Anyone can get depression
Regardless of age, education or ethnic background. Women get a depression more often than men. In the Netherlands, where PsychosisNet comes from, about 9 percent of adults (18 to 65 years) have, in a year, a combination of complaints that fits what we call ‘a depression’. This is shown by the population study NEMESIS-3 (2019-2022). Around 2008 it was 5 percent. The percentage of people who have a depressive episode at some time in their life is much higher (more than 15%).
Who has depression?
It is hard to put an exact number on it, because the boundary between ‘natural’ mental distress and depression in the sense of ‘diagnosis plus treatment’ is sometimes not clear. Depression is more common in women than in men, and above all around the age of 35 to 40.
A depression often passes, but sometimes not by itself
About half of the people who are depressed recover within three months. Another group, about one fifth, can be troubled by it for years.
Severity, duration and frequency of a depression
Depressive episodes vary strongly in severity and impact. With a mild depression there are a few depressive symptoms and people can function with little help. With a moderate or severe depression there are more complaints. Depressions also differ in duration and frequency.
For about half of the people a depressive episode lasts less than three months. For 15 to 20 percent of people with a depression the episode is chronic and can sometimes last several years.
Sometimes a depressive episode occurs only once in someone’s life, but often such a period returns. The chance of recurrence is 50 to 80 percent, and it can increase as someone has had more episodes. That is why the treatment of depression pays more and more attention to preventing a relapse.
Depression comes with other phenomena
Depression and anxiety
Depression very often travels together with anxiety. In practice it is often a mixed picture of low mood and anxiety. Some people use the term ‘anxiety-depression’.
Depression and psychosis
Depression and psychosis also often go together. As your mood gets lower, you look at the world around you more and more through a haze of gloom, which can become psychotic. You then see a world of guilt, penance, downfall, threat and misery, and this can go so deep that other people can no longer follow you. Then the depression has become ‘psychotic’.
Depression and your inner voice
Your inner voice can then also take the form of external voices that accuse you of being worthless and want to push you towards suicide.
Depression always has a context
Context 1. The context in which the depression arose
The most important thing in the diagnosis of depression is attention to the context in which it arose. The context is often existential, societal or relational. Many people struggle because they do not feel connected to other people, or because they find their life has little meaning.
People, young people too, also struggle because they do not feel at home in a society marked by ever more demands to shape, measure and perform down to the last detail, in which there is less and less room for natural human variation. Everything that does not meet the hurried norm of the neoliberal society is then regarded as ‘deviant’.
Context 2. Relationships with other people
Low mood and mental distress often have to do with relationships with other people.
Relationships are not seldom under strain because of problems in the division of roles around the household, finances and care for the children. There can also be problems in relationships at school or at work, for example in the form of bullying and subtle ways of exclusion.
Context 3. Physical distress
Another context of mental distress in depressive form is physical. Both in the sense of having a chronic physical illness and in the sense of a disturbed relationship with the body.
A disturbed relationship with the body can occur with an unhealthy lifestyle: overweight, chronic inflammation, too little sleep, too much alcohol or drugs, unhealthy food and so on. Such a lifestyle is often not compatible with mental health.
Anxiety and depression also occur in the context of ‘pain’ from earlier, above all serious early childhood adversity and trauma. It is always important to ask about this in a fitting way.
Context 4. Individual susceptibility
Depression and anxiety also have to do with individual susceptibility, which can be partly genetic, in how people react to a changing environment.
Some people are more inclined than others to react with emotions to complex environments. Under conditions of stress and difficulty, people with such a susceptibility can develop anxiety or depression.
Talking about depression starts with talking about the context
So however you want to look at depression (cause, symptoms, treatment, prognosis), be aware that everything has to start with understanding the context in which the low mood and the lack of energy occur. Otherwise a lot of mental distress is wrongly medicalised.
Depressive symptoms with other causes
Sometimes depressive symptoms are seasonal: think of the autumn or winter depressive episode. After childbirth, women can develop a postpartum depression.
If you are low in mood you start to see the world differently, sometimes so strongly that psychotic experiences occur, such as delusions and hallucinations.
Bipolar susceptibility
With a bipolar (or manic-depressive) susceptibility the person has depressive episodes and manic episodes that alternate over time.
Anxiety and panic
Most depressive episodes come with feelings of anxiety and panic: susceptibility to anxiety and susceptibility to depression are ‘siblings’ and have to be seen in combination.
Addiction
Addiction and depression also very often go together and reinforce each other.
Do you need help now?
PsychosisNet offers information. We do not offer a chat, a helpline or crisis support. If you or someone else is in immediate danger, call the emergency number in your country. If you are thinking about suicide, or you need to talk to someone now, see Need help now? for helplines by country.
Prof. dr. Ralph Kupka is professor of Bipolar Disorders at Amsterdam University Medical Center, and clinical psychiatrist at two large mental health centers: GGZinGeest in Amsterdam, and Altrecht in Utrecht. He is chair of the Dutch Foundation for Bipolar Disorders (KenBiS) and Vice-President of Education of the International Society for Bipolar Disorders (ISBD).
Ralph has been active in national and international research consortia of bipolar disorders since 1995, and chief editor of the first Dutch handbook about this illness. He has chaired guideline committees and is board member of AKWA, the quality institute for mental health in the Netherlands.
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