Educationals

Incidence

The prevalence of depressive illness is estimated to be around 3% per year i.e. there are about 40 crore people around the world who will develop diagnosable and treatable depressive illness. In India, surveys have shown that 4% of the population have had or are suffering from an episode of depressive illness. That would put the number of persons suffering from depressive illness to be close to around 3.5 crore. Depressive illness is :

• the cause of 20% of the suicides in the country
• the cause of a third of the alcoholics taking to drink
• the major cause of absenteeism at work and loss of productivity
• the fourth to the tenth most frequent diagnosis made by family doctors
• the disability due to depressive illness exceeds that of most major chronic illnesses including diabetes, mellitus, arthritis and angina pectoris

Depressive illness is in fact the "common cold" of psychiatric illness. Though depressive illness is so widespread, the number of patients who consults a family doctor are few, and still fewer consults a psychiatrist.

Cause

There is no single cause for depressive illness. In fact depressive illness is a result of a combination of three major factors (bio-psycho-social factors) which play a significant role in its causation and maintenance:

• Hereditary (Biological)
• Psychological
• Social

CASE : A BEREAVED FATHER

A successful businessman working for 12 to 14 hours a day had suddenly stopped going to work and was not attending to his business for the last three months. He had lost sleep, his appetite was poor and had lost about 5kgs in weight. He used to lie in bed, not communicate with anyone and was constantly lost in his own thoughts. He was frequently crying and often expressed a desire to commit suicide. This sudden change in behaviour had taken place following the sudden death of his young promising son of 22 years in a car accident. Family and friends had tired to persuade him to join work at least for a few hours a day or to take a vacation, but had failed to convince him to do so.
He was diagnosed to be suffering from severe depressive illness. With treatment he improved and resumed his activities within six weeks. He remarked that "I did not know what happened to me. I had no energy to go out or talk to anyone. My body was not under my control." It is important to understand that this patient was suffering from depressive illness. He was not shirking his work purposely or he had not suddenly become lazy. Although the triggering factor was obvious (untimely death of a young son), giving him good and well meant advice of doing something (action or going back to work) was not the treatment he needed. Rather than sympathising with the person ("Depression is a natural reaction after such a tragedy"), it is important to realise that this is an illness and that medical treatment will help the patient get well.

Depressive illness like any other illness is a disease . Just like in other physical illness like typhoid fever and jaundice, where there are certain chemical changes in certain parts of the body, in depressive illness there are chemical changes in the brain. These chemical changes bring about symptoms of depressive illness.

Hereditary Factors

Depressive illness runs in families. The parents, siblings and children of a depressed person are at a higher risk for depressive illness than those who do not have a depressed person in the family. An identical twin is at an even greater risk.

Psychological Factors

The nature and personality make up of an individual and the attitudes he display, predisposes or protects the person from depressive illness. Some of the attitudes which make the person vulnerable to depressive illness are :

Higher expectations than what the reality is (larger the gap between expectations and reality, more the frustration leading to predisposition to the illness behavioural and attitudinal expectation from spouse, children, other family members, friends and relatives; financial expectations etc.

• Low frustration tolerance level
• Uncompromising, rigid attitude leading to conflicts
• Difficult in maintaining good and cordial interpersonal relationships: strains in husband - wife relations with frequent misunderstanding and quarrels, father - child or mother- child relationship not good
• Unable to express or ventilate negative emotions and suppressing them most of the times
• Finding faults in others most of the times.