Most common among the mental disorder is depression. Five to ten percent of patients attending clinics will be suffering from clinical or major depression. Many of them will be experiencing debilitating or disabling symptoms of feeling low, depressed or hopelessness and will have little interest or pleasure in doing things.
Though the problems related to depression is on the rise, the difficulty faced by the doctors as well as family members in understanding that a person is suffering from depression in its initial stage is a big challenge. As a result, undiagnosed or misdiagnosed cases of depression abound.
What do we mean by depression? How different is it from feelings of sadness or grief which all of us experience when we lose our near and dear ones? Is depression a passing state or is it an illness? If there is a difference, then how do we understand it? While answering these queries, we need to be familiar with some terms which are commonly used in describing cases of psychological illness.
Mood is the aspect of emotion which is subjectively felt by an individual. Thus we feel elated, sad, and anxious and most of us know what inner state of mind is recognized as such. It is a symptom. Affect, on the other hand, is the facial demeanour or expression which is a reflection of the underlying mood. This is observed by an external observer (a physician or family member) and is thus a sign. Thus sadness is a mood state experienced by most of the healthy persons in response to a negative experience. Depression on the other hand is a pathological state characterized by prolonged sadness that is not in response to or disproportionate to a negative experience. A depressed person is unable to experience joy (or reduced joy) in previously pleasurable activities. A depressed person may be seen with a peculiar facial expression comprising knitted eyebrows, downturned angles of mouth or sagging frame.
Depression is a disease like any other physical disease like Diabetes (chronic) or Pneumonia (acute) that would be having some distinctive features like onset, presentation and progress, which would help to diagnose it with certainty and precision. It comes under the broad category of mood disorders. It usually starts in the mid- 20s and occur more frequently in women than men. The age of onset of depression is reducing with passing generations for various reasons. These may include mounting stress levels due to increased urbanization and globalization, lack of adequate and correct nutrition due to changing diet patterns, changes in social structure e.g. break up of joint families. Increase in the incidence of other medical illnesses like cardiovascular disorders or diabetes which make people prone to develop depression. From children to old people, men and women of all ages, from a daily wage worker to the wealthiest of people, 1 in 10 people experience major depression. What make things difficult is the fact that precious life and work hours are lost while people fight with it. Depression is the second leading cause of disease burden. India ranks fifth in the list of nations burdened by depression.
In most cases, depression doesn't have a single cause. Instead, it results from a mix of things, like genetic factors, certain events of the past that act like triggers, current circumstances, and other risk factors. The well-known depression triggers, to name a few are trauma, grief, financial troubles, and unemployment.
The exact cause for depression is not known but studies suggest that certain chemicals in our brain can trigger depression and at times subtle structural changes of the brain itself makes the individual prone to it. A familial pattern is observed wherein it is seen more often in first degree biological relatives. Loss of loved ones, disappointments, business failures and failure in examination, monetary losses are often found to be the triggers of depression.
Homoeopathy takes into account such precipitating factors as part of the symptom totality as each cause may indicate a different remedy thus making therapeutic approach and outcome comprehensive.
The symptoms of depression can be complex and vary widely between people. According to the National Institute of Mental Health (USA), common symptoms of depression may include difficulty concentrating, remembering details and making decisions, unexplained fatigue and decreased energy, feelings of guilt, worthlessness, and/or helplessness, feelings of hopelessness. . Irritability, restlessness, loss of interest in activities or hobbies once pleasurable including sex, persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment, persistent sadness, anxious or "empty" feelings, thoughts of suicide and suicide attempts may also be present.
The illness may start as a gloomy feeling with either excess or lack of sleep. Negative thoughts often crawl in, with a sense of pessimism and low self worth. Weeping becomes more frequent, one feels hurt easily. At times, there is a feeling of agitation wherein the individual may act out her/his anger. Thoughts of self harm to the extent of ending life aren't far away. One may start eating excessively or may not eat and thus there may be excess weight gain or weight loss. Constipation may also set in. There may be a desire for solitude. Sometimes, the individual may also experience anxiety, compulsive behavior, impulsive sexual behavior, bodily discomforts like fatigue, dull aches in the body along with low mood. In fact, a lot of people would report of these latter symptoms and fail to report their mood state. Only a knowledgeable physician after carefully examining the physical system and not finding anything physically wrong would suspect that these symptoms may be as a result of depression. This is also known as masked depression.
There is no blood or radiological investigation which can diagnose depression but there are a few physical illnesses that mimic it. Thus, before diagnosis of depression, it is sometimes necessary to rule out these physical illnesses namely Thyroid illness, Vitamin D or B12 deficiency states which may have similar presentation.
A detailed psychiatric history and mental status examination is usually sufficient for the diagnosis. Questions relevant to the mood, life events, how the person feel and think about them are asked. The facial expressions and body language are observed. There are few assessment forms like the Personal Health Questionnaire Depression Scale (PHQ-8) which may identify the illness Often, depression goes undiagnosed due to lack of awareness, social stigma of seeking support of a mental health care provider.
It is important to know the type of mood disorder and depression a patient has since different types of disorders have a different course. Some carry a danger of relapsing (Recurrent Depressions); some carry the possibility of turning into an excited – manic- phase and are called bipolar; and some carry the risk of committing suicide. Hence the doctor generally does carry out relevant enquiry and find out the specific diagnosis.
Depression is a common mental disorder that can take a terrible toll on individuals and families. Suicidal behavior is a serious complication of depression and may be fatal. The individuals with a previous history of depression and suicidal attempts are more prone to it again. Chronic illnesses like diabetes, hypertension etc. can show a rapid progress in an individual suffering from depression.
Other complications associated with depression are excess weight or obesity, which can lead to heart disease and diabetes, pain and physical illness, alcohol or substance use, anxiety, panic disorder or social phobia, family conflicts, relationship difficulties, and work or school problems, social isolation, self-mutilation, such as cutting, premature death from other medical conditions.
Modern day treatment comprises of antidepressants, medicines which are given for symptomatic relief and target at altering the chemicals in the brain which are considered responsible for the depression. Psychotherapy (the talk therapy) can also be equally effective for most of the patients. Patients need to be under close observation through the period when the depression is severe and is a cause for concern.
Sadock and Sadock, 2009, “Comprehensive Textbook of Psychiatry”, 9th Edition, Sadock Benjamin James, Sadock Virginia Alcott, Ruiz Pedro(Eds), Wolters Kluwer / Lippincott Williams and Wilkins.
American Psychiatric Association: Defense Levels and Individual Defense Mechanisms. In Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington D.C, 1994:752
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