“I wish I had my hand chopped off so that people would know I am suffering”. This was how a patient described his depression. He was suffering but the suffering was not external, rather it was internal. People could not believe that he was ill. He dressed and walked like normal. They told him to pull himself out of it to be more positive or to do more exercise. They couldn’t understand that he was undergoing an illness.
Depression is a common illness. It is more common than hypertension or diabetes. The lifetime occurrence of depression in any country is between 8% to 10%. Contrary to common belief it is not an illness of developed countries alone. It occurs in developing countries like ours just as commonly as in other countries. The World Health Organization and the World Bank studied the disability that diseases bring and found that Depression is the fourth most disabling disease in the world. It is predicted that in 2020 it will rise to being the second most disabling disease. The World Health Organization also estimates that more people die from suicide than from Tuberculosis deaths in the Asia Pacific region. The most common cause for death by suicide is Depression.
There are numerous direct and indirect costs that are lost due to depression. These costs include costs due to inability to work, health utilization costs and cost to families who have to look after and support their family members suffering depression. Depression occurs more in women than in men in a ratio of 1:2. There are many postulates to this and some of them include that women may be more willing to discuss their emotional issues. Women have hormonal changes that may increase the risk of depression. Also men may self-medicate their depression with alcohol or drug use.
The central features of depression include a low mood or feeling sad and anhedonia. Anhedonia is the inability to derive pleasure from pleasurable activities. An example of this is when a person who enjoys gardening, just can’t find the mood to do anymore gardening. Other symptoms include a general feeling of tiredness, loss of appetite, sleep disturbance, inability to concentrate, a feeling of hopelessness, uselessness, and worthlessness, guilt feelings and suicidal thoughts.
Depression is different from normal sadness as a diagnosis can only be made if a patient has at least five of the symptoms described above and it has lasted continuously for at least two weeks. The symptoms are significant enough to cause social and occupational impairment as well. There are various medical conditions that can also cause or that may occur concurrently with depression and these need to be ruled out. Assessment often includes an interview with family members as well.
Depression is treatable. Close to 85% of people suffering from depression recover and go back to a level of functioning before the start of their illness. Treatment for depression is often multidimensional including antidepressants, counseling, cognitive behavior therapy, family therapy, psychotherapy and social therapy. Antidepressants are useful in treating mild, moderate and severe depression. Psychotherapy alone may be useful only for mild depression. Combination treatments however have the best results.
Treatment is divided into two distinct periods. Because of the complex way the treatment works, response to treatment only begins two to three weeks after starting it. Most patients feel significantly improved after four to six weeks. The second phase of treatment includes a continuation of the same treatment for a pre-determined period to prevent the depression from recurring. Treatment is available at all psychiatric clinics throughout the country. As it is now recognized as a public health issue, treatment is also available at all primary care centers as well as in general practice.
It is vital that people suffering from this disabling illness shed their fear and prejudice from seeking treatment that is effective and which is now widely available. Depression is not a personal weakness. It can strike anyone at anytime and has no preferences. People such as Prime Ministers and movie stars have and do suffer Depression. Families and communities have a responsibility to help their members to seek appropriate help. The earlier the onset of treatment the higher the chances of recovery.
Assoc. Prof. Dr. Philip George
M.B.B.S., MMed (Psych), Cert in Substance Abuse (U.Melb), AM (Mal)