DOCTOR’S CORNER
TRANSIENT feelings of sadness and disappointment are a part of normal life.
When these feelings are prolonged and “overly intense and continue beyond the expected impact of a life stressor or arise in the absence of a stressor”, we say that the person has a depressive disorder.
In medicine, the term depression has at least three different meanings.
The term depression may be used to refer to a mood, a feeling, an emotion, an affective state; a symptom of a depressive disorder or the depressive disorder itself.
Typically, a person suffering from a depressive disorder has a depressed mood to a degree that is definitely abnormal for the individual, most of the day and almost every day, largely uninfluenced by circumstances, for at least two weeks.
There is loss of interest in activities that are normally pleasurable and decreased energy or increased fatiguability. This state may be accompanied by preoccupation with guilt, self-denigrating ideas, decreased ability to concentrate, indecisiveness, diminished interest in usual activities, social withdrawal, helplessness, hopelessness, and recurrent thoughts of death and suicide.
Sleep disorders are also common.
In some, the depression is so deep that tears dry up; the patient complains of an inability to experience usual emotions — including grief, joy, and pleasure — and of a feeling that the world has become colourless and lifeless.
For such patients, being able to cry again is usually a sign of improvement.
Other symptoms may include: loss of confidence and self-esteem, unreasonable feelings of self-reproach .
There may be change in apetite with corresponding weight change.
There is a condition called “somatisation”, where “the problem in the head” starts to show itself physically and the patient goes to see the doctor complaining of all sorts of physical problems such as pain, weakness etc.
In other words “stress” can manifest itself through physical problems.
The doctor may examine the patient and do investigations and find nothing.
If that happens psychiatric or psychological problems will have to be investigated.
Knowing about depressive disorders is important because of the consequences.
Depression is a huge cause of substance abuse.
Dependence on drugs is often due to depression as we discussed earlier in our article on alcohol abuse.
Over 20 percent of depressed patients are alcohol dependent and 25 — 50 percent attempt suicide.
The first 10 years of the illness bears the highest risk.
Twenty percent of these people commit suicide if no or inadequate treatment is given.
There is poor vocational outcome and six months after the depressive episode only 43 percent remain employed, while only 21 percent will still be working at the previous level of employment.
Depressed people often run into financial problems aggravating their situations even more.
Many different causes of depression have been found. Most of you will probably come up with a longer and more detailed list of possible stressors.
We will look at some of the commonly known causes in medical practice.
Stress itself tops the list. It may be due to many of the things you have listed on your list including separation, loss of loved ones, financial problems etc.
Anger turned inward, negative thoughts about self, negative thoughts about experiences and the world, negative thoughts about one’s future are common causes of depression.
One group that is at risk of developing depressive disorders are those people who suffer from a condition referred to as “personalisation” i.e. those that assume responsibility for someone else’s feelings or behaviours and patients with “arbitrary inference” — people who jump to conclusion with little or no evidence.
Internal factors such as personal inadequacies and focusing on personal flaws and or fixed personality factors are also important causes of depression.
Other views of the causes of depression have focused primarily on the role of genetic factors and biochemical abnormalities.
Monozygotic twins are twins that have developed from a single egg that has split into two.
A review of early twin studies, suggested that if one of the monozygotic twins has a depressive disorder, then there are 76 percent chances of the other twin developing the same disorder as compared to 67 percent for monozygotic twins reared apart and 19 percent chances in dizygotic twins.
This suggests a strong genetic predisposition.
More recent studies have provided similar findings.
Research has also suggested that children with a depressed parent are approximately three times more likely to develop a major depressive disorder than are children with non-depressed parents.
However, environmental factors like the ones we have mentioned can’t be ruled out.
Studies have revealed bio-chemical abnormalities in the brains of those patients with depressive disorder especially with chemicals that are required to transmit chemical information in the brain.
In fact a deficiency of these chemicals was found, which is why the drugs that are given in depression have their own mechanism in replenishing or balancing these chemicals.
Added to genetic and biochemical factors, there are also social risk factors for the development of depressive disorder, which include: being divorced or separated, being widowed, having someone in the family with the condition, major adverse life events, substance abuse, physical illness, social isolation, having poor intimate relationships, loss of a mother before age 11, change in social support systems and long term treatment with certain medicaments such as hormonal therapy like steroids or contraceptives.
