The slow killer

Experts believe that by 2020 AD, depression may become the second biggest threat to human health, after heart ailments. Fifteen per cent of the men and 25 per cent of the women suffer from it currently. Its prevalence kills slowly but surely, says Kuldip Dhiman.

YOU are curled up in a lonely corner of the dark and dank storeroom of your home. You feel safe here because you are far away from the wicked world. Although you are feeling a little secure, your heart is heavy and there seems to be a lump in your throat. You are sinking. Nothing matters anymore, nothing ever will. As the shadows grow darker, you say to yourself, ‘What have I achieved in life? Nothing. Nothing at all. Why was I ever born?’ You brood over your inconsequential life and look up in despair. As you do so, your eyes rest on the ceiling fan. And now you begin to wonder whether two metres of rope would be sufficient.

Beware: You could be suffering from severe depression.

The word depression, or what doctors call ‘depressive disorder’, would hardly set the alarm bells going for most of us, but remember, the situation could be as serious as any terminal illness. Physicians have been aware of this mental condition for many centuries. Greek and Roman doctors believed ‘melancholia’ was a form of insanity; and in Charak Samhita we are told of shokajanya unmaanda, that is, grief resulting in insanity. But it is only in the present century that depression has begun to be taken seriously by doctors and psychologists.

Some experts fear that if effective measures are not taken, then by the year 2020 depression might become the second biggest ailment, after heart diseases. Highlighting the seriousness of the problem, Dr Ajit Avasthi, Additional Professor in the Department of Psychiatry, PGI, says:"In our country depression is often accompanied with physical symptoms, hence, it is often inadequately diagnosed and treated. Depression often affects the course and outcome of co-existing physical illnesses, leading to an unnecessary drain on already scarce investigative and treatment resources. The World Development Report, 1993, estimated that depressive disorders are by far the largest contributors to the global burden of disease caused by mental health problems. Depression is fairly common— 15 per cent of the men and 25 per cent of the women suffer from it. It is the cause of at least one out of five suicides. Nearly one-third of the alcoholics take to the bottle because they can’t cope with depression. In the USA, depression costs the nation as much as cardiac problems do."

Dr Rajeev Gupta, Reader, Department of Psychiatry, Dayanand Medical College, Ludhiana, and author of several research papers and a book on depression, adds:"In general, at a given time 5 per cent of the population suffers from depression. In the West about 3 per cent of the general population is diagnosed with depression by general practitioners in a year. And roughly an equal number may be remaining undetected on consultation. Only 10 per cent of those diagnosed in general practice are referred to psychiatrists. One person in 1000 in the general population is hospitalised for depression. Depression can occur at any age, to a member of any social or racial group, in any geographical region, in any time of the day or year. It occurs twice as frequently in women as in men, particularly women with young children. It is more frequent in young adults than was previously thought. It is common among those who are physically ill and those who are alcoholics. At least half of those who experience bouts of depression have a further attack, and about 12 per cent of the cases are chronic."

How depression attacks

Depression is such a deceptive ailment that at times even doctors fail to spot it, so it is not surprising that patients themselves or their relatives and friends are unable to recognise early storm signals. There is a marked difference between ‘blues’ and more serious forms of depression when a person’s gloomy feelings predominate for weeks instead of days. The range of depression could vary from ‘normal’ to ‘pathological’, from a fleeting, momentary mood of sadness to an intense, persistent conviction of worthlessness and hatred for self. These feelings of sadness may be pervasive, and the sufferers often can’t pinpoint the reason for their miserable state. Many people lose motivation or interest in things they normally enjoyed.

Restlessness, difficulty in concentrating, sleep problems, and a decrease in sexual desire are also common symptoms of depression. About 70 per cent of the depressed people lose their appetite, while a minority feel hungrier and eat more, especially at night. In what is termed as ‘manic depression’, some sufferers may also go on an impulsive shopping spree, become extremely talkative and energetic, ring up acquaintances at odd hours, or ring up people in authority for minor inconveniences, while others might complain of neck pain, digestive disorders, a tightness in the throat, blurred vision, nausea, muscle cramps and painful urination.

Depression might strike women after a stressful event such as giving birth, resulting in what is known as ‘post-partum blues’. Women experience a feeling of having lost something, in sharp contrast to the feeling of joy and happiness they possessed during pregnancy. The monthly cycle and menopause are two other important factors that cannot be ignored, because the hormonal changes taking place in a woman’s body during these times often play havoc with her emotional state.

Other events that could trigger off depression are retirement, redundancy, death of a dear one, or departure of a grown-up child from home. Most of us at weekends might dread what is known as ‘Blue Monday’. The thought of having to work through six more days make us feel low. The feeling of boredom, either with the self or someone else, may be one sign of feeling depressed. At first the patient might sleep badly, or might wake up at three or four in the morning and might be unable to go to sleep again. At these moments the most embarrassing, shameful and humiliating experiences of our lives are likely to surface into consciousness as we lie in misery, hating ourselves more and more. Then, there are those who might try to hide sadness with laughter, but in the end the bubble bursts resulting in severe consequences. Some might start thinking of committing suicide. If things come to such a pass, it is time to seek medical help.

Why do people get depressed?

Until recently, there seemed no logical explanation for conditions like those we have just described. A recent research now suggests that brain-chemistry malfunction is probably the culprit. Severe depression that responds to treatment with anti-depressant drugs is thought to be caused by a reduction in the levels of certain neurotransmitters — chemical messengers that alter mood by stimulating brain cell activity. It is suggested that the drugs that reduce the active amount of neurotransmitters like serotorium and norepinerphrine induce depression, while drugs that increase their amount help to raise a patient’s spirits.Doctors think that schizophrenia coincides with too much of the neurotransmitter dopamine in the brain, and counter this with drug antagonists of dopamine quite successfully.

Traditionally psychologists have classified depression as neurotic and endogenous depression. Neurotic or reactive depression results from a combination of constitutional personality disorders and some precipitating stress. The patient is unable to handle stressful situations in life, such as failure in a venture, loss of job, or unrequited love. In such cases there is a possibility of stress developing into depression. Here there is a cause for the depression, but it is not something that would have caused depression in a better-adjusted individual.

Endogenous depression, on the other hand, has many of the characteristics of a physical illness, which indeed it probably is, for most psychiatrists believe that it is caused by some biochemical disturbance as yet undiscovered. It was earlier believed that depression is basically psychological, and that if the patient was taught certain techniques, depression could be simply willed away. Psychologists, however, don’t subscribe to this view any longer. There is strong evidence that depression has a physical component.

Is it in your blood?

There is a marked hereditary element in endogenous depression, and people whose close relatives have been affected are at a greater risk in comparison with the rest of the population. A genetic vulnerability appears to exist, at least in some forms of depression. If you are genetically susceptible, ordinary setbacks and normal periods of grief — illness, financial or midlife crisis — could trigger a serious depression.

The good news is that even if depression runs in your family, you may never develop the disease.

Are women more prone to depression?

It is generally held that depression is twice as common in women as in men. Statistics show that women are twice as likely as men to suffer from every kind of depression, except manic depression. Men are more likely to experience other mental disorders such as alcoholism, drug abuse, and behavioural problems in childhood and adolescence. The greater number of women sufferers is probably a reflection of the hormonal changes which they experience. The menstrual cycle is associated with variations in mood, and many women suffer ‘premenstrual tension’ . A greater portion of water is retained at this time, and resulting changes in the concentrations of the various minerals in the body may produce subtle alterations in brain function.

But it could also be argued that men actually get depressed as much as women do, but are diagnosed less often. They refuse to seek medical help because they do not want to be seen as weaklings.

Managing depression

Even when depression has a primarily psychological basis, it can be as real a physical condition as diabetes or heart disease, and just as debilitating. If ignored and left untreated, depression can deepen; thoughts of suicide may turn into attempts; or patients might begin to vegetate. And even if one episode subsides without treatment, the condition cannot be counted as cured. At least 50 per cent of the depressed people experience recurrences. Since the problem is serious, could we do something about it before depression strikes? Dr Gupta suggests: "Light exercise, yoga, hobbies, meditation, and a balanced diet could help. Vegetarian diet is considered helpful in avoiding and countering depression. Citrus fruits containing vitamin C and vegetables containing vitamin E are helpful in fighting negative aspects of stress. Caffeine-containing items like coffee, tea, chocolates, and cola drinks increase anxiety levels. Going away to a hill station or a beach does wonders in certain cases."

"When nothing works," the doctor adds, "sleep deprivation could be tried, because it is a standard treatment for depression and is employed when the patient does not respond to drugs or any other treatment. In some cases this has proved to be effective.

There are many other methods to fight depression, but Dr Avasthi cautions:"Let me stress that there can be no clear dichotomy between the mind and the body. Before attempting cure, you must consider three important factors: biological, psychological, and sociological. In this highly competitive age, let’s say, failure to pass an exam or an interview, will have different effect on different people, depending upon their psychological state. Once it has affected a person, and becomes depression, it becomes a biological disturbance. In this case, although the origin was due to sociological factors, the physiology also gets affected. So to treat a person, we have to give the patients drugs, and we will also have to use psychotherapy, and also take care of the social environment. In some cases, the biological inputs may be more important, while in others environmental factors could play a crucial role. The good news is that depression is one of the conditions that can be treated with a very high success rate. Even by just using drugs, about 70 per cent of the cases are cured, but if other methods are used in combination, we can take care of the remaining 30 per cent of the cases too."

Coping with a depressed person

When one member of a family falls victim to depression, other members also tend to get affected in many ways. Matters might become complicated because most family members of a depressed person are not professionally trained to deal with depression. So, what can you do if someone close to you is depressed? "The first thing the family can do," advises Dr Avasthi, "is to become aware that depression is a medical condition, therefore, they have to take the patient to a doctor at the earliest. Once the treatment has been initiated, the family must make sure that the treatment is not stopped. It is often seen that after the patients show some some signs of recovery, families tend to discontinue the treatment. This premature cessation of the treatment leads to a very high relapse rate."

The family should create a better environment at home, and provide moral and emotional support. In this highly competitive age, you must set goals according to the talents of your children. Set too high a goal; and it is bound to result in depression because the child will be unable to measure up to your expectations. So be reasonable in your judgement and expectations. This will help not only in the management of depression, but also in prevention of future depressions. Don’t push the patient too far. You could organise family or social support groups, so that the stigma attached to depression disappears. As mentioned earlier, depressed people are afraid to seek medical help. Now, if you have a fever, you have no problem in seeing a doctor, but in case of depression, you might hesitate. Remember, depression is not an inherent weakness in you; you have nothing to be ashamed of. It is just like any other ailment that can be cured with the help of your loved ones, doctors, and with a little effort from your end.