In a depression dilemma

In a depression dilemma

Divya, a 31-year-old, came to the clinic one afternoon. She gave a slightly embarrassed smile and said, “I am not sure who I should talk to, or where to start, and if this is the right place to come?” She went on to say that she was feeling very low and sad all the time. She was not having fun at work. And coming home and taking care of the family felt like a huge burden. Due to lack of sleep, she was finding it very hard to concentrate at work as well.

Further, she started to cry and said, “I used to enjoy spending time with my kids and family, but now, due to my present condition, I am unable to do that. I just don’t want to be around anyone, and want to be left alone.”

According to the World Health Organization, depression is the leading cause of disability and ill-health across the world. More than 300 million people are suffering from depression, out of which women are known to be the major sufferers. Very few people recognise that they are suffering from depression and fewer seek help for the same.

What is depression?
People with depression usually experience low mood or sadness, or a feeling of being ‘down in the dumps’ for most days of the week. One may experience difficulty with sleep. Feelings of guilt, poor concentration, irritability, and in some cases, hopelessness and worthlessness are some of the symptoms that people might experience. In cases of severe depression, one can have suicidal thoughts.

Most people who attempt suicide are ambivalent about dying, but due to deep depression, can’t find a way out of their problems. Suicidal thoughts or attempts are not signs of weakness, but a cry for help which has to be identified at the right time.

Depression can be an independent illness ranging from mild to moderate to severe. Mild forms of depression can be diagnosed when one is having trouble with concentration, is unable to feel motivated at work or at home, and has feelings of sadness. On the other hand, in severe depression, one can have constant thoughts of hopelessness, worthlessness and/or thoughts of suicide.

Depression can also be a part of an illness called bipolar disorder, where a person’s mood fluctuates from being ‘high’ or ‘elated’, with a decreased need for sleep.

The causes & cure

Depression can be biological and can run in the family. Significant stress in the environment such as excessive pressure at work, unstable home environment (for example, violence or abuse, use of alcohol and drugs by the individual with depression or persons at home, leading to strife in relationships) can all be contributing factors for the onset of depression. Sometimes, the onset of depression does not have a specific cause.

Depression does have treatment and most people can be cured. Only if the depression is long-standing and is severe, one might need long-term treatments. There are various types of treatments for depression such as:

n Therapy: If the depression is mild to moderate, evidence-based therapy forms such as cognitive behaviour therapy (CBT) can treat the condition.

n Medication: In cases of moderate to severe depression, SSRIs (selective serotonin reuptake inhibitors) are the most commonly used medications. Less commonly used medications are TCAs (tricyclic antidepressants). There are several other options and alternatives to the above medications which can be discussed with a psychiatrist. These medications are not addictive and can be tapered off at a later stage when an individual feels well, and on discussion with the treating psychiatrist.

Ideally, a combination of therapy and medication has the best outcome. Lifestyle modifications such as cutting out alcohol, cigarettes, and other drugs, regular eating and work habits and exercise, go a long way in the treatment and cure of depression.

(The author is a consultant — Department of Psychiatry, Sakra World Hospital)

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