Depression

What is Depression?
Depression is a medical Illness & not just a feeling of hopelessness. It's more then just feeling sad.

How common is Depression?
It's as common as the Common Cold. According to the World Health Organization, it's the Third Most Common Illness in the World after Infectious diseases & Heart disease. It's the 4th to the 10th most frequent diagnosis made by the family doctor.

Who is at risk to get Depression?
All of us are! An alive human being (with fair intelligence) is the greatest risk!! As confirmed by scientific data ¼ to 1/3 of us are going to have it once in lifetime. Every 3rd female and every 5th male will have it at least once.

What are the causes of Depression?

• » Biological
• » Psychological
• » Social

Biological causes:

I. Chemicals / Neurotransmitters: Neurotransmitters are the chemical messengers, which are critical in the transmission of nerve impulses in our brain and nerves. The level of certain neurotransmitters, NORADRENALINE & SEROTONIN are decreased in the brain. Most of the medications used for treating depression (Anti depressants) help in elevating the levels of these chemicals in the brain.

II. Genetic: For every possible physical and mental feature there is a gene in our cells. So is a gene for Depression. The parents of a depressed person are at a higher risk for depression. If a sibling has depressive illness then there is a 15% chance, that it will be there in another sibling .If the onset of depression is after the age of 40 yr. then chance of it being genetically transmitted is less.


III. Hormonal imbalance: Though the exact mechanisms are not understood but imbalance of female sex hormones can lead to depression. Depressions in the postmenopausal and post partum (after delivery) period are the examples.

Psychological causes:

I. Personality/ Attitudes: Following types of personality traits predispose to depressive illness.

• » Very ambitious
• » Anxious
• » Obsessive/perfectionist
• » Setting very high standards for self

Persons having above traits/attitudes are more likely to experience depressive episodes in their lives as compared to people who don't have such type of personality.

II. Coping strategies with life events: How we deal with stressful events like separation/divorce/death, etc. determines how predisposed we are to depression. People who are

• » Impulsive
• » Aggressive
• » Self centered

Are more likely to have depression.

Social causes and social supports:

• » A lot of stressful life events like death/divorce/disease predispose to depression.
  
  
• » Interpersonal relationships matter a lot - good relations with the friends / spouse / siblings have a positive effect in preventing depression.
  
  
• » Single people are more prone to depression than couples.
  
  
• » Similarly, studies have found divorced persons to be more prone to depression.

What are the features of depression?
Most of the people who feel low and depressed are given a lot of advice by friends and relatives. It is automatically assumed that these feelings of low energy / low mood are just a matter of time and would get better if the individual made a little effort to feel good and happy.

Persistence of such feelings of lethargy / low energy / low mood despite all this indicates that the person may be suffering from clinical depression. Following are the features that a depressed individual experiences.

Biological features (duration - 15 day or more)

• » Decreased sleep--- the person gets up very early in the morning say, at 3 am & can't sleep again. Frequent awakenings. Poor quality of sleep.
• » Decreased appetite/ weight
• » Dryness of mouth
• » Constipation
• » Reversed diurnal variation - everybody feels better in the morning but a depressed patient feels worst in morning & slightly better in noon to evening.
• » Generalized body ache - lot of poorly localized pains and aches like headaches, abdominal pains.
• » Easily fatigued & lethargic.
• » Panic features like palpitations and sweating.

Psychological features

I. Sadness of mood

II. Decreased pleasure & interest in activities which they enjoyed previously

III. Decreased attention, forgetfulness, like forgets where he/ she has kept things.

IV. Easily irritated

V. MOST IMPORTANTLY, OCCASIONALLY NO WISH TO LIVE.
BAD NEWS IS THAT THIS CONDITION CAN BE FATAL. 40% OF ALL SUICIDES REPORTED ARE IN PEOPLE WITH DEPRESSION.

GOOD NEWS IS, IT IS EASILY DIAGNOSABLE & EASILY TREATABLE.

What are the treatments available for depression?
A number of medicines are available suitable to different Patients. Broadly these are termed as Anti Depressants. These drugs remain the mainstay of therapy for depression.

There are certain important things to be kept in mind regarding anti depressant use:

• » ADEQUATE DOSE, FOR ADEQUATE DURATION IS THE CARDINAL RULE.
  
  
• » SOMETIMES SMALL DOSES FOR LESS DURATION IS GIVEN BY NON SPECIALISTS It leads to incomplete recovery with frequent relapses.
  
  
• » Antidepressants are NOT sleeping pills.
  
  
• » THEY ARE NOT HABIT FORMING.