Depression, which takes 8,50,000 lives every year, can set in at any age cutting across communities and genders. In their quest for life people are getting too close to the brink
A grief without a pang, void, dark, and drear,
A stifled, drowsy, unimpassioned grief,
Which finds no natural outlet, no relief,
In word, or sigh, or tear
These famous lines from Samuel Taylor Coleridge’s Ode to Dejection paint the darkness of depression with a mellow touch. But in reality, the dreaded depression sucks all happiness and saps all energy out of our life.
It’s very common for us to encounter problems like sad mood, loss of interest in work, disturbed sleep or appetite, low energy and bad concentration. But the common problem can become deadly and plunge you into an abyss.
“Depression is a common but serious illness, and those who experience it surely needs a treatment to get better,” says Dr Rajiv Sharma, MD, AIIMS who presently runs his own clinic in the capital.
There’s no single cause that one can pinpoint causing depression. “Rather, it is the likely result from a combination of genetic, biochemical, social and psychological factors. Anyone at any age can become depressed,” notes Dr Sharma.
Research indicates that depressive illnesses are disorders of the brain. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behaviour appear to function abnormally. “Medically speaking, important neurotransmitters - chemicals that brain cells use to communicate - appear to be out of balance,” explains the psychiatrist.
Highlighting prevalent reasons, he adds, “Some types of depression tend to run in families, suggesting a genetic link. However, it can occur in people without family histories of depression as well. Trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger.”
Society, a culprit
The worst part about depression, which takes 8, 50,000 lives every year, is that it could happen at any age and in persons of all genders. Nobody is D-proof! And somewhere the society is to be blamed. The increase in pressure to become upwardly mobile and meet expectations of bosses and family are leading to an increase in incidence of depression in urban India. “Desire for materialistic needs and expectations of society often drive people to depression,” says Dr Sharma.
Little wonder, suicide is among the top three causes of death in India between 16 and 35 years of age, with number of attempts being 10 times more than the number of suicides. Young sales executive Amit Pathare (name changed) is a case in point. Pressure to meet sales target in office and wife’s desire for luxury drove him up the world. “I took loans to buy a LCD TV and a car. I had to work extra hard to get incentives to pay the instalments. The tension to meet targets and pay loans was so much that I started losing sleep. I started feeling lethargic, irritated and often thought of taking sleeping pills. Thankfully, my friend took me to a psychiatrist,” he shares.
Ironically, mental illnesses are estimated to account for 12 per cent of global burden of disease, yet the mental health budgets of majority of countries constitute less than 1 per cent of their total health expenditures. A WHO report reveals that mental illness affects people in all countries, but most patients do not get the care they need because of lack of resources, fear of seeking help and lack of mental health policies.
But are we as a nation equipped to deal with the growing epidemic in terms of infrastructure, psychiatrists, psychological facilities and cost of treatment? “An episode of depression serious enough to require treatment occurs in about in 1 in 4 women and 1 in 10 men at some point in their lives. Approximately there are 4000 psychiatrists in India to take care of 125 crore population and a very few medical colleges have psychiatry departments. So it is obvious – our country doesn’t seem well equipped,” avers Dr Sharma.
Not so fair
Interestingly, women are more prone to such bouts. A leading theory of women and depression attributes the reason to sex hormones, which induce depression in some women by affecting messenger chemicals in the brain that influence mood. According to doctors who study the relationship between hormones and mood, the sensitivity of these neurotransmitters may increase when hormone levels are high or in a state of flux and decrease when they are low and stable. “In plain terms, women tend to develop depression more often than men, particularly, after child birth and menopause,” notes Dr Sunil Mittal.
Signs
Are there any telltale symptoms which could help one detect a depressed person? There are many who get to know when they are depressed. However, some people do not realise it. They might be aware of the fact that they are lacking mental well being and are not performing well, but will conclude that they have a physical illness, opine doctors. “What is important to note,” points out Dr Sharma, “is that people with depressive illnesses do not experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness.”
Some of the common symptoms are:
• Persistent sad, anxious or “empty” feelings
• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Insomnia, early-morning wakefulness, or excessive sleeping
• Overeating, or appetite loss
• Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment.
Stitch in time
Experts reassure that depression, even the most severe cases, is a highly treatable disorder. Just like any other illness, the earlier the treatment begins the more effective it is. Dr Mittal shares the steps to be taken if one doubts depression. “The first step is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can also cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she conducts a psychological evaluation or refer the patient to a mental health professional. The mental health professional then conducts a complete diagnostic evaluation. He finds out whether there is any family history of depression and gets a complete history of symptoms. Once diagnosed with depression, a person can be treated with a number of methods. The most common treatments are medication and psychotherapy,” he elaborates.
But to get the treatment started and help a patient come out of depression, it’s important to clear any myths that are associated with the problem, say doctors. For example it is only a myth that today’s competitive world predisposes a person to depression. Though the world today is very competitive and may lead to some anxiety and torment, a person should be able to handle such situations in daily life, believes Dr Sharma. “If they cannot, they should visit a psychiatrist to get out of the dumps,” he avers.
Myth: Depression is a problem of the western industrialised world and not of developing countries.
Fact: Depression affects all people in all cultures across the world. However, in some countries ‘sadness’, particularly in old age, is considered ‘normal’ and not a disease to be treated by a doctor.
Myth: Even if depression is an illness, it cannot be treated
Fact: Depression is a treatable disorder. There are many drugs available even in developing countries which are effective and affordable.
Myth: There is no need to go to a medical doctor for treatment. One can cure depression by will power, a holiday, or downing a peg or two.
Fact: Will power cannot cure depression. A depressed person experiencing lack of pleasure in his surroundings will not enjoy his holidays either. Alcohol may worsen the depression. Depression should be treated with prescribed medicines and social support of the family and community.
Myth: If you have everything in life, you cannot suffer from depression.
Fact: Though low socioeconomic status may be a contributing factor for depression, it can affect people across all socioeconomic strata. Many rich and famous people have been known to have suffered from depression.
Self help
• Take a 15-30-minute brisk walk every day. Else dance, jog, or bike if you prefer.
• Depression can affect appetite. One may not feel like eating at all, but another might overeat. Proper nutrition can influence a person’s mood and energy. So eat plenty of fruits and vegetables.
• Depression is a self-destructive effort to avoid feeling. Accept that emotions are natural and helpful. Learn that mood changes are always started by an event, a memory or, a dream.
• People with depression remember and blame themselves for bad events, while they forget about and give others credit for good events. Their low expectations mean they often give up too easily. Don’t let that ever happen again.
•Many things that worry us are really unimportant; we’ve just gotten over-involved. Instead of battering your head against a brick wall, learn to walk away.