THE PSYCHOLOGY OF DEPRESSION AND HOW IT IS AFFECTED BY ADDICTION

THE PSYCHOLOGY OF DEPRESSION

AND HOW IT IS AFFECTED BY ADDICTION

INTRODUCTION

Depression affects many people worldwide and can literally impair their living and lifestyle as well as having a negative influence in their relationship with other people, themselves, and their Higher Power. People who do not have a predisposition to depression probably cannot understand what a depressed goes through and possibly feels these people simply have a lack of motivation, are overtly complacent or lazy, and love this ‘chosen morbid’ lifestyle. According to the National Institute of Mental Health, “each year about 6.7% of U.S. adults experience major depressive disorders. Women are 70% more likely then men to experience depression during their lifetime.” One thing that must be clear is that there is a vast difference between sadness and depression. Sadness occurs during appropriate moments of grieving, trauma, and after-shock lasting for a certain period of time and can feel as though a person’s life has been entirely disordered and pulls the person into helpless and powerless moods. Whereas, depression can occur sporadically regardless if anything has or has not happen in a person’s life and can last from anytime from a day to several months.

Living with depression is a highly sedated state of being making even the simplest tasks appear impossible and causing a life of stagnation where the person is unable to find the motivation to achieve their goals thereby emphasizing that life for them is pointless. There are different forms of depression i.e.: major depression; dysthymia, adjustment disorder, seasonal affective disorder, premenstrual dysphoric disorder (PMDD), postpartum depression; psychotic depression; atypical depression; agitated depression; and manic depression (found in people who have bipolar disorders). Depression can already be a predisposition in the person and when they find themselves using alcohol and drugs to abate the symptoms of this sedated life; the person makes their situation worse. Alcohol and drugs create a surplus of hormones and neurotransmitters that stimulate the brain to work overtime and eventually thereafter the system overload has been saturated in the brain; the central nervous system crashes. This will cause lethargia, insomnia, confusion or loss of concentration, and feelings of powerless and hopelessness.

In many if not all cases, once a person goes into recovery from any form of addiction (gambling to substance abuse); depression follows from natural emotional responses like guilt and shame but also from the maladjusted neurology caused by their addiction. This is why it is advised that recovering addicts should see clinical psychologists who may recommend them to psychiatrists and/or neurologists to see if the person has any forms of a mental illness that may manifest in depression so they can put on the required medication (usually anti-depressants). Once the person has been put on their medication; their mood begins to stabilize and they will either find their depression melting away or they can actually use the learned skills that they where either taught in a rehabilitation treatment facility and/or their therapist to deal with their depression in healthy wise. Any person who once lived with depression regardless of whether or not it was caused by their addiction will eventually be able to live a constructive and productive life as well as have wonderful relations and life a fulfilling life.

WHAT IS DEPRESSION?

The characteristics of a depressed person are:

• Feelings of hopeless and heighten distress

• Restlessness, anxiety, and irritability

• < >< >

Loss or increased appetite

• Lack of concentration

• Loss of motivation and desire

• Suicidal thoughts and attempts

• Persistent sadness

• Emotional numbness

• Slurred speech and movement

• Overwhelming sense of guilt, worthlessness, and a sense of having no value in life

• Alcohol and substance abuse

According to studies on the research of depression, there are a variety of factors that cause depression including stress, grief, genetics, and change in hormone levels. Women suffer from depression in various stages of their lives due to the hormone changes when they are having their monthly menses and when a woman goes through menopause. It will also affect women after birth not only because of the hormone changes but women feel that there is a grieving process that they go through after giving birth as everything in their life alters. Some women miss the idea of being pregnant and the internal love that happens during the development from embryo to fetus of their newborn so when they give birth they may need psychological treatment to learn to accept and deal with this new change. Alternatively, some women cannot accept the new responsibilities of bringing up a child and the stress and anxiety becomes so overwhelming that they can fall into depression.

MAJOR DEPRESSION

People who suffer major depression may have this predisposition probably from genetics and if they go into their family background they will discover that someone or people have some kind of depression which is why it is helpful for a person to discuss with their family if this may be true for them. This exploration will also be of use as it will allow the person with depression to feel not so alone or abnormal as this mental illness has a tendency to make people feel highly inadequate. Major depression has to be treated with medication to avoid massive suicidal thoughts and attempts. This form of depression is unbearable and can literally debilitate a person physically, vocationally, emotionally, and spiritually without medication. It is beyond ‘feeling the blues’ and can often feel like the world is coming to an end. Major depression can cause a person to cry uncontrollably for days or feel emotionally numb which both are unhealthy feelings.

DYSTHYMIA

“Dysthymia (or Persistent Depressive Disorder) has been recently renamed in the update DSM-5 in 2013. This disorder last for most of the day, for more days than not, for at least two years (at least one year for children and adolescents).” (Psych Central, 2014). Dysthymia is similar to major depression but perhaps only worse and it causes a low self-esteem along with poor concentration and difficulty making decisions. One must be appropriately diagnosed with this disorder by a clinical psychiatrist before one can be given the correct medication for this case.

ADJUSTMENT DISORDER

People with adjustment disorders have a general mood destabilization problem where they have inability to deal with stress and anxiety. The symptoms of this disorder would manifest within roughly three months where there is an event or a situation that causes the person any form of pressure whether it has to do with an upcoming wedding, celebration, or event that the average person can plan for without finding themselves worrying constantly or having emotional and/or nervous breakdowns. However, once the stress trigger (event) has ended, the symptoms will persist for another few months. There are different forms of this disorder: adjustment disorder with depressed mood; adjustment disorder with anxiety; adjustment disorder with both depression and anxiety; and adjustment disorder with disturbance of conduct.

SEASONAL AFFECTIVE DISORDER (SAD)

Although it is true that many people are affected by the weather; people with SAD actually get into a depression that will last until the sun appears again making winter times particularly difficult. The main causes of SAD is the lack of availability of sunlight and there is a theory that states that infrequent exposure to the sun alters the internal biological clock in people creating an irregular level of hormones. During winter, people also have to change their sleep patterns which may cause their moods changing to a more depressed state of being. The quickest remedies to this disorder is enhancing the levels of vitamin D in one’s diet and creating a form of light therapy which could be as easy as switching on the lights at home during those rainy, gray days and winter periods.

PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

PMDD affects about 3% - 8% of women during the year when they are having their menstrual cycle. Again, the main reason that can cause this depression is due to the changes of hormones which affect the woman’s mood and often creating sporadic episodes of depression, anger, and other intense emotions. The other main obvious cause for this depression is the level of cramps since most people are understandably irritable and stressed when they are in pain. What will definitely worsen these periods are: alcohol and substance abuse; obesity; high levels of caffeine; and a lack of physical exercise.

PSCYHOTIC DEPRESSION

This form of depression has been noted as feeling black and empty with the chronic state of numbness. According to the Black Dog Institute, ‘the symptoms of psychotic depression can be summarized as: observerable severe depressed mood; severe social impairment; severe psychomotor disturbance (agitation, retardation, cognitive processing problems); and psychotic features such as delusions and/or hallucinations. The psychotic features that are consistent with mood and the delusions are more common than hallucinations.’ The nature of psychotic depression tend to be characterized as pathological guilt which may cause the unnecessary depression for example when a parent has lost a child due to reason he feels that he may have prevented and is constantly is consumed about having stopped the death can lead to an obsession creating this form of depression. It can also lead to cognitive dysfunction which alleviates the processing problems like pseudo-dementia.

Atypical Depresssion

Atypical depression is rare and some doctors have speculated that this is because it has been not diagnosed. This depression shows when a person has more days of unproductive moments creating a form of disability affection their academic and vocational life. The lethargic moods are heightened by drowsiness, increased weight, and unusual level of esteem. Atypical depression is physically and mentally overwhelming possibly because of the overreaction to negative situations, events, and feelings. Leaden paralysis is another symptom of atypical depression and this refers to a sense of heaviness in the extremities making their physical movements notably slowed down. Atypical depression has a high risk of suicide and drug abuse than any other depression.

Agitated Depression/Bipolar

Bioplar is mental illness disorder that is noted by its manic moment of hyper-euphoria and manic depression. The depression can be alleviated by any form of change, chronic sickness, chemical imbalance, and alcohol and/or substance abuse. It is known that people who suffer this form of depression also have delusions exhibiting signs of mania which causes irate agitation and hostile behavior. These people should be diagnosed correctly by a neurologist and clinical psychiatrist in order to take effective medications to avoid suicides or any other chronic attempts of hostility either by hurting themselves or others.

HOW DEPRESSION AFFECTS THE BRAIN

“Adrenal glucocorticiod (the ‘stress’ hormone), which helps regulate the metabolism and is produced by the adrenal gland, a tiny gland that sits on top of the kidneys, interacts with serotonin 5-HT receptors in the brain during conditions of a chronic stress or severe allostatic load...this feedback allows receptors in the hippocampus to control both the hormonal and higher thinking reponses to stress.” (Lopez, The Neurobiology of Depression, 2012). Serotonin is the hormone responsible for mood balance and when there is an imbalance for serotonin, for whatever reason, in a person’s brain – it becomes difficult to deal with stress and any other intense emotions including joy, anger, and passion. Depression is affected by the imbalance of this hormone which is one of the reasons why depressed people find it difficult to deal with stress and anxiety on a daily life and tend to overreact under these conditions.

Hence, people who suffer with depression are susceptible to complacency and falling into the comfort zone of tuning out the rest of the world by sleeping in bed or experiencing periods of heavy lethargic periods. While the rest of the world is able to use the pain or discomfort to be used as leverage to work harder, do better, and play faster; the depressed person cannot function at all and finds himself in a black hole feeling like he is getting sucked under. He is unable to foresee that by working through the discomfort, he can allow himself to experience pleasure by doing something about his discomfort or pain. In an article by Alex Aciman and Katt Steinmetz, The Happiness of Pursuit, in the July 2013 of TIMES magazine; they discuss the neurological background of depression and how it disturbs their inability to pursue happiness. They agree that depression is a genetic and should a person have someone in their family who suffers from depression there is a likelihood that this gene is carried on through the bloodline. They confirm that the gene, 5-HTTLPR, associated with serotonin is what causes the anxiety and risk avoidance that ultimately prevents a person from breaking through the wall and doing something to alter his mood to find some form of happiness or achievement by staying non-productive.

Dopamine is another neurotransmitter found in the brain that acts like the ‘reward/pleasure’ point that people with depression have less than the average person which is one of the reasons that depressed people find it difficult to find happiness and stay content. Both dopamine and serotonin are ‘feel-good’ transmitters and for most depressed people the only way to correct this imbalance is by taking such medication like anti-depressants that regulate these hormones in the brain. Dopamine also is the neurotransmitter that avails a person to set and accomplish goals that boosts his level of joy and happiness in life. This is important for a person to acknowledge that although there are risks and certain levels of discomfort from working and paying your dues to achieve at whatever one is pursuing; the serotonin assists in sending messages to the brain for energy and enthusiasm to execute plans to focus on the eventual reward that is being sought.

“At the neurological level, happiness is a very complex thing, and lots can go wrong. Studies of the brain conducted with functional magnetic resonance imaging (fMRI) show varying levels of happiness-related activity in the left prefrontal cortex and the more primitive basal ganglia, which form part of the reward loop; the amygdala, which processes a range of basic emotions; the septal area, which is involved in the experience of empathy; and the anteria insula, which helps focus our attention on the things that are making us happy in the first place.” (Aciman & Steinmetz, The Happiness of Pursuit, TIME July 8 – July 15, 2013).

HOW ADDICTION AFFECTS DEPERSSION

The amygdala is the center of the brain that is responsible for emotions, emotional behavior, and motivation. The addict is, by nature, an emotional being who responds more from his feelings then reason which makes him react irrationally in most if not all situations. Overstimulaton of this amygdala causes intense emotions such as fear and anger and when a person uses stimulants or sedatives; the addict rouses this part of his brain and added with the abnormal increase of dopamine release; the addict literally mutates his natural brain chemistry permanently gradually. The addicts is prone to fantasizing about the future engaging in extreme ideals that he feels that he is adequate to perform regardless of his abilities and when he does not achieve them his already stimulated amygdala creates intense emotions causing self-pity, resentment and eventually he will fall under depression. The same could be said about the way the addicts tends to look back in his past wishing for things or wishing he hadn’t done things and cannot focus on anything else which equally causes the same emotions that is presented by his future thoughts.

It has often been noted that addicts and/or alcoholics use their substance of their choice to stave off depression. Stimulants create a ‘rush’ allowing the person to feel high waves of euphoria, excitement and fuel an endorphin flow that only last as long as the substance takes hold. Crack and crystal meth have rushes that can take only a few minutes and less depending on the tolerance of the addict. Sedatives like marijuana, heroin, prescription pills, and alcohol work differently. The chemicals in sedatives are used to numb emotions in order for the person to not have to feel the intense feelings such sadness, anger, or anxiety and therefore is attractive to the person who is going through a difficult time, has anger management issues, or is already predisposed to any level of depression. However, both stimulants and sedatives are followed by a crash in the central nervous system. Once the crash sets in, all levels of dopamine, endorphin, and serotonin either half or decrease in the brain causing the addict to feel lethargic, demotivated, depressed, anxious, restless, and irritable which is why the must obvious thing for the person to do is use the substance again which, naturally, creates addiction.

It has been researched that most if not many people who suffer from alcoholism and/or substance also have depression. Regardless of whether the depression was preexistent or set upon through the substance the addict was taking; it makes life difficult for recovery. The withdrawal from the alcohol or drug increases the levels of depression which one of the many reasons why those in treatment centers go through a torment of emotional turmoil raging from rage, hostility, to severe depression. Treatment centers are valuable supportive systems for such recovering addicts as they have professionals who can handle the depression onset, other patients to engage with to ease the depression, and are often recommended to see psychiatrists and neurologists to put them on a diet of medication to deal with the depression so it does not interfere with the already preexistent negative affects from addiction. Secondly, the statistics for relapse are higher with those addicts who do suffer from depression since many of them cannot deal with life and emotions on sober terms and quickly find themselves returning to their substance of choice to numb them out.

TREATMENT

People suffering from depression are recommended to stay in psychiatric treatments centers so they can be effectively monitored by the professions and nurses. They are given certain medications specifically TCAs and antipsychotic medications. There are four basic types of anti-depressants that would be recommended for depression: tricylic antidepressants (TCAs); Monomine Oxidase Inhibitants (MOIs); Selective Serotonin Reuptake Inhibitors (SSRIs); and Serotonin and Neroprinephrine Reuptake Inhibitors (SNRIs). TCAs and MOIs augment the levels of neroprineprhine and serotonin transmitters by increasing them. SSRIs increase the functions of serotonin.

According to Pscyh Central, “there are a number of antipsychotic (neruoleptic) medications available. These medications affect the neurotransmitters that allow communication between nerve cells. All these medications have been shown to be effective for schizophrenia. Some drugs are very potent and the doctor may prescribe a low dosage. Unlike some prescription drugs, which must be taken several times a day, some antipsychotic medications can be taken just once a day. In order to reduce the daytime side effects such as sleepiness, some medications can be taken at bedtime. Some antipsychotic medications are available in ‘depot’ forms that can be injected once or twice a month”. People with such a severe level of depression must be hospitalized for the period of time suggested by the medical team until further notice. However, these people have can live a normal life providing they take their medications and have follow up treatments with their psychiatrists and psychologists.

Bipolar patients must first be diagnosed by a neurologist before anything can be done in order to avoid putting on medications that will not work or make their conditions worse as chronic depression and temporal lobe epilepsy may be confused with bipolar disorder. Most medications given by doctors are lithium, anticonvulsants, benzodiapines (which should be avoided by all costs with recovering alcoholics and addicts), and antipsychotic medications. Bipolar disorder is something that can be maintained as opposed to treated and the people who suffer with this disorder need to be stringent on their medication to avoid having any unnecessary episodes that will set them back. Recovering addicts and alcoholics who suffer with bipolar disorder need to be extra careful as this disorder causes both hyper mania that will escalate into heighten levels of euphoria making them forfeit any rational and become susceptible to wanting to use their substance of use. There is also a similar risk should they fall into manic depression as these black moods are unbearable and the idea of taking a stimulant to make them feel better is equally dicey.