Pointing out that the rate of major depression in the classical sense is around 17 percent in world literature, Psychiatrist Prof. Tarhan stated, “However, antidepressant use is increasing faster than the rate of depression. The increase in antidepressant use does not mean that depression is increasing. Usage has increased by over 50 percent in terms of boxes in the last 10 years. While this increase is observed globally, it is progressing much faster in Türkiye.”
President of Üsküdar University, Psychiatrist Prof. Nevzat Tarhan, evaluated the causes and solutions of depression in the 'Akla Ziyan' program with Nevzat Tarhan, broadcast on EKOTÜRK.
Approximately 50% of society experiences a depressive mood
Prof. Tarhan, emphasizing that feeling depressed is a natural experience for everyone when evaluating depression, said, “The depressive mood we call low morale occurs from time to time in everyone. This sometimes lasts for a few hours, sometimes it is experienced with anxiety. There are many subtypes of the state of despondency we call depression. Feelings such as an inability to enjoy things, sadness, grief, and sorrow form the basis of this state. Approximately 50 percent of society experiences a depressive mood.”
If it lasts three days, it's minor; if it exceeds 15 days, it is major depression
Prof. Tarhan stated that the duration of depression is critical in clinical evaluation, “A despondency lasting three days is defined as minor depression. If it lasts more than 15 days and shows continuity, it is considered major depression. If this mood becomes chronic, we face a milder but long-lasting type of depression called dysthymia,” he said.
Prof. Tarhan, stating that in dysthymia, a person is in a constant state of despondency, said, “Cyclothymia, on the other hand, is characterized by a person being depressed for a period and overly joyful for another period. Individuals who can exhibit such variable moods, embracing their child lovingly in the morning and then saying ‘Why did I give birth to you?’ in the afternoon, can be seen in a borderline personality pattern. Although anxiety disorders are often perceived as low morale, a feeling of despondency lies at the core of depression,” he stated.
Increased antidepressant use does not mean increased depression
Prof. Tarhan, pointing out that the rate of major depression in the classical sense is around 17 percent in world literature, said, “However, antidepressant use is increasing faster than the rate of depression. Many people use antidepressants for different reasons. The increase in antidepressant use does not mean that depression is increasing. Today, many specialists, from physical therapy experts to internists, prescribe antidepressants. Even a patient with a heart condition can often be immediately prescribed antidepressants. Usage has increased by over 50 percent in terms of boxes in the last 10 years. While this increase is observed globally, it is progressing much faster in Türkiye,” he stated.
Masked depression is observed with gastrointestinal problems, fibromyalgia, shoulder-neck-back pains
Prof. Tarhan, stating that there are different forms of depression, and masked (covert) depression is one of the most striking, continued his remarks as follows: “A person may not be aware of being depressed; it may not be understood by their close circle either. Symptoms often manifest as physical complaints such as gastrointestinal problems, fibromyalgia, shoulder-neck-back pains. These psycho-physiological conditions, developed due to chronic stress, lead to antidepressant use. The gut-brain axis has a critical role in the development of depression. The raw materials for serotonin are produced in the gut; beneficial bacteria are decisive in this process. Disruption in the gut microbiota can trigger depression. In experiments with mice, it has been observed that transferring the gut microbiota of a depressed person leads to the formation of depressive behavioral models in animals. In other words, the relationship between gut health and mood is now clearly established scientifically. For this reason, some patients who visit internal medicine doctors report benefiting from antidepressant treatment, and doctors continue to prescribe antidepressants for similar complaints.”
Prof. Tarhan, stating that antidepressants can block the crying circuit in the brain, said, “You might cry internally, but no tears come from your eyes. Therefore, they should not be given randomly to everyone,” he stated.
Not everyone experiencing the same event falls into depression in the same way
Prof. Tarhan noted that mild forms of depression can often be cured with psychotherapy, “Correction of nutritional disorders and adjustments made within the scope of nutritional psychiatry can also reduce depressive symptoms. Therefore, it is not correct to start medication immediately upon seeing symptoms of depression; the duration of the symptoms must be evaluated. How long a person has been feeling depressed is critically important in diagnosis. Some individuals are genetically more prone to depression. These individuals can fall into depression even with minor stresses. For this reason, genetic analysis is performed in cases resistant to depression treatment; individuals' susceptibility to depression is evaluated through these genes. This is also why not everyone experiencing the same event falls into depression in the same way. Some experience depression openly and clearly, while others may experience it in a masked way,” he said.
Has conformism increased antidepressant use?
Prof. Tarhan explained that the causes triggering depression are diverse, and traumatic experiences, shocking events, or childhood traumas can set the stage for the onset of depression, stating, “However, depression is not always associated with stress. Even in individuals with no problems, trauma, or reason to be sad, depression can start suddenly. This is because more than six subtypes of depression have been identified, and some of them are entirely independent of stress. A decrease in growth factors in the brain can lead to a depressive state. Similar mechanisms are observed in neurodegenerative processes such as dementia. Depression in men is experienced atypically, in the form of irritability,” he stated.
Prof. Tarhan stated that the widespread adoption of conformism, rather than the prevalence of depression itself, is the reason for the global surge in antidepressants, “People cannot tolerate even the slightest negative emotion. Distress, sadness, and despondency, which are a part of life, are immediately attempted to be suppressed with medication,” he said.
It is not right to resort to medication immediately for a day's low morale
Prof. Tarhan emphasized that the culture of comfort and ease brought by modern life causes individuals to rapidly turn to psychiatric solutions at the smallest difficulty, “Conformism, meaning a pursuit of comfort and ease, is becoming widespread all over the world. As a society, we have also been caught up in this trend. People immediately turn to antidepressants when they encounter a small obstacle. We even raise children this way. However, a child does not grow without falling; swimming is not learned without swallowing water. It is not right to resort to medication immediately for a day or half-day of low morale. A person should first try to find their own solutions. If this condition lasts for 15 days and shows major depressive symptoms, then it is necessary to seek expert support. A depressive mood occurs in everyone; humans are not robots,” he stated.
Psychological capital should be managed like financial capital
Prof. Tarhan, stating that psychological capital should be managed like financial capital, said that the brain's default mode network overworks in depressive processes. Prof. Tarhan said, “The best way to regulate this network is for a person to live purposefully. Individuals who wake up in the morning with a purpose and have medium-to-long-term goals manage their psychological capital well and do not leave room for depression. A person who catches the flow experience becomes more resilient,” he stated.
Prof. Tarhan, reminding that pursuing meaning and purpose is one of the five pillars of psychological resilience, said, “When a person encounters a problem, if they can solve it, they solve it. If they cannot solve it, they put it in a box in their mind, shelf it. When the time comes, they open that shelf and solve it. They do not obsess constantly. This is one of the methods we use in therapies,” he said.
Beliefs play an important role in individual stress management
Prof. Tarhan also stated that beliefs play an important role in an individual's stress management, and that the individual's conception of God in their mind affects their sense of trust, adding, “A powerful divine conception that controls everything awakens feelings of peace and awe in a person. This can naturally activate the mechanism we call ‘radical acceptance’ in therapy,” he stated.
Prof. Tarhan, noting that Portugal stands out remarkably when antidepressant usage rates in Europe are examined, said, “Within seven years, Portugal has stood out both in terms of usage amount and rate of increase. It needs to be investigated whether there is cultural fragility behind this, or a special genetic susceptibility in that region,” he stated.
Depression can also manifest with forgetfulness
Prof. Tarhan, stating that depression can manifest in unexpected ways, said, “Depression suddenly begins in someone who has never been depressed before. ‘I've never used antidepressants in my life, why should I use them now?’ they say. However, depression can sometimes even manifest as forgetfulness. This is called ‘secondary forgetfulness’. Because attention is impaired in depression, memory slows down, and the person believes themselves to be forgetful,” he stated.
Prof. Tarhan, emphasizing the decisive role of emotions in depression, said, “A person can fall into severe depression even because their cat died. Because they had invested their love in it. Emotions are very important in depression. In Damasio's words: ‘I feel, therefore I am.’ Feelings precede reason,” he said.
Prof. Tarhan stated that social media has a very large share in the rise of depression on a global scale, “Social media has greatly raised people's expectation levels. People mistake something they don't need for a necessity. A person looking at filtered visuals feels worthless. Perfectionists think negatively for 50 out of 60 minutes, and the brain enters a depressive mode,” he said.
Antidepressant use expected to increase by 100%
Prof. Tarhan, evaluating the rapid increase in antidepressant use, said, “Antidepressant use is expected to increase by 100% between 2024 and 2034. Currently, there is a $37 billion market. When combined with other drugs affecting the brain, it has become almost the largest sector after the arms industry. The global system is deteriorating our mental health. Depression is increasing because investments are not being made in protection and prevention efforts; instead, drugs are being marketed,” he said.
Prof. Tarhan, reminding that Üsküdar University has been providing education on psychological resilience for years, said, “Psychological resilience is now a new branch of science. Since 2013, we have been teaching Positive Psychology as a course to all students at the university. Harvard introduced this course in 2015, Yale in 2018,” he stated.
We are working on digital therapeutics
Prof. Tarhan explained the new project they developed as follows:“We are working on digital detox and digital therapeutics. The person enters the program and works on psychological resilience with positive reinforcements. These are like digital pills. They protect an individual's mental health before they fall into depression. This is a big project, requiring an investment beyond the university,” he said.
Prof. Tarhan also shared a mental health formula that everyone can easily apply, “A person needs to pay attention to four parameters: See beautifully, feel beautifully, think beautifully, live well. Feeling comes before thinking. If you evoke beautiful feelings, beautiful thoughts will naturally follow. That's why we say ‘Think Well, Feel Well, Be Well’...” he concluded.