Dr Abhishek Chowhan
Depression affects people of all ages, from all walks of life and in all countries. It is a devastating illness which causes mental agony and impacts functioning of an individual to carry out simple day to day social, personal, familial and occupational obligations. In severe cases depression can lead to suicide and is leading cause of mortality in the age group of 15 to 29 years. Depression is the most common psychiatric illness with prevalence between 10% to 20% in general population. What is alarming is that due to rapid urbanisation, modernisation, competitiveness and lifestyle changes, stress in day to day life is increasing, thus increasing the incidence of depression. According to recent estimates the number of people living with depression increased by over 18% between 2005 and 2015. Depression is also largest cause of disability worldwide. More than 80% of this disease burden is among people from low and middle income countries.
On 10th October 2016 i.e., world mental health day the World Health Organisation (WHO) launched a one-year campaign to spread awareness about this debilitating illness. Recognising the importance of the campaign, this year’s World Health Day has the theme of ‘Depression: Let’s Talk’. The world health day is celebrated each year on 7th of April to mark the foundation anniversary of WHO. The campaign ‘Depression: Let’s talk’ more specifically aims to achieve education of general public regarding the depression, its causes & consequences, including suicide, and to aware the public about the available treatment options. Additionally, it seeks to educate the support group of individual having depression i.e., friends, family and peers so that they can understand the illness and help the person effectively.
Depression is a syndrome which can have some of the many symptoms as presentation. A person with depression may have sad mood, loss of interest in almost all routine daily activities (e.g., work, social life, sex etc.), sleep disturbances, fatigue nearly every day, significant weight loss or weight gain, loss of confidence, worthlessness, guilt, irritability, appetite problems, difficulty in concentration or making decisions, non-specific pains & other bodily symptoms, digestion problems, headache, and in severe cases thoughts of death or suicide. Presence of at-least one-third of above symptoms may indicate that the person is having depression.Depression can affect how a person acts, feels and think, and yet many people don’t realise they are depressed until long. They may not discuss their symptoms with near ones for the fear they may not understand them or may judge them. There is no blood test for depression. Depression is a problem of neurotransmitters in brain which are immune to the currently available biochemical testing. Some test which are available are more of research purpose rather than having any diagnostic significance. Thus monitoring of symptoms by self or by near and dears is very important for an early diagnosis of depression.
Depression once diagnosed is treated by a psychiatrist or in milder cases by a psychologist (especially when medications are not required). What plan of treatment, whether medical or psychological, is decided based on the presenting symptoms, severity of illness, any biological disturbances like sleep or appetite, family history of depression and necessity of a quick relief like in suicidal tendencies. It is important to recognise that depression is like any other medical illness like diabetes and hypertension and hence symptoms will not go away of its own. When depression begins to interfere with everyday functioning it is a good indicator that treatment is required. The goal of treatment is to help an individual reclaim a sense of control and rediscover pleasure and fulfillment in daily activities.
Having said this the role of immediate family members, friends and near ones cannot be undermined in the treatment of an individual with depression. Family and friends are often the first line of defense in the fight against depression. That’s why it’s important to understand the signs and symptoms of depression. You may notice the problem in a depressed loved one before he or she does, and your influence and concern can motivate that person to seek help. Sometimes it is hard to know what to say when speaking to a loved one about depression. You might fear that if you bring up your worries he or she will get angry, feel insulted, or ignore your concerns. You may be unsure what questions to ask or how to be supportive.If you don’t know where to start, the following suggestions may help. Remember that being a compassionate listener is much more important than giving advice. You don’t have to try to “fix” the person; you just have to be a good listener. Often, the simple act of talking to someone face to face can be an enormous help to someone suffering from depression. Encourage the depressed person to talk about his or her feelings, and be willing to listen without judgment.Don’t expect a single conversation to be the end of it. Depressed people tend to withdraw from others and isolate themselves. You may need to express your concern and willingness to listen over and over again. Be gentle, yet persistent. Avoid saying, “it’s all in your head”, “we all go through times like this”, “this will pass”, “what’s wrong with you”; instead say, “you are not alone in this, I am here for you”, “you and your life is important for me”, “tell me what can I do to help you”. One of the most important things you can do to help a friend or relative with depression is to give your unconditional love and support throughout the treatment process. This involves being compassionate and patient, which is not always easy when dealing with the negativity, hostility, and moodiness that go hand in hand with depression.
It may be hard to believe that the person you know and love would ever consider something as drastic as suicide, but a depressed person may not see any other way out. Depression clouds judgment and distorts thinking, causing a normally rational person to believe that death is the only way to end the pain he or she is feeling. When someone is depressed, suicide is a very real danger. It’s important to know the warning signs. These include talking about suicide, dying, or harming oneself, expressing feelings of hopelessness or self-hate, acting in dangerous or self-destructive ways, getting affairs in order and saying goodbye, seeking out pills, weapons, or other lethal objects, sudden sense of calm after a depression etc. If you think a friend or family member might be considering suicide, talk to him or her about your concerns as soon as possible. Many people feel uncomfortable bringing up the topic but it is one of the best things you can do for someone who is thinking about suicide. Talking openly about suicidal thoughts and feelings can save a person’s life, so speak up if you’re concerned and seek professional help immediately!
(The author is a Consultant Psychiatrist Government Medical College, Jammu.)
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