Throughout the course of our lives, we all experience episodes of unhappiness, sadness, or grief precipitated by unexpected events like failure in exams, rejection by loved one, death of a close one, personal tragedy or difficulty such as divorce, loss of a job, etc and may feel depressed (some people call this "the blues"). Most of us are able to cope with these and other types of stressful events. Over a period of days or weeks, majority of us are able to return to our normal activities. This is called Normal Reactive Depression. Normal Reactive Depression is different from Medical Depressive Illness. Normal Reactive Depression requires no treatment. Just assurances, supportive empathy and encouragement would be useful. It does not affect day to day activities and routine life. People bounce back within a few days.Medical Depressive Illness is not a normal variation of mood. The symptoms of this disease last for weeks and months and the person suffers a lot affecting their regular pattern of living.It is the illness in the brain's nerve circuits that affects or changes our thoughts, moods, behaviour, activity, attitude, habits and personality from what we normally are. Some neurotransmitters like Serotonin, Norepinephrine and Dopamine are less in quantity in some parts of the brain leading to dysfunction of the brain's neural circuits.
If one has a depressive disease, they are often unable to perform daily activities as before. They may not care enough to get out of bed or get dressed much less work, do errands, or socialize. During this phase, the depressive illness fluctuates with few normal days of functioning and mood. One may feel better on few days of the week but then the depressive symptoms prevail on most days and gradually the number of days of depressive illness increases.
When one meets their doctor, they usually complain of:
A headache, back pain, body pains and pains in other parts of the body especially hands and legs.
Weakness despite eating well especially in the hands and legs.
Tiredness despite doing regular work.
Sleep disturbances - difficulty in falling asleep or dissatisfaction with sleep.
Gastric problems like acidity, constipation and bowel problems
Other psychological symptoms include:
- Feeling sad or depressed.
- Loss of interest in job - leading to decreased efficiency, changing jobs and in some job loss; loss of interest in housework - leading to unclean, unkempt house, delays in washing clothes and dishes and cooking food; loss of interest in day to day activities like brushing teeth, bathing, wearing non-ironed clothes and lacking interest in appearance.
- Feeling tired most of the time despite doing regular or less than regular work leading to the postponement of regular work, delayed bill payments and procrastination.
- Lack of enjoyment or pleasure in activities than before leading to dropping of hobbies, avoiding socialization, going out or watching movies.
- Feeling lazy, lethargic and being slow leading to the postponement of work.
- Decreased concentration leading to memory problems and forgetfulness leading to poor academic performance or accidents.
- Decreased confidence, self-esteem, self-worthiness or feeling inferior to others.
- Become indecisive, fickle-minded, dependant, unable to organize, plan etc.
- Thoughts that other people are bad, thinking bad about themselves or ignoring them and will not help them.
- Thoughts of worthlessness, being a burden to family members, unworthy of the love of near and dear ones.
- Thoughts that the world is a bad place, full of negativity etc.
- Thoughts of guilt, self-hate and frustration.
- Thoughts that current situation will not improve in future, hopelessness, helplessness and thoughts of being alone in the whole world.
- Decreased initiation, motivation or enthusiasm than before.
- More irritability, anger, explosive behaviour than before.
- Sleep disturbances like difficulty in falling asleep leading to internet surfing or watching TV ( channel surfing), waking up early or late, wanting to sleep more and feeling dissatisfied with the sleep.
- Appetite disturbances( change in eating habits) - not interested in eating or eating more than usual or even late night snacking
- All these thoughts lead to sleep medication abuse, alcohol misuse, headaches/backaches (unexplained/no clear medical cause) and painkiller abuse, antacid abuse etc.
- Ideas, thoughts, plans of wishing to die, suicide harming oneself, suicidal attempts in severe patients.
Treatment includes medicines and counselling or psychotherapy including other treatments like Cognitive behaviour therapy, supportive therapy.
- Antidepressants are generally prescribed.
- Treatment is provided by psychiatrists who are medical doctors who have completed specialized training in depressive disorders and treatments.
- Antidepressant medications are not sleeping pills or addictive in nature.
- They have to be taken initially at a small dose with gradual increases in doses under the supervision of a psychiatrist for about 6 - 9 months on the dose to which they respond.
- In those who have been suffering from the depressive disease for a long time or repeatedly, the medication has to take for at least 2 years or longer as advised by the psychiatrist.
- People with the depressive disease can safely be treated in a series of outpatient visits.
- Hospital care may be necessary for people with more serious symptoms and is required for those who are contemplating suicide or cannot care for themselves.