Depression

Monika Nigam

Introduction:

Human nature varies throughout the world. The perception and understanding of the situation by an individual depends upon diverse issues. Grasping and tackling these matters require intellect and prior experiences, but occasionally situation turn out to be beyond the controls and this leads to hopelessness, despair and anguish called depression. The condition if ignored becomes devastating. Depression is severe medical condition that engrosses the body, mood and thoughts. It can affect person’s outlook, routine activities, behaviour and conduct. It can change the overall personality. Individual(s) with such illness cannot simply “put themselves together” and get better

Reasons that sow the seed of depression:

In this competitive epoch and demanding life, stress cannot be evaded. Every single person is striving to meet the challenges and prove one’s worth; unable to do so germinates the seed of depression. As a result, depression is becoming prevalent, affecting 1 in 8 people in a population. It is irrespective of colour, caste, creed, economy, age etc; studies show that it affects females more than males. It is a multifactorial condition, contributed by genetics, environment, events in life, socio-economic reasons, any medical condition(s) and the reaction of an individual to situation

Genetics: Some individual get this in their inheritance although it doesn’t always hold true as some individuals even though they receive in their genes, show no signs of the same while others despite of no family history show severe symptoms of depression.

Environment: the phenotypic characteristics of an individual are the implications of environment. Reaction to a particular situation and taking hold on the same not only demands intelligent but also exposure that environment provides.

Life events: the demise of a close member either in a family or a friend or separation of parents, changing school of kids all these can be the contributing factors for depression.

Family and Social Environment: the family atmosphere is the vital part of life, after facing the stress outside; the cosy, comfortable and motivating atmosphere puts together all the lost energy to face out all the defies. Any compromised living condition like poverty, homelessness and violence, may affect the self-esteem of a person and can build up the situation of depression.

Medical Conditions: Numerous medical conditions, especially that affecting hormone balance and alter mood can cause depression e.g. hypothyroidism. Treatment of these medical conditions relieves depression. At teens hormonal changes affect the school performance and cause depression.

How the brain responds to depression:

Brain is a complex network of nerve cells. The message between these nerve cells is communicated by the chemicals called neurotransmitters. Some of these neurotransmitters regulate mood and their decreased or inhibited level (or interruption of anatomical pathways in brain or as a consequence of treatment with certain drugs) bring anxiety, stress and depression. In such cases depression may be referred as an organic mood disorder. Balance of neurotransmitters is affected by stress.

Organic Affective Disorder: These are the diseases that may cause affective disorders by direct action on the brain.

1.Neurological: Cerebrovascular disease, Cerebral tumour, Multiple sclerosis, Parkinson’s 

    disease, Huntington’s chorea, Alzheimer’s disease, Epilepsy.

2.Endocrine: Hypothyroidism, Hyperthyroidism, Cushing’s syndrome, Addison’s disease,

    Hyperparathyroidism.

3. Infections: Glandular fever, Herpes simplex, Brucellosis, Typhoid, Toxoplasmosis.

4. Connective tissue disease: Systemic lupus erythematosus

5. Malignant disease

6.  Drugs: Reserpine, Phenothiazines, Phenylbutazone, Corticosteroids, oral contraceptives,

    Interferon

7.  Organic cause for Psychiatric Disorder

 Types of Depression: three main depressive disorders are-

Major Depression: also called as major depressive disorder (MDD). One of the major reasons for suicide and disability is depression. The result could be either due to medical illness or due to unexplained symptoms. The day-to-day activities are affected especially the capability to work, sleep, eat and take pleasure in any kind of entertainment. It can occur only once but is episodic. Chronic condition may necessitate indefinite treatment. Dysthymia: also called as dysthymic disorder. It could be enduring, though not disabling but protect the proper functioning and to sense good. Individuals suffering from Dysthymia may also experience major depressive disorders during their lives. Bipolar disorder: also called as maniac-depressive illness. The major symptoms are cycling mood changes like a wave. There could be severe highs called as mania and lows called as depression, flanked by intermittent normal mood. When the individual is in depressed mood then it depicts all the symptoms of depression on the contrary when in the manic cycle, the individual may be overactive, overwhelming with energy, over- talkative. It is because of this behaviour the thinking ability, judgement for a particular situation and also social deeds are badly influenced. This brings serious inconveniences and embarrassment.

Symptoms of Depression: There is a disparity in the symptoms among the individuals and also there is a discrepancy between the sexes. Depression is present in quarter to half of all medical patients (Davidson’s principle and Practice of Medicine). They can be categorized as:

Psychological

Importunate sad, worried or empty mood Reduced self-esteem Feeling of hopeless, pessimism Feeling of guilt, worthlessness and helplessness Loss of interest or pleasure in hobbies and activities that were once enjoyed (anhedonia) Suicidal thoughts or suicide attempts

Somatic

Decreased energy, fatigue, being “slowed down”  Difficulty concentrating, remembering and making decisions                                                                                                                                                          Trouble sleeping, early morning awakening or over sleeping Appetite and /or weight changes Restlessness, retardation and irritability Persistent headaches, digestive disorders and chronic pain that do not respond to routine treatment. Loss of libido Bowel disturbance

Management & Treatment: Depression is treatable. First step is realization (find out patient’s concerns and also provide an appropriate explanation and reassurance) and physical examination to prevent the onset of other symptoms. Secondly, a differential diagnosis is important as depression is outcome of adverse circumstances in vulnerable persons. The imperative part is differentiation of an adjustment disorder with depressed mood from depressive disorder. Adjustment disorders are transient reactions to adversity. Whereas, depressive disorders are characterised by more severe and persistent mood disturbance.

Medication and short-term psychotherapies including “talking” therapies are effective for the treatment of depression. Severe and recurrent conditions of illness require a combination of treatment for best outcome. The treatment may have to be continued once a person starts feeling better.

 Depression has some correlation with the ageing; it could be implicated with the illness, loss of memory and forgetfulness, feeling lonely or may be other psychological reasons. The psychotherapy of the patients and creating positivity in them help them to come out of depression and suicidal tendency.

It is my personal experience that if the factors causing depression in the person are not reminded to him rather reminding all the positive things what he has and what he is worth for brings lost confidence and zeal to live a great life! The close members’ understanding plays a very crucial role, as constant feeding of positivity and maintaining a joyful and encouraging atmosphere can keep the patient away from depression and suicidal thoughts and he will understand the significance he has in others life and how important he is for the society!