Dr Manu Arora
World Mental Health Day observed on the 10th of October every year, provides a unified effort globally to promote greater public awareness and understanding of mental health and mental illness. This year ‘World Federation for Mental Health’ observes mental health day with the cause to make people more aware of ‘Depression: a global crisis’.
World Health Organization (WHO) estimates that depressive disorders ranked as third leading cause of the global burden of disease in 2004 and will move into the first place by 2030. Another alarming fact about depression is that it carries high risk of suicide. WHO reports a status of about 1 million suicides every year. The first national study of deaths in India, published in the British Medical Journal, The Lancet, reports that suicide has become the second-leading cause of death among the youth in India. Unawareness often tends people to ignore the illness and which is a major reason that depression go unreported and untreated.
Depression can affect anyone, young or old. At the outset it is important to know the basic difference between sadness and depression. Everyone has ups and downs in life. Sadness is a part of human life, a natural reaction to painful circumstances. But if a person frequently pass through a down state of mind without any specific reason lingering for weeks, months or sometimes years and seriously disturbs the daily activities of the person with loss of appetite, sleep, low interest in work and negative thinking, then depression may be the likely diagnosis. Depression can be triggered by any major life event as well, such as the death of a loved one, separation from loved ones, divorce, or a health problem. It can also be caused by an underlying medical disorder, interactions between various drugs or may co-exist with other illnesses. Level of depression may vary from mild to severe. Many depressed people describe their condition as “living in a fog.” Regular drinking of alcohol, even in moderate amounts, can cause or worsen depression as well. An estimated 80 percent of depressed individuals can be treated, with most feeling better within weeks.
Women experience depression about twice as often as men. Many hormonal factors may contribute to the increased rate of depression in women-particularly such factors as menstrual cycle changes, pregnancy, miscarriage, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, caring for children and for aging parents. Many women are also particularly at risk of depression after the birth of a baby (clinically known as postpartum depression), transient low feeling “blues” are common in new mothers. The hormonal and physical changes, as well as the added responsibility of a new life, become factor for depression in some women.
Although men are less likely to suffer from depression than women, it is also sometimes true that men are less likely to admit depression, and less willing to treat it. However the rate of suicide in men is four times than that of women, although more women attempt it. Depression affect the physical health in men differently from women. Studies shows that depression is associated with an increased risk of coronary heart disease in both men and women, but men suffer a higher death rate.
Men’s depression is often covered up by alcohol or drugs, or by the socially acceptable ways like working excessively long hours at office, etc. They usually express symptom by showing irritability and anger, rather than expressing feeling of hopelessness and helplessness, hence, depression may be difficult to recognize as such in men.
Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, and feel misunderstood. Oftener teachers may fail to identify it. Sometimes the parents become worried about how the child’s behavior has changed. The presentation of symptoms of depression is very different in children than adults and requires a keen clinical intervention. Teenage depression is also a common occurrence. It is a serious problem that impacts every aspect of a teen’s life. Teen depression can lead to problems at home and school, drug abuse, even violence or suicide. Teenagers face a host of pressures, from the changes of puberty to questions about their self image, identity and where they fit in among others. The natural transition from child to adult can also bring parental conflict as teens start to assert their independence. It is not always easy to differentiate between depression and normal teenage moodiness. Making things even more complicated, teens with depression do not necessarily appear sad, nor do they always withdraw from others. For some depressed teens, symptoms of irritability, aggression, and rage are more prominent.
Depression in the elderly is also an area that goes undiagnosed and untreated. When an elderly person visit clinician, the symptoms described are usually physical, and many times they are reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or share grief after a loss. At times they even feel their low mood may be side effects of medication they are taking for a physical problem. If a diagnosis of depression is made, treatment with medication and/or psychotherapy will help the depressed person return to a happier, more fulfilling life.
There is a range of different treatments available for depression, including counselling and medications. The right treatment depends on the individual needs and the situation in which they belong to. It is important to stay on until the right treatment is found. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance can also be helping to understand and accept depression and return to a happier, more fulfilling life.
Things to remember
* Recognize depression timely.
* Stresses that sound small to others may be very important to the person at risk and be taken seriously.
* If a person you know won’t go for help himself or herself due to unwillingness or ignorance, go by yourself first to get advice on how to best handle the situation.
(The author is consultants Psychiatrist, Govt Medical College, Jammu)
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