What is depression?
Clinical depression is a medical condition where a person feels
very low or sad over a long period of time. It is more severe than
the general feeling of hopelessness that a person may feel after a
particularly stressful event in her life and often results in a
change in the person's functioning. During bouts of depression, a
person feels extremely dejected and has feelings of inadequacy or
low self esteem. They take a gloomy outlook upon life.
How is it caused?
It is now believed that depression is caused by a combination of
genetic factors and exposure to a stressful life event. In other
words, the chance of a person having the condition increases
considerably if one or more family members has it. It is also
fairly well established that a change in the activity of certain
chemicals in the brain is associated with depression. Clinical
depression is seen more in women than in men. Women in their child
bearing years are more vulnerable to it.
There are many causes for clinical depression:
* It can be inherited i.e., the chance of a person having the
condition increases considerably if one or more family members
have it.
* Environmental factors like the death of a parent can cause a
depressive episode.
* Physical illnesses like cancer and heart disease may be followed
by depression. There may also be conditions like Parkinson’s
disease, whose symptoms include depression.
* Depression can also be a side effect of certain drugs used to
treat hypertension.
* Some people have personality traits that make them more
susceptible to depression. These people view themselves as losers
and have a negative attitude towards themselves.
What are the symptoms?
A patient with depression may have physical symptoms in addition
to psychological ones. The most commonly seen symptoms are:
* Sleep disturbance, either excessive sleep or insomnia (lack of
sleep)
* Continuous fatigue and tiredness
* Headache
* Feeling of irritability and excessive crying
* Loss of appetite
* Loss of interest in any activity
* Vague pains in the body
* Fluctuation in weight
* Constipation
* Decrease in sexual urge
* Poor concentration
* Poor co-ordination of limbs
* Feelings of worthlessness, helplessness and guilt
* Suicidal thoughts sometimes culminating in suicide attempts.
How is it diagnosed?
The first thing that any doctor will do is take a detailed and
thorough history and rule out the possibility of a physical
illness giving rise to these complaints. This may include blood
tests to detect anaemia or thyroid problems. Once physical illness
is ruled out a psychiatrist can make the diagnosis based on the
cluster of symptoms commonly associated with the depressive
condition. The doctor confirms over a two week period that the
episode is not due to a temporary stressful event. Once all other
causes are eliminated, the diagnosis is confirmed.
Initially a person seeks medical help when she is depressed for
most of the time during the day. The psychiatrist then diagnoses
the condition based on the symptoms associated with the depressive
condition. In case the doctor sees the main symptoms of the
condition like sleeplessness, apathy, lack of interest and loss of
appetite and a constant feeling of fatigue, depression is short
listed as a possible cause.
What is the treatment? Drug treatment is the most common method of treatment.
Antidepressants are prescribed in adequate doses. These generally
include oral medication from a group of drugs known as tricyclic
antidepressants. These have a calming effect on the patient and
also help in reducing sleep problems.
Therapy to improve the patient’s outlook towards events is begun
in conjunction with the drug treatment. The person is encouraged
to think positively and to shun thoughts of worthlessness, guilt
and suicide.
In severe cases, shock treatment (Electro Convulsive therapy) is
given. It is mostly resorted to when the patient cannot wait for
the drugs to become effective or when she goes into deeper
depression and stops reacting completely to situations, a
condition known as depressive stupor. A combination of treatment
measures is usually helpful in bringing depressive episodes under
control.
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