Positive Health Online

Depression, as the word itself suggests, is a low feeling, an experience of nothingness and low spirits. The word also implies "to smother, push down..." And quite so...the feeling of being low and depressed often arises if an individual pushes down or suppresses desires, talents and the way he or she wants to be, his or her natural, free self.

This malady afflicts people of all age-groups and all walks of life. In fact, highly talented individuals, more often than not, fall a prey to this insidious and seemingly mild problem. But while mild depression is not such a cause for concern, severe depression, if not detected and treated on time, can be life-threatening and may even lead to suicide.

Even small children are not free from the chances of falling into a depression. Often confused perception of parental love or the lack of it, can lead to feelings of rejection and low self-esteem. If allowed to remain for a long period of time, these feelings can intensify into depression.

Depression is a growing health problem and one of the least understood diseases. It affects adults and children of all ages and can be very serious. Untreated depression may lead to suicide, which in America, is the ninth leading cause of death and the third leading cause in teenagers.

There are two types of depression: reactive and endogenous.

• Reactive depression is understandable and is usually an appropriate response to a sudden life crisis. Symptoms may include: deep sadness, poor concentration, feeling out of control, frustration, helplessness, lethargy, nervousness and self- recriminations;
• Endogenous depression has the above symptoms, but is less understandable, as there appears to be no obvious cause. There is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors.

Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behaviour appear to function abnormally. In addition, important neurotransmitters - chemicals that brain cells use to communicate - appear to be out of balance. But these images do not reveal why the depression has occurred.

Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of depression as well. In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger. Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other factors.

Pinky Dhawan, Counsellor, observed that depression affects all age-groups from small children to old people. She added that depression, if of the clinical kind, can be cured through medication and therapy. A combination of both works well and specific cases have to be treated in different ways.

There are several forms of depressive disorders. The most common forms of depression are major depressive disorder and dysthymic disorder.

• Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it keeps occurring throughout a person's life;
• Dysthymic disorder, also called dysthymia, is characterized by long-term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also undergo one or more episodes of major depression in their life;
• Psychotic depression occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions;
• Postpartum depression, occurs within one month after a new mother delivers a baby. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth;
• Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD can be treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms;
• Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. A patient of bipolar disorder experiences sharp mood swings, from extreme highs (e.g., mania) to extreme lows (e.g., depression).

Depression is linked with biochemical imbalances of neurotransmitters in the brain, particularly dopamine, serotonin and norepinephrine. For example deficits in serotonin can lead to feelings of fatigue, despair and nervousness, and excess norepinephrine can cause mania. This neurochemical connection has resulted in the creation of antidepressant drugs that some doctors believe are the only effective means of treating depression. These drugs artificially keep an adequate supply of neurotransmitters available to brain cells to lift mood, optimism and tension.

Various drugs have been introduced since the 1950s, including: monoamine oxidase inhibitors, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). The SSRIs command a world market of about three billion pounds a year. The most popular, Prozac, is fast becoming the standard treatment for depression. Although these drugs are invaluable in some cases of serious depression, for short periods of time, all the categories of antidepressants have serious side effects. They produce withdrawal symptoms, interact detrimentally with other drugs, offer no long-term solution and 30% of people do not respond to any of these drugs.

Sometimes a patient of depression goes on living with the malady without realizing what is it that is causing him or her to be dysfunctional, listless or demotivated. This young mother's example, perhaps, best illustrates this point. Aged 30, and mother of a one-year old, she had bouts of violence and ill-temper, had difficulty concentrating and had hallucinations of evil spirits haunting her house.

Having bitter fights with her husband almost on a daily basis, this woman had almost become neurotic with intense insecurity and possessiveness. She once carried on a petty fight over what she perceived as her 'territory' and kept removing her neighbour's flower pot from the porch as she thought a few inches of the plant dangled over her space. She would behave almost in an insane manner, blocking her neighbour's gate with the plant so that she would topple over it. Making pools of water over her neighbour's portico was a regular routine with her. Violent outbursts, coupled with filthy language reduced her to a pitiable and despicable person, whom many people started avoiding.

Once she confronted her neighbour, asking her where she had kept her kid's milk bottle as she could not find it. Then she asserted that some paranormal forces or ghosts were stealing her baby's belongings as she could not find the baby's teether either.

This lady, maladjusted as she was to her environment and to her marriage, was a case of 'latent' depression. She would be overcome by intense bouts of jealousy if she saw people around her doing well, and suffered from feelings of inferiority and inadequacy, which interfered with her daily routine. But she refused to take treatment and insisted that she was fine. Her illness has since worsened, she constantly fights with her husband and scolds and snaps at her tiny baby. Timely and skilful professional intervention is a must in such cases. Depression, if recognized, can be treated with great success.

A young software programmer's life also had several periods of depression. Having been brought up, fraught with emotional turmoil as his mother was divorced from his alcoholic father, he was not very stable emotionally and maladjusted with his friends and family members. He was brilliant and did very well in studies. He had a violent and nasty temper and often suffered from bouts of high fever and chest congestion. He exhibited all the signs of bipolar depression and had to go in for counselling through which he recovered by leaps and bounds. Taking up a successful, full-time job and having a healthy relationship with his colleagues and superiors, he soon outgrew his inferiority complex and negativity.

Mild case of depression can be cured with behaviour therapy and counselling. The more severe kinds of depression need medical intervention and medication over a period of time, sometimes throughout one's life.

An obsessive compulsive disorder (OCD)often manifests in the form of depression. The patient, obsessed with certain kinds of behaviour or objects, behaves abnormally and repeats a certain activity over and over again.

He or she might be obsessed with cleaning his body and may have frequent baths during the day or keep washing his or her hands. He or she may be a compulsive shopper or a compulsive eater. Often depressed patients turn to 'addictions', to food, to shopping, expensive cars or houses, in order to get 'relief' by the momentary pleasure these things offer. Patients have wrong impressions about themselves, imagining themselves to be powerful and rich. They make grandiose plans, and think they are capable of doing things far beyond their physical or mental capabilities. In fact, the very reverse happens after a few hours or after a day, when they get overcome by feelings of frustration, helplessness and sometimes find it difficult to function normally.

So really, depression is not something to be feared. A patient of depression requires sensitive and patient handling. He or she needs utmost acceptance and care. People around the individual should be educated on how to treat him or her so that their condition does not worsen. With effective counselling and treatment, patients can rejoin their normal work schedules and lead happy, fulfilling lives.


References and Further Reading
1.The National Institute of Mental Health website
2. Berne Eric: What Do you say after You say Hello. Corgi Books. 1974.
3. Coleman James C: Abnormal psychology and Modern Life: DBTaraporevala Sons & Co. Pvt Ltd. 1976.