Preventing depression and relapses

Depression, like most disorders that affect humans, has both a genetic and an environmental component. There are some genes that appear to increase the risk of developing the disorder, but they always act in conjunction with other genes and environmental factors.

It appears that the serotonin transporter gene and genes involved in the serotonergic system , whose functions include regulating wakefulness, emotional and sexual behaviors, food intake and vomiting, pain perception and muscle tone, are candidates for susceptibility to depression, given that many antidepressant drugs act on these systems.

Serotonin is known as the happiness hormone ; low levels of serotonin in the body are associated with depression, fatigue, negative attitude, irritability, mood swings, difficulty controlling anger, insomnia, difficulty concentrating, anxiety, and uncontrollable emotional changes.

We must always keep in mind that the environment is very important and there may be triggering factors such as some trauma (loss or others) that can favor the appearance of depression.

We need to do things that make us feel good, happier, and more integrated. Having good relationships with people is important. It's also important to do activities that make you feel satisfied with yourself, both physical and mental, such as brain games, for example. Walking with people you trust for 20 to 30 minutes a day is highly recommended, as is taking care of your appearance. Improving concentration is also crucial.

When discussing the prevention of depression (major depressive disorder), it's important to distinguish between primary and secondary prevention. Primary prevention of depression involves identifying risk factors that can contribute to the development of a depressive state. Secondary prevention in individuals with depression focuses on reducing the risk of relapse and the chronicity of the disorder.

For the family , it's about recognizing any changes in the affected person's mood and referring them to specialized professionals. For the professional , it's about recognizing and addressing the first signs or symptoms of depression in the person being treated, in order to prevent it from progressing to full-blown depression.

Besides seeking help from a professional, there are other things you can do to improve your mood.

Some of the preventative guidelines that work are:

• Keeping a record of your thoughts is a good way to identify those that contribute to your distress. These are thoughts like, "I feel useless" or "Nobody cares about me." Just because we think something doesn't mean it's true ("don't believe everything you think"). This recommendation won't work if your mood is very low and you find it difficult to refute negative thoughts (reframe them into positive ones). In this case, avoid writing down your thoughts and seek help from a professional.
• Practice relaxation techniques . Relaxation is fantastic for reducing stress. Learn some relaxation techniques; you can also find some effective tutorials on YouTube.
• Avoid alcohol. If you drink alcohol to cope with a very low mood, it could worsen your symptoms even further.
• Stay active . Exercise helps stimulate hormones (like endorphins) that make you feel better. Set a realistic goal to increase your activity level. For example, if you've found it difficult to even leave the house lately, an achievable goal could be to take a five- or ten-minute walk outdoors.
• Make time for things you enjoy . When we feel down, it can be difficult to stay motivated and keep doing what we truly love. Even in these circumstances, trying to carve out time and do what you enjoy will help you (little by little) to experience some pleasure.
• Connect with others . It's common to isolate yourself when you're feeling depressed, but this can actually make you feel worse. Try reconnecting with your friends. Again, make your goal realistic: if you've been avoiding your friends, a good starting point could be sending a message or (at least) replying to one of them. If you can't leave the house, you could invite a friend over.
• Learn something new. Developing new skills lifts your spirits. Write a list of ideas, activities, and skills you'd like to try and learn, and choose which one to start with.
• Talk to someone you trust. Talking about how you feel with a family member or close friend can help a lot.
• Get enough sleep. Sleep has a very positive effect on our physical and emotional health. Establish a healthy and functional routine to feel better physically and mentally.

Distinguishing between sadness and depression can be difficult if you haven't experienced it before. If you have already experienced depression, you'll be able to tell the difference. If you haven't, you might confuse it with apathy, but a professional diagnosis is best to avoid any doubts and proceed with treatment. You might feel apathetic due to life circumstances: an argument, a loss, a setback, etc., and this can lead to sadness. This isn't depression, but if it persists, it can develop into depression. If you also experience a lack of activity and social interaction, then you should consult a professional because you may be entering a depressive state. First, consult your primary care physician and then a specialist to determine if it is indeed depression.

Depression treated early is easier to overcome, but the first step is knowing that you have it.

Sadness , first and foremost, is an emotion. This emotion is the opposite of joy and happiness. As an emotion, it can be experienced under normal circumstances, that is, in everyday life, or after a more or less dramatic event, such as bereavement, loss, or an argument. In other words, sadness is an emotional reaction to events and therefore cannot be avoided or pushed away. Like all emotions, it has a beginning and an end. Thus, its duration is limited and variable. This is one of the characteristics that distinguishes sadness from depression. Recovery from depression is not a quick process and may require long-term treatment.

I'm very sad. Do I have depression?

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Depression, unlike sadness, doesn't manifest as a single, specific sad event, but rather as a generalized reaction to any situation. It can present as an inability to open up or verbalize one's suffering, a lack of interest or pleasure in various activities, insomnia or hypersomnia, difficulty completing almost any task, chronic fatigue, physical discomfort, irritability, and a state of despair that leads to a loss of any ability to perceive the future as better.

Depression can manifest acutely (with very intense and sudden depressive episodes) or become chronic and continuous, with sudden periods of worsening. Acute depression is also called a major depressive episode, clinical depression, and unipolar depression.

While depressive episodes can occur only once in a lifetime, people typically experience multiple episodes of depression. During these episodes, symptoms occur for much of the day, nearly every day, and for at least two weeks, and are characterized by intense feelings of sadness, loss of interest in people and activities, trouble sleeping, persistent thoughts of self-harm, fatigue, mental confusion, apathy, or anger.

Apathy can manifest itself in different ways:

• Lack of effort or energy to do everyday things.
• Dependence on other people to plan their activities.
• Lack of interest in learning new things, meeting new people, or having new experiences.
• Lack of concern for their own problems.
• Not feeling emotions when good or bad things happen.

For it to be considered apathy, the symptoms must be severe enough or occur frequently enough to affect social life, work, or other aspects of life. And they cannot be due to drugs, alcohol, or any other substance.

To counteract apathy, the following is recommended:

• Be encouraged to go out and spend time with friends, even if you don't feel like it.
• Doing things we used to enjoy, like going to concerts or watching movies with family or friends.
• Attending music or art therapy classes has been shown to help combat apathy.
• Try to exercise every day.
• Break down large tasks into smaller ones to get a sense of accomplishment.
• Reward yourself every time you finish an activity.
• Get enough sleep every night.
• Join a support group for people with apathy.

When apathy arises, it is important to try physical and relaxation activities, such as 4 or 5 well-executed breaths outdoors, and to connect with people who understand and support us.

There is no single answer. Certainly, one can fully recover from reactive depressive states, even those of some severity. The more severe the depression, the more complex and lengthy the pharmacological and psychotherapeutic treatments may be.

Studies show that a person who has had a major depressive episode has a 50% risk of experiencing another . With each additional episode, this risk increases. Although not easily "curable," depression is quite treatable. Therefore, receiving appropriate treatment can shorten the duration and severity of an episode.

There are several treatment options, the most common and effective of which involves a combination of medication and psychotherapy while the individual is experiencing an active depressive episode. This treatment can last for months or at least until the symptoms become more manageable. Once the recurrent depressive episode has subsided, psychotherapy can be discontinued, and the affected person may continue taking medication to prevent it from recurring.

Medications for recurrent major depression should be taken even when they are thought to no longer be necessary. This is to prevent relapses, which in most cases are more severe and resistant to treatment than the first episode.

The brain can be compared to a complex electrical network, within which "short circuits" can occur, leading to a disorder. Antidepressants and therapies act like "insulating tape," gradually restoring the proper functioning of damaged brain circuits and stimulating the brain to function optimally. Over time, and depending on the results obtained, the amount of "insulating tape" can be reduced as much as possible. However, to consolidate the results achieved and prevent the short circuits from recurring, this must be done gradually and, above all, following the recommendations of a healthcare professional.

The teacher's role in providing emotional support to students with depression is crucial. The teacher can offer warm, human contact, combined with emotional support, deep understanding, and encouragement. The teacher can help the student express their emotions by listening attentively and pointing out that, with treatment, they could overcome their depressive disorder. The teacher's approach should always be proactive : they should encourage the student to participate in group activities, especially those involving play or physical activity. If the student refuses, the teacher should continue trying, but without forcing the student to do everything immediately (fun and the company of classmates are important, but too many demands can increase the sense of failure already inherent in depressive disorders).

The teacher is just the first link in a collaborative network that includes the school administration, parents, and mental health professionals from both the public mental health network and the school itself. This network is perhaps the most important element in implementing support measures for specialist care.

The truth is, this is a bit complicated, because if you don't feel like doing anything, and there's no one to help, advise, or support you, even with a lot of willpower, you won't succeed. Sometimes you do, but I think most of the time you fail. The most important thing is to be patient with yourself and try to tackle responsibilities with a lot of motivation, breaking them down into smaller, manageable chunks.

I think the best thing is to connect with the people around you who understand what you're going through, try to be self-critical so you can move forward and go back to doing those activities you feel comfortable with.

The signs of a depressive relapse are varied, numerous, and can manifest in many different ways. In general, the typical aspects of this disorder are:

• Deflated mood (deep sadness)
• Loss of interest in normal daily activities (apathy).
• Difficulties in cognitive functions: for example, lack of attention and memory.
• Rumination (rehashing the same thought), that is, the tendency to continually think about one's own symptoms, one's own condition, and negative thoughts about one's own future.
• Reduction of daily activities.
• Loss of pleasure from doing anything (anhedonia).
• Feeling of chronic fatigue.
• Reduction of social contacts.
• Sleep-wake rhythm disturbances, increase or decrease in nighttime sleep.
• Changes in eating habits (with increased or decreased appetite).
• Decreased sexual desire and other problems related to the sexual sphere.
• It can also manifest itself at a somatic level: chronic fatigue, generalized pain, gastrointestinal problems.

The progressive and constant reduction in daily activities leads to both perceived ("I am no longer able to do my things") and actual incapacity. Other typical behavioral aspects of relapse may include neglect of personal hygiene and physical appearance.

In some cases of very deep depression, a general slowing of the person's motor skills (psychomotor slowing) can be observed.

I recognize it when apathy, chronic fatigue, insomnia, moodiness, and constantly dwelling on the same thoughts begin to appear. These are signs that you're about to relapse, if you haven't already. If we detect these signs, we should consult our specialist for treatment.

The best approach is always to set achievable goals, so you don't feel disappointed when you don't reach them and can experience emotional rewards. We need to try not to take on more than we can handle, connect with people with whom we can discuss things but not argue, try to manage daily problems with positive ideas that don't cause stress, and seek professional support when we feel overwhelmed. Relapses must be accepted, and professional help sought. Patience is key because depression doesn't resolve itself overnight, and it's important to surround ourselves with a supportive and understanding environment, surrounded by those closest to us.

Useful strategies for managing stress and anxiety include:

• Exercise. Currently, many studies have shown that exercise has a powerful anti-stress effect.
• Do diaphragmatic breathing exercises: breathe in slowly through your nose and then exhale through your mouth using your diaphragm and abdominal muscles.
• Do meditation.
• Do relaxation exercises.
• Have good sleep habits: sleep between 7 and 8 hours.
• Maintaining social relationships.

Breathing exercises usually reduce anxiety considerably, and those who have the opportunity to do yoga and tai chi exercises, which can be done both at home and outdoors, release a lot of stress.

The first thing to do is accept the relapse, then seek professional help to advise you on what you should do to improve, try to be patient with yourself so as not to fall into despair, and do everything possible to be in a pleasant environment that does not aggravate the relapse further.

It's unthinkable to help a friend or family member with a relapse on your own; professional help is essential. A person experiencing a relapse of depression may be demotivated and confused, finding it difficult to begin a new treatment. They may even be convinced that there's no hope for them. Therefore, it can be crucial to help your loved one become more active and identify the appropriate treatment with their professional.

Depression greatly affects the life of the person experiencing it, but also the lives of those close to them. If a partner, close friend, or family member has a relapse, the life of the person who accompanies them on a daily basis is likely to be affected as well. Firstly, because the person with depression tends to withdraw and become inaccessible or "unfriendly," and, of course, the relationship suffers.

Furthermore, the fact that a loved one is depressed can awaken all sorts of negative feelings in us: guilt, fear for the future, feelings of helplessness, sadness, and even anger. All of these feelings are quite normal, and in this storm of emotions, it's easy to forget about ourselves and our own needs.

That's why it's important to know how to occupy your own space and satisfy your own needs, but without falling into the trap of guilt: "If I take care of myself while he suffers so much, then I'm being selfish."

It's not only important to be able to think of yourself and put yourself first (sometimes), it's even necessary. Maintaining your own balance isn't a selfish act (in the negative sense of the word), it's a necessity. Only by remaining grounded, strong, and clear-headed will you have the energy needed to be of support to your loved one.

During relapses, family members should pay close attention to the risk of suicide, talk openly with their family member and, possibly in agreement with him or her, immediately inform their health professional of any warning signs.

Well, first of all, understand the person with depression, help them with whatever they need, try to make them as comfortable as possible in this environment, try to get them to do activities as much as they can without forcing them.

Try to make their life easier, encourage them to do activities without overwhelming them. Understanding the person with depression helps them connect with you more, builds trust, and allows you to help them with what they need. Music is also a good therapy for relaxation and reducing anxiety and stress.

Scientific literature shows strong associations between suicidal ideation and depression. While depression predicts suicidal ideation, it does not predict suicidal behavior, and most people with depression do not engage in suicidal behavior. Furthermore, treatments specifically targeting depression do not necessarily reduce suicidal ideation and behavior. Treating depression may alleviate suicidal impulses or improve coping with the source of distress.

I believe that the feeling of uselessness, of not being able to defend yourself in life, not managing everyday problems well, not having a supportive and helpful environment, or not following the advice of medical and social professionals can trigger suicidal thoughts.

Scientific studies have shown that combined treatment with antidepressants and psychotherapy is more effective than either treatment alone.

Psychotherapy is also known as talk therapy or psychological therapy. Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy. Mental health teams can recommend other types of treatment that are tailored to your individual needs.

Writing down your thoughts is a good way to identify those that contribute to feeling bad; these might include thoughts like "I'm useless" or "nobody cares about me." Just because we think something doesn't mean it's true ("don't believe everything you think"). If your mood is very low and you find it difficult to challenge negative thoughts, avoid writing them down and seek help from a mental health professional.

Laughter therapy is a therapeutic technique that provides benefits for health, quality of life, and emotional well-being. Laughter increases oxygen flow and accelerates heart rate, thus stimulating circulation. It relieves tension and strengthens our bonds with others, thereby increasing our sense of well-being. It promotes the release of hormones into the bloodstream that improve mood and make us feel more relaxed and cheerful. After a good laugh, we feel relaxed and are generally able to put our problems into perspective.

I believe that music therapy is a good activity; group therapies led by professionals can also help, but this must be assessed by the person attending, as sometimes they don't feel comfortable and it can be a setback.