Sometimes you feel very sad and therefore think you are depressed. But, in the same way, a depressive state can be underestimated by thinking that it is “only” a deep sadness.
So what is the boundary between state of mind and pathology? How to understand when the discomfort you feel can be traced back to a real depressive disorder that requires the intervention of a specialist?
We talked about it with the professor Giampaolo Perna, psychiatrist responsible of Center for Anxiety and Panic Disorders of Humanitas Pius X. With his help, we tried to define the contours of a pathology, often underestimated, which only in Italy it affects overall more than 3 million patients and which has been indicated by the WHO between leading causes of disability in the world.
«The question is very important – underlines Professor Perna – It is indeed fundamental to distinguish an emotional reaction, even an intense one, from a pathological condition because in the first case it must be managed, in the second it must be treated. If curing sadness is in fact wrong, it would be equally wrong to try to manage depression without treating it.
So how do you know if you are sad or depressed?
«First of all we must consider that the boundary between a condition of low mood and clinical and pathological depression it is not dictated by intensity but from context in which it manifests itself. If the context is consistent, the drop in mood, however intense, is a plausible reaction. A concrete example is the loss of a loved one: feeling very sad, in conjunction with an event of this type, is completely normal. What characterizes a chronic depression, on the other hand, is the inconsistency with respect to the context ».
Are there any other elements that can be a wake-up call?
«Pathological depression is essentially characterized by two aspects: the loss of willpower and inability to feel pleasure. If these two elements are not present, it is easier to deal with a decline in physiological mood. When, on the other hand, even those things that should generate a positive reaction do not, we have a greater propensity to believe that it could be depression. Another important aspect also concerns the so-called ‘vegetative sphere’, or the vital functions: sleep disturbance, loss of appetite and reduced sexual pleasure function, are signs that, when they present themselves in severe form, suggest a depressive condition ».
Often, the hereditary component is also a concern. Can it play a role in depression?
“The presence of depressive illnesses in the family is a risk factor. In pathological depression there can be one genetic vulnerabilityHowever, this does not mean that the disease is inherited, but rather a predisposition, on which environmental factors and, therefore, life experiences can then act. Early childhood traumas, such as abuse and mistreatment, are, for example, elements that predispose to the development of depressive illnesses ».
It is estimated that in our country, depression affects women with a clear prevalence (almost 2 million out of three million patients). Why are women at greater risk?
«The woman has a greater emotional reactivity than the man; possesses a higher emotional intelligence but on the other hand also a more intense emotional vulnerability. Not only that, the influence of can also play an important role hormonal factors: let’s think, for example, of mood changes that can occur in the premenstrual phase or post partum depression “.
Can teens also suffer from depression? And what aspects should a parent pay attention to?
“The depression can strike at all ages, the indicators are the same: decrease of pleasure and will, first of all. However, it must be borne in mind that adolescence is an extremely delicate age and therefore the context has a greater weight. It is a phase of very strong changes, both from a cerebral and environmental point of view. It is therefore easier for a boy to have some emotional reactions, even very strong ones, without it being depression».
The problem with depression is that it is often not understood from the outside. What is the behavior to follow when you are close to a person in pain? Does it make sense to urge her with phrases like “try to cheer you up” or “try to react”?
«In the case of a state of demoralization and low mood, the stimulus is fundamental. However, studies have shown that behavioral activation can also work in clinical depression. Stimulating the person to act physically, to take action, can have positive effects on the mechanisms underlying depression. This certainly does not mean stigmatizing the condition of suffering in words, urging the person suffering to ‘wake up’. Instead, we must try to accompany her in the concrete to follow behaviors such as going out, completing small things at home, in short, remain as active as possible».
Depression and health emergency, a very current issue today. At the Department of Biomedical Sciences of Humanitas University you have conducted a scientific study to evaluate the impact of the COVID-19 pandemic on the health and mental well-being of the Italian population. What emerged?
«We have certainly found an increase in cases of low mood linked to the context, therefore to the perception of danger, the limitations imposed and the duration of the emergency. But we must distinguish: many people feel apathetic and are experiencing the so-called ‘pandemic fatigue’ but not all of them have clinical depression. A condition that, it should be stressed, must always be carefully evaluated by a specialist “.
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