All Is Not Lost

Snap out of it,  say friends and relatives if you are feeling down or  having the blues. However, the person soon starts to feel better, with or without such ineffectual advice, as negative thoughts and feelings usually last for about two weeks.
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Several bouts of depression may occur during the course of a lifetime. These may be precipitated by chronic illness, the loss of a loved one, financial difficulties or failures. If the precipitating situation changes for the better, recovery is faster.

Depression becomes a disease when it lasts longer than two weeks. It may occur as repeated attacks with short symptom-free intervals, or it may be present constantly. Sometimes a precipitating factor may not exist. It is a difficult diagnosis for the person and his or her relatives to accept as there are no outward physical signs of illness. There is only an all-pervading sense of gloom and inability to get things done. Everything becomes too much of an effort. The person may also become increasingly isolated as he or she fails to keep social obligations or maintain relationships. Constant talk about death, pacing, agitation and withdrawal are danger signals. It means the depression is severe enough for the sufferer to even attempt suicide. Getting over it  is no longer an option and medical treatment is required.

The changes during a bout of depression are not due to a weak personality. The altered behaviour results from an imbalance in the ratios of three chemical messengers in the brain: serotonin, adrenaline and dopamine. This may be genetic, with the condition running in families. Or it may be a response to a life event, precipitated by medication or hormonal changes.

Women become depressed four times more often than men. This is because the female hormone, estrogen, affects the brain chemicals. Menarche, menstruation, pregnancy and menopause produce sudden marked alterations in a woman’s hormone levels. Sometimes  post delivery” blues may be severe enough to incapacitate the mother and even drive her to suicide.

People of all age groups and communities are prone to depression. Children react differently in such a situation than do adults. They perform poorly in class or may refuse to go school. They may develop vague abdominal symptoms and vomit. Adolescents, who generally have confused and uncontrolled emotions, may respond to an underlying depression with unreasonable anger or substance abuse.

Monsoon days are dull and grey with little or no sunlight. The darkness and enforced physical inactivity may aggravate an underlying depression.

National public health does not consider depression a priority as it is a nebulous condition which is not contagious. But depression does seriously affect the national economy as many patients remain undiagnosed and untreated. Their productivity is affected as they are frequently absent from work, apparently uninterested, inefficient and have poor interpersonal relationships.

Sleep disturbances   excessive sleep or insomnia   may be the first sign of depression. There may be early wakening with an inability to fall asleep again. The weight may increase or decrease as the person experiences appetite swings, eating too much or too little. Alcohol or drugs may be used as an escape mechanism to elevate the mood. After the initial euphoria passes, there is a rebound and this worsens the condition. In older people, depression may manifest itself as vague physical symptoms, aches and pains which defy diagnosis, requiring repeated unsatisfactory visits to the doctor.

Depression may alternate with elation in people with a “bipolar disorder”. Such people may be withdrawn and non-functional or productive and creative depending on their mood swings. They either talk too much or not at all.

Once depression is diagnosed, it needs to be tackled. Taking sleeping tablets (sedatives) purchased without a prescription OTC (over the counter) to correct the sleep disturbances alone is not the answer. A combination of anti-depressant medication and psychotherapy probably works best. The medication corrects the imbalances in the chemicals in the brain. The drugs belong to various groups and subtypes. The response of each person varies; a drug that works for one may not work for another. The medications take around six weeks to start acting. Once the mood becomes stable, the person is able to function normally.

Children and young adults respond paradoxically to some anti-depressants. Drugs like paroxetine may increase the suicidal tendency in persons between 18 and 24 years of age. Treatment in adolescents and young adults thus has to be carefully monitored.

Patients need to be supported by family, friends and psychotherapy during treatment. Otherwise, they may prematurely discontinue the treatment thinking that the drug   does not work.  Also, once the symptoms have disappeared, treatment needs to be continued for 9 to 12 months for complete recovery. This, too, may not be followed as patients may not see the need to continue medication once they start feeling better.


Source: The Telegraph (Kolkata, India)

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