Feeling down or depressed once in awhile is normal for most people. However,
if these feelings become very intense and persist for a very long period of
time, and obstruct normal daily activities, clinical depression has set
in and must be treated.
Depression is not a temporary setback in emotions or a result of emotional
weakness. It is a real mental illness that cannot be overcome
by sheer will. It brings many difficulties occupationally, socially,
and physically. Unlike sadness or sorrow, depression does not resolve
with a change in circumstance (good news, for instance), and unlike the
gradual recovery from mourning a loved one's death, it does not get better.
If depression is not treated, it can persist for several years, hampering
relationships, reducing productivity at work, undermining confidence and
self-esteem, and, ultimately, even leading to suicide. A depression sufferer is
not able to solve his/her problem on his/her own. It is a mental illness that
requires professional treatment. With proper treatment, depression is
relatively easy to treat and has a success rate as high as 80%.
Depression is a common disorder occurring in 15% of men and 25% of women
during their lifetimes. Presumably, women have a higher tendency to suffer
depression than men because of the extra societal pressures put upon them and the
hormonal roller coaster they go through during pregnancy and delivery. Generally,
the first episode of depression happens in the mid-twenties, and then again
during menopause for women, and after retirement in men. Although depression
is a relatively easy disease to treat, without prompt and proper care, it can
become chronic or recurrent.
Depression, just like other diseases, can appear in many different forms. It
is divided into three major groupings: major depression, dysthymia, and
manic-depressive. In all three types of depression, the number, severity, and
duration of the symptoms will vary depending on the individual.
The most serious of the three types, major depression, affects the body
physically, emotionally, mentally, and behaviorally. Thus, work performance
suffers and even daily activities, such as sleeping and eating, can be affected.
Dysthymia is a relatively mild form of depression in which unhappiness lingers
for a long period of time bringing sub-par performance in daily activities.
Sometimes, patients with dysthymia also exhibit symptoms of major depression.
Manic-depressive depression does not occur as frequently as the other forms
of depression. Here, the patient is seen to alternate from a state of
depression and mania, forming a periodic cycle. Mania can be described as a
condition of being restless, occupied in thought, and unnecessarily busy in
behavior. In contrast, depression is a submergence of feeling, a settling of
thought and behavior, which together with its antithesis, mania, comprise
manic-depressive. The depressive cycle of manic-depressive depression often
appears in the form of major depression, as discussed above.
There are many different causes of depression.
Physiologically, neurotransmitters, the substance that links nerve cells to
other nerve cells, may be the source of the problem. It is believed that the
brain's activity, namely our thoughts and emotions, arise out of the change in
the properties of these neurotransmitters. In the case of depression, it is
believed that a decline in the activities of the neurotransmitters,
norepinephrine and serotonin, are involved in the disorder.
Heredity can play a factor in depression. If a close relative (parents,
siblings, or children) suffers from depression, the chances of falling into
major depression are 2-3 times greater. Although heredity is an influential
factor in causing depression, it does not necessitate it.
Environmental, Psychological, and Societal
There are environmental, psychological, and societal factors that can also
drive a person into depression. A person with low self-esteem, a strong
superego, weak social interaction, and a very dependent personality will be
more susceptible to these external pressures, whether it may be due to
divorce, failure, or family discord.
The most notable symptoms of depression are gloominess, loss of interest
and pleasures, fatigue, and loss of vigor. In addition, there are other
symptoms, such as loss of concentration and attentiveness, loss of
self-respect and self-confidence, guilt, lack of self-worth, hopelessness,
thoughts of suicide, insomnia, and a loss of appetite. Sometimes, these
symptoms may occur due to the accumulation of unexpressed anger, emotions,
or personal preferences bottled up by peer-pressure, societal rules and
customs, resulting in a redirected expression of these emotions in the form of
various psychosomatic symptoms, such as loss of appetite and sexual desire,
insomnia, etc. For teenagers, anger or other misgivings may be expressed
with truancy, by smoking, drinking, getting into fights, or leaving home.
Menopausal women may exhibit symptoms of "being on pins and needles"
and become anxious and irritable.
The treatment of depression can be divided as follows: medication,
psychotherapy, and electroconvulsive therapy. Some people are cured by
psychotherapy or taking medications. Most people, however, choose to
take advantage of both, benefiting from the fast acting power of medications
and the know-how of coping with daily problems acquired from psychotherapy.
The important point here is that most people can be treated for depression
with proper attention. In rare cases, electroconvulsive therapy is used to
treat extreme depression.
Traditionally, depression has been treated through the use of three types
of antidepressants, namely tricyclic antidepressants (TCAs), monoamine oxidase
inhibitors (MAO inhibitors), and selective serotonin reuptake inhibitors (SSRIs).
TCAs are encumbered by side effects such as dry mouth, constipation, drowsiness,
and a decrease in sexual performance. MAO inhibitors have the inconvenience of
having to avoid certain foods, such as cheese and wine. Recent additions to the
antidepressant lineup do not have such side effects. These include the new
class of antidepressants called SSRIs. Since antidepressants take 2 to 6 weeks
to take effect, it is important that drug use be maintained for a reasonable
amount of time before deciding to quit. If any difficulties arise, consult the
prescribing doctor immediately. Alcohol and other medications can interfere
with the potency of antidepressants and must be avoided.
Psychotherapy aids patients by identifying and resolving their problems through
consultations with a psychiatrist, and helps patients get a better understanding
of their mental illness. Behavioral therapy involves directing individuals to
gain satisfaction and initiative by their own actions, and helping them to
understand ways to avoid behaviors that may lead to depression. It also teaches
them to adjust to their environment, becoming a master of their environment
rather than a slave to it. Personal relations therapy and human-behavioral
therapy are also helpful. Personal relations therapy rectifies the wrongs of
personal behavior that contribute to depression, and human-behavioral therapy
eliminates the patient's negative behavior and frame of mind that is associated
with depression. Retrogressive psychotherapy focuses on the psychological problems
of childhood as the center stage for resolving conflicts in the patient's current
Electroconvulsive therapy is useful in treating very severe depression accompanied
by suicidal tendencies, as well as those patients incapable of taking
antidepressants. It is very effective in treating patients who have not completely
recovered after using antidepressants.