According to the World Health Organization (WHO), depression was the second most common disease in the world in 2020. It is estimated that by 2030 it could be the most common disease. It can be life-threatening and at the same time it is a very ‘democratic’ disease - it affects people of all ages, economic status and backgrounds. We talked to dr Agata Rudnik, Director of the Academic Centre for Psychological Support at the University of Gdańsk, about depression, low mood and how we can help others and ourselves.

Karolina Żuk-Wieczorkiewicz: It is said that depression is a fatal disease. To what extent is this a legitimate statement?

Dr Agata Rudnik: - Depression is a serious illness. It is indeed one of the factors that can lead to suicide. It is estimated that in Poland up to 15 people take their own lives every day (and 12 out of 15 suicides are committed by men). The WHO predicts that depression will be the most commonly diagnosed disease by 2030. So if anyone still has doubts as to whether depression exists, I say yes, it does. And it is a disease.

- What is the scale of the phenomenon?

- About 350 million people worldwide struggle with depression. In Poland, the number of cases of depression is estimated at around 1.5 million, although it should be emphasised that we are talking about diagnosed cases. Meanwhile, it is estimated that up to 50% of cases of this disease may be undiagnosed. People between the ages of 20 and 40 are most often diagnosed. I think it may be this group that is more aware. I am glad that a change is visible - that people are starting to take better care of their mental health - but there are still groups that are not sufficiently cared for in this respect. This applies, for example, to older people - and we know that depression can affect them - or to men. There are many myths about this disease, but one thing is certain: depression is a democratic disease. Anyone can face it and it can affect absolutely anyone, regardless of age, gender, wealth or education.

- How does depression manifest itself? And how can it be distinguished from a temporary ‘blow of melancholy’?

- In order to be able to diagnose depression, its symptoms must accompany us for at least two weeks. We are talking about symptoms such as low mood, loss of interest in everything, and the fact that we no longer enjoy the things we used to enjoy. We are more tired and less active. There may be problems with memory or concentration, appetite disorders, sleep problems, and pessimistic views of the future. In addition, there is low self-esteem and low self-confidence. Suicidal thoughts can also arise. If these symptoms last for more than two weeks, they can indicate that you are dealing with depression.

You mentioned myths. On the one hand, there is more and more talk about seeking help, but on the other hand, certain information is being questioned. What are the most common and dangerous myths and misconceptions about depression?

It is sometimes said that depression is just sadness. This is not the case. The classification of mental disorders states that depression is a mental disorder that can be caused by many different factors. I myself am a proponent of the biopsychosocial model, which indicates that these factors can be biological (e.g. hormonal or genetic), psychological or related to the life situation in which we find ourselves. We know that the onset of depression is associated with neurotransmitter transmission disorders in the brain. Inflammatory factors may be important. Importantly, depression as a disease has various dangerous effects. These effects appear in many areas: they can affect our body (somatic effects), but also have a social or economic character (because we are unable to work or maintain our relationships with others).

- What other myths do we face?

- One of them concerns the treatment of depression. On the one hand, there are the famous: ‘Pull yourself together’, and ‘Go for a run, it will definitely pass’. I will come back to this running because it is not the worst advice. It is worse when a person in a depression hears ‘What are you complaining about, others have it worse’. And why would it help someone to hear that others have it worse? Such a person is likely to feel worse themselves.

- What about pharmacotherapy?

- I'll start by saying that a psychiatrist makes the diagnosis of depression (I should mention that we don't need a referral to see a psychiatrist). He or she is the one who prescribes medication. Unfortunately, there is a belief that pharmaceuticals either do not help or are addictive. Meanwhile, the effects of the drug often take time to appear, even 6-8 weeks from the start of pharmacotherapy (sometimes it is a matter of choosing the right dose). On the other hand, it is confirmed that the drugs work, help and are not addictive (especially modern drugs). It is also not the case that if someone starts taking medication, they will have to take it for the rest of their life. However, it is important not to stop taking medication on your own, but always in consultation with your doctor.

- There is sometimes talk of a seasonal lowering of mood, for example, the ‘autumn blues’. How does this relate to depression? Does this ‘seasonal depression’ exist or not?

- Research confirms the existence of such a seasonal decline in mood. In classifications, it does not function as a separate disease entity, but within recurrent depressive disorders, there is the so-called ‘depression with a seasonal pattern of course’ or ‘seasonal affective disorder’. It sounds nice in English: seasonal affective disorder, or SAD for short. The onset of such disorders usually occurs in autumn (October/November) and ends around March/April when there is more light.

- What are the symptoms of SAD?

Irritability, memory problems, high anxiety levels, isolation, aversion to everything, including work. I guess it's quite common (laughs).

Sometimes you hear about an ‘epidemic of depression’. Why are more and more people being diagnosed?

There could be many reasons for this. On the one hand, more diagnoses could be due to the fact that more people are seeking help. On the other hand, many factors nowadays favour the development of depression: the situation in the world, which makes us feel a lot of anxiety, the pressure we put on ourselves (e.g. regarding keeping up with the Joneses, having an ideal life), a high level of maladaptive perfectionism. We fall into a spiral of negative thoughts and emotions and are unable to escape it. There is a lack of balance between work and pleasure, and we lose the ability to relax. Our relationships with others are also becoming weaker. We are often so overstimulated that we prefer to spend time alone. Meanwhile, social support is an important protective factor. The ability to talk about emotions works similarly.

- How can we help ourselves?

When we feel bad or life is not going well, we often tend to isolate ourselves. However, research shows that we should spend as much time as possible with others - and it is this support from others that is the most important thing we need so much. I'm not saying that it should replace medication (which is sometimes necessary), but this social support is extremely important.

In the case of professional help, both pharmacotherapy and psychotherapy are important, but I emphasise that we should use methods that are supported by evidence (so-called evidence-based medicine). Let's stick to what science says.

- So what does science say?

- For example, it points to the effectiveness (in therapy) of cognitive-behavioural trends. One technique in this trend is behavioural activation. It says that we should do more things that we enjoy. When we are struggling with depression, it can be difficult to motivate ourselves to do anything – and the aforementioned ‘go for a run’ can feel like climbing Mount Everest. That is why it is so important to gradually increase our commitment not to what we ‘should’ do (or do because of someone else), but to what is really important to us, what we enjoy - and what helps us.

- How?

- It's about taking that one, smallest step. What can I do today to make things a little easier for myself? Maybe I don't have the strength to meet up with someone, but maybe I do have the strength to write a short message. Maybe I don't have the strength to go for a run, but maybe I'll prepare my running gear. Maybe I'll put my shoes on the next day - and so on. It is important not to put pressure on yourself (‘because we should’), but to calmly do what you know can help you.

Thank you for the interview!

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Students, doctoral students and employees of the University of Gdańsk who are looking for support are encouraged to contact the Academic Psychological Support Centre.