Facts and Figures

Conquering Depression

Introduction

The emotions of feeling sad, unhappy or disappointed are part of a human being’s normal existence, and are experienced by everyone almost on a daily basis. Such emotions may be associated with failure in academics, setback in a relationship, loss in a financial investment. break-up of a love affair, or with the death of a loved one. However, after feeling low for a few days. during which time there can be changes in the sleep pattern and appetite. disinterest in daily chores etc., the person undergoing depressive symptoms usually returns to normal within a reasonable period of time. On the other hand. there are times when this state of sadness or unhappiness may continue to such a degree and for such a length of time that it far outweighs the significance of the precipitating factor. The sufferer continues to be in a prolonged state of sadness and withdrawn from his/her personal, social and occupational activities. In such situations, a diagnosis of depression should be considered.

Normally, emotions such as anxiety, anger, pride, love, pain or joy interact to motivate a person to a goal-directed action. However, when certain emotions predominate and persist beyond their usefulness in motivating people for their goal- directed behaviour, they become morbid or pathological. This is what happens in patients with depression.

All human beings also have variations in their ‘moods’. Mood can be understood as the amalgam of emotions that a person feels over a period of time. The effects of mood on a person’s behaviour are widespread and complex. Mood determines a person’s attention, thought, behaviour and interests and, at the unconscious level, influences functions such as appetite and sleep. Many physical sensations, such as energy, pain, strength and sex drive are directly influenced by emotions.

Thus moods can cause a significant change in a person’s behaviour. Depression is traditionally classified in all major classification systems under mood disorders or affective disorders.

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Depression as a disease should be clearly differentiated from depressive symptoms or depressive moods, which are an integral part of human emotions. There are qualitative as well as quantitative differences between a state of unhappiness in reaction to the adverse events in the world outside, and depression as a disease state. It is essential for doctors, the general public and health planners to understand that depression as a disease, unlike depressive moods, is neither a normal variation of mood nor an appropriate reaction to severe stress. Also, depression does not constitute a failure of "will power" or "weak character" in a person.

There are some people who periodically or chronically remain in a depressed state in spite of their having all social privileges and material comforts, severely compromising all their functions, culminating in about 15% of cases in suicide.

Mood disorders are traditionally recognized and classified into two distinct groups: depression and bipolar disorders. Each of these have specific and distinct features and long-term course. However, the predominant symptom of any mood disorder is a distinct period of abnormal and persistently altered mood. Bipolar disorders, also known as manic depressive illnesses, are distinguished from depression by the occurrence of manic or hypomanic episodes in which patients becomes overly active, alternating with depressive episodes, while patients suffering from depression persistently feel sad. Although some patients have only a single episode of depression or mania in their lifetime, the longitudinal course in most of the patients is characterized by multiple episodes with intervening symptom-free intervals. Sometimes, patients with mood disorders may experience bodily symptoms such as headache or weakness, which may be the presenting complaints or manifestations.

Depression is a significant public health problem because it is relatively common and its recurrent nature profoundly disrupts patients’ lives. Though estimates from developing countries are not available, depression costs the US economy more than US$ 43 billion annually in medical treatment and lost productivity. General population surveys conducted in many parts of the world, including some SEAR countries, have revealed a high rate of depression with a lifetime risk of 7-12 % for men and 20-25 % for women. These rates of occurrence are unrelated to race, education, income, or civil status. Depressed patients show impairment in all major areas of functioning--personal care, family responsibilities, and social and occupational functioning. The gravity of such impairment/disabilities is almost equal to or greater than that for patients with other chronic illnesses like hypertension, diabetes, coronary artery diseases, and arthritis. Patients with depression spend more days away from work, become medically ill more often, suffer greater physical disability, and die at a younger age than the general population. Depressive symptoms, but not meeting the medical criteria for depression, are frequently seen in patients with other diseases and cause increased use of medical services as well as increased rates of morbidity and mortality.

Unfortunately, despite the seriousness of depression and all the associated consequences which can be effectively treated at any level of care all over the world, only 30% of cases with these disorders are properly diagnosed or treated. The situation may be worse in SEAR countries.

A number of factors may be responsible for this state of affairs:

     Psychiatric services are not available in all parts of the Region, and tend to be concentrated in the cities.

     General physicians, who are the primary health care providers, lack sufficient skills to diagnose and treat mental disorders.

     At the primary health care level, depressed patients may present primarily with bodily symptoms rather than emotional complaints. Thus, the diagnosis of depression is not made.

     In spite of recognizing depressive symptoms, many patients may want to overcome them by their "will power".

     The prevalent stigma associated with mental illness may prevent many individuals from approaching a psychiatric facility.

In the last 50 years, rapid strides have been made in the treatment of depression. Newer drugs have been discovered with better efficacy, less side-effects and better tolerance, and are being used for short-term and long-term treatment. Besides drugs, non-pharmacological therapies like psychotherapy and cognitive therapy have been found beneficial. In the modern day and age, there is absolutely no reason why people anywhere in the world should continue to suffer from depression.

         
Yogeeta