Depression: Mental Disease / Illness

Introduction:

Sitting on boat stern the tired boatman sings out in full throat, "O my boatman mind! Take hold of thy oars, no more can I ply (Mon majhi tor boitha ne re ami ar baite parlamna)! At dead of night Asia Begum, mother of five, bewails from the corner of a slum, "Oh Allah! Get me off from this earth; I am just undone!" Man gets exhausted at the monotony of ongoing life; even so there crop up many strange problems when these problems tie down a person hands and feet, at that point the sailing of life becomes rough and tough. A man cannot free himself from those at his will. As a result unwanted depression descend's upon the his life. Twenty first century is the era of competition. Man becomes a victim of depression whenever the pan of deprivation gets heavier in the haggling between what was gained and what was deprived from. Depression is increasing day by day in the world. The more the complexity of life increases, the depression is increases, the more the social life style is becoming artificial. Restlessness in the society is escalating and depression is increasing. Human beings suffer from some form of depression soon after falling in accidents of cetain kinds. Within life, there exist lust, greed, pervertion and contrasts. And hence newer and newer problems get evolved. Man becomes depressed in his failure to surmount these problems. Depression may also result from the evils of economic indigence, social insecurity and political instability. To a depressive person this ongoing life seems to be ugly and devoid of joys and festivities.

Definition:

Depression is a type, of psychiatric disorder which is characterised by severe distrobatice of mood in the form of dysphoria along with a number of physical and psychological symptoms affecting personal, social and occupational life of an individual.

Etiology :

There have been many approaches to the etiology of depressive illness. Following are the factors responsible to the etiology of depressive illness.

Biological Factors

  1. Genetic causes
  2. Biochemical factors

Psychological Factors

  1. Psychological make-up
  2. Personality
  3. Psychodynamic factors

Social Factors

  1. Unhappy Family

    Due to frequent quarrel, misunderstanding among family members. Lack of warmth and trust among the members can have unwanted effects leading to depressive illness.

  2. Psychosocial Stressors

    The experience of various psychosocial stresses such as bereavement, loss of status and prestige, loss of loved persons, financial catastrophe, poverty, unemployment, injustice, insecurity, severe competitions, all may acts as nonspecific stresses for making manifest predisposition to depressive illness.

Physical Factors :

Depressive illness may develop after prolonged use of some drugs and after some physical illness, operation and accident.

  1. Drugs:

    Reserpine, methyldopa, oral contraceptives etc.

  2. Illnesses:

    Influenza, Degenerative diseases in the brain, cerebral arteriosclerosis etc.

  3. Operation:

    Hysterectomy, Amputation of the limbs.

  4. Accident:

    After head injury, physical trauma, R.T.A.(Road Traffic Accident) etc.

Symptoms (Features) :

Typically following features are the characteristics of depressive illness.

a) Psychological Features

  1. Depressed mood
  2. Psychomotor retardation
  3. Tearfulness
  4. Loss of confidence
  5. Ideas of guilt and worthlessness
  6. Hopelessness, helpless and pessimistic feelings
  7. Negative feeling regarding past, present and future
  8. Impaired concentration
  9. Poor memory
  10. Suicidal attempt

b) Biological Features

  1. Disturbed sleep
  2. Poor appetite
  3. Decreased body weight
  4. Decreased libido
  5. Amenorrhoea features
  6. Constipation

c) Somatic Features

  1. Headache
  2. Muscular pain
  3. Gastro-intestirrial symptoms
  4. Cardiovascular symptoms
  5. Respiratory symptoms


Neurochemistry of Depression

Persons suffer from depression due to fatiguness of some special cells. Each nerve cell is located a bit far from one another. The intervening area between two nerve cells is called synapse. To keep the nerve cells active, a type of electricity flows in between the nerve cells.

This electricity is produced from some special types of chemicals. These chemicals are called neurotransmitters of biogenic amines. These biogenic amines remain stored inside the nerve cells. During electrical flow these chemicals come out front nerve cells and take positions in cells adjacent to the nerve. These chemical substances create electrical pulses in the next nerve cell. The flow in between the nerve cells is very slow in patients who are depressive. The biogenic amines which keep the nervous system fresh are:

  1. Adrenaline
  2. Nor adrenaline
  3. Dopamine
  4. Serotonin

A person suffers from depression due to many reasons. Firsty, if the biogenic amines cannot work properly on coverings of nerve endings, then nervous system gradually turns fatigued. Secondly, if less amount of neurochemicals accumulate in synaptic junctions then neurochemicals fail to create electric pulse. Therefore it is evident that directly or indirectly less amount of neurotransmitters turn a person depressive.

A kind of chemical named B - Andorphin is responsible to keep the human nervous system afresh. Depressive patients have very little amount of this chemical in the body. Besides that, scarcity of some hormones as found in depressive patients body.

Identification and Statistics :

There is no statistics of identified depressive patients in our country. However, according to the World Health Organisation report some 3 per cent of the total population are depressive.

Types of Depression :

Depression can generally be classified into two forms.

  1. Endogenous Depression :

    The amount of neurotransmitters is normal in patients of this type of depression. But during electrical flow the chemicals can not properly flow cut of the cells. As a result nerve cells face obstacle to flow of electrical pulses.

  2. Psychogenic Depression :

    This type of depression results form excessive mental labour. The person who thinks a lot about a certain matter generally suffers from psycogenic depression. In psychogenic depressive patients, too less as amount of neurotransmitters is stored in nerve cells. This trace amount of neurotransmitters fail to keep the brain and nervous system refreshed.

  3. Organic Depression :

    The cause of this kind of depression is different. Persons are attacked by organic depression if there is scarcity of blood supply in geriatric patient or if there be any disease of the brain. Now-a-days the rate of psycogenic depressive patients is increasing alarmingly.

Suicide from Depression :

It has been seen that 20 per cent of depressive patients get suicidal tendency and among them 5 per cent try to commit suicide this way or that. During treatment of psychiatric patients it is important to identify the patients who have got chance to commit suicide. On many occasions it is not possible to identify them accurately. Yet the psysicians take into consideration some factors to identify the risk group. These factors are called presuicidal symptoms.

Prevention :

Our brain remains fresh and active due to supplementation of vitamins and amino acids in balanced diet. Sometimes the deficiency of only one vitamin may cause depression, so nutritional therapy, or keeping an eye on balanced diet, is one of the ways to remove depression. Human mood depends on neurotransmitters. Vitamins and proteinacious foods enhance the amount of neurotransmitters. Vitamin B complex is beneficial to the patients.

If depression is caused due to vitamin deficiency then it can be gotten rid of within a few days. This is why many physicians prescribe Vitamin B Complex for depressive patients. Alcohol or wine is one of the causes of depression. So if any alcoholic depressive person phases out the liquor then change take place in the mental condition. Autosuggestion or self criticism is another way of getting rid of depression. Attention towards innovation, and always seeking out positive always like to remain aloof. They like isolation and habituate in monosyllabic answer to multiple queries. So, friends and relations are the best medicine for the depressives. Hence, if you are depressive then engage yourself in plying and games against your ailing will. Go to clubs and meetings, loiter in parks with dear ones. It might seem boring at first, later the mind will again become animated with time. Always be cheerful and euphoric and you will never get depressed. Regular physical exercise helps remove depression without medication. Physical exercise leads to chemical changes in brain. B-Andorphin type neurotransmitters increase due to exercise, mood elevating hormones increase in the blood stream. As a result mind gets refreshed, and helplessness, nothingness vanish form the mind. Conjugal harmony is one of the remedial factors for depression. If the depressive member of a couple gets love and foundlings from the other than depression cannot find any room to stay. Lengthy separation between husband and wife many cause depression. "A sound mind lies in a sound body" goes the saying one of these cannot be chirpy while the other is kept deprived.

Treatment :

Medicine is not always the need for the cure of depression. The longer the medicine can be avoided, the better. Medicine for depression can be classified into few groups. Imipramine, Amitryptyline, Desipramine types are among these. The doses of these medicines is increased gradually. It is not safe to continue the medicines for a length of time. There are some side effects. In such cases treatment is given by administering lithium. The lithium dose can be adjusted after detremining the lithium level in blood. Antidepressive medicines keep the biogenic amines moving around nerve cells and keep the patients always fresh and euphoric.

Present day physicians have assigned to psychotherapy the topmost position for the treatment of depression. Now-a-days it is being said that cognitive psychotherapy is effective for depressive patients, but assertive psychotherapy is contraindicated.

Man has not the full control over the happiness, sorrow pain and delights of the world. So conflict between mind and environment is not something unusual. Social restlessness, curse of unemployment, deception in love affairs against all these the mind need be strengthened.

Those who seek happiness after accepting antipathy of life with a smile, get it. On the other hand those who can not accept the flip side of life and instead cry all the time for joy, they never get to catch the golden deer named happiness. Life appears to them like the pitch black darkness of the new moon. That is desirable to none of us. So, we should take steps to find the means of solving the depressive problem immediately.

Some role model, some personality, some lion hearted people and service rendering institutions are needed for solving the problems of an intricate life. Only then it will be easier to be free from the deprenssiveness that is growing day by day. Now-a-days a type of treatment known as EMDR (Eye Movement Desensitisation Reprocessing) is gaining way in western therapy.

Submitted By
Dr. Mustafa Abdur Rahim
The author is MBBS OCH(ICH) PGT.(Psych), HIV/AIDS trained (Thailand), Director, Samajik Shaysthya Kendra.

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