According to latest World Health Organisation’s (WHO) estimation more than 300 million people are now living with depression. These alarmingly high figures necessitate serious approach towards depression. To address issues around prejudice and discrimination and continuing stigma associated with mental illness, the WHO celebrated the World Health Day on April 7, as the campaign against “Depression, Let’s Talk”. Even in high income countries, 50 per cent people with depression don’t receive treatment.Depression is the main cause of ill health and disability. As per WHO, just 3 per cent of Government health budget is invested in mental health, varying from <1 per cent in low-income countries to 5 per cent in high-income countries. Suicide has become second leading cause of death among 15-29-year-olds. Every 40 seconds someone dies of suicide. The goal of this year theme is to remove stigma and prejudice and encourage people to come forward to seek help.
Depression is a disease of brain just like diabetes which is a disease of glucose metabolism. If one can’t be oblivious to medicines needed for diabetes, why to shrug off from treatment of depression. Depression is not simply sadness. Sadness is temporary condition but depression is a persistent and pervasive condition. Pervasive sad mood, low energy level and decrease in interest in previously pleasurable activities and inability to carry out daily activities for at least two weeks constitutes depression.
Cultural diversity may influence the presentation of depression. In my clinical practice, I have seen people more comfortable in reporting depressive symptoms physical in nature rather than mental for example, many depressed Indian patients present with persistent tiredness, chronic pain, dizziness, headache. There is a huge denial of psychological symptoms. Feelings of guilt, delusions involving physical health, and religious and physical symptoms without any demonstrable organic cause may be part of depression. Culture may markedly influence the presentation of depression.
Depression is common in middle-aged and elderly but increase incidence is being seen in children and adolescents also. Child’s “school refusal’, somatic complaints like daily stomach pain may be part of underlying depression. In adolescents, depression may have subtle presentation like agitation, irritability, substance/drug abuse and decline in academic performance.
Depression presents subtly in new marriage (more common in women specially married cross cultural patriarchal society) as laziness, tiredness, introversion, decrease in social interaction, irritability, crying spells, anxiety in presence of new relatives and environment, if pervasive in early years of marriage, it may be depression. In new mothers consistently crying, difficulty in bonding with the newborn, disturbed sleep, headache and finding it too tough to take care of newborn and sometimes even thoughts of harming the baby signal depression (post-partum). In elderly with chronic illness like hypertension, diabetes, arthritis and cardiovascular illness there is increased risk of depression or vice versa depression increases the risk of all these chronic diseases. Depression may present in elderly as increasing feeling of loneliness, even in presence of caring family members, chronic pain not having physical causation, feeling of worthlessness, death wishes etc.
Depression can happen even if all things are going right (despite fairly loving spouse, good family and economical conditions). Person showing signs of depression should not be laughed at saying “you have world’s best things, people are better off than you”. It may put them into more guilt. In a nutshell, depression is not simply sadness. Sadness is transitory but depression is pervasive condition having underlying psychological and physiological presentation having varied presentation influenced by cultural context.
By 2020, depression is projected to be the second- highest cause of years of productive life lost due to disability (DALYS). Rising depression in youth is leading to loss of productivity and is impacting economic growth. Depressive patients have comparatively shorter life span not only because of mental illness but also because of neglect of physical health leading to medical co-morbidities like obesity, poor self-care, nutritional deficiencies, diabetes, hypertensionn and cardiovascular disease.
How sad and prejudiced? We are sensitive to somebody with fever but not with depression. Although stigma towards mental illness is declining there’s miles to go.
If you feel you are having depression, “talk” to someone you trust or seek professional help. As a family member/friend, let the person in depression be assured that it’s a illness that is curable. You should listen without judgment and not pass comments like “you love to be sad”, “what else do you need in life”. Be empathetic and encourage them to seek professional help.
If medication is prescribed, help them to be regular with medication and to have patience for results. Apart from this, patient should be encouraged for regular sleeping, eating pattern, regular exercise, yoga, etc.
Let’s talk freely about depression and provide support for people with depression.
Don’t deny yourself the needed help.
