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Christina Shires
English 122
Jackson Culpepper
28-3-18 One Size Does Not Fit All
“I know who I was when I got up this morning, but I think I must have changed several
times since then” utters Alice when speaking to the Caterpillar in Wonderland. Though Alice’s
confusion stems from finding herself in a land unknown to her, those with depression can feel
the very same confusion when it comes to “changing several times since then.” Depression alters
moods, produces self-blame, causes a wish for death, and can change activity levels.
1
Simplified, depression results in a person experiencing mood swings or “many different sizes,”
as Alice puts it. To help those struggling with depression, antidepressants can be taken.
Antidepressants are drugs which help relieve symptoms of depression. Yet, antidepressants are
not the only way to treat depression. In order to truly overcome depression a combination of
remedies such as therapy, exercise, eating right and taking antidepressants help to effectively
treat depression.
Depression is a mood disorder that affects thoughts, feelings, and behavior. It causes
feelings of sadness or hopelessness that can last anywhere from days to years
2
. Depression is
different than being upset or temporarily sad. More humans suffer from depression than from
any other single disease.
3
According to the fourth edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association, the probability
during one’s lifetime of developing a major depressive disorder (MDD) is 5-12 percent in males
and 10-25 percent in females. Females also, at any given point in time have a 5-9 percent chance
of suffering from a major depression while males have a 2-3 percent chance.
4
Depression is higher is females than males for several reasons. Girls tend to hit puberty
before boys do. Puberty causes girls’ hormones to rage and, when mixed with the pressures of
school, parents and figuring out sexual identity, depression rates rise.
5
Depression rates can also
rise during pregnancy. Being pregnant causes hormones to rise as well as restricting women with
what they can do. During pregnancy women cannot drink alcohol, take medication, certain foods
are off limits and caffeine must also be limited. Women can also accidentally get pregnant, have
miscarriages, or lose the ability to become pregnant altogether. Collectively, the stress and
weight put on women during pregnancy or while trying to become pregnant results in higher
depression rates than found among men.
6
Depression affects certain parts of the brain, which alters the whole. There are three parts
of the brain which are affected by depression: the hippocampus, the prefrontal cortex, and the
amygdala. The hippocampus is found near the center of the brain. It stores memories and
regulates the production of a hormone called cortisol. The body releases cortisol during times of
physical and mental stress, including during times of depression. Problems can occur when
excessive amounts of cortisol are sent to the brain due to a stressful event or a chemical
imbalance in the body. In a healthy brain, brain cells (neurons) are produced throughout a
person’s adult life in a part of the hippocampus called the dentate gyrus. In people with MDD,
however, the long-term exposure to increased cortisol levels can slow the production of new
neurons and cause the neurons in the hippocampus to shrink
7
.
The prefrontal cortex is the second part of the brain affected by depression. The
prefrontal cortex is in the very front of the brain. It handles regulating emotions, making
decisions, and forming memories. When the body produces an excess amount of cortisol, the
prefrontal cortex also appears to shrink.
8
The prefrontal cortex handles self-control and
physiological functions such as keeping proper glucose and insulin levels. As nerve tissue in this
region disappears due to constant stress, one’s ability to counteract potentially dangerous desires,
such as for addictive substances, or control impulsive behaviors to do dangerous things, may
wane. The prefrontal cortex is important for survival and adaptation to life’s challenges.
9
When
the prefrontal cortex shrinks, the ability to function properly is lost as the cortex is no longer able
to do its job.
The third affected part of the brain is the amygdala. The amygdala is the part of the brain
that controls emotional responses, such as pleasure and fear. In people with MDD, the amygdala
becomes enlarged and more active due to constant exposure to elevated levels of cortisol. An
enlarged and hyperactive amygdala, along with abnormal activity in other parts of the brain, can
result in disturbances in sleep and activity patterns. It can also cause the body to release irregular
amounts of hormones and other chemicals in the body, leading to further complications.
10
The brain is not the only thing to suffer from depression, the body is also affected. Loss
of appetite is one of the first signs someone may be experiencing depression. If the appetite
returns, that may be a sign the depression is lifting. There are three types of depression: mild,
moderate, and severe. Mild depression symptoms include: hopelessness, self-loathing, weight
changes, reckless behavior, and insomnia. Those with mild depression may experience a dulling
desire to eat food and no longer relish or enjoy eating. Moderate depression symptoms include
problems with self-esteem, reduced productivity, feelings of worthlessness and excessive
worrying. Those with moderate depression may miss meals altogether without realizing it and
the desire for food will be gone. Severe depression symptoms include delusions, feelings of
stupor and hallucinations. People with severe depression also may experience suicidal thoughts
or behaviors.
11
People with severe depression may have to force themselves or be forced to eat.
Severely depressed people may stop eating altogether in which case, after several weeks will
experience tremendous weight loss.
12
Sleep patterns are also affected when someone is depressed. Those with mild depression
reported waking up several minutes to half an hour earlier than the alarm clock is set for, they
also were found to sleep more than usual. People with moderate depression wake up one to two
hours earlier, experience a restless sleep and need a hypnotic or sleeping pill to go back to sleep.
These people may sometimes sleep up to 12 hours in a day. Those with severe depression awake
after sleeping for five or six hours. They may find it harder to fall back asleep and may spend the
time sleeping in a light sleep.
13
Considering depression affects sleep patterns, appetite, and has other side effects,
depression aligns with being a disease. Based on the medical model which is a paradigm on
which the practice of clinical medicine is founded, a disease is symptoms which are seen as
manifestations of the pathological physiological process. The symptoms are diagnosed and then
treated in order eliminate or suppress/control the symptoms so one can live longer.
14
Considering
this, since depression affects both the physical and mental health of those who have it, it is a
disease. Depression affects the prefrontal cortex, hippocampus, adrenals, bones, heart, and
blood.
15
It robs people of energy, impairs the brain from functioning normally and causes those
who suffer from it to lose interest in hobbies, work, play and sometimes even loved ones.
16
Diseases usually need treatment and sometimes they even have a cure. With this mind set,
depression needs treatment and though there is not a “one -size-fits-all cure”
17
according to
Stephen Ilardi, PhD. author of The Depression Cure: The 6-step Program to Beat Depression
without Drugs, “depression is beatable.”
18
However, before we evaluate whether it’s better to
treat depression with or without drugs, we must first look at the effects drugs have on people
with depression.
To treat depression people often take antidepressants
19
. Antidepressants are drugs used to
treat mood disorders. There are several kinds of antidepressants and each have their place. The
most popular group of antidepressants are SSRIs (selective serotonin reuptake inhibitors). SSRIs
ease depression by increasing levels of serotonin in the brain. Serotonin is one of the
neurotransmitters, which are like chemical messengers, that carry signals between brain cells.
Lack of serotonin directly correlates with depression because serotonin naturally manages
moods, body temperature and pain. It is also associated with controlling breathing, anxiety,
aggression, appetite, and sexual functioning. SSRIs easy depression by blocking the reabsorption
(reuptake) of serotonin in the brain, making more serotonin available.
20
SSRIs are called
selective because they seem to primarily affect serotonin, not other neurotransmitters. The
