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Ask the expert

Once an individual suffers a primary episode of major depression, what are the chances they will suffer a second one?

Statistically there is always a greater chance because you may have a biological predisposition, and, if that’s the case, it’s still part of you. More often than not, if your temperament is such that you’re very hard on yourself, and have high expectations, you will be more prone to it. If you understand the factors that contributed to it, some of them can be changed and you can prevent another episode. But, without any changes, if you’ve been depressed, you’re always going to be more likely to become depressed.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

Is sleeping a lot considered an indicator of depression?

When a person sleeps a lot, it can be an indication of depression. But of course, it can also be an indication of anemia or some other physical problem, so it’s not always psychological – that’s why I think you need to be properly assessed. A proper assessment includes a psychological and a physical assessment as well. As a psychologist, I’m not going to do a blood test on people; I don’t know anything about medicine. But I do know that, if I ask someone if they saw their doctor lately and they said: “Yes, I saw him last month and had a blood test, and everything was normal,” then I know that the problem is most probably not physical.

So, what you want to know, first and foremost, is whether it is unusual. Some people just sleep a lot. Some people sleep ten hours a night, and that’s what they need to function; they’ve been doing it all their lives, it’s not an issue. If a person normally functions well with seven or eight hours and they find themselves constantly tired and needing more sleep, then there is some change. Then the question is: is that change physical or psychological? Obviously, if they told me that they lost their job and, since then they haven’t been able to get out of bed, chances are it’s more psychological. But still, we need to do a proper assessment to understand really what the source is.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

If depression is sadness taken to extreme, can extreme happiness also be considered a mental illness?

Just pure happiness is not a disease. But, if you’re overly optimistic, you may not necessarily protect yourself when you’re really facing a threat. Having said that, there is mania, which is very different. I don’t know what you’re referring to but, when we talk about bipolar disorder, some people have strong mood swings: a person can have a depressive episode that tends to be unrelated to circumstances -- it’s more a biologically-based illness -- or they can have a rise that is not just feeling good but actually a state of mania or hypomania. In this state, you have an incredible amount of energy; you may sleep one hour at night, and find that you’re well-rested. There are authors who’ve written entire books on a weekend in a manic high, or people who have started businesses and so on. And when it gets more extreme, a psychotic process can take place. At very high levels, a person can have what are called delusions of grandeur – they might think that they are God and are all-powerful. One person said to me once: “I drove home at three o’clock in the morning, and went through all the red lights because I knew I could control the traffic.” The guy thought that he was God and he was testing his powers by driving through all the red lights just to test it. Fortunately it was three o’clock in the morning, but he could certainly have killed himself. I made sure his family got a court order and brought him in because this was a serious condition.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

What are some causes of depression?

The causes of depression include the biological background, meaning other family members with the same type of difficulties. This genetic component makes people more vulnerable to developing depression, although this outcome is not inevitable. Usually these people have a vulnerability to certain life events (usually early life events). So depending on your family history and temperament, you may at some point develop depression.
- Johanne Renaud, MD, Mini-Psych School 2010

I was told that depression is hormonal, and not a medical problem. Is this true or false?

 Depression can be hormonal, and that is one of those instances where it would fit into axis III. It’s not a true clinical depression like an axis I but it can be exactly the same. For example, postpartum depression is clearly a hormonal-related depression.

-Joseph Rochford, PhD, 2009, Mini-Psych School 2009

Are suicide risk assessments conducted on patients admitted for depression?

Depression is indeed the main risk factor for suicide, but the opposite is not true: not everybody who is depressed is going to think about suicide. While we do not have a predictive evaluation, we do have certain risk factors that we can assess. However, suicide risk assessments are still very difficult.
- Johanne Renaud, MD, Mini-Psych School 2010

Is depression genetic?

Usually if a parent has depression, this person’s offspring has a 3 to 5 times higher risk of depression. The genetic component of depression is quite complicated and there is not only one type. This heterogeneity means that everybody is at risk in some way.
-Johanne Renaud, MD, Mini-Psych School 2012

Is it normal to be depressed at times for short periods?

I used to hate Septembers because I had to go back to school, which meant that summer was over! Certainly when days shorten and there is less light, there can be more depression. This can especially affect people in the Far North, who get only 2 or 3 hours of sunlight a day at certain times of year. Also, when the weather gets colder, we're often not as physically active, which can affect our mood. Depression can come and go. We're not always sure what causes it. Sometimes, it's just normal fatigue. Sometimes recurring events can make us feel a little more depressed, like deadlines, exam periods, annual reports―the kinds of things that tend to recur. Also, if someone special has passed away at a certain time of year, that season will remind us of that person. There are many possible explanations for seasonal depression.

It's difficult to determine what is normal and what is not because there are so many human reactions and a lot of factors that we are not aware of. However, one of the guidelines professionals use is: How does it affect you? Does it stop you from going to work? Does it stop you from going out? When it starts to affect your day-to-day functioning, then it starts to be less normal. This is one way of assessing whether things have gone a little too far.

-Camillo Zacchia, Mini-Psych School 2007

What is the length of time for which the patient needs to present a certain set of symptomatology for diagnosing depression?

If someone is depressed for five months and isn’t able to function, would you say that they don’t need treatment until they have another month under their belts? It’s an arbitrary decision. We simply use a time period to distinguish between a very brief episode related to a circumstance, bad news, etc. If you lose your job, you’re going to be depressed, but they’re not going to give you treatment right away unless you remain depressed for a period of time. I think the longer it is, the more of a problem it obviously is. If you’re depressed because you lose a loved one, I wouldn’t expect you to feel better after two weeks. What is a normal period of mourning? Would it be six months? Would it be two years? Some people are functioning quite well after a month or two and some people need longer. Don’t get too lost in specific criteria; as far as you’re concerned, what matters is how you are doing. And if you’re not doing well, then you want to consider getting some sort of treatment.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

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