing the depression or are they the result of being depressed? And then there is the potential impact of stress on the body, which is still being explored. The changes in the brain’s biochemistry and anatomy that have been associated with depression may actually be caused by how our bodies cope with stress.
At this point, it appears safe to say that depression is an extremely complex disorder that can be linked to both psychological and biological factors. As we have seen in previous sections, people may become vulnerable to depression for various reasons, including family history, early childhood problems, trauma, or life problems. Understanding these different causal factors and what can make people more susceptible to becoming depressed will be critical in finding better ways to prevent depression and to treat the symptoms as they develop.
19. Is depression genetic?
Despite numerous studies looking at the biology of depression, the question of whether depression is caused by heredity or the environment continues to be controversial. Still, research with identical twins and adoptees, as well as family studies of people with depression, does suggest that the risk of depression is higher for those with a close relative who suffers from depression.
For example, having an identical twin with depression places people at a much higher risk of developing depression themselves than they would with a depressed fraternal twin (due to greater genetic similarity). To rule out the possible effects of family upbringing, some researchers have also looked at identical twins who were separated as infants and raised in separate families, though, so far, the sample sizes have tended to be too small to make for any conclusive results.
Even having a close family member with depression (such as a parent or sibling) may mean a greater chance of developing similar symptoms over time. One classic study looking at psychiatric patients diagnosed with different types of depression found that 22.9 percent of the mothers of these patients and 13.6 percent of the fathers had mood disorders as well. As for their siblings, the risk of them also having depression was substantially higher when one or both of their parents also had symptoms.
Many of the research studies looking at genetic factors in bipolar and unipolar depression have focused on the heritability estimate of these different conditions. Heritability is defined as the proportion of total variation between individuals that can be accounted for by genetic differences alone—in other words, the extent to which a trait is caused by genetic rather than environmental factors. Even though heritability estimates have varied widely across different research studies, one 2006 overview of twin research places the heritability of depression at around 38 percent (suggesting a moderately strong genetic component).
Despite the extensive research done on the heritability of depression in humans, no specific genetic markers for depression have been clearly identified. Given the difficulty of doing this kind of research in humans, most studies to date have used laboratory animals specially bred to mimic different symptoms of depression. These symptoms can include reduced appetite, anxious behavior, vulnerability to learned helplessness, and an inability to feel pleasure. There are also laboratory procedures used to simulate depression in laboratory animals and to measure the effectiveness of new antidepressant medications.
While results have been largely inconsistent, some potential candidates for depression marker genes have been identified using animal research. Studies are still underway to determine how these specific genes may interact with environmental factors to increase the risk of depression as well as how they relate to stress and coping.
Even though most evidence to date shows that genetic factors can play a role in the development of depression, it is important to remember how complex depression can be. As we have seen so far in this book, people can become depressed for numerous reasons. For that reaso
n, no two cases of depression are alike, and there is no way to predict the kind of symptoms people will develop and how well they will respond to treatment. Much more research will be needed before we can develop a real understanding about how genetics and environmental factors can interact to make people more vulnerable to depression.
20. Can bullying lead to depression?
Bullying is typically defined as the use of force, threats, or coercion to abuse or dominate others. In recent years, researchers have identified four main types of bullying:
emotional or relational bullying aimed at undermining a victim’s social reputation, often by spreading rumors about their behavior (sexual or otherwise)
verbal bullying involving the use of name calling, teasing or mocking, or other verbal abuse aimed at undermining self-confidence or isolating intended victims from their support networks
physical bullying, or the use of force, stealing possessions, or vandalism to intimidate victims. Physical bullying usually escalates over time and often involves groups of abusers singling out individuals they consider to be vulnerable.
cyberbullying is the newest form of bullying and was made possible by the rise of digital communication devices and an Internet allowing for anonymous posting of messages, images, and videos. Just like emotional bullying, cyberbullying often involves undermining a victim’s social reputation by spreading rumors as well as posting graphic images taken without the victim’s consent. Along with harassment, victims can also be stalked by anonymous abusers as a prelude to physical or sexual violence later.
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