Archive for September 22, 2008

depression , some more

September 22, 2008

There are some who say that Buddha, and for that matter Jesus too was depressed. Perhaps they did display sadness in words and deeds, but that sadness was an emanation of empathy, which made posterity confer them with divinity, and not the yearning for sympathy that is characteristic of a depressive disorder.

Melancholia, one of the early descriptive terms for depression, dates to ancient Greece. All cultures, all over the world have recorded from early times, in epics and poetry, descriptions that would, in modern scientific and medical thinking, be called clinical depression. For centuries many have postulated on the cause of depressive illness, and based on their background and the scientific data available in that period, attributed it to body humors, bile, and in some cultural contexts a curse.

Symptoms are the manifestations of a dysfunction in any mechanism, and when the mind becomes dysfunctional with a depressive disorder the following symptoms are commonly seen- low mood or sadness nearly every day almost the whole day, loss of energy, lack of faith in one’s self- worth, sleep and appetite disturbances, neglect of self- care, inability to enjoy or indulge in previously pleasurable activities. If these symptoms persist and cause deterioration in social / occupational functioning, then the illness requires immediate intervention. In severe depression, suicidal ruminations are common and critical.

Depression, though often considered a reaction to unpleasant events, as an illness is quite common, and rather complex. Various factors contribute to a depressive illness. Genetic, neurobiological and environmental factors are the ones most commonly considered as causes of depressive illness. If you are depressed it does not mean your child is going to get depressed, similarly the chromosomes of your parents are not making you depressed. Genetic possibilities have been debated in psychiatric research but not conclusively proven. However if depression runs in the family, then one can be expected to breakdown more quickly and easily than other people in the face of stress. Unpleasant environment or events can trigger a sad mood which may be a forerunner of the illness spectrum.

Diabetes, hypothyroidism and many endocrine disorders can instigate depression in people. HIV, tuberculosis and some more systemic infections can cause depression. Some drugs used to treat other illnesses can cause depression.

Women in particular have a tendency to get major depressive disorders. Hormonal imbalance and endocrine dysregulation can cause depression.  Preceding or following menstruation some women experience and exhibit mood changes. This is not to be confused with major depressive disorder, in which the mood worsens as days pass. Immediately after child-birth, some women experience a depressive-psychotic breakdown, and this is called post-partum disorder.

When we talk of a major depressive disorder, we should keep in mind that this is an illness, caused not by anyone or anything outside. Neurotransmitters, chemical substances necessary to process functioning in the nervous system are considered as the most important cause of this illness. Therefore medical management is essential.

Medical management of depression involves prescribed medication, and in some rare cases even electric shock therapy is considered appropriate. When the thought process is numbed by the depressive illness, the affected individual cannot be counseled. The neurochemical balance must be restored. This is where the popular `Prozac’ comes into play. There have been anti-depressant drugs much before fluoxetine (the real name for prozac) came into vogue. There are many more newer antidepressants that have been discovered and available in the market.

Antidepressant medicine is intended to regulate neuro-chemicals like serotonin and norepinephrine and the actions of dopamine. There are many types of antidepressants and the choice of the drug for the individual is always based on the clinical assessment of the consulting psychiatrist.

Of course, as with all medicines (including the commonly consumed paracetomol) there are side- effects for each of these anti-depressants. The most common side-effects of antidepressants are constipation, blurring of vision, dryness of mouth, nausea, and in a few cases drowsiness. Depending on the severity of the illness and the side- effect the drug needs to be continued or changed.

It is a myth that medications used in psychiatry are for sleep, and they will be addictive. Many are also under the wrong notion that an individual has to take medicines life-long. These false ideas propel people to take recourse to alternative therapies. Reiki, Pranic healing, Aroma therapy and the whole range of non-pharmacological treatments are widely advertised and therefore acclaimed. They may to a small extent contribute to recovery in secondary depression (which would have subsided anyway over a period of time). In the case of major depressive disorder, only medication will help. Maybe after the initial phase, when the symptoms are controllable and tolerable, these techniques will help the individual to believe in recovery. It needs to be emphasized again and again that major depression being a medical illness needs medical treatment.

Besides the commonly encountered frustrated sadness after a failure, depression comes in many forms. Major depressive disorder is the severe form that needs immediate treatment as it contains a volatile suicidal risk. Sometimes mood swings from the sad end to the excited, both extremes stretching all norms of behavioral expectations. This condition is called manic depressive psychosis. In some cases there is a condition called atypical depression, where the individual would be more agitated and touchy, trying to do things he actually cannot, becoming irritable and losing concentration easily. This condition requires a correct clinical diagnosis for proper treatment.

There are people who always look low, down, unable to laugh and enjoy life, but who are capable of functioning in their occupational role well. They are called depressive personalities, and no treatment is going to bring a ready smile on their face. This is something the individual has learnt from early days. His motto and theory of life would be “I can only lose, so why should I smile, after all being happy does not last long”.counseling does not help these people since their ideas and notions are deep rooted in their psyche.

When someone is down with depression in your intimate circle, keep a watch without making it appear intrusive. Depression invites suicidal thoughts. Give them company, but do not patronize. You cannot make them see sense till the acute phase is over, so do not try to talk them out of it. All you can do in the beginning is to wait for the medication to start working and in a couple of weeks the individual will be ready to listen and understand reality and logic.and then, talk, talk more and talk sincerely.

Some other conditions mimic depression. There are many who apparently seek philosophical and mystic meanings in life, not doing anything constructive or productive. For some this is a mask for their laziness or incompetence. Some like to play the sick role as it generates sympathy and accrues attention. A close and careful observation of the life-style, work pattern and past record will help in distinguishing these pseudo-depressives.

Depression, gloom, fatalistic thinking, pessimism, disregard for personal grooming or comfort, and long periods of inaction are all seen in some artists. Depression does not create an artist. Only the artist, like any other individual can get depressed. It is also a myth that depression spurs creativity since many poets write wonderfully about the state of sadness. Creativity can always find an apt expression whether the mood is sad, happy or angry. It just so happens that happiness is a song while sadness is a poem. Literature abounds with descriptions of depression. William Styrron’s ‘Darkness Visible’ is a beautifully written account of a major depressive disorder. Any artist can create a wonderful work on depression, but not in depression. One has to be out of depression to become functional and creative. The good news is that though depression is debilitating, it is definitely treatable quickly and effectively with the newer drug formulations.

written 2005, part two of the previous post