Depression Clinic

Depressive disease is a medical disease that affects feelings, thoughts, behaviour, physical health, interpersonal relationship, job performance, sex life and other behaviour patterns of the affected person day after day. Depressive disease is not just “feeling of hopelessness”. It is more than being sad or feeling grieved about a loss.

Depressive disease is universal and has been prevalent in the society since time immemorial. Its clinical features were described in ancient Indian literature by Sudarka, a renowned playwright of the 2nd century B.C. Depressive disease is prevalent in people of every country and every culture, affecting both the sexes and sparing neither the rich nor the poor. It torments all ages, forcing the exit of some through self destruction (suicide) and steadfastly maintaining its core clinical features down the centuries.

The term “Depression” is so commonly used in everyday parlance that it fails to convince the people around that “Depression” could be a disease in itself. The depth and the intensity of Depressive disease is usually not recognised and not appreciated by the family members of the sufferer and the people around him. Depressive disease is in fact one of the most agonizing illnesses and its real intensity is experienced only by the sufferer.

Depressive feeling is a sad, hopeless feeling lasting for a short period, usually as a reaction to some frustrating or emotionally upsetting event. The feeling is overcome by person himself within a short period, mostly without the help of others. The feeling is turned to happiness by pleasing events. The routine work and the responsibilities are continued to be performed without difficulties. The symptoms and signs of Depressive disease are similar to those in adult cases. The children are more irritable, have less depressive moods, instead of weight loss, there is a failure to gain weight. The children have more physical symptoms like unexplained headaches, pain in abdomen, generalised body aches, fatigue and tiredness.

In Depressive disease, the sad, gloomy mood remains for a long period, the whole day, day after day. The mood is not Lifted by pleasant events. The work and or responsibilities suffer. In addition, one or more of the following areas are also affected: thoughts, behaviour, physical health, interpersonal relationship, job performance, social life, etc. Depressive disease requires proper medical treatment.

Death of a family member of the normal person will lead to depressive feelings. In the majority of such cases, the depressive feelings remain for 2-3 days. The person resumes responsibilities and routine work within a week. But if the reaction of the person remains for 3 to 4 weeks or longer (crying, suicidal ideas, loss of appetite, sleeplessness, not going to work, pensive mood etc. then this is Depressive disease which requires medical treatment. This is not just so called normal reaction to death but is much more than normal reaction as in the case of “bereaved father”.

Depression results from an imbalance in the chemical messengers in the brain which the nerve cells use to communicate with each other. Depression is associated with low levels of two of teh chemical messengers, serotonin and noradrenalin.

For some people, low mood is a response to shortening day length. In seasonal affective disorder, depression starts in the autumn and continues until the spring. During summer the person is usually free of any depressive symptoms. This pattern of depressive episodes is associated with carbohydrate craving and weight gain rather than loss. SAD responds to light treatment although sometimes drug treatment with SSRI type of antidepressant is needed. Even depressed people who do not have pure SAD often feel worse during the winter months.

There is no single cause for Depressive disease. In fact, Depressive disease is a result of a combination of many factors. Depressive disease is bio-psycho-social disease and not just psychological as is wrongly believed.

Depressive disease can run in the family. The parents, siblings and children of a depressed person are at a higher risk of developing clinically diagnosable Depressive disease than those persons who do not have a depressed patient in their families.

Like any other medical illness, Depressive disease is a Bio-Psycho-Social disease. In typhoid fever and in jaundice, there are certain outside factors (bacteria or virus). The biological factor in that individual also plays a significant role. If individual has enough resistance, he will not succumb to the illness (typhoid or Jaundice). But if resistance is low, bacteria or virus will have upper hand
producing illness.

Common Depression Causes and Risk Factors

The nature and personality make-up of an individual and the attitudes he displays, predisposes or protects the person from Depressive disease. Some of the attitudes which make the person vulnerable to Depressive disease are:

Depressive disease is often triggered off by stressful events in life. The major precipitating social factors for Depressive diseases are :

• Any loss i.e., loss by death of a close one, loss of prestige, failure in business or examination.
• Occurrence of negative emotionally stressful events and factors.
• Sudden death of family members or friend or serious illness of the self or family members to whom the patient is closely attached.
• Quarrel with important person.
• Children not coming up to expectations either in education or in occupation.
• Sometimes positive events, like promotion in job.

Suicide is a latin word ‘Sui’ means self and ‘cide’ means to kill. The term suicide is used to describe any deliberate act of self-harm which results in death. By contrast attempted suicide includes any deliberate act of self-harm which does not result in death.

Attempted suicide includes two categories of act (a) deliberate self-poisoning (or overdose) and (b) deliberate self-injury. Deliberate self-poisoning describes the intentional ingestion of more than the prescribed amount of medical substance or ingestion of substances never intended for human consumption (e.g. insecticides, pesticides, etc.) irrespective of the intended outcome of the act. Deliberate self-injury describes intentional, self-inflicted injury irrespective of the intended outcome.

Thought, intent, ideation and act of suicide are pathological and caused dysfunction to life leading to either death or survival with physical and mental disability. There is no one who has not experienced a thought of suicide but every one has strength of mind (will power) and brain mechanism to regulate subconscious impulses and live life in a regulated manner. Suicide is a result of gross disturbance of this regulatory and defense mechanism.

Suicide is a multi-faceted process. It involves a victim, a situation and stress. Combination of factors of biological vulnerability, stressful situation, potential precipitating factor, lack of support from family or poor social support lead to psychological despair leading to suicidal act. Some of the suicidal acts are cries for help. When factors are left untreated, suicidal attempt is likely to be repeated killing the individual.

Almost all people who commit or attempt suicide have psychiatric illness. Highly significant psychiatric factors in suicide include Depressive disorder, Schizophrenic disorder, substance abuse. 95 % of the persons who commit or attempt suicide have diagnosable and treatable mental disorder. Hence, suicide is preventable. Depressive disorder is diagnosed in 75 % cases and schizophrenic disorder in other 10% cases.

Most commonly, suicide seems to arise from a depressed person’s feeling that life is so unbearable that death is the only escape from severe emotional pain, financial loss, loss of self-esteem, terminal illness and other such factors. A suicidal person experiences hopelessness and helplessness; ambivalent conflicts between life and unending stress and no apparent possibilities for change or improvement (as in the above case). These feelings and attitudes are distress signals. The next step is intentional, self-inflicted death.