Prof N Heramani Singh
Background:
The World Health Day is a global health awareness day celebrated every year on 7th April, under the sponsorship of the World Health Organization (WHO). The World Health Day is held to mark WHO’s founding, and is seen as an opportunity by the organization to draw worldwide attention to a particular subject of major importance to global health each year on 7th April since 1950. World Health Day 2017, celebrated on 7th April aims to mobilize action on Depression. This condition affects peoples of all ages from all walks of life, in all countries. It impacts on people’s ability to carry out everyday tasks, with consequences for families, friends, and even communities, workplaces, and health care systems. At worst, Depression can lead to self-inflicted injury and suicide. A better understanding of depression which can be prevented and treated will help to reduce the stigma associated with the illness, and lead to more people seeking help. That is why WHO has timely chosen this year’s theme “Depression: Lets talk”. At this juncture, mentioned may be made that World Federation for Mental Health also had already observed World Mental Health Day, 10th October 2012 with the same important subject under the theme of “Depression: A Global Crisis: to bring awareness of depression and to promote mental health with the aim to reduce stigma to the person who is suffering. This world Health Day is probably the 3rd opportunity for promoting mental health in public in general and health professionals in particular. Themes related to mental health awareness and promotion came very rarely viz: theme of the world health day 1959 was “Mental illness and Mental Health in the world today” and in 2001 was “Mental Health: Stop exclusion, dare to care”
With this background, now, let’s talk and discuss about “Depression”
What is depression?
Transient depressed mood in reaction to negative life experiences is normal. Feeling sad is normal reaction to experiences that are stressful or upsetting. Most people, children as well as adults, feel low or “blue” occasionally. Whereas, “Depression” becomes an illness when the depressed mood is serious and prolonged (continuously not less than two weeks) and is accompanied by other symptoms and disturbances of functioning.
More precisely “Depression” is a common mental disorder that presents with depressed mood, loss of interest or pleasures, decreased energy, feeling guilt or low self-worth, disturbed sleep or appetite and poor concentration. Moreover, depression often comes with symptoms of anxiety these problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday responsibility.
At its worst, depression can lead to suicide: Almost 1 million lives are lost yearly due to suicide, which translates to 3000 suicide death every day in the world. In lower rate calculation WHO again says that for every 40 seconds one person commit suicide, 20 or more many attempts to end his or her life (WHO, 2012).
A Depressive episode depending on the number and severity of symptoms can be categorized as mild, moderate or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not to cease to function completely. During a severe depressive episode on the other hand, it is very unlikely that the sufferer will be able to continue with social work or domestic activities except to a very limited extent.
Bipolar affective disorder typically consists of both manic (elated mood) and depressive episodes separated by period of normal mood. Manic episode involve elevated mood and increased energy resulting in over activity, pressure of speech and decreased need of sleep and increased self esteem.
While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males. In fact, depression is the leading cause of disease burden for women in both high income and low and middle income countries. Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children. The risk factor could mean that maternal mental health in low income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next.
Epidemiological aspects:
Overall prevalence of depression is 17%, fourth as cause of disability worldwide and has projected that may rank second by 2020, more common in females, most common between the ages of 25 and 44 years, second leading cause of death among 15-29 years olds (WHO –update), 43% of sufferer fails to seek help for their symptoms, of these diagnosed two thirds are not prescribed proper and adequate medication and 15-20% of cases run a chronic course.
Common types of depression:
1. Major depression (already discussed);
2. Dysthymia: Symptoms similar to Major depression disorder but less severe and more chronic (continuously at least 2 years in adults & 1 year in case of children),
3. Bipolar Depression (already discussed);
4. Seasonal affective Disorder (SAD): Depression that results from changes in the season; begin in the fall or wake of winter, or when there is decreased in sunlight; depressed mood, increased craving for carbohydrates, rich food; excessive sleep & weight gain and common in Denmark, Norway and Sweden.
Causes of Depression:
Multiple theories: Abnormalities in serotonin, norepinephine and depamin levels in the brain; hormonal dysregulations, cortisol, thyroid hormones etc; genetical vulnerability and stressful life events and family interactions will also contribute to the development of depression.
Miscellaneous special presentations of depression:
(1) Childhood depression:
Children show more symptoms of anxiety (i.e. phobias, separation anxiety), physical vague complaints, hearing of non existing voices (hallucination), express irritability with temper tantrum and behavior problems.
Adolescents shows more sleep and appetite disturbances false beliefs (Delusion), suicidal ideation & acts, with inclination to substance abuse
(2) Post Partum Depression:
Moderate to severe depression after she has given birth may occur soon after delivery or upto a year late. Usually occurs within first 3 months after delivery may occur when the baby blues do not fade away.
(3) Old aged depression: Less verbalization of emotion or guilt; minimize or deny depressed mood (“masked depression); preoccupied with physical symptoms – 65% false belief that some organ or body part has gone something wrong; cognitive impairment (like forgetfulness /memory disturbances) can be marked; hopeless feelings appear to be persistent; depressive ideation, anxiety, psychomotor retardation, weight loss and associated disabilities; false belief and other features of out keeping from reality and associated medical conditions like diabetic, hypertension, heart disease and dementia.
(4) Depression with medical conditions: Diabetic with depression; heart disease with depression; cancer with depression; HIV with depression and Alzheimer disease wit depression.
(5) Disruptive Mood Dysregulation Disorder (New update):
Children with persistent irritability and frequent episodes of extreme behavior dyscontrol are added to the depressive disorders for the age children upto 12 years. They typically develop unipolar depressive disorder or anxiety disorder, rather than bipolar disorders, as they mature into adolescence and adulthood. They are recognized as Disruptive Mood Dysregulation Disorder.
(6) Premenstrual Dysphoric disorder:
It has been confirmed a specific and treatment responsive form of depression disorder that begins sometime following ovulation and remits within a few days of menses and has a marked impact on functioning.
(7) Substance & medical conditions with Depression:
A large number of substances of abuse, some prescribed medication and several medical conditions can be associated with depression like phenomena. This fact is recognized in the diagnosis of substance /medication-induced depressive disorder and depressive disorder due to another medical condition.
Common physical symptoms with/because of Depression:
Unexplained headache; weakness; weight loss or gain; back pain; joint pain; abdominal pain; constipation; indigestion or change in bowel habits
Complications:
Suicide; alcohols and other substance abuse; decreased treatment adherence to medical therapies; anxiety disorder; heart disease and other medical condition; work or school problems; family conflicts; interpersonal relationship and social isolation;
Management:
Depression is a mental disorder that is pervasive in the world and affects us all. Unlike many large scale international problems, a solution for depression is at hand. Efficient and cost effective treatments are available to improve the health and the lives of the millions of people around the world suffering from depression. On an individual, community, and national level, it is time to educate ourselves about depression and support those who are suffering from this mental disorder.
Good news: Depression can be prevented and treated effectively by psychotherapeutic medicines (antidepressants) and other psychological treatment methods like Cognitive Behavior Therapy (CBT).
Summary:
Like diabetics and heart disease major depression is a serious medical illness and it is quite common; depression has been associated with both chronic medical and psychiatric conditions; psychological, biological, environmental and genetic factors contribute to its development; depression is often under-diagnosed and undertreated; effective treatments are available and treatment guidelines recommend that antidepressant treatment be continued for a minimum of 4 to 9 months after remission.
Conclusive message:
Depression is a disabling medical mental disease. It can be prevented and treated cost effectively. Psychological and mental health first aid should be provided to an individual who attempts to commit suicide or in mental crisis or distress just like we give first aid to any medical conditions, trauma or injury. We should give psychological & mental health first aid to a patient who is trying to commit suicide by telling him that you are not alone in this world, we all are here for you. So you can not die.
Let us spread the good news that depression can be prevented and treated cost effectively.
(The writer is Professor & HOD, Psychiatry Department, RIMS, Imphal and also president of Indian Psychiatric Society Manipur State Branch)
Source: The Sangai Express
