MORNING, noon and evening news brings increasing dismal stats about the widening rapid spread and a growing number of deaths from 2019-nCoV. Many are not only overcome by fear, a good number are stressed out, and depressed.
But, how do we know if what is afflicting us—constant, gloom and doom mood, listless tossing in bed at night or virtual sleeplessness for days, loss of appetite, negativism, short temper, or withdrawal from family and friends is not just a case of PMS (premenstrual syndrome), or menopause?
Depression is a common mental disorder, worldwide. Globally, according to World Health Organization (WHO), more than 300 million people of all ages suffer from depression. In fact, depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.” Interestingly, more women are affected by depression than men for obvious biological reasons (i.e., given life cycles of menstruation, PMS, perimenopause and menopause, and psycho-emotional makeup).
Still, depression is different from the usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Prolonged, chronic depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school, and in the family. At its worst, depression can lead to suicide.
According to WHO stats close to 800,000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds. In the 21ist century, the burden of depression and other mental health conditions is on the rise globally, with wars and rumors of wars, ISIS and spread of terrorism, ecological disasters, the onslaught of pestilence like billion locust attacks in Africa, and the rise of pestilence.
Although there are known, effective treatments for mental disorders, between 76 and 85 percent of people in low and middle income countries receive no treatment for depression and mental illness. Barriers to effective care include a lack of resources, lack of trained health-care providers and social stigma associated with mental disorders. Another barrier to effective care is an inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed with antidepressants.
To dramatize the cold stats just cited, while Pinoys continue to regard the United States as land of promise, 25 million Americans suffer from depression each year. Over 50 percent of all people who die by suicide suffer from major depression. If one includes alcoholics who are depressed, this figure rises to over 75 percent. Yet another stat points to depression affecting nearly five to eight percent of Americans ages 18 and over in a given year. Sad to say, we have no parallel data set pertaining to the Philippines.
But what is a depressive disorder?
Depressive disorders are nothing new— mood disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. The Greek ancient medical practitioner, Hippocrates referred to depression as melancholia, which literally means “black bile”. At the time of Hippocrates, black bile, along with blood, phlegm, and yellow bile were the “four humors” (fluids) that described the basic medical physiology theory.
Visual arts and literature have portrayed depression for hundreds of years. But what do we mean today when we refer to a depressive disorder? In the 19th century, people thought of depression as a matter of heredity—an inherited “weakness of temperament”. The famous psychoanalyst, Sigmund Freud, in the first half of the 20th century, linked the root of depression to guilt and conflict while John Cheever, author, and a modern sufferer of depressive disorder, traced it to conflict and traumatic experiences with his parents.
Whatever the cause of depression in a particular case, most mental illness experts agree on the following indicators:
1. Sad, irritable mood exceeding normal sadness or grief. Specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional problems than is normal.
2. Depressive signs and symptoms comprise not only negative thoughts, moods, and behaviors. It also includes specific changes in bodily functions (for example, excessive crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). Signs, like sleeping or being in bed the whole day, very slow movements, are the changes in functioning associated with clinical depression. People with certain depressive disorders, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.
3. Depression is a huge public health problem, due to its affecting millions of people. About 10% of adults, up to 8% of teens, and 2% of preteen children experience some kind of depressive disorder. On the other hand, postpartum depression is the most common mental health disorder afflicting women after childbirth.
Depression often assumes various disguises, which causes it to be frequently under-diagnosed, especially in the provinces.
Is there hope for depression?
Although a Harvard medical graduate and long term psychiatrist wrote that after 20 years of practice, he has come to realize that chemical/drug treatment of depression is much like The Emperors’ New Clothes (all mental doctors believing anti-depressants and anti-psychotic drugs can cure), “there is really nothing there”. Still, there are some tried and tested effective treatments for moderate and severe depression.
Health-care providers offer psychological treatments such as behavioral activation, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), or antidepressant medication such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).
Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.
Psycho-social interventions are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children, and are not the first line of treatment in adolescents, among whom they should be used with extreme care.