What causes depression ?
Genetic disposition , early childhood events , hormonal and chemical imbalances , current life events , lack of social support , isolation and cultural factors are all thought to play a part in making depression , one of the most common conditions some 15 out of every 1000 patients will present with depressive symptoms to their doctor , while many more try to” soldier on “alone , general surveys however suggest that up to 75 % of people will admit to “ loss of energy “ an d loss of sparkle and feeling sad . Alcohol abuse can result from depression as the victim to drink to mask the symptoms .
Depression is a common disorder in psychiatry and is as old as difficult to pinpoint an organic cause of depression .
Depression as a disorder is often known as mood disorder , it shows itself in the form of sad feeling , because it evokes reactions of sadness and disappointment , the cause of depression is understood in terms of environmental problems and difficulties , by and large , sufferers of depression and their relatives search for causes and solutions in the environment .
It is not easy to say that only environmental problems or only physiological problems are responsible for occurrence of depression , with recent advances in biological psychiatry it is now possible to understand the role of various physiological factors including neuro chemicals in depression , however depression is a multi casual disorder with biological , psychological and social factors operating together , many people develop this disorder often because of biological vulnerability , in fact these people more often than not develop frequent bouts of depression . very mild disturbances in the environment can contribute to depression in these individuals .
Biological Factors : the most common one is a family history of depression . the risk for an individual is 25 % , if a sibling and one of the parents have a history of depression . This risk increases further to 40 % , if both parents are affected by depression . However some dramatic advances in brain biochemistry have helped in understanding the occurrence of many of the mental disorders . The dysfunction of biochemistry in brain which causes depression is being studied extensively in terms of neurotransmitters imbalance , depression is a result of absolute or relative deficiency of neurotransmitters . The commonly identified neurotransmitters are serotonin , norepinephrine and dopamine , but depression is a complex process involving various chemicals , the success of treatment of depression depends upon the actions of these drugs in balancing the function of these neurochemicals . The other biochemical area affected in depression is endocrinal function in the brain e.g, hormones .
Social Factors : to day’s urbanized lifestyle has created more stress , interpersonal loss , disappointments , there are various studies that explain the relationship of these factors to depression , in developed countries , studies show that working women experience depression more often than , non-working women . In a developing country like India , unemployment , poverty , gender discrimination and illiteracy generate all sorts of problems and stressors , there is a poor social relationship resulting in less opportunities to nurture and to be nurtured . Then there are some specific traumatic and unpleasant life situations , events like divorce , loss of job , illness , bereavement , and marital disharmony leading to depression , other important stressful factor is loss of mother in early childhood , however it is important to know that depressed people have tendency to concentrate on negative events more than normal people .
Psychological Factors : stress is not always a problem for every body , many people experience the same life situation , but not every body develops depression .
Those who have personality problems like dependency , immature coping styles , unassertiveness etc., are more prone to depression invariably have a pessimistic outlook towards life , these people lack energy and effective coping styles , their style of thinking is illogical and emotions are inappropriate , the emotional disturbances are in the form of guilt and anger . it is difficult for these people to challenge their own defeatist thinking process , hence psychological intervention is essential to take care of the depressive thinking process .
Early Signs and Symptoms :
Can not concentrate : this could be one of the earliest signals , the individual finds it very difficult to go through even the headline of a news paper , takes longer to read a page in a book or concentrate on his favorite activities which he could execute comfortably earlier , errors and delays in work are commonly noticed .
Irritable : irritability is also an early feature , small errors by close friends or members of the family provokes disproportionate reactions , snapping back on minor irritation towards people around becomes noticeable , when this change of behavior is pointed out the person does acknowledge it as wrong but expresses helplessness and inability to rectify it .
Physical signs and symptoms will depend on the nature and type of addiction and the stage which the addict has reached . general symptoms may include mood swings , behaving out of character , irritability , lack of sleep , unreliability , poor performance at work or frequent illness , neglecting food , change in appearance .
Alcohol : will produce gastric symptoms , early morning vomiting , the shakes , loss of memory , loss of sexual interest and potency .
Coffee addicts : are often in a terrible hurry , breath rapidly , suffer from palpitations , frequency of micturation and gastric disturbance .
Drug addicts : may develop pinpoint pupils ( from using heroin ) red eyes and drowsiness ( cannabis ) disorientation and giggly behavior (LSD) sniffing a dry cough and skin feeling around the lips ( cocaine )
Tobacco addicts : may smell , cough have yellow stained fingers and teeth .
Awake much before the sun rises : if one is awake much before his schedule wake up time and can not sleep further in spite of all normal efforts it could mean that she/he is heading for an episode of depression , early morning insomnia is a characteristic feature of this illness . bad dreams may be associated such as that of blood , death accident etc.,
My house is new but still I don’t feel nice : an anticipated pleasure which is associated with a desirable change ( e.g, buying a new house and living in it , promotion in a job , academic success etc., ) refuses to cause any excitement which in normal circumstances should result in feeling good .
“Put off the TV and leave me alone “: this is a common quote one hears from a depressive and is also one of the earliest manifestations , inability to tolerate day to day noise such as that of the TV , children playing , etc., surprises every one around
I am bored and Lazy , I feel like bunking : difficulty in getting off the bed , to work , laziness in the morning which at times improves as the day progresses is a signal of depression . Sloppiness untidiness not caused due to physical illness ; can be announcements of an impending episode of depression .
I am not interested : lack of interest in normal pastime activities like seeing a movie , playing sports , talking to friends etc., is an early sign of depressive blues .
I am not hungry as before : hunger for food is less and even favorite dish does not stimulate the palate in the absence of any physical cause , only rarely could over eating be an early signal .
I don’t get turned on : appetite and interest in sexual activities decreases very early in depression .
All the above symptoms may be seen in normal people as well, but then they are transient and temporary , if it persists beyond 2 weeks and are associated with other features described later , one can make a diagnosis of depression when depression strikes .The following attitudes become marked when the blues really set in .
I feel sad all the time : An all round feeling of sadness which is pervasive is the hall mark symptom of a depressed person . This can be associated with either withdrawn or an agitated behavior , I feel worthless and hopeless ; feelings such as these are predominant , such people feel they are not fit to live in this world .
I feel guilty , I am a sinner : when one is in the thick of depression , one feels disproportionately guilty over small errors of the past , he or she broods over past events , all such thoughts invade the ill person’s mind repeatedly and render him or her helpless and miserable , attempts at pushing away these thoughts are unsuccessful .
I feel like crying all the time : crying spells are very common and may be provoked by small events at times , others may become mute and totally withdrawn . It is better dead than being alive : ideas of self harm occur to 50 % of those suffering from depression , some may express that there is no point in living , while others may have suicidal ideas .
I am easily tired : depressed individuals feel very tired with out any physical cause , they are easily fatigued and complain of lack of energy .
I have headaches and pain all over the body : physical aches and pains may be the only complaints of depressed people . These pains are not caused by any physical illness , a large number of these patients seek solace from a general physician or specialists from every branch of medicine except a psychiatrist .
I am an alcoholic but also depressed : depression and alcoholism may coexist in the same person . some depressives also self medicate with alcohol to feel good good resulting in disastrous complications .
I get depressed for a few months and then I become very happy : depression seen following pregnancy is termed post partum depression , during menopause and just few days prior to the date of menstruation also the above symptoms of depression might appear , depression can occur in children as well , childhood depression too present the features mentioned above , other symptoms indicative of depression in children are behaviors such as refusal to attend school with out any obvious reasons , stealing , truancy , clinging behavior , diminished scholastic performance , aches and pains , bed wetting , this should alert the family members to seek help .
Treating Depression : depression can be successfully treated and especially if detected early . complication such as suicide , loss of job , diminished quality of life and others can be prevented if handled in time . the three main methods of treatment are medicines ( pharmaco therapy ) , counseling , psychotherapy ( talk therapy ) and electro- convulsive therapy ( ECT )
Medicines : In severe depression where the individual is emotionally paralysed and devastated , medicines are essential . In mild to moderate varieties of depression also medicines do help , though in very mild types most people do not reach a mental health professional . The choice entirely depends upon the treating psychiatrist , these medicines act by altering and setting right the imbalance of chemicals ( neurotransmitters ) in the brain , no self medication by the sick person should be attempted , medicines start acting only after a few days and take approximately 6 weeks for recovery in most individuals .
Talk Therapy : counseling and psychotherapy have been found beneficial in depressed patients , cognitive behavior therapy , one type of talk therapy has shown impressive results . this aims at correcting distorted thinking . , another type of talk healing is the inter personal problems , but talk therapy alone may not benefit an ill individual . A combination of medicines and talk therapy speeds up the process of recovery .
Electro Convulsive Therapy : this a form of tretment mainly reserved for those who exhibit frank suicidal thoughts along with depression and those who do not respond to other forms of treatment , the procedure involves mild general anaesthesia and an electric current of approximately 90 volts for a very brief period of 0.8-1.2 seconds applied to the brain bifrontally , 4-6 ECT’s are necessary and the procedure is generally carried out on an empty stomach on alternative days .A few individuals may need more ECT’s , electro convulsive therapy can be life saving for a suicidal depressed patient , temporary loss of memory is caused after the procedure and is reversible , it does not cause brain damage , is not very expensive and is reasonably safe . ECT’s do not cure depression but help control the intensity of the illness , medicines to sustain the improvement needs to be continued for a duration prescribed by the treating psychiatrist , hospitalization may be necessary for such patients .
Who treats depression : depressives who need are generally treated by a psychiatrist , but general practitioners who are enlightened and educated about this disease can also treat the illness . counseling and psychotherapy is provided either by a psychiatrist or a trained psychologist / counselor , medical social workers with a degree in MSW can also provide counseling and pscho-education to family members , on an average treatment and very few need maintenance treatment for years .
Tips For Patients :
Always clarify with the therapist about cost side effects and length of treatment .
Do not change or omit doses .
Allow supervision by close family members
Do not take advise about medications from lay people , most probably they will misguide you
keep your family and family physician involved in the treatment process .
do not take up any major responsibilities during early phases of treatment
when about to loose control of self rush to your friend , family member , your therapist or any emergency medical facility of a hospital
trust your therapist and clarify all honest doubts
do not consult astrologers , fortune tellers and quacks
no intoxicants such as alcohol etc., should be consumed during a bout of depression .
Family Has a Role :
The role of the family in helping a depressed individual recover is important , members of the family can help the person overcome the emotional pain with least complications , their response to the depressed person should be :
Early Detection : any behavioral change which is undesirable and persistent causing distress and dysfunction should be taken cognizance of and brought to the attention of a mental health professional
Acceptance : all the members of the family should recognize and accept the inevitable fact , that depression is an illness and needs help , they should also understand that the person suffering is helpless irrespective of educational status , sex , caste , and class .
Seek Professional Help : the relatives should seek professional help at the earliest and should not try any home grown methods to treat him /her at home . The best advise one could give is to seek treatment
Encourage Sharing : A depressed individual at times may not share his pain with his loved ones because he /she is scared to hurt them , on recognition of symptoms , family members should allow the ill ., individual to express freely his /her emotions . this listening should be non-judge mental , it helps initiate and continue treatment .
Resolve Conflicts : any conflict or disharmony between relatives needs to be amicably resolved . Disagreement between family members and the depressed individual should be buried and every one around needs to rally round the sick person . Being a family can give .
Suspend decisions : A depressed person may at times take catastrophic decisions like quitting a job winding up a business etc., the family needs to be alert to such decisions and suspend it till complete recovery .
Don’t Blame : Most often family members look around for a cause of depression and appropriate blame on either the patient , environment , other family members or friends , depression may not be preceded by a cause and management of symptoms should receive priority .
Seek Counseling : Family members need to seek counseling for themselves as the illness can cause turmoil in the family , all fears doubts about the illness should be shared by the family members with the therapist . An unsuccessful suicide attempt for instance , can traumatize the entire family , all such feelings should be clarified and resolved with the help of the therapist .
Ensure Confidentiality : the relatives along with the therapist should ensure complete confidentiality of the patient . this is different from being secretive , taking the spouse and in-laws in to confidence with the consent of the patient helps recovery .
Don’t Push : At times relatives believe that resumption of day to day work help the patient , this is not true and should not be attempted as depression is like a fracture of the mind and needs time to improve just as one would not push a person with a fracture to join work immediately , similarly a depressed individual should not be forced to resume normal life when he is in no state to do so .
Avoid Criticism : criticism , hostility , indifference would hamper recovery , an overdose of love during recovery is essential , but one should remember that this only assists recovery and the mainstay of treatment still is medicines , counseling and /or ECT’s , close monitoring , medications of a depressed patient should be supervised and monitored by a family member , it should also be kept out of reach during recovery .
Close Monitoring : medications of a depressed patient should be supervised and monitored by a family member , it should also be kept out of reach during recovery
Facilitate Re-entry : A depressed person after recovery may at times be embarrassed to meet friends , other relatives as he/she would have apprehensions in explaining the cause of absence . This should be resolved by the family members through effective liaison with the employer , friends etc.,
Be Informed : the family should collect information at the on set of treatment about the course of the illness , suicide help lines and emergency counseling centers and share this with the patient .
Guard The depressed : accompany a depressed patient always when hospitalized for treatment , never ever leave him/her alone during recovery , keep all dangerous things away from the depressed , such as sharp objects , poisonous substances etc.,
Watch for depression the physically ill : those who have long term physical illnesses which are debilating should be explored for depressive symptoms , treat them when present .
Prevent Relapse and Recurrence of depression : Incomplete treatment , leads to relapse , hence proper follow up should be ensured , recurrence can be prevented by resolving stressors , through counseling and some life skills training .
Depression Can Kill : Remember suicide is the most devastating complication of depression which can be prevented by early detection and treatment , half of all these who suffer depression which , harbor suicidal ideas , especially among those who exhibit continuous sadness , ideas of self harm should be probed , contrary to popular belief , inquiring about suicidal thoughts does not provoke an attempt , the other symptoms to watch out for .
Becoming Worse : Deterioration of depressive illness despite treatment is an important warning signal that family members should watch out for attempts to bring the patient back to normal by altering medications or forms of treatment is necessary .
Sudden change : When a depressed patient suddenly brightens up and claims to be completely cured , watch for suicidal behavior and seek immediate help . This may also be a switch over to mania from depression in a person suffering bipolar disorder / manic depressive psychosis .
Threats : Any message implying a suicidal threat especially in some one who exhibits any form of altered behavior should be taken seriously .
Missed appointments : In patients who already are on treatment missed appointments should be immediately investigated for depression .
Past Attempts : All attempts of self harm should be taken seriously and help of mental health professional should be sought , minor attempts of self harm should be investigated for depression .
Treatment Refusal : when depressed patients refuse treatment or any form of help suspect an intent to harm . Instance of suicide in family : patients on treatment for depression should be closely monitored especially those whose close blood relatives have attempted or committed suicide in the past .
More Prone To Harm Oneself : Suicide does not choose its victim , Intelligence , education , race , caste , class has little influence . Though women , unmarried individuals , those who lack social support and alcoholics are more prone to attempt suicide , some women during post partum depression ( following child birth ) may feel like killing the child and committing suicide , news paper report which narrate incidents such as “ mother jumps into a well with child “ are mostly cases of women with post partum depression .
Counseling alone will not help a patient give up suicidal thoughts ,unless the depression itself is treated vigorously suicidal thoughts will not stop or decrease . after all the ideas of self harm are only a symptom , not the illness itself .
One problem is the feeling of shame associated with a suicide attempt . in many cases families hush up the matter and do not seek help from a psychiatrist , this can be dangerous and in fact lead to a successful attempt .The other inhibition people is the fact that attempted suicide is a crime as per the Indian panel code and is a punishable offence .
Depression is a treatable illness and complications such as suicide can be prevented .Unfortunately in India a large number patients remain undiagnosed and lack of treatment facilities . The concept of emotional hygiene and mind as an organ which can fail due to changes with in the body or due to stress from outside is poorly understood , the need today is to recognize that rational scientific approaches should be used to tackle depression in the same manner as we manage diarrhoea and diabetes . Many patients being unable to distinguish between bio chemically mediated major depression and stress –induced reactive depression , resort to either environmental change to ease the pressures of life for their depression or to self building . The commonest measure to be sought out for this purpose is “ yoga “ .
Yoga does have a role to play in building up the physical resistance to prevent or cure physical ailments but has given dismal results in the management of depression . Yoga teachers themselves can and do suffer from major depression , mental health professionals are also not immune to this illness .
Other alternative therapies resorted to are ayurvedic and homoeopathic medicines . Two psychiatrists practicing homoeopathy do claim excellent results but in the absence of any statistical data there can not be appropriate evaluation . treatment in homoeopathy is individualized and no single drug is universally applicable as an antidepressant , this makes it difficult to conduct proper trials to test the efficacy of homoeopathic medicines in depression which alone would convince the medical fraternity , alternate therapies may have some thing to offer in the management of depression .
Myth and Reality : depression is caused by biochemical factors , psycho-social stressors individually or in a combination , evil spirit and irrational faith delays detection , treatment and recovery .The fact remains a severely depressed person is emotionally paralysed and physically slow and is in no state to pursue such activities , depression is like a facture of the mind , a fractured mind can not do physiotherapy before his fracture is treated and healed . depression may be a consequence of an event in the environment or an interpersonal conflict , but not always so , it can manifest without any apparent psycho-social cause and can be a result of biochemical alterations in the brain , family members fail to realize that once depression sets in the patient is helpless and can not control his thoughts , negative thoughts come into the mind of a depressed individual by itself , just as one can not control a fever with out medical help , negative thoughts can not be controlled with out professional help , asking a person with a fractured arm to strengthen his muscles before treatment of the fracture .
Depression is caused by biochemical factors , psycho-social stressors individually or in a combination evil spirits and witch craft have nothing to do with any illness , this irrational faith detection , treatment and prolongs recovery .Praying to god will not harm depression and may provide courage to seek help and suffer the emotional agony but is not a treatment by itself , professional help is necessary . Time is not always the best healer , as we seek treatment for physical ailments , similarly depression should be detected early and treated , this helps prevent complications such as suicide .
Depression is not the same a dehydration neither is it a result of lack of food intake etc., hence intravenous fluids are not the treatment of choice . depression is a treatable disorder and is a life long in a large majority . Relapses may be seen just as in influenza or malaria , but again is treatable , people who have had depressive episodes can marry or lead normal lives , taking the spouse into confidence is extremely important . support of the family and timely helps . A holiday or change of environment may help a few who have mild depressive reactions as a result of severe life stress . A holiday or change of environment may help a few who have mild depressive reactions as a result of severe life stress , it does not help those suffering from devastating depression , marriage is not a cure for depression and can be catastrophic during the illness . This is untrue and as far as suicide is concerned research has shown that people who harbor suicidal ideas and threaten self harm are more prone to carry out the threat , counseling and psycho education of the patient and the family members are crucial in the treatment of depression
Medicines and counseling when combined hastens recovery .
Symptoms and Homoeopathic Medicines
Feelings are much worse after listening to music , a fear of going out , of crowds , of crossing the road , in fact , life becomes intolerable because of these fears , anxious , restless and hurried ——-Aconitum
Extremely miserable , imaging all sorts of illnesses , a great tendency and desire to swear , impaired memory , very easily offended , almost total loss of confidence —–Anacardium
Mentally very restless with great anguish and fear , especially of dying , may feel no treatment can help , the worst time is midnight to 3 am —-Arsenicum album
Disgusted with life and may think of committing suicide , over sensitivity to noise , intolerance of slightest contradiction , depressed from grief and disappointed love ——Aurum metallicum
Sad and hopeless , the slightest thing causes tears , can help women with dark hair and eyes who are delicate , sensitive people , depression follows grief , loss of sleep and sudden emotional situations ——Causticum
Depression may also feel melancholic and full of anguish , periods may cease —-Helliborus niger
Nervous and sensitive , apt to be easily excited and easily offended , feelings of mental exhaustion , full of contradictions such as laughing at sad news , tearful with very rapidly changing moods —–Ignatia
The worst time is immediately after sleep , no desire for company , depressed , but also excitable , engaging non stop talking , averse to being touched or wearing tight clothes ——lachesis
Extreme depression , convinced is suffering from an incurable disease , timid and tearful , also indifferent to what is being done for them , may feel hurried and that life is aimless —–Lilium tigrinum
Extreme sadness in the morning on waking , loss of self confidence , a fear of being alone , extreme apprehension , the worst time is 4-8 pm , physical weakness —-Lycopodium
Great sadness , depression occurs because of a chronic illness , any consolation make things worse , feelings of irritability and cries easily , dreams of being burgled —–Natrum muriaticum
Sad feelings occur after listening to lively music , gloomy and irritable , there is no wish to speak or listen to others , fed up with life , the illness often follows a previous head injury —-Natrum sulph
Sad and cries easily , changeable and contradictory moods , symptoms are better outside —–Pulsatilla
Mentally restless and depressed as well as physically restless becomes frightened during the night frequent suicidal thoughts ——Rhus tox
Indifference to family , but a dread of being alone , cries while talking about the illness , easily offended , exhausted feelings , both physically and mentally .—-Sepia