DEPRESSION

DEPRESSION 

These days, ‘depression’ has perhaps become one of the most common words in everybody’s vocabulary. Most of the time, people use it in the context of its literal English definition: sadness. But for a mental health professional, the technical meaning is altogether different. While the complete nomenclature is “Depression Episode/ Major Depressive Disorder” the single word “Depression” is more popular even in the medical sphere. Perhaps this is also one of the main reasons why depression is widely misunderstood by all.

 All healthy human beings experience sadness or depressed mood, i.e. downcast emoticons or a sense of loss. Feeling this way in response to unpleasant events is quite normal. However, clinical depression- an abnormal state- is difficult to understand. In spite of being the second most common of human suffering at present, and projected by WHO to be the first by 2020, depression often goes unnoticed by sufferers, caretakers and medical professional alike.

·         What is a Depressive Episode?

A depressive episode is a mood disorder, with unusual sadness. Clinically it is diagnosed on the basis of fixed signs and symptoms as described in the standard WHO International Classification of Disease (ICD-10) guidelines.

Symptoms of Depressive Disorder (must be present for at least 2 weeks )

1.       Sad mood for two or more weeks

2.       Loss of interest

3.       Fatigue or decreased energy

4.       Loss of confidence or self esteem

5.       Self reproach or guilt

6.       Recurrent thoughts of death, suicide or suicidal behavior

7.       Agitation or retardation

8.       Diminished concentration , indecisiveness

9.       Sleep disturbance

10.   Appetite and weight change (Increase or Decrease)

For health professionals, skilled interventions are required for people with any disorder to relieve distress and prevent complications. And depression is a grave problem. If normal sadness is a regulated tap water, the latter is comparable to a huge, overpowering flood. Unless one goes through it personally, it is hard to empathize. Often guardians and well-wishers will try to cheer up the sufferer by offering all possible pleasurable stimuli. Unfortunately, the ‘switch’ inside the patient’s brain which toggles between happiness and sadness is stuck at the latter, and no amounts of effort can turn it to the happy mode.

This effectively means that s/he cannot stop pessimistic thoughts, and will have low self-confidence, decreased concentration and memory, feeling of worthlessness, helplessness and hopelessness. It is quite common to feel suicidal, as death can seem like an escape from suffering. In fact, out of all the suicide that occurs among people today, depression contributes nearly 70%.

In severe cases, people may have psychotic symptoms, i.e. they may lose touch with reality. They may have delusions that they have committed unfortunately sins and that people are against hem and will punish/persecute them.  Sometimes people with depression will also have hallucinations and hear voices that others can’t.

·         Cause of Depression:

In a few cases, depression may arise due to physical illnesses, e.g. thyroid, adrenal gland problems, brain injury/tumor, misuse of drugs and psychoactive substances. However, in majority of the cases, the reasons are obscure. There are many theories regarding what triggers this condition and the most robust evidences, so far, are in support of biological reasons like genetics, neuro-chemical and hormonal imbalances in the brain. Individual psycho-social factors also increase the risk significantly. However, contrary to popular belief, stress is not mandatory, nor is lack of will power. The strongest of the strong-willed may undergo episodes of depression.

·         Solution to the problem

It would be ideal to be able to completely wipe out depression. Preventing aforementioned physical illnesses and misuse of drugs may help a little, however in depression with obscure causes, despite maintaining the highest living standard, addressing all sorts of life stressors, total prevention is still a farfetched goal. For the time being, the best possible solution would be easily detected and intervention. For this, there must be a high degree of awareness not only among medical professionals, but also the general public. Majority of people suffering from depression usually, exhibit physical pain, loss of appetite, weight, energy, etc. and all medical professionals should be on high alert whenever any physical symptom cannot be explained in terms of physical illness. Once depression is suspected, prompt referral to trained mental health professional must be encouraged.

                The treatment of depression is quite simple and effective. Tailored prescriptions of antidepressants, mood stabilizers, anti-psychotic medications, along with a combination of appropriate psychotherapy provide the best results. In particular cases, hospitalization and electroconvulsive therapy may also be needed.

                A depressive episode normally lasts for 6-9 months, even without treatment. But it is not advisable to leave it untreated or to wait for it to subside. We should remember that timely recognition and treatment of depression means reduction of 70 percent of all deaths by suicide. In a country where suicide accounts for almost 17 percent of maternal rate, this makes even more sense.

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