The focus of the World Health Organisation (WHO) for 2017 on World Health Day is Depression with a theme “Depression, Let’s Talk”. Depression is a common mental illness that affects 16 to 20 per cent of people in their lifetime. Approximately 300 million people suffer depression worldwide. Disability is measured to quantify the impact of an illness. It is found that depression is now the most disabling of all illnesses including all physical illnesses put together and hence has made WHO take steps and advise its members to create awareness. Depression can occur in any age group, affect people of any socio-economic status, urban or rural lifestyle, cultural or ethnic background.
Depression, known in ancient literature as melancholia, a word derived from Greek, may have affected people from King Henry VI of England to King Louis XVI of France to Abraham Lincoln. Designated as the consequence of a weak mind in some cultures, such attitudes hinder recovery and lead to further isolation from society, more stigma.
As with the body, the mind can be diseased or ill or strained. With physical illnesses, people talk of pain or swelling. But if the person feels low, is unable to function or is not sleeping well, he may not talk about it because of worry of not being acknowledged or taken seriously. He may even worry that others might say he is making up the ailment. But there is truly no health without mental health.
Depression in adolescents and consequently suicides are on the rise. Elderly persons with physical ailments, bereavement of close friends or relatives or even spouse leading to loneliness may suffer depression in silence. Unemployed unmarried or separated individuals in their early adult age and middle age, are victims. It is not uncommon for woman to suffer from repeated bouts of depression with irritability around monthly periods, termed Pre-Menstrual Dysphoria.
Woman during pregnancy and specifically in the first few months after childbirth can suffer intense feelings of sadness, tiredness and hopelessness which leads to severe depression that can be detrimental to their own self and their baby. Similarly feeling doomed can be part of the woman’s mental state around menopause.
A person has unintended or slowed down thoughts as an initial sign of reacting to stress. Thoughts in a depressed individual predominantly are of adverse assumptions of the future or one’s own surroundings, family and friends and about one’s own self. Anger may be related to ongoing frustrations from feelings of sadness. These adverse thoughts and emotions will then affect the individual’s activities and functioning.
The individual has a sense of being stuck in a closed tunnel, with no optimism of being able to get out of this situation. The person may feel life is not worth living; may get tired easily; feel he/she can’t carry on because everything is a burden, and lose interest in everything. A person who once enjoyed music or cricket does not get any joy from these anymore. The person may keep away from social gatherings, isolate oneself, see no future, feel no one can help, and sees oneself as the most miserable person on earth. There may even be feelings of guilt or a belief that the victim deserves to be punished.
Depression can affect body and brain functions, by affecting sleep and eating patterns, and causing changes in weight and concentration. One can see the change in the belief system, when this illness takes over the person. Suicides are on the rise, and nearly 150,000 people in India commit suicide every year. Most common cause for suicide is depression. Thus many suicides can be prevented by simply detecting depression. This can be done by creating awareness, and ensuring the person gets the right help. The illness is like a cloud or early morning mist, creating a sense of haziness in the thinking process. It is like driving in a fog; it slows the person down and forces him to be cautious.
Adverse experiences from the past or even from childhood would have helped evolve a personality. Some learn to shout, scream or argue and that leads to fights between family members. Or people develop habits of smoking and alcohol misuse while some develop depression or anxiety. Healthy distractions include yoga and meditation, spiritual work, playing sports, gym and exercise and doing charity work. One can make these as their hobby.
More than everything occupying oneself deeply in employment and enjoying it can itself help to develop the sense of tolerance to overcome effects of stress. A person not occupied by work is likely to have intrusive adverse thoughts which can be gateway to depression. Having no goals, aims or direction are sufficient to create a platform for depression to set in.
The person supporting such individuals can reiterate “The problem is the problem. You are not the problem!”; explain this is a simple illness called depression that can be dealt with and overcome, or if severe, be treated by a psychiatrist.
Nineteenth century biologist Charles Darwin says the species that can adapt to change are the ones that will survive. Nothing is permanent and everything is bound to change. The human being is expected to adapt or in simple terms make necessary adjustments to changing circumstances and situations. It is better to re-train the mind to focus on positive ideas.
Thoughts impact on an individual’s behaviour. Spiritual gurus preach about need for clarity and nurturing of thoughts. Generally they teach how important it is to remain aware of one’s own self, and examine them. There is a saying “what you think, you become”. Getting involved in spirituality, religious rituals, learning and practising yoga could be preventive. Learning any one technique of meditation, practising mindfulness, doing regular exercise and eating healthy all go a long way to maintain physical as well as mental wellbeing.
Individuals should ensure they strengthen their support system, and not keep isolating themselves by pushing their relatives or friends away. Employment is a must. In India, youth population is on the rise. Occupying oneself in meaningful activities can itself prevent depression and other mental illness.
Consulting a psychiatrist if your family doctor suggests this may help to clear your doubts about underlying causes of depression. In some cases, this simple consultation and support may be sufficient for treating milder forms of depression. Treatments such as Cognitive Behaviour Therapy and Supportive Psychotherapy can be very effective. In a few cases, a psychiatrist may need to prescribe an anti-depressant. Myths exist among general public that medications are dangerous or addictive. Like any medication, anti-depressants will have side effects; however most of them are mild and seen in early days.
Engaging depressed individuals in a dialogue is the most important thing. It is suggested that the person talk to a trusted friend or relative. It is alright to put your hand up and say, “I need help or support or I need to talk”. It is imperative to make someone aware, so you can be guided back quickly to your track. The World Health Day theme enhances awareness about this disabling illness. It is important to seek treatment, recover and thus promote overall health.
The writer is a consultant psychiatrist based at Bengaluru. He has worked in UK and India.