WHAT IS DEPRESSION?

Depression is the disease of fashion. And I say, even in the statistical sense:
that which occurs most frequently in the population. Some believe it is also a m
odern disease, and that has brought modern civilization. And this is not true no
w Hippocrates in the fourth century BC, described in the book "Epidemics", the s
ymptoms of melancholy, its causative agent being called "black bile", which corr
upted humours. A little later, Celso, should brighten and soothe the melancholy,
as he has lost the estimation of himself. Areteo of Cappadocia in the first cen
tury AD, defined as melancholy: Animi angina in a cogitaitone defixus absque feb
re "anguish of spirit fixed in thought without fever." In the second century, Ga
len depressive distinguishes three forms: the localized in the brain, the digest
ive and widespread. V century, Cassian speaks of heartburn or disease of the mon
ks ", consisting in a kind of boredom or tedium vitae, by which it loses the tas
te for life and the monastic regime. Saint Isidore of Seville in the seventh cen
tury, says in his book "Synonyms", that the symptoms of melancholia are: anguish
of soul. accumulation of demonic spirits, black ideas and lack of future and a
deep despair. Most doctors and medieval writers relate the melancholy with sin,
or say it is the consequence of a guilty existence that deserves punishment. Suc
h is the case of Hildegard of Bingen and Constantine the African: his book "blue
s" is a beautiful bridge that connects the science of late antiquity to the Midd
le Ages. The Renaissance was the golden age of melancholy. The melancholy is sho
wn as a selective privilege, suitable only for poets, artists and philosophers.
Thus Paracelsus almost a moral praise of this disease. André du Laurens, a fami
ly physician of Henry IV, wrote a book explaining the features of this disease.
It advocates measures refined out of it: the improvement of air, contact with na
ture, spread in the rooms roses, violets and lilies. Another contemporary of Du
Laurens, Jacques Dubois, less learned and erudite, but more practical, underline
s the risk of suicide with these people, proposing the custody of them and have
no sharp objects at hand or come to the windows of rooms very high. It also list
s a number of measures to combat insomnia. Another doctor at the time, Francesco
Gerosa, in his book "Magic", makes a careful analysis of many physical and spir
itual damage that can lead to melancholy, he proposes a complex therapy: a syrup
with about one hundred ingredients. An important figure of this renaissance is
the English physician Timothy Bright, who stated in his Treatise on the melancho
ly "feelings suffered by these individuals. The first monograph is collecting so
lid the genesis, structure and outcome that individuals suffering from this evil
. With him we should point out Plater, Jean Fernel and Raulin. It catches on the
use of vapors. Raulin, personal physician of Louis XV, shows his preference for
solvents, on the basis of their clinical action is softer than the emetic and p
urgative.
There is a Spanish character of this period, little known, the doctor Francisco
Vallés - XVI century, which rejects the sacred concept of the disease and says
that is produced by natural causes, often triggering environmental factors. In t
he Baroque published a book that has been a pioneer within this broad field that
is depression. This is the "Anatomy" of the blues ", written by Robert Burton,
a clergyman, philosopher and teacher, whose classes in Latin, was the delight of
his students, this illustrious character colloquial, he was always aware of you
r bodily sensations, illnesses discovered here and there, scattered body geograp
hy. The quality of his descriptions and the fineness of its grain, put on the ta
ble as this diverse and complex clinical picture. We can not lose sight of Willi
s, Sydenham, Frederick Hoffman and Anne Charles Lorry, among others. In the eigh
teenth century has its own light Spanish doctor of Arab origin Arrufat Piquer, s
ystematizing in detail the condition of the Spanish monarch Ferdinand VI, diagno
sed with a double statement: mania-melancholia. Subsequently mood turns into two
opposing poles: passing the psychological and moral collapse, the sadness and a
pathy deeper, to the exaltation festive mood and overactivity. It has the merit
of being the first to be linked in the same nosological link euphoria and depres
sion.€In the nineteenth century the names that stand out are the following Fren
ch and German doctors. On the one hand, Pinel, in his Treatise on medical and ph
ilosophical mental alienation, "says that the essence of this disease lies in a
mock trial on himself and on the state of his body, his disciple, Esquirol, prop
oses the use the term "lipemanÍa" because it is a moral disease involving the l
oss of zest for life. A little later, Falret first used the expression of "folie
circulaire" and Baillarger of "folie gae double forme", with the aim to highlig
ht the oscillating sequence of humor, who roams the pole festive depression. Amo
ng German physicians must emphasize at the outset to Griessinger, which shows th
at mental illness is a brain disease and, secondly, as can be triggered by psych
ological factors. And so we come to one of the great patriarchs of Psychiatry, K
raepelin, that some of the comments of French doctors who preceded him and set o
ut a new diagnosis "manic-depressive insanity" is inherited, symptoms rests prim
arily on the emotional life may occur in succession or alternating and generally
have a similar prognosis in all cases. The great originality kraepeliana was to
apply the same medical scheme proposed for other better known diseases, such as
general paresis (last stage of syphilis) and dementia praecox. And we enter ful
ly into the twentieth century. Bleuler proposed the term "endogenous affective p
sychosis", marking its origin and genesis interior. Kurt Schneider, the eminent
German professor, prefers to speak of "cyclothymic psychosis", which was very su
ccessful even in the vernacular, as Cyclothymic is defined by a crossing of cycl
es ranging from sadness, joy, disappointment at the festival, Y finally come to
this call by name on the history of depressive illness, three recent classificat
ions: that of the World Health Organization (WHO) in its ninth edition (1978), w
hich speaks of
endogenous depression (affective psychoses), reactive (neurotic depression) and
depressive reactions (they are adaptive). Second are the "Research Diganostic Cr
iteria (RDC) of the American group in California, University of St. Louis, who h
ave the interest of laying the foundation to work with car operational criteria
for research, speaking of three basic : major depressive disorder, minor depress
ive disorder and intermittent conditions. Third, we met the criteria of the Amer
ican Psychiatric Association, which aims to facilitate diagnostics including dec
ision trees, through which detect the presence or absence of certain symptoms. S
o here a concise history of the disease par excellence of mood. By tracking in i
ts most intimate fabric must be emphasized that the main thing in it, nuclear, t
he main symptom is none other than the decline in mood, there are different form
s of the same medical phenomenon. The river of depression, festooned with willow
s and elms, is navigated by sadness, grief, despair, apathy, boredom, despair, d
emoralization, lack of will to live, basically. The lush forests to cool down th
e valley and looking depressed in the past so many whys of disappointments. Depr
ession is the disease of melancholy. Tunnel where all the inner landscape become
s dark, shadowy gloom, in more serious cases, gloomy: sadness campaign for his c
ompliments and everything looks black, past and future. Depression is a biologic
al illness caused by a biochemical brain disorder rather complex, where they are
involved a number of substances that transmit impulses between neurons. These a
re called endogenous depressive disorders. NeurobioquÍmica nature, inherited an
d need pharmacotherapy (medication) At the opposite end are those forms arising
from events and depressive problems and difficulties of life: depressive reactio
ns and calls before the most recent scientific terminology the names as dysthymi
c disorder. Exogenous and endogenous mixed nature, chronically depressed mood, w
here the most common expression of this disease is that of discouragement and of
ten associated with a mismatch of personality, which makes the evolution is stuc
k, fixed, hard to approach a marked improvement. Between them lies an intermedia
te range of forms and modes of depression,€ranging from minor depression recurr
ent brief depression, through those that occur in the premenstrual tension syndr
ome so common in women. universal disease, known since the days of Mesopotamia,
Egypt and Eastern medicine, to descriptions of Hippocrates, Galen and some of th
e most celebrated Greek and Roman physicians (Celso, Areteo of Cappadocia, Ephes
us Sorano). Symphony unpleasure that engulfs a person in every way and leaves it
at the mercy of the waves where the mood comes and goes, but with a tironelo: d
epressed and powerless to the normal tasks of life.
1. Concept: Mood disease that moves between two opposing poles, endogenous and r
eactive. Today the word depression is multifaceted, has many meanings in everyda
y language, so it has taspasado the strict limits of psychiatry. So it comes to
political pressure, economic, social ... and even young people use the word "dep
ression." 2. Symptoms: like any other disease it consists of a constellation of
clinical manifestations can be grouped into five different levels, but are inter
twined with gold: physical, psychological, behavioral, cognitive (relating to th
e processing of information stored in our brain) and assertive (mentioned social
skills). The physicists include three main expressions: headache, insomnia (and
various disorders of sleep-wake rhythm) and diffuse somatic complaints geograph
y scattered body (chest tightness, pinching stomach, feeling of tiredness and ex
haustion. The psychological study of experiential side by subjective expressions
, where sorrow and its derivatives are again the backbone of clinical performanc
e. I do not want a qualification to me in the ink: between normal sadness and de
pression that is characteristic of qualitative differences quantitative and tend
er. The one that occurs in healthy people is comprehensive, moderate, in line wi
th the reality of the facts, it is relatively bearable although this depends on
why the trigger and his best remedy is time, that heals all wounds. pathologic l
ess sympathetic sadness, excessive, no data is often such concrete support in re
ality, usually get to do unbearable, it does if it is extended in excess, ideas
emerge and / or suicidal tendencies. The latter makes necessary hospital expense
s in a center of attention and vigilance, by the fear that has the same patients
and their families, loss of self. concerto for two pianos and orchestra, the th
eme of the score is the affliction, a piano is installed in there, distant and i
ntimate of endogeneity, another in the here of the proximity of everyday ordinar
y life. Instruments soulless rehearse a message of indifference and sinking, whe
re almost everything is past and guilt. Symptoms behavior reflects a general blo
ckade of behavior, deadpan verbal language (number of words per minute) and body
language (face, gestures, mannerisms) that can reach the silence. If anxiety is
associated with restlessness, anxiety, anticipation of what worse and a certain
state of alert. The depressive behavior as a business card is the sad and desol
ate. the cognitive are those that relate to the mindset that this subject has be
en manufactured in the scenes of his mind and reveal the how to assemble the inf
ormation of events experienced. Deposit where they accumulate and concentrate in
a confidential manner everything that enters intimately. Following this line of
argument depression can be defined as errors, mistakes and distortions in the p
rocessing of information that has been coming that person. We follow here the co
mputer metaphor. In the depression, everything lathes, disfigures and distorts,
as the cruising speed is high, the truth of the glass we see oneself is full of
false interpretations self, his past and his future. Everything is black. The ou
tputs are closed. And the tunnel is long and narrow. The subjective perspective
presided by pessimism paralyze any motivation. Maximization of
minimizing negative and positive. The die is cast: the personal vision skewed to
wards the worst is unable to see otherwise. Symptoms or socially assertive are:
tendency to isolation and rejection of contact with others. They influence each
other. This is summarized as follows: not be for anyone. 3. Clinical forms, alth
ough the range is wide, I want to stay with four strains particularly frequent a
nd high profile psychopathology. They are unipolar depression, bipolar€Bipolar
rapid rates and the aforementioned, dysthymia, depressive. The monopole are thos
e with a single pole, provided always depressed or euphoric (statistically rare)
. The bipolar were called until recently, following the terminology Central, man
ic-depressive psychosis: are characterized by the alternation of depressive and
euphoric phase and this substitution usually occurs during the spring and fall.
As the myth of eternal return. The bipolar rapid cyclers are a submodalities of
the above, but with very short cycles between joy and sadness pathological: symp
tom-free intervals become increasingly scarce, in hours or overnight, all da sym
ptoms a shift in the opposite direction, from night to morning changes the pictu
re. These are a real challenge to the physician. The first two are relatively cl
ear, and if treatment is known of the drug do not usually present problems. The
fast bipolar require the involvement of various metals (lithium and sodium) to c
urb this swing biological-emotional and in some cases, thyroid scan is necessary
, since it seems generally occurs in a high percentage of them hypothyroidism. T
he latest data confirm the association of an underactive thyroid and fast cycle.
We finally met with dysthymia: mix them two places clear in its concepts and co
nfused in his actions. a depression of a certain intensity and a personality tas
torno. The combination of both tends to encronización. They are serious, becaus
e it tends to stress only in therapeutic drug therapy and psychotherapy overlook
ed or anything more, it offers only a small vision of where you have to correct
and modify their personal structure. Psychotherapy is the art and craft of polis
hing psychiatrist, file, edit, purifies and guides to a new way of being and und
erstanding the world. Task psychological gold. Carve the edges, changing the way
s of reaction, adjust and harmonize the various ingredients that stay in the psy
chological heritage, to greater emotional stability. To top it off, two syntheti
c notes: teaching the importance of a mature person has the capacity to delay th
e reward at the same time, have self-confidence. Current Psychiatry has made gre
at strides in all aspects. But there is a tendency to Bucar immediate solutions
supported almost exclusively on a medication with minimal personal involvement.
Excessive use of drugs that could change if there were areas of greatest contact
and doctor-patient communication. And making psychological therapy in their ric
h and varied facets. The latter species brings up the skills to psychotherapy th
at has the psychiatrist. This is the era of the brain. And also in psychology. B
oth are needed. Find and track the biochemical pathways in the downstairs of our
conduct. And to know the mechanisms and devices that operate in our personality
on the floor above. A staircase unites and sister, new research methods.
Dr. Enrique Rojas Professor in Psychiatry