When discussing depression as a symptom, a feeling of hopelessness is the most often described sensation. Depression is a common problem in the modern world, and a growing cause of concern for health agencies worldwide, due to the high social and economic costs involved.
Symptoms of depression, like the disorder itself, vary in degree of severity, and contribute from mild to severe mood disturbances. Mood disturbances may range from a sudden transitory decrease in motivation and concentration to gloomy moods and irritation, or to severe, chronic prostration.
Depression has been part of the human condition since antiquity. Hippocrates, the ancient Greek "Father of Medicine," is generally credited with the first description of an emotional disorder and is thought to have coined the term "melancholia,” Although life is filled with unexpected events such as the death of a loved one, loss of a job, major illness, or other catastrophic events, not everybody becomes depressed. Most individuals suffer only temporary feelings of depression and find ways to adjust to life's challenges. However, there are certain individuals who experience a major depressive episode when faced by stressful situations. Most individuals with depression have difficulty in dealing with the challenges of daily life, and even minor obstacles or difficulties may trigger exaggerated emotional responses. Frustrating situations are frequently met with feelings of despair, dejection, resentment, and worthlessness, with people easily desisting from their goals.
People with depression may try to avoid social situations and interpersonal interactions. Some people with depression overeat, while others show a sharp loss of appetite (anorexia). Symptoms of depression include at least five of the following changes in the individual's previous characteristics:
- Loss of motivation and inability to feel pleasure
- Deep chronic sadness or distress
- Changes in sleep patterns
- Lack of physical energy (apathy)
- Feelings of hopelessness and worthlessness
- Difficulty with concentration
- Overeating or loss of appetite
- Withdrawal from interpersonal interactions or avoidance of others; death wishes, or belief in his/her own premature death.
In children, the first signs of depression may be irritation and loss of concentration, apathy and distractibility during classes, and social withdrawal.
Some adults initially complain of constant fatigue, even after long hours of sleep, digestive disorders, headaches, anxiety, recurrent memory lapses, and insomnia or excessive sleeping.
An episode of major depression may be preceded by a period of dysthymia, a mild but persistent low mood state, usually accompanied by diminished sexual drive, decreased affective response, and loss of interest in normal social activities and hobbies. Depression can mimic the symptoms of many diseases, and physical symptoms may include severe headaches, muscle aches, stomach aches. and even fever.
With treatment, more than 80% of people with depression respond favourably to medications, and the feeling of hopelessness subsides; they are able to resume their normal work and social activities.
Depression may occur at almost any stage of life, from childhood to middle or old age, as a result of a number of different factors that lead to chemical changes in the brain. Traumatic experiences, chronic stress, emotional loss, dysfunctional interpersonal relationships, social isolation, biological changes, aging, and inherited predisposition are common triggers for the symptoms of depression. Depression is classified according to the symptoms displayed and patterns of occurrence. Types of depression include major depressive disorder, bipolar depressive disorder, psychotic depressive disorder, postpartum depression, premenstrual dysphoric disorder, and seasonal disorder. Additional types of depression are included under the label of atypical depressive disorder. Many symptoms overlap among the types of depression, and not all people with depression experience all the symptoms associated with their particular type of the disorder.
Depression has been classified as a mood disorder or 'affective' disorder. Mood is defined as a powerful, sustained emotion that, in the extreme, markedly affects a person's perception of the world and ability to adequately function in society. Mood disorders, depression, and anxiety are common illnesses in our society. Lost work time, family conflicts, personal strife, and other consequences of the disease can eventually lead to complete disruption of one's life.
Depression and mood disorders have become increasingly recognized as widespread health problems. In spite of this they are often under-diagnosed and under-treated because of the stigma associated with them. Some people are genetically predisposed to react more strongly than others to life's inevitable blows. Scientists have traced this susceptibility in part to how the body processes a neural messenger called serotonin, which is linked to mood, and helps cells learn and communicate. Serotonin is the 'feel good' neurotransmitter of the brain. It is responsible for us feeling happy, relaxed, and calm, motivated, and at peace with our lives and our role in the world. People suffering from depression invariably have low levels of serotonin. Investigators have also explored the role of the hippocampus, an area deep in the brain critical to memory formation, in severe depression, and they have used brain imaging to try to pinpoint areas in the brain that flare up or go quiet when people are suffering from spasms of despair. It is possible that activity in a part of the brain known as the Brodman area 25 may be associated with the experience of despair.
The incidence of depression is higher in certain families, indicating that a biological vulnerability can be inherited. However, not everybody with a genetic vulnerability develops the illness. Psychological makeup plays an important role in vulnerability to depression. People who have low self-esteem, and are readily overwhelmed by stress are prone to depression.
A serious loss, chronic illness, difficult relationship, financial problem, or any unwelcome change in life patterns can also trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive illness.
People with negative thinking patterns, who are pessimistic, have low self-esteem, worry too much or feel they have little control over life's events are also more likely to develop clinical depression.
Childhood experiences are the colours with which the adult draws his or her pictures of life. Adverse childhood experience such as persistent criticism by parents, rigid goal-setting in Childhood, fear of failure, parental conflicts are common and destructive. These can all become the seeds for depression in adult life. An interesting but troublesome set of expectations many of us form as children concerns 'happiness'. We must learn and teach our children that continued bliss is not an attainable goal for anyone, and instead aim at the best that one can realistically expect from life as a human being.
We must learn that fear of failure is the greatest cause of failure in the world. It is also one of the major causes of depression.
The diagnosis of depression is clinical based on the experience of the physician, the presence of symptoms and the elimination of physical causes.
Depression is not simply 'all in the head'.It has physical causes, linked to abnormalities in brain chemistry. However unlike other illnesses the diagnosis can not yet be confirmed through one diagnostic test, and only when we can finally diagnose it by means of an abnormal blood test or something similar will those who suffer from depression be given the same degree of acceptance as those who have 'acceptable' problems such as angina and diabetes.
Depression can be treated successfully. However, people tend to react differently to the available treatments. For example, one medication may be effective and well tolerated in one person but not another. Choosing the right treatment is an individual process, that will depend not only on the severity and the type of depression, but also on the person's circumstances, and his or her preferences and the doctor's recommendation.
The best treatment is a combination of positive thinking, positive talking, and antidepressants. Antidepressants (also called mood elevators), can improve mood, sleep, appetite, and concentration. However, they can take from 6 to 12 weeks before real signs of improvement are experienced. It is important to keep on taking your medication or discuss it with your doctor. Common antidepressants are amitryptaline and Imipramine. All antidepressants work by altering the effects of important brain chemicals, called neurotransmitters. The neurons use the neurotransmitters to communicate with each other. The neurotransmitters that play the most significant part in the treatment of depression are serotonin and noradrenalin.
Depression is a real condition and it can be treated. It is not a sign of weakness. It's your body's way of telling you that you may need help. The good news is, you don't have to live with depression. If you think you are depressed, talk to your doctor about getting treatment.
An attitude of contentment is the foundation of positive thinking. Contentment unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. Contentment makes sense of our past, brings peace for today, and creates a vision for tomorrow. Learn to be contented and you may never be depressed.
Dr. Shabihul Hassan
Chief Medical Director
Dr. Hassan's Hospital & Diagnostic Centre