Depression: causes, symptoms, prevention

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Extract from the article: Depression affects a significant number of people in Africa, warns the World Health Organization (WHO). More than 28 million people suffer from depression, "making it the most common mental health disorder on the continent". Although common, depressi

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Depression affects a significant number of people in Africa, warns the World Health Organization (WHO). More than 28 million people suffer from depression, "making it the most common mental health disorder on the continent". Although common, depression is an illness whose origins are still poorly understood. Yet its consequences are far-reaching, affecting every aspect of the victim's life. In this dossier, Pr Kolou Simliwa Valentin Charles Dassa, Stress Counselor/Psychiatry, CHU Campus Lomé-Togo, discusses the signs, complications and prevention of depression, and explains why it represents a challenge for medicine.

In Togo, according to hospital studies, depressive disorders account for 20-30% of consultations and 30-60% of hospital admissions nationwide. Depression is an illness that is little known, ignored or even neglected by the population. Yet its consequences are far-reaching, affecting every aspect of the victim's life.

What is depression?

Depression is « a pathological state that occurs suddenly or gradually, and nothing is as it was before.The subject loses all dynamism, the taste for the things in life, sleep and appetite, morale and the ability to feel emotions.The core of depression is psychic pain, which we now know is carried by the same neural networks as physical pain », explains Pr Kolou S.Valentin Charles Dassa, Stress Counselor/Psychiatry, CHU Campus Lomé-Togo.

This explains why painful symptoms such as headaches, backaches and muscular pains are also symptoms of this illness.

Where does the pathology begin?

We all experience negative emotional states. These states set us off on the right path, in the sense that they give us the jolt we need to get through this stage: a cognitive jolt, to get our minds off things and move on, or an affective and emotional jolt. According to Pr Kolou S. Valentin Charles Dassa, « pathology begins when the ability to bounce back seems impossible, and results in persistent malaise and impaired functional capacities. There are many warning signs. There are somatic effects such as pain, loss of restorative sleep, loss of appetite, weight loss, suicidal ideation and loss of libido ».

Is it a more common illness today?

« The frequency of depression is similar in every country in the world: it's not confined to the so-called developed countries, where it's more often diagnosed and treated.In Togo, it is the number one mental illness diagnosed in consultations at health facilities », reveals Pr Kolou S.Valentin Charles Dassa.

Why are women more often affected?

On average, women are twice as affected as men. Hormonal factors may play a role: estrogen and progesterone have an impact on emotional state. « Sociological factors are also likely to play a part: many women face two professions, at work and at home, and enjoy less professional gratification than men in equal situations.But other questions also arise, such as the existence of a genetic vulnerability factor linked to gender, or a more frequent diagnosis linked to women's greater capacity to express their emotions », stresses the psychiatrist.

We're also seeing the ravages of teenage depression. What can be done about it?

The diagnosis of depression in adolescents is particularly « difficult to make », given the role of behavioral disorders in the symptoms of a depressive episode.What's more, teenagers are less inclined to seek help and treatment than adults: you don't get sick at this age », says the specialist. « And the impulsive, risk-taking behavior frequently observed at this age can be life-threatening: suicide is the first or second leading cause of death in adolescence. You have to know how to react, not hesitate to seek help, so as not to hide behind the vague notion of an adolescent crisis.And avoid the worst », he points out.

The elderly are not spared...

After the age of 50, the diagnosis of depression is often misunderstood: « because the association of old age and sadness is easily accepted, and because the semiology can be misleading when cognitive symptoms (attention, memory and even orientation in time and space) suggest the onset of irreversible dementia. The frequency of suicide increases steadily with advancing age: suicide in the elderly is not sufficiently taken into account », notes Pr Dassa.

How important is the genetic factor in the origin of the disease?

Depression is a complex disease. « There isn't just one gene for depression, but many different types of gene that may be involved.This confirms the role of genetic vulnerability or, on the contrary, natural protection, and opens up the possibility of going further by identifying subtypes of depression according to genetic profile », notes the psychiatrist.But beware of thinking of the genome as a static element, definitively fixed at the moment of conception.

 

Environmental factors count too?

The environment, particularly during the child's brain development, is capable of activating or inhibiting the expression of genetic inheritance. And this can leave a lasting mark on the individual. « Emotional deprivation during childhood, separations and other traumas are significantly more frequent in depressed adults. Negative life events have an obvious weight before the first depressive episode, whereas they are optional during subsequent episodes », lists the psychiatrist.

What do we know about its biological mechanisms?

Abnormalities are often observed in depressed subjects, particularly in stress hormones, thyroid hormones and immune mediators. According to Prof. Kolou Dassa, « cognitive functions are impaired: attention, memory, judgment and reasoning, followed by functional abnormalities in neuronal networks. Depression is a psychosomatic illness, since it associates an alteration of various psychic and somatic functions, but the mechanism determining this mood disturbance is still unknown ».

Is it necessary to use antidepressants to treat the disease?

It is recommended that « antidepressants should be reserved for severe depression, with minor forms requiring only psychotherapeutic treatment. The use of antidepressant medication is unavoidable.These molecules take effect within four to six weeks », says the specialist.Effectiveness is measured by the reduction in depressive symptoms and the return to a family, social and professional life.

Is it enough to get out of depression?

« Any prescription of an antidepressant presupposes careful accompaniment of the patient, which is already a form of supportive psychotherapy. Psychotherapy methods can be proposed according to the patient's aspirations and condition », advises Pr Dassa. Cognitive-behavioural psychotherapies have proven their effectiveness as a complement to medication. Psychoanalytically-inspired psychotherapy can also be useful for better understanding and correcting emotional functioning.

What can be done for those who resist treatment?

In severe forms of depression or those resistant to these therapies, « it may be necessary to resort to brain stimulation techniques.Some forms of depression do not improve with current treatments.Depression is no longer a fatality, and today, any depression can find an effective treatment », suggests Pr Dassa.

We've noticed that depressed people don't receive appropriate treatment. How do you explain this?

Proper treatment means, first and foremost, receiving the right dose of antidepressant for the right length of time. « Often, people who have been prescribed an antidepressant have spontaneously stopped treatment early, either because they saw no effect, or because they felt better.This situation raises questions about the quality of prescribing », says the psychiatrist. « The latter must be preceded by an accurate diagnosis that does not confuse transient emotion or depression with depression, by agreement between doctor and patient on this diagnosis, and by a treatment plan understood and accepted by both patient and doctor », he adds.

And what can be done about it?

For Charles Dassa, « we need to progress to the point where we understand that depression is not a simple psychological reaction, but an illness with many pathophysiological mechanisms yet to be discovered. This mood disorder disrupts what is most profoundly human: our ways of choosing, thinking and loving. This is not easy to understand: all too often, we look for a psychological explanation, whereas we need to understand the neurobiological dysfunctions of depression. Several measures would be welcome, such as supporting research, informing the public about all aspects of this pathology and its treatments, and encouraging all healthcare professionals to look for signs of depression ».

Can we say today that we know how to cure depression?

« We know how to treat depression. We have effective, well-tolerated medications, and we've learned more about this illness.In turn, the general public increasingly recognizes that this pathology requires medical help.However, many patients emerge from their depression only imperfectly cured: either because not everything possible was done to achieve this cure, or because therapeutic tools have reached their limits in certain cases », says Stress Counselor/Psychiatry.But this only concerns a tiny proportion of depressions.

Abel OZIH