Depression: a complex condition

How do you recognize this disease and what are the treatment options? Read it here.

About depression

Depression occurs in about 3% of the Dutch population – around 550,000 people (source RIVM). About 8% indicated to have been depressed in 2014. It is estimated that approximately 20% of the Dutch population will suffer from depression in their lifetime.

Depression is a mood disorder characterized by a loss of lust for life or severe depression. In everyday speech, the term “depressed” is used for a variety of moods, ranging from a brief dip to severe depression. Not every depressive, gloomy or sad mood is a mental illness.

Everyone has felt down at one point or another and did not feel like doing things. These kinds of feelings are very normal and in most cases go away on their own. This is different when the underlying cause of the sad feelings is depression. Then the gloomy mood, loss of interest, and lack of pleasure can get worse and last for a long time. The dividing line between “normal sadness” and having depression is sometimes difficult to determine. In the case of depression, the rule is that this is only spoken of when certain symptoms are more often than not present for two full weeks.

Causes of depression

Vulnerability often plays a role in the development of depression. Sometimes this is hereditary. Vulnerability can also arise from learning processes in interaction with the environment. Negative life events can pose an increased risk in the development of mood disorders.

Social and environmental factors

Loss, psychological damage, or other traumatic life circumstances are examples of social or environmental factors that can lead to depression. If social support is lost or someone has to deal with social rejection, they can end up in social isolation. By not being socially active, depressive behavior can spread and the depression eventually persists.

Genetic Factors

Research on twins has shown that there is a 65% chance of a mood disorder if one half of identical twins suffer from it. In fraternal twins, this probability is about 14%. Children of parents with depression are nearly three times as likely to develop depression themselves. Just because someone has a genetic predisposition to depression does not mean that the depression will actually be present. Environmental factors also play a role in the onset of depression.

Neurotransmitters

Antidepressants target chemical dysregulation in the brain and are intended to positively affect mood. They interfere with the chemicals (neurotransmitters) that are released in the communication between brain cells. Certain substances, such as serotonin and norepinephrine, are less common in certain areas of the brain in depressed people.

Hormonal dysregulation

Hormonal dysregulation is related to chemical dysregulation in the brain. The pituitary gland in the brain regulates the hormones and influences the thyroid, adrenal, and gonads, among other things. The pituitary gland is a small gland in the brain and is connected to a brain stem (hypothalamus). In some depressed people, an increased dose of the stress hormone cortisol is found in the blood. Those who produce more cortisol often react more strongly to stressful events or situations.

Cognitive Theory

Proneness to depression can arise when someone has had negative experiences in childhood. Because of this, there is a chance that negative beliefs about the person themself arise. These beliefs can be triggered by unpleasant situations at a later age. Worthlessness, inadequacy, and a sense of dissatisfaction are results of the negative view of oneself. This negative attitude can even lead to hopelessness and apathy. Thus, negative beliefs are a source of depressive emotions and behavior.

Diagnosis

How is depression diagnosed? According to the DSM-5 (a psychiatric classification system), depression is when at least five of the following symptoms have been present for at least two weeks. The symptoms should indicate a change from previous functioning. Furthermore, at least one of the symptoms should be a depressed mood (1) or loss of interest and pleasure (2).

  • Depressed mood (or irritability in children and adolescents) most of the day, almost every day.
  • Significant reduction of interest in or enjoyment of (almost) all activities, during mostly the entire day, nearly every day.
  • Accidental, noticeable weight loss or weight gain, or an increase or decrease in appetite. In children, there may be a lack of expected weight gain.
  • Sleep complaints: not being able to sleep (enough), having to sleep too much, almost every day.
  • Psychomotor agitation or inhibition almost every day.
  • Fatigue or loss of energy almost every day.
  • Feelings of worthlessness, or serious and/or inadequate feelings of guilt.
  • Loss of ability to think, concentrate, or indecisiveness.
  • Feelings of despair, suicidal thoughts, fantasies of suicide without specific plans, a suicide attempt, or a specific plan for suicide. Not just the fear of dying.

People are sometimes inclined to wait for the symptoms to resolve on their own or for the symptoms to increase, while it would be better to seek help at an early stage. Recognizing complaints and seeking help at an early stage increases the effectiveness of the treatment and can prevent depression from lasting unnecessarily long.

It is wise to be aware of the signs that could be a precursor to the development of depression. Note: the presence of one signal or combinations of several of the signals is not sufficient to speak of depression. It can also fall within the spectrum of what is deemed normal. Therefore, see them mainly as warnings, to increase alertness for such symptoms, as there is a chance of developing depression.

It is important to recognize depression or depressive symptoms quickly and combat them to prevent them from getting worse. Light treatments are then still possible. But quick recognition is not always easy.

In addition to psychological complaints, there are physical complaints that can indicate depression. It often takes a while before people realize that their physical complaints may be related to their depression.

Treatment

There are many forms of treatment for depression. Below are some possible treatment options. However, not every treatment or combination thereof is always effective. That is why we at Brain Research Center are conducting research into new medicines that may help in the treatment of people with depression, for example, if existing medication does not work.

Would you like to know more or receive help? Always contact a medical specialist.

For detailed information, you can also visit the site of the Depression Association, the patient association by and for people with depression and their loved ones: https://www.depressievereniging.nl/

Cognitive-Behavioral Therapies

Cognitive-behavioral therapy is a combination of behavioral therapy and counseling. One of the founders of this therapy, the American psychiatrist Aaron T. Beck, developed a theory and a method of treatment that focuses on the client’s cognitions: their thoughts, fantasies, memories, and views on events.

Cognitive-behavioral therapy assumes that not the events themselves give a person negative feelings and a certain behavioral pattern, but the “color glasses” through which they see things. Anyone who learns to interpret these negative thoughts differently gets a more objective view of their own feelings and perceptions. This allows negative feelings to disappear and for behavior to change.

Cognitive-behavioral therapy is one of the most widely used forms of treatment in the Netherlands. It is a short-term, structured form of therapy that focuses on the present and the future. The client’s story matters. Together with the therapist, you should discover where the “wrong” thinking came from.

Medication

A psychiatrist is a medical specialist who, like all doctors, is authorized to prescribe medication. Medicines are available for many psychiatric conditions that can contribute to the treatment of your complaints. Medication can be prescribed for anxiety and mood complaints, sleeping problems, and ADHD symptoms, among other things. Normally, medication is only used for severe forms of such complaints. Medicine is usually only prescribed in combination with other forms of treatment, mostly some form of talk therapy.

Short-term treatment

Short-term treatment is suitable for people who have not been depressed for a long time and have not yet become heavily affected by their symptoms. The purpose of this assistance is to help them on their way so that they feel able to tackle the problems independently. Personal competence and self-reliance are central. There are different names for short-term “treatment” or short-term interventions. It is almost always one of the following two types.

  • Guided self-help: emphasis on own initiatives.
  • Activating guidance in a series of short conversations. This is also called Problem Solving Therapy.

Research

At Brain Research Center we actively research possible solutions for depression. Are you suffering from depression, and not improving? Then the Janssen Escape research might be suitable for you. Click here for more information on this research.

Frequently Asked Questions

I am already taking other medication, can I keep taking them?

Yes, you will continue to take your current medications. After your registration, we look closely at your current medication use. If you use a lot of (heavy) medicines, this may be a reason for not being admitted to an examination, but this varies per study. Under no circumstances should you give up your current medication use.

Will the regular treatment with my current specialist (neurologist / geriatrician) continue while participating in drug research? Or will Brain Research Center take over?

The regular treatment with your current specialist (neurologist/geriatrician) will in principle continue during the period of the examination. The Brain Research Center will inform your specialist and general practitioner about your participation. During the investigation, checks will be carried out at various times. In case of abnormal results, Brain Research Center will, with your permission, contact your general practitioner or treating specialist. In case of changes in your health, your general practitioner or specialist may also easily consult one of our research doctors.

Is Brain Research Center also looking for participants without symptoms or without diagnosis to participate in drug research?

Brain Research Center mainly conducts research on patients who have already had a diagnosis, but sometimes there are also studies that look for healthy volunteers. You can therefore also apply if no diagnosis has been made.

Can I stop the research prematurely or are there conditions attached?

Yes, you can stop at any time. There are no conditions attached to this.

Brain Research Center has several drug studies: can I indicate which research I am interested in?

Yes, you can read about current studies on our website. You can indicate your preference for a study: for example, would you prefer to participate in a short study (for example, a few months) or a long study (for example, several years). The Brain research center determines, among other things, on the basis of your medical history, age, and current medication use whether you are suitable for the research of your preference. Different criteria apply to each study and the options are examined together with the research doctor. Participation in a study is of course always in consultation.

What does participation in research mean in specific terms?

Step-by-step plan for participating in research:

  1. Sign up
    Sign up at the Brain Research Center.
  2. Telephone intake and request medical history
    You will be called for an intake by telephone, information about Brain Research Center will be sent and a form to be signed to request the medical history from the attending physician (this history is necessary to determine whether you are eligible for research). You will be asked whether you have a so-called study partner. This is often your partner, a brother or sister, son or daughter, or neighbor: someone who knows you well and who can answer questions about your daily functioning. This person must be available to travel occasionally to appointments at Brain Research Center.
  3. Introductory meeting and choosing a study
    If Brain Research Center does not discover any reasons in your medical history why you should not participate in a study, an introductory meeting of half an hour will be scheduled in the Brain Research Center with the pre-screening specialist and research doctor. In this conversation, you get to know more and your preferences and expectations are mutually expressed. You will then receive detailed information about a number of drug studies so that you can read it through at home and discuss it with family or friends if necessary. You then choose which study you want to participate in.
  4. Screening
    During the screening, all kinds of examinations are done to determine whether you can participate in the drug study. Sometimes the inspection only includes a series of questions, sometimes laboratory tests are necessary. These studies are of course always carried out in consultation with you and with your permission. This screening takes one and a half to three hours and differs per drug research. Based on the results, it is determined whether or not you can participate in the chosen drug study. If you are not eligible for one study because, for example, your memory is still too good or too weak, you may be eligible to participate in another study. Each study uses different criteria for participation.
  5. Randomization
    In drug research, some of the patients are administered the drug in question. The other part of the patients will receive a placebo. A placebo is a medicine without active substances. The patients are randomly placed in a group by a computer. Neither the patients nor the Brain Research Center knows who is assigned to which group. In this way, the research results can be compared well: does the group receiving the real drug perform the same, better or worse than the placebo group? Once the drug trial has been completed by all participants, you will be notified whether you were given the working drug or placebo.
  6. Follow-up appointments
    If the screening has been completed successfully, follow-up appointments will be scheduled. The number of appointments and the duration of the appointments differs per drug study. On average, patients come to Brain Research Center 1 to 2 times a month for a visit of half an hour to a few hours. During the introductory meeting, you will receive more information about this. The documentation that you will receive also states how often you visit the Brain Research Center during the research. When planning the appointments, we naturally take into account any working hours and vacation plans of you and your partner as much as possible, but we also ask for flexibility on your part.
  7. After the research
    When you have gone through the entire research, the results will be assessed: have you remained stable, have you progressed, or have you regressed? We can then decide together, for example, to go through another study or to end your time at Brain Research Center.

Can I participate in research multiple times?

Yes, that’s possible. When you have gone through the entire research process, the results will be assessed: have you remained stable, have you progressed, or have you regressed? We can then decide together to go through another study, for example, or to end your time at Brain Research Center.

Is there a financial compensation for patients?

All patients are of course reimbursed for travel and parking costs. Lunch is also provided for longer visits. There is no other financial compensation. You are participating in a clinical drug trial because the drugs offer you a chance for improvement and because you want to help future generations with a drug for brain diseases. Another advantage of participating in a study is that your clinical picture is properly monitored and you receive good guidance and support from professionals during the study.

What does randomization mean?

In clinical drug research, some of the patients are administered the drug in question. The other part of the patients will receive a placebo. A placebo is a medicine without active substances. The patients are randomly placed in a group by a computer. Neither the patients nor the doctors know who is assigned to which group.

What does blinding mean?

A computer randomly places the patients in a group. One group will receive the drug in question, the other group will receive a placebo. A placebo is a medicine without active substances. Nobody involved in the investigation knows which group you are in. We call that blinding.

What do the drugs look like?

The study medication consists mostly of tablets. You can take this daily at home. Depending on the drug study, the medication can also be administered every few weeks by injection or by IV. This is done in the Brain Research Center under the supervision of the doctor.

Do I always have a chance to get a placebo?

In most drug studies there is indeed an effective and ineffective (placebo) drug. The Brain Research Center has no say in the allocation of resources: this is done automatically and the Brain Research Center does not receive that information. The Brain Research Center can only request this information in acute emergencies. There are also a number of drug studies that only work with active substances. The research doctor can inform you about this during an introductory meeting.

Will the deductible of my health insurance be used if I participate in a study of the Brain research center?

No, the treatments at the Brain research center are not covered by health insurance. So you do not have to worry about any reduction of your deductible. For each drug trial, a separate insurance policy has been taken out for all participants. If you have any questions about this, ask them during the telephone intake or during the introductory meeting. Keep in mind that other things, such as check-ups with your own specialist (outside the Brain research center), go through your own health insurance.

Would you like to know more or participate?