Depressive disorder or depression is a serious illness caused by alteration of the brain neurotransmitters. It should not be mistaken from sadness which tends to be a temporary response to a stressful event which has recently occurred. It is the 2nd most leading cause for disability and decreased work productivity in the world.
One in 5 people in India suffer from depression according to WHO. If left untreated depression can go on for years. Most people have recurrences even after the first episode is treated.
Depression can develop across age groups. It can occur across races, socioeconomic groups and can have devastating consequences for the individual and the family.
Depression can have a varied presentation. Some have pains, some have anxiety, some become slow and report they don’t ‘feel sharp’. The symptoms will affect their social, work life and day to day functioning.
There are 3 core symptoms
- Pervasive sad mood (feeling sad most of the time)
- Anhedonia (Losing interest in all activities)
- Anergia (feeling weak,fatigued with slight exertion)
Other common symptoms include:
- Decrease or increase in sleep
- Very low or very high appetite
- Lack of concentration
- Hopelessness or helplessness, feeling unworthy
- Becoming slow or agitated
- Multiple body aches and pains with no medical explanation
- Suicidal thoughts
If these symptoms are present for 2 weeks and affect functioning of the individual he is said to have depression.
Depression can occur after a crisis or occur spontaneously. It can be cause by a complex interaction of genetic, environmental factors
Childhood adversity: Early loss of parents, childhood abuse, birth complications are some factors that can make an individual susceptible to depression
Genetics. Various genes have been identified. Some variants of these genes predispose an individual to develop depression. Depression runs in families
Stressors: Marital problems, financial issues, work related pressures are some of the common life circumstances that can cause depression
Medical Illness: Chronic medical illnesses, stroke, Heart attack can predispose an individual to depression. Low Vitamin B12, hypothyroidism can mimic depression. Certain medication like beta blockers (hypertension), anticholesterol medicines (statins) and steroids can cause depressive features
Substance Abuse or addiction can lead to depression. 20% of people with substance abuse have depression. In such cases both need to be treated for good outcomes.
Depression responds very well to treatment. Treatment plan has to be tailored for the individual. Medical conditions like hypothyroidism, anemia have to be ruled out. If patient is suicidal it is an emergency and plan is made accordingly. Depending on the severity treatment is planned.
The forms of treatment are:
Medications like antidepressants, benzodiazepines can be given. Moderate or severe depression warrants medication treatment. Once symptoms subside then therapy can be initiated.
Therapy like cognitive behavioral therapy, interpersonal therapy by a trained clinical psychologist can be given.
In severe cases not responding to medication/therapy and in suicidal patients modified electroconvulsive therapy is given. Other brain stimulation techniques like rTMS, tDCS can also be given in resistant cases.
Alternative approaches like yoga, acupuncture, meditation, exercise can be recommended. These are adjuvants which help and should always be given together with medication, therapy or brain stimulation. They are by themselves ineffective.