What is Depression?
Depressed persons usually describe their mood as depressed, anguished, mournful, irritable or anxious. The patient explains it as a progressive loss of interest or pleasure in normally enjoyable activities, like reading a newspaper, watching television, going for a walk or participating in sports. However, very often, the patients may not admit to feeling sad, as they may consider it below their dignity to experience sadness in the absence of an appropriate cause, particularly in the presence of other family members or friends. But the patient’s facial expression, voice and overall appearance may corroborate the presence of a sad mood. Frequently, there is a tendency to cry, and the patient may weep while alone or with a listener. This article covers the most definite ways to see depression.
Diagnosing Depression:
The term ‘depression’ may signify many things. It may be viewed as normal when occurring under certain circumstances, for example, in response to a death or loss of business. It is viewed as abnormal when it occurs under inappropriate circumstances, when it is of inappropriate severity, continues for a long time and interferes with a person’s activities of daily living. As a symptom, depression is associated with a number of psychiatric disorders. Depression by itself has a predictable course, associated biological abnormalities, genetic inheritable pattern and treatment response. A mild depressed effect or mood does not signify the presence of a serious disorder. To determine whether a depressed mood or effect is of clinical significance, there must be a complete evaluation to determine the clinical context of the depression. This means that it should be possible to define a threshold at which a constellation of depressive features becomes a condition distinct from the ordinary blues. This article covers the most definite ways to see depression.
How common is depression in the community?
With well-defined diagnostic categories and reliable operational criteria available, the frequency of depression can be measured in the community. High-risk population groups can be identified in the community and the effectiveness of various treatments and preventive measures determined. Historically, disease burden has been based on mortality statistics. However, these statistics underestimate the burden from non-fatal conditions such as neuropsychiatric disorders.
The World Health Organization has introduced a new concept of measuring suffering of populations based on time lived with disability which has been described as, Disability-Adjusted Life Year (DALY). According to World Health Report 1999, in 1998, an estimated 39% of all DALYs lost in low and middle-income countries, in which most Member Countries of WHO SEAR fall, were attributable to noncommunicable diseases, of which, 10% of the disease burden was due to neuropsychiatric conditions. This article covers the most definite ways to see depression.
A large proportion of the burden of disease resulting from neuropscychiatric conditions is attributable to unipolar major depression, which was the fourth leading cause of overall disease burden in 1990, while in adults aged 15-44 years, it was the leading cause of DALYs lost word-wide. The disease burden resulting from depression is estimated to be increasing both in developing and developed regions. However, establishing a diagnosis of depression versus a normal fluctuation in mood is a crucial issue in estimating the true frequency of depression in the community. This is relevant not only for doctors who must distinguish normal variations in mood from depression for the purpose of treatment, but also for health planners and policy-makers for making provisions for mental health care in the community.
Consequences of Depression:
The most disturbing consequence of depression is death by suicide. Depression not only leads 15% of its victims to committing suicide, it kills them at a younger age.
However, the number of suicides associated with depression does not truly represent the burden of suffering caused by depression on society. The number of deaths does not take into consideration the age at which death occurs. Diseases that kill at a younger age are a greater public health concern than those that affect predominantly older individuals.
Depressed people also tend to suffer more from various medical disorders, and die prematurely. Thus it has been reported that patients above the age of 55 with depression had a death rate four times higher than those without depression. Most of these deaths occurred from heart disease or stroke. Also, depressed people tend to use medical services more often, as they suffer from various medical disorders from time to time, thus raising the cost of medical services to the community at large. This article covers the most definite ways to see depression.
What can be Done?
With the advancement in pharmacological sciences and a better understanding of the biochemical basis of depression, a number of drugs have been introduced for the treatment of depression and prevention of relapses on a long-term basis. However, it is ironic that even in the affluent west, only one-third of persons with such disorders are under appropriate treatment. The situation is worse in the countries of South-East Asia, where such cases remain underdiagnosed and undertreated, despite the fact that these drugs are now quite affordable and easily available everywhere. The reasons usually cited for this state of affairs are:
- Patient’s disbelief in medications;
- Sense of hopelessness;
- Viewing illness as untreatable;
- Physician’s failure to recognize illness;
- Illness factors like marked lethargy, disinterest and death wishes;
- Poor recognition of consequences, and
- Society’s negative attitude towards illness and medication.
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