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Published On: Saturday April 29, 2017
The oxford English dictionary defines depression as “a mental condition characterized by severe feelings of hopelessness and inadequacy, typically accompanied by a lack of energy and interest in life.”
This might sound relatively harmless to a bullet wound, but can, in fact, be just as debilitating; if not more. WHO states that nearly 350 million people worldwide suffer from depression, making that 5% of the entire human population. The problem seems to be highlighted among young adults. Over the decade, depression has become one of the leading causes of disability and disease burden. A mere glance at the psychology of popular TV shows or trends give an idea about the harsh reality of this widespread struggle.
What are the signs?
With phrases like “crippling depression” and “triggered” being thrown around as frivolous humour on social media, it is imperative to understand what this condition truly implies, and what it does not. A mood swing is common and likely to diffuse with distraction or chocolate, but an untreated depressive episode can last nearly 9 months to 1 year. While an ordinary bout of sadness can be overcome with change in activity or a well meaning smile, a depressed individual might find no lasting relief from these changes. Contrary to popular belief, people suffering from depression cannot simply “snap out of it”. An individual who exhibits any 5 of the below listed symptoms may be clinically depressed:
- Severe and persistent sadness
- Lack of interest in once pleasurable activities (Anhedonia)
- Restlessness and anxiety
- Decreased concentration, self-confidence/ guilt
- Disruptive sleep pattern
- Loss of appetite or sudden change in weight
- Suicidal thoughts or actions
- Unexplained pain
Depression can be of varying types such as Melancholic, Manic, Unipolar, Bipolar Or Recurrent. Depending on number and severity of symptoms, an episode could be classified as mild, moderate or severe.
Who can it affect?
Depression is said to develop in early adult years. It may sprout from tragic memories, abuse, chronic physical disease, loneliness, or unemployment. Research has found that many, who experience one major depressive episode, are likely to have another in the course of their life. Nearly 20% of patients admitted in hospitals with chronic conditions are found to have depressive episodes. Also, it is seen to develop in patients suffering from long standing conditions such as cardiac disease, diabetes, cancer, and the like. Statistically, more women than men have been documented to suffer from this condition, but this is debatable as men often refrain from seeking medical help for mood disorders.
What do the Fact sheets say?
Depression is a systemic neurodegenerative disease and not merely a chemical imbalance. This means that there is evidential gain/loss in tissue at highly specific sites of the brain. It is found to be progressive when left untreated. To bring this into perspective, it should be noted that a greater loss of brain tissue is found in Depression than Parkingson’s. Patients with depressive illness lose approximately 7 years of life much as untreated hypertension predictably shortens life. The disease burden (indicating loss of years due to disability) of depression is greater than Ischaemic Heart Disease, Alzheimer’s or Alcohol Use Disorder. Only corroborating the fact that depression in indeed a real and debilitating disease and not just “a foul mood.”
How does it affect the body?
Early research found that levels of neurotransmitters such as serotonin were lower in depressed patients than normal. It was theorised that this could be the cause of the disease but further research revealed that it was rather the effect. Till date there is no clear criteria classifying the “cause” of depression but it is attributed to a myriad of possibilities ranging from trauma and prolonged stress to genetic disposition. Scientists have found that patients with depression are at a higher risk of developing systemic diseases and vice versa. Depression is said to affect neurogenesis (formation of new neurons) as well as neuroplasticity (formation of new neuronal pathways) distinctly in different regions of the brain. According to Dr. Philip W. Gold, “Depression is a dysregulation of stress response.” He explains that our body naturally prepares for a stressful condition by being alert, not distracted, anxious and on edge. For surviving a condition that is temporary, this response is essential. But when the stress is
prolonged, this type of response begins to have a detrimental effect on the body. Anxiety is believed to be coarsely controlled by a part of the brain known as the Amygdala, while emotions are regulated by the Hippocampus. In depression, the Amygdala shows increase in neurogenesis and neuroplasticity while the hippocampus and prefrontal cortex show a decrease in the same. Subsequent change in biochemistry causes the person to be lethargic, fatigued, anxious, unmotivated and apathetic.
Grim as the facts may sound, it is comforting to know that depression is treatable and that some neuronal loss can be reversed. The treatment advised is often a combination of Cognitive Behaviour Therapy (CBT), Interpersonal Psychotherapy (IPT) and Pharmacotherapy. The first two deal with personal interaction while the last works on biochemistry (drugs like TCAs, MAOIs, SSRIs etc). Treatment models such as “Stepped care approach” are designed to assess the most effective intervention. It must be well understood that a person suffering from depression should consult an expert and not self diagnose or self medicate. This is important because depression mimics conditions caused by some physical diseases such as hypothyroidism, Vitamin D deficiency, hypoglycaemia etc thus needing accurate lab tests and expert differential diagnosis. Also, taking Anti-depressants without prescription or close monitoring, can be extremely dangerous. Alternate treatment methods are readily available. Though not backed with extensive research, they are found to be more acceptable by the patient. These include nutritional supplements (St Johns’ Wort, SAMe), Acupuncture, relaxation techniques, Guided Imagery, Massage Therapy, Art/ Music Therapy, Spirituality and aerobic exercise. Senior authorities on the subject agree that the effectiveness of such therapies are variable.
Depression is a proven fact and not to be dismissed lightly. Modern science is redefining life by introducing a holistic approach to health. As we return to the footsteps of ancient medicine, we’ve come a full circle in search of well-being and found that no aspect of a human being is dispensable. A delicate balance of mental, physical and social health has to be protected and empowered. If you are experiencing symptoms of depression, do not fret to consult a specialist. There is plenty of room for hope and more so, Joy. For ultimately, all one does, is but in pursuit of happiness.
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Content Credit: Dr.Nikita Pandey, Pune