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One of the most widespread and challenging illnesses that plagues mankind today is depression. The vast majority of people face depression to some degree in their lifetime. However, in most cases it’s just a passing phase and is usually triggered by life changing events such as abrupt severe illness or death in a family. Occasional blues are part of life and it does not require any treatment.
Depression is becoming more and more common because of the fast paced, competitive and stressful lives that we live today. MDD or Major Depressive Disorder is a serious mental illness which affects over two hundred million people across the world, which is 3% of the world population. These numbers were picked up from a study conducted in 2015. Today, it could be much more.
Moreover, the percentage of those affected at some point in their lives varies from country to country. Seven out of one hundred people face this ailment in Japan while the figure in France stands at twenty one in every hundred. Ironically, the life time rates are much higher for developed countries, around 15%, while developing countries boast 11%. These are astounding and worrying numbers.
Studies have shown that the onset of MDD occurs during adulthood, typically in a person’s twenties and thirties, with women being twice as likely to develop depression than men.
Yet another study has proved that depression is the second most lethal disease in terms of disability. This means that depression is a debilitating condition which significantly hinders a person’s ability to function normally and live a fulfilling life. The other illness which has a higher rate of disability is lower back pain.
What is Depression?
There are several schools of thought when it comes to depression. While many believe it is not an illness but just a byproduct of human adversities, others believe it is a legitimate medical condition which requires the skills and expertise of a health professional.
What are the Symptoms of Depression?
There are many varying symptoms of depression. Some are more easily recognised than others. Each patient will experience a unique combination of the symptoms of depression including:
Persistent feeling of sadness
Lack of motivation
Mood swings or mood disorder
Self imposed social isolation
Inability to focus or concentrate
Sudden weight gain/loss
Feelings of desperation and/or hopelessness
Suicidal ideations or fantasies
Major depressive episodes lasting weeks or even months at a time
Vincent Van Gogh’s 1890 painting “The Sorrowing Old Man” is a perfect pictorial depiction of this mental disorder. It is no secret that he grappled with severe depression himself. In addition to Van Gogh, scores of famous writers, poets and painters have suffered from depression. Ernest Hemingway is another example. His depression and alcoholism tore at his mind, rendering him paranoid and disoriented until his eventual suicide.
Depression Among Children and Young Adults
Depression is becoming a serious threat to children and adolescents. A growing number of young people today are falling prey to depression. According to the Federal Center for Mental Health Services, depression affects as many as one in every thirty three children and one in eight adolescents. More and more college students are being referred for depression and the number of such individuals who rely on psychiatric medicines is also rising. Alarmingly, this number is increasing by one percent every year.
Early detection and intervention is key. Studies have shown that, in the case of children and young adults, early intervention improves the chances of these individuals of going back to a normal lifestyle significantly.
This is caused by growing pressure from society. As our society places more and more value on achievement, career success, financial gain, fast paced living and the idea of “having it all”, it’s no wonder that children and young people are crumbling under the pressure that’s placed on them.
New mothers and expectant mothers are especially susceptible to depression. They are at higher risk as high levels of stress caused by pregnancy and the raising of infants and small children. This typically leads to a rise in the production of stress hormones and triggers several neurological and behavioral changes. Falling into depression is not uncommon during these times. Unlike other forms of depression this requires special handling and different kinds of therapies and medicines.
Depression occurring in children will likely be a lifelong condition. Unfortunately, depression is not an illness which can be simply cured forever. Unlike a flu or chest infection which are completely cured through oral medications and surgeries, depression is a mental illness and is infinitely harder to see, measure, treat and fully recover from. It can be managed to a point, often very successfully, but it cannot be cured completely.
Mindfulness-based cognitive therapy (MBCT) is one of the various new approaches which have been developed for children and young adults. It prevents relapse and offers long periods of depression free life. Mindful exercises include meditation and breathing while aerobics also offers long term relief. It is clinically proven that recurrent depression may prove difficult to address in the long run. Reducing the chances of another depressive episode requires a cohesive, long term plan incorporating various techniques and approaches.
Taming The Inner Critic
The “Inner Critic” is a term used to describe the negative thinking and thought patterns associated with depression. This is a very common feature in people suffering with depression.
The appearance of the Inner Critic is what begins and fuels depression. This often leads to hyper self-criticism and extremely harsh judgement of the self. People who have an Inner Critic hold themselves to unrealistically high standards and compare themselves harshly to everyone they see around themselves.
Over time this has an immeasurable negative impact on their sense of self-worth, self-respect and self-esteem. Critical “self talk” such as; you are a failure, you are ugly, you are incapable of a particular task can have dramatic effect on an individual’s life.
Anger is an integral feature of depression. It is an emotional turbulence that is difficult to curb and at the same time if not allowed to set free it can lead to self injury and thereby enhancing the depressive disorder quotient. The idea is to allow anger to freely pass through without hindering its passage and also make sure no one is harmed in any way. People ailing from depression are made to understand the importance of this emotion, and to recognize and accept the same in a healthy way.Overcoming depression is all about taming the inner critic.
Types of Depression
Depression is classified according to its symptoms. Some of the common variants are as follows.
Clinical depression is quite common in mild forms. It is an illness which hinders the patient when performing day to day chores and also reduces logical and rational thinking. It results in sleeplessness, lack of appetite and interest and also affects the behavioral attributes of the affected person.
Identifying the cause is not easy, and doctors typically monitor several parameters before arriving at an appropriate medical conclusion. Moreover, the concerned individual should exhibit the symptoms for at least two weeks to be declared as a depressed person. Depression can be triggered by past or present episodes or incidents, and it may further develop under unique circumstances.
Clinical depression is characterized by the following symptoms which can vary in intensity depending upon the trigger.
Dispirited behavior throughout the day, which continues for days, weeks, months or even years. There is absolutely no interest in or motivation for any past or present activity. It results in frequent crying or irritation of varying intensities.
The concerned individual may lose weight due to erratic eating habits or complete loss of appetite. On the other hand some types of depression might push such people towards binge eating and resulting weight gain. Any sudden drama change in weight is a typical feature of clinical depression.
Insomnia is a very common symptom of clinical depression. Insomnia results in a total inability to fall asleep and/or stay asleep. Patients may struggle to get even one hour of undisturbed sleep per night for extremely long periods. This actually worsens the patient’s condition as they cannot get the sleep required to cope with their depression. It results in a vicious cycle which has an intensely negative impact on the patients mental health.
Hypersomnia is the opposite of insomnia. Patients suffering with hypersomnia are persistently lethargic. They feel both mentally and physically exhausted at all times and cannot seem to get enough rest to feel refreshed and energized. This can have a profoundly negative impact on the patient’s career and relationships.
Self loathing pushes the sufferer to the edge of sanity. It creates a sense of despondency, failure and builds up undue guilt which could trigger serious consequences such as suicidal thoughts and inclinations.
Diminished recollection power, lack of focus, indecisiveness and forgetfulness are some of the other compelling symptoms associated with a wide variety of depression types.
Persistent Depressive Disorder
One of the common variants, persistent depressive disorder lasts for a period of two years and is characterized by unusual mood swings. The person reflects signs of depression which are mild in nature, but obvious to an observer. It is also called dysthymia.
This is typically related to women who are pregnant or have recently given birth. The signs are much more obvious and the anxiety quotient is much higher. The symptoms can last for years if untreated and include the typical symptoms of depression with the addition of a lack of connection between mother and baby and an unwillingness on the Mother’s part to care for her infant. For both mother and child it is extremely important that the signs of postpartum depression be spotted as early as possible in order to minimise its effects.
This is a complex disorder. It is a bouquet of several disorders such as depression, delusions and hallucinations. A person with psychotic depression may hear and see disturbing things which are not true or real at all. Hallucinations can have far reaching negative effects on the patient’s personal life. The individual is under constant threat from things that are just not present. The delusions can force them to turn against loved ones whom they believe to be in conspiracy against them. Psychotic depression requires unique and comprehensive treatment.
Seasonal Affective Disorder
Also called winter depression, this form of depression doesn’t affect the concerned individual in any other season. The typical symptoms include withdrawal from social life, remaining indoors most of the time, overeating and obvious weight gain due to unrestrained indulgence and comfort eating. It eases out at the end of the season only to return the next year.
Although not a true variant of depression, it still reflects some of the symptoms of this illness. For example, the person shows signs of depression such as low mood swings which is why it has been added to the list here. However, a bipolar disorder condition exhibits mania and hypomania symptoms also which are not related to the classic clinical depression.
Depression and mental illnesses in general can be infinitely more complex and more difficult to treat than typical physical health problems. It requires seasoned experience to understand the suffering of the person who is in depression. The treatment is typically based on the symptoms which vary from person to person. Therefore the course of action also needs to be fine tuned. Some of the standard treatment methods and medications are as follows.
Antidepressants help calm the brain and weaken the mood swings which are produced by certain chemicals. They aim to boost the production and absorption of serotonin in the body. Serotonin is the chemical hormone responsible for feeling happy and calm. People with depression often suffer from a lack of serotonin and antidepressants can really help with this.
However, these medications are available in several variations just like the illness. Therefore, doctors spend a chunk of their time fine tuning the prescribed medicines, the ones that offer maximum relief and minimum side effects. Unlike other medicines antidepressants take time, usually a minimum of six to eight weeks, to show even preliminary results.
It could take a couple of months for the individual to show signs of improvement. It all depends on how well the person has been diagnosed and how well he or she is responding to the chosen medication. If the desired results or improvements aren’t seen after a certain period of time, the doctor will most likely try a different form of antidepressant and see if the patient reacts more positively to that.
Many patients begin their course of medication in good earnest but then stop without consulting the doctor when they feel better and assume that they are cured. This often results in relapse and would require another round of diagnoses and fine tuning of medicines. The pullback has to be gradual to minimize the often drastic effects of withdrawal.
Psychotherapy is a medical term for counseling. Through psychotherapy, depression is addressed with some of the most complex, evidence based approaches in health care today. These approaches have been tried and tested comprehensively through years of clinical trials. In tandem with antidepressants they offer wonderful results.
Doctors at the American Psychological Association believe that psychotherapy can offer major relief from depression as it identifies the cause or causes that contribute to negative thought patterns. In this way, psychotherapy tackles the actual root cause of the problem whereas medication alone can only every act as a bandaid.
Some of the methods used in psychotherapy include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. To put it in simple terms, these approaches aim to reprogramme the brain, correcting negative thought patterns and replacing them with skills and tools necessary to maintain positive mental health.
“Talk therapy” on the other hand allows individuals suffering from depression to talk about their inner demons to a trained professional and address them head on. These professionals have an in-depth knowledge and understanding of the ways in which life events can shape our thoughts and emotions and influence our mental health.
At times patients resist opening up as it is common for depression to be rooted in traumatic memories which they feel uncomfortable sharing or reliving. In the past talk therapy was looked down upon and not taken seriously as a treatment for real illness. Thankfully it’s now widely accepted and the shame and guilt which was once associated with seeking the professional help of a therapist is over.
Brain Stimulation Therapies
If medicines and psychotherapies prove to be insufficient to curb the depression then the other option which doctors exploit is electroconvulsive therapy (ECT). Research has shown that patients who respond poorly to the above mentioned treatments react well to ECT. It offers them immediate relief from some of the compelling symptoms. In some cases ECT is the first option used by the doctors.
This happens when the patient shows intense signs of depression and a rapid response is required or in those cases where medicines cannot be used safely due to the aggressive behavior of the concerned person. On its own ECT has proven to be an effective option in treating patients with extreme behavioral disorders.
The treatment consists of series of sessions which can be spread over several weeks. Incidentally, ECT does not require the patient to be admitted to the hospital. It can now be performed as an outpatient service.
If depression is not addressed or treated in time it can push the patient towards the unthinkable. Although psychiatric diagnostic methods and tools are still insufficient there is much hope for people out there who are suffering.
Depression is a very serious illness. While in the past many people brushed it off as nothing more than a “case of the blues” and expected those suffering with it to just get on with their lives, we now have a much better understanding of what depression really is. With appropriate treatment, therapies and support from family and friends, depression can be tamed. A person can lead a normal, fulfilling, happy and healthy life. All it requires is patience, understanding and the right kind of help.
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