Dr. A. Kabir
Introduction â€“ Depression is a major public health problem because it is frequently causes disability and distress for patients and their families and results in severe socio-economic losses.
It has been estimated that there are at least 100 million people suffering from some form of clinically recognizable depressive disorder who could benefit from qualified help.
The lifetime rates of major depression are higher in females than males and this trend is consistent in all of the countries across diverse cultures.
It has been shown that socio-economic losses which are either directly as for example in terms of â€œproductive days lostâ€ or indirectly as for example, in terms of â€œfamily disruptionâ€.
Symptoms by which the treating physician attains at a tentative diagnosis (of depression) are as follows :
A)Â Â Â Depressed â€“ Mood for most of the day for at least 02 (two) years (as indicated either by the patient him/herself or observed by others)
B)Â Â Â Presence of two (or more) of the following (while the patient is in depressed condition)
Â·Â Â Â Poor appetite (anorexia) or over-eating
Â·Â Â Â Lack of sleep (insomnia) or too much sleep (hypersomia)
Â·Â Â Â Low energy level or fatigue.
Â·Â Â Â Low self-esteem
Â·Â Â Â Poor concentration or difficulty in making decision
Â·Â Â Â Feeling of hopelessness/helplessness
Â·Â Â Â Occasional suicidal tendency
The association of depressive symptomatology with certain physical condition or with drug intake should be kept in mind. It is known that several months after heart disease (myocardial infraction), no less than one third of patients report dipression. Malnutrition, viral infection, some neurological disorders are associated with depression. Barbiturates and several anti-hypertensive agents (which reduces or helps lowering high blood-pressure) are frequently found as factors in developing depression.
Similarly, in the elderly it is sometimes difficult to determine whether apathy, memory loss and difficulty in concentration are early signs dementia (forgetfulness) or a part of depression.
In evaluating depression in the medically ill, it may therefore be useful to emphasize the cognitive symptoms (such as feelings of worthlessness, hopelessness and helplessness) rather than physical symptoms that could have been caused by physical illness.
AIDS is a typical present day situation where such dual assessment and management is required. Depression, anxiety and personal disorder symptoms are often associated during the early stage of AIDS, calling for treatment with â€œsedative antidepressantsâ€. In contrast, during the terminal stage of AIDS more â€œstimulant anti depressantsâ€ are required to treat the depression.
Conclusion : Depression is already frequent enough and its consequences are such that it constitute a Major Public Health Problem. Unfortunately there is every likelihood that the frequency of depressive disorder will increase in the years to come.
Life expectancy is increasing in most countries and the number and the percentage of people running a higher risk of developing depression are also increasing accordingly. The rapidly changing psycho-social environment of human being such as educational/professional stress, family disintegration and social isolation often give rise to situation of acute/prolonged environmental stress which may lead to depressive reactions.
Relational or social problems that may have contributed to the illness (depressive disorder) or are consequences of it, are often of much concern and should be dealt with in supportive â€œPSYCHO-THERAPYâ€. The therapist needs a good understanding/training and skilful supervision which are essential to maintain a high quality of care.
Depression in patients with concomitant physical illness is often left untreated because it is unrecognized or because of fear of drug interactions/ineffectiveness. However, the wide range of anti depressants available today makes it possible in most cases, to find a medication that will effectively address the patients depression. The anti depressant treatment should be carefully monitored for its potential side effects which should be balanced accordingly.
Many medically ill people report depressed mood. Differenting a â€œtrue depressive syndromeâ€ from the â€œexpected mood changeâ€ is problematic.
Depressive disorder is a problem faced by both the developing as well as developed countries the rich and the poor, young and old, male and female.
Psychiatrists, other mental health & general health-workers, the patients and their families can all do much to diminish problems related to depressive disorders. The time to act is TO DAY & RIGHT NOW.
(The Author is a Medical Officer at NEIGHRIMS)
Ref. :- Sartorius N â€“ Depressive disorders in different cultures. 1983. World Health Organisation, Geneva
Dr. A. Kabir