Second Opinion:Difficulties distinguishing between sadness, unhappiness, chronic stress and real depression, and the genuinely voiced concerns of such diverse figures as John Waters and Prof Patricia Casey that we are misdiagnosing the latter or "medicalising unhappiness" has led to much confusion.
Fifty per cent with depression are neither diagnosed nor treated, so we have to resolve this dilemma. Sadness, happiness, fear and anger are emotions, originating in the "emotional brain" (the Limbic Mood Department, situated in the middle of the brain) - specifically the Stress Box (amgdla). The latter, in charge of our stress system, also assigns emotions (particularly negative ones) to thoughts/memories.
Emotions are of short duration, and change rapidly from minute to minute or hour to hour. Our emotional brain is very powerful, exerting strong influence over our "logical brain" (the Frontal Mood Department at the front of the brain) - specifically the Behaviour Box (prefrontal cortex) which controls our rational decision-making/behavior.
Emotions such as sadness/happiness must be distinguished from mood, defined as "an emotional state", lasting for a reasonably long period of time (hours/days), usually described as positive/negative (feeling up or down). All of us have periods when our mood is down and vice versa. Mood is "created" by a complex passage of information between the emotional brain and the lower part of the frontal mood department logical brain. The upper part of the latter exerts some cognitive control over the mood created, except in depression when this control is lost.
It's normal to feel sad for short periods, and experience bouts of low mood lasting for days at a time, but this has to be clearly distinguished from depression, defined as a period of seriously low mood lasting for a minimum period of two to four weeks and usually six to nine months.
Depression is an illness combining physical symptoms such as total exhaustion, difficulties with appetite, sleep, sexual drive, concentration (reading the paper) and memory; and psychological ones such as anxiety, negative thinking, poor self-esteem, extremely low mood and suicidal thoughts. It causes chaos in the day-to-day life of the sufferer. Clearly this is totally different from simple sadness or normal short bouts of low mood which we all are familiar with.
This clinical picture has been backed up by research from world expert Prof Helen Mayberg. She examined Area 25 which lies at the heart of the information flow between the emotional and logical brain. She found that in normal sadness, Area 25 was overactive but was "closed down" by the logical brain when the period of sadness passed.
In depression, she found this area was constantly overactive in all cases, remaining so, for many months, until the bout remitted or was treated. The logical brain was unable to regain control over the emotional brain, with negative thoughts flowing through Area 25. In all forms of treatment for depression, such as drug/ psychological therapies, if effective, these will normalise this area.
Prof Mayberg has also done a lot of work comparing drug and psychological therapies. The former acted from the bottom of the brain upwards, normalising Area 25 within six to eight weeks if effective; the latter, particularly CBT (cognitive behaviour therapy) worked from the top of the brain downwards, switching off Area 25, albeit at a much slower rate. The ideal, both clinically and on scanning, was a combination.
The other condition often confused with depression is chronic stress. All of us in modern Ireland experience regular bouts of the latter. High mortgages, commuting, work pressures, both partners working, difficulties with child minding, increasing material needs/consumption, all contribute to the problem.
Tiredness, increased tension, reduced concentration, sleep difficulties and general dissatisfaction with life are endemic. (I often use the term "tired but wired".) Many present complaining of exhaustion, querying if they are depressed.
The difference between the two relates to the severity in depression of physical/psychological symptoms such as fatigue, sleep, concentration, memory, low mood, poor self-esteem, severe anxiety, negative thinking and suicidal thoughts.
Biologically chronic stress symptoms occur because higher glucocortisol levels in the body target the three big mood cables (serotonin, dopamine and noradrenalin) in the brain, whereas depression also affects the emotional and logical departments as well as affecting the same cables to a much greater extent. This is why the symptoms are much more severe in the latter.
There is a general air of "unhappiness" pervading the Ireland of 2007. A combination of chronic stress; difficulties with the increasing pace of life; searching for "happiness" in material things; a loss of our spiritual identity; the way in which modern technology creates instant, involuntary accessibility demanding prompt resolution of all our problems; and increasing levels of alcohol; all contribute. It is vital, however, that we do not confuse this malaise, chronic stress and general unhappiness with true depression.
Dr Harry Barry is a GP with a practice in Drogheda. He is the author of the book, Flagging the Problem, A new approach to mental health, published by Liberty Press, €19.99. He is also a director of Aware.