Depression: changes in appetite and sleep are symptoms – 02/06/2023 – Mental Health

Depression is a chronic psychiatric disorder that affects more than 300 million people worldwide, according to the WHO (World Health Organization). In Brazil, according to the PNS (National Health Survey), more than 16 million live with the disease.

Unlike a common feeling of sadness, depression generates symptoms such as lack of energy and concentration and affects sleeping and eating patterns, explains Bruno Machado, psychiatrist and specialist in mindfulness techniques.

Read the interview with the expert below.

What characterizes depression?
Depression is a mental disorder composed of at least five symptoms. Among which, necessarily, there must be a reduction of interest in daily activities or even the impairment of the individual’s mood. Which, in general, is perceived by the occurrence of sadness for most of the day.

In addition, indisposition, loss of concentration, insomnia, daytime sleepiness, weight loss, weight gain, agitation, psychomotor slowing, among others, can together compose variable presentations of this clinical condition.

It is important to emphasize that the diagnosis is defined only by these symptoms, and the triggers, risk factors or even laboratory tests are not diagnostic criteria.

Is there a genetic cause for depression? Or if people from the same family have the disorder, could it also be caused by a behavioral issue in this family nucleus?
Today we know that genetics play a relevant role in an individual’s risk of developing depression, but it cannot be considered a single cause.

A curious example of this is that a person who has an identical twin brother with depression, therefore with the same genes, sometimes will not show symptoms throughout his life.

The chances of having depression when there are cases in the family increase. But, in reality, it is the interaction of these genes with the individual’s experiences that will be decisive for the development of the condition.

Is there an answer in science that explains why some people face very difficult situations in life, such as extreme poverty and trauma, without falling into a serious picture of depression, while others present the disorder without apparent specific reasons?
There are protective factors that reduce the possibility of a person with painful experiences developing depression.

People who have a healthier sleep habit, who have a more optimistic worldview as a personality trait, who are not lonely and who work in activities less prone to sedentary lifestyle will have biological protection against depressive disorder.

It is surprising, but jobs, even with excellent remuneration, that may favor a sedentary lifestyle, an unhealthy diet, exposure to light from screens at night and little sun exposure during the day can facilitate the occurrence of depression.

Sometimes, poorly paid jobs that are considered heavier, but which require the individual to walk more, to have more contact with the sun, to live with a healthy group, can play a protective role, that is, counterbalancing the risk factors to which we assume you are most exposed.

How can a person know if they are just going through a blue phase or if they are depressed?
Sadness is a normal feeling and can occur proportionately at some stages of life. However, it does not occur concomitantly with this broader set of symptoms, such as indisposition, loss of focus, insomnia, change in appetite, agitation and irritability.

In a mourning phase, some of these symptoms may even manifest themselves, without configuring depression yet, as long as the duration is short and the intensity of the symptoms is lower.

We know that there are different types of depression, for example classic or major depressive disorder, postpartum depression or psychotic depression. How is this distinction made in the office? Does each type need a different treatment?
The distinction is made by the clinical history of the patient, with the identification of characteristics and events that specify each type of depression.

When we suspect that a triggering organic disease has occurred, it is possible to use tests to investigate, for example, hormonal and neurological changes that have contributed to triggering the disorder.

In this case, the tests help to find a trigger, but they do not diagnose the type of depression.

Is depression in a teenager different from depression in an elderly person?
Age does not enter directly into the diagnostic criteria. Therefore, it is possible for a young person and an elderly person to have the same type of depression.

However, it is a fact that some diagnoses are actually more typical at certain ages. We most often see bipolar depression or drug-induced depression in a teenager.

In the elderly, it is more common to observe, for example, depression induced by an organic disease or by certain medications.

Is it possible to overcome depression just with good life habits, such as exercising, sleeping and eating well?
I would say that they are fundamental elements to prevent depression. They are also useful to prevent a relapse and are of great importance in the treatment. However, after the triggering of the depressive disorder, the trend is that psychological and psychiatric treatment is necessary, the latter being able to be with or without medication.

From what moment do you need to seek help from a mental health professional, such as psychologists and psychiatrists?
When the individual realizes that sadness or loss of interest in activities lasts for more than two weeks, occurring most of the day, it is already important to seek help.

Another clue is to see if sleep, concentration, or appetite are affected in any way.

Is the use of antidepressants always essential? Or is it possible to overcome depression with psychotherapy and a more organized and healthy routine?
For mild depression, treatment may initially be conducted with psychotherapy alone. But it is important that, even in a mild condition, if there is no adequate evolution, the psychologist should refer the patient to a psychiatric medical evaluation.

Drug treatment can have great results for many patients, but there are patients who do not see results or cannot tolerate them due to adverse effects. In these cases, greater availability of other scientifically recognized approaches would be important.

In addition to drug treatments, in psychiatry we carry out neuromodulation treatments, with emphasis on Transcranial Magnetic Stimulation (TMS), which is already definitively recognized by Anvisa (National Health Surveillance Agency) and by the FDA (American food and drug regulatory agency ), allowing the biological treatment of most forms of depression without the possible side effects of medication use.

Unfortunately, this is a treatment that is still not widely available in the SUS (Sistema Único de Saúde), with rare exceptions of accessibility, such as at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP). There is also great resistance on the part of health plans in our country, making it inaccessible for most of the Brazilian population.

Many people are afraid to start taking antidepressants and become dependent on the medicine. Is it common for treatment to be prolonged, extending for years or for a lifetime? Or is it usually removed from the improvement of symptoms?
Antidepressant drugs, as a rule, can be withdrawn relatively easily, since they do not provoke a feeling of reward and pleasure, unlike what would happen if the treatment were done with some calming and stimulants, which really manifest a risk of addiction. Therefore, with the remission of symptoms and after a recommended maintenance time, the antidepressant can be gradually reduced and suspended, with effective medical discharge.

However, we cannot confuse it with the existence of chronic depressions, which require prolonged use. It is important to point out that, in this case, the person did not lose control over the medicine or become dependent on it, but it is the symptoms that return due to the pathological condition, requiring a longer treatment, as happens in many chronic diseases in medicine. such as diabetes and hypertension.

Ketamine has been used in cases of persistent depression. What do you think about the use of this substance? What does the patient need to know before considering seeking treatment?
Ketamine and its “younger sister”, esketamine, are drugs of great importance against resistant depression, because they really show a high remission rate in these difficult-to-control conditions. It also highlights an important role in the management of suicidal behavior.

However, it is important to emphasize that they should only be used in more complicated cases, which have received an adequate diagnosis and unsuccessful treatments with other safer options.

Both are anesthetic substances that involve greater risks, with contraindications and possible adverse effects, including the possibility of chemical dependence. However, in certain cases, the benefit versus the risk can be quite favorable.

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