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Mental Health

Let’s Get Real About Depression

A 21-year-old university student comes to see me in my clinic. She looks anxious and tired. Her family says she has not been sleeping well, cries all the time, hardly eats and recently has been talking about suicide. She has recently stopped going to university because, ‘what’s the point?’. Two years ago she suffered from similar symptoms when first admitted to university which resolved after medication treatment. She remained well until about two months ago.

What is depression?

Unlike everyday sadness or a momentary low mood, the illness of depression or more appropriately ‘Major Depressive Disorder’, sometimes referred to in lay terms as ‘Clinical Depression’ is a serious medical illness characterized by a variety of physical symptoms such as aches and pains, stomach problems, palpitations, breathing difficulties and many other physical symptoms. In addition to the physical distress, the person suffering from depressive illness also experiences profound disturbances of sleep and appetite, a persistently low mood, frequent crying spells and often, thoughts of ending their life. These are accompanied by ‘psychological symptoms’ such as feelings of despair, hopelessness about the future and a general pessimism about life and the world.

What depression is not?

Depression is not a ‘lack of willpower’, a ‘character flaw’, a result of ‘black magic’ or other occult effects or the willful ‘fault’ of the person suffering from it.

Telling a person with depressive illness to ‘use your willpower to recover’ or ‘pull yourself out of it’ is about the same as telling a patient with a heart attack to get up out of bed and run a marathon.

How is depressive illness diagnosed?

Even though depression is a medical illness with many bodily symptoms, the biochemical abnormalities in depression are at a molecular level and cannot be detected by ordinary blood tests or other medical investigations (X-rays, CT/MRI scans etc).

Therefore, doctors have to rely on a person’s description of their symptoms plus the effect that the illness has on their life and day to day activities. If the symptoms are severe and a person is significantly hampered in their daily routine (not being able to work, go to school or college or not being able to perform daily household duties), depression can be reliably diagnosed.

Is there any treatment for depression?

Yes! Just like any medical illness, depression can be effectively treated and complete recovery from depression is not only possible, it is very likely if the person receives effective treatment from a qualified doctor such as a psychiatrist. Treatment of depression usually consists of a combination of medication plus ‘talk therapy’ (sometimes referred to as ‘Counseling’ but more appropriately ‘psychotherapy’). The choice of treatment depends on the duration and severity of the symptoms. If the symptoms are mild, a psychiatrist may prescribe only ‘talk therapy’ (usually with a psychologist) and no medications. Psychotherapy may be individual but can also involve couples or families. In case of more severe symptoms, medications are usually prescribed in combination with psychotherapy. Since depression is usually a chronic illness which persists over a long period of time, treatment also needs to continue for at least 6-8 months (sometimes longer) after which a person can usually be tapered off medicines and lead a normal life.

Just like with any other illness, if a person develops depression, it becomes slightly more likely that they can develop depression again at some point in the future, even after complete recovery. Appropriate precautions and a healthy lifestyle can minimize the chances of relapse.

Can depression be prevented?

Yes. Many lifestyle interventions can help minimize the chances of a person suffering from depression. A healthy lifestyle with a balanced diet, regular exercise, adequate amounts of sleep daily, avoidance of excessive amount of alcohol and complete avoidance of illegal drugs are some steps that everyone can take to avoid depression.

In addition, maintaining your physical health is important. Regular physical examinations (once a year) to rule out medical illnesses (especially for those over 50), treating chronic medical illnesses like diabetes and hypertension effectively, and taking all prescribed medications is important. Controlling your levels of stress by managing your relationships (at home and at work), making time for pleasurable activities, avoiding negative people and events and, if appropriate, making time for spiritual reflection (including prayers etc) can also help. A psychologist can help in identifying and managing negative triggers and stress in your life even if you do not have depression.

The writer is a psychiatrist practicing in Lahore. He taught and practiced Psychiatry in the United States for 16 years. He tweets @Ali_Madeeh


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