Indian Write-Ups

According to WHO, Depression affects about 340 million people worldwide and is among the leading causes of disability throughout the world.1 Fortunately, very safe and effective treatments are available to help a person come out of depression completely and to lead a satisfying, productive life. To help an individual cope better with the illness. Here are answers to some of the most frequently asked questions about depression.

What is depression?

Depression is a disorder of the brain and the mind that disrupts a person's mood, behaviour and thought process. The individual suffering from this illness has a persistent low mood / loss of interest in previously pleasurable activities, that is out of proportion and/or lasts longer than the passing feelings of unhappiness that everyone experiences. It is a treatable medical disorder for which counselling and specific medications (if required) are available that help most people.

When does depressive disorder begin? Who does the illness involve?

Depressive disorder affects all age groups including children, adolescents, adults and the elderly; the highest prevalence is in the middle aged. Women have been found to be involved twice as frequently as men. Depressive disorder affects people irrespective of cultures, races and social classes.

What are the common myths/misconceptions about depressive disorder?
Some of the common misconceptions about depressive disorder include the beliefs that:

• Depression is caused by witchcraft, bad omens etc.
• Going to mandirs, dargahs and churches alone will help
• Bad parenting, childhood trauma or personal weakness causes if,
• Antidepressant medications are sedatives and are habit-forming
• Newer episodes of depression cannot be prevented in any way

All these beliefs do not carry any truth at all. Immediate professional help must be sought from a doctor in case of suspected illness.

What is the risk of other family members being affected? Is depressive disorder inherited?

It has been found that the chances of having depressive disorder are somewhat higher if one has a biological relative with a mood disorder. Some studies suggest a three-fold increase in the rate of depressive disorder in family members of such individuals; however, multiple factors have been implicated in the causation of the illness.

What causes depressive disorder?

The causation of depressive disorder is multifactorial. Changes in the chemical transmitters in the brain, heredity and various environmental factors have been held responsible. Neurochemical abnormalities make people with depressive disorder more vulnerable to emotional and physical stresses. This theory of an inborn vulnerability interacting with an environmental trigger is similar to theories proposed for various other medical conditions. For example, a physical exertion when superimposed on inherent high cholesterol may precipitate a heart attack. It is important to remember that treatment for all such medical conditions, including depressive disorder, focuses on counselling, taking the right medication and making life style modifications to control the illness.

What are the symptoms?
The symptoms and signs of Depressive disorder include:

• Persistent sadness
• Loss of interest in activities of that were previously pleasurable
• Difficulty in concentrating or remembering
• Sleep disturbances (insomnia, early morning awakening or access sleep)
• Symptoms suggestive of associated anxiety including tingling, numbness, palpitations, sweating etc.
• Appetite and weight changes (loss or gain)
• Feelings of guilt, hopelessness or pessimism, helplessness, worthlessness
• Thoughts of death or suicide

Anyone experiencing a few or all of these symptoms for at least 2 weeks may have depressive illness and should seek the advice of a doctor.

Is it necessary to treat depressive disorder?

It is of utmost importance to recognize and diagnose depression as early as possible and to initiate proper treatment. At early diagnosis and proper treatment has been found to decrease the frequency of future recurrences and hospitalization. With early treatment, the possibility of excellent recovery is high. It has been found that treatment delays are associated with a greater need for hospital treatment and a worse outcome. Further, the more acute episodes of depressive disorder a person has, the harder it is to treat each subsequent episode. Early recognition and intervention in an episode may not only save the patient months of pain and suffering but also may be life saving by preventing the attempts of those 15-20% patients with depressive disorder who commit suicide.2

What are the treatment options for depressive disorder?
The treatment options for depressive disorder include:

• Pharmacological treatment
• Counselling and psychosocial management
• Family education, support and intervention.
• Modified Electro-Convulsive Therapy.

Pharmacological Treatment:

Involves the use of medication for (a) managing an acute depressive episode and (b) preventing the development of new depressive episodes. Management of acute depressive episodes involves the use of antidepressant including SSRIs, Tricyclic Antidepressants or MAO inhibitors. Most guidelines suggest continuing antidepressants for at least 6-9 months after recovery from the first episode and for at least 18-24 months after recovery from an episode in recurrent depressive disorder. A mood stabilizer may be started by a psychiatrist for prevention of recurrent episodes of depression.3

Counselling and Psychosocial Management:

Psychotherapy plays an important role in reducing the stresses that can trigger new depressive episodes. It may be focused on an individual, a group or a family.

Behavioral therapy focuses on maladaptive behaviour that increases or decreases stress and how to modify such behaviour for helping the patient. Cognitive therapy identifies and changes pessimistic thoughts and maladaptive assumptions.

Interpersonal therapy focuses on reducing the strain that a depressive disorder may place on relationships.

Family Education:

The role of the family in helping patients is of utmost importance. The family members play a crucial role by supporting the patient in emotional, psychological and financial distress, encouraging compliance with medication, preventing complications and learning the individual warning signs of recurrence to help diagnose the new episode early.