Depression and anxiety are the commonest mental health conditions. Depression affects 5-10 % of the population (almost 1 in 20 in India). It has many causes and ranks as the largest contributor to global disability and suicide. Depression is accompanied by anxiety (in 60% or more cases).
There is still a lack of mental health awareness and acceptance. Depression and anxiety are often dismissed as attitudinal issues, behavioral problems, or exaggerated reactions of so-called difficult people. This often creates hurdles in its timely diagnosis and intervention. Mental health conditions like depression and anxiety should receive timely and holistic treatment with a combination of diet and nutrition, lifestyle modification, medicines, counseling, and psychotherapy. This can effectively improve a person’s quality of life and physical-social well-being.
SIGNS AND SYMPTOMS OF DEPRESSION
Depression can manifest with both psychological and physical signs. The symptoms below may be seen in most people at some point in time. However, when they become persistent, are present on most days over a period of time, and start impacting day to day functioning, the person can be said to be suffering from clinical depression or major depression.
- Loss of interest in daily activities- No care or interest, and inability to enjoy past hobbies, entertainment, social activities, or sex.
- Anger or irritability- Feeling agitated, restless, violent, and having a low tolerance for routine things. A feeling of ‘everyone and everything is getting on one’s nerves’.
- Difficulty in concentration – Trouble focusing, making decisions, coping, or remembering things.
- Recklessness- Engaging in escapist behavior such as gambling sprees, reckless driving, or dangerous sports and adventure.
- Substance abuse- Binge drinking, using recreational or narcotic drugs.
- Feeling of worthlessness- Self-loathing, calling oneself worthless and a failure. self-criticizing and blaming oneself, with constant feelings of guilt, and excessive crying.
- Feelings of helplessness and hopelessness- Losing all hope, thoughts of dying or ending life, and feeling trapped.
- Appetite or weight changes- Increased appetite with cravings or decreased appetite, weight loss or weight gain of more than 5% over 1 month.
- Sleep changes – Decreased sleep with early morning waking, or sleeping too much and at unusual hours.
- Loss of energy- Feeling fatigued, weak, and physically drained with sluggishness for routine actions, feeling of exhaustion after small tasks, and taking longer to complete usual activities.
- Unexplained aches and pains- Frequent, and persistent headaches, back pain, leg pains and general body-ache which doesn’t respond satisfactorily to routine pain killers and to which no physical cause is found.
- Digestive problems- Complaints like constipation, abdominal pain, feelings of gas, fullness and bloating, acidity, indigestion, and nausea, often with no diagnosable cause or no significant improvement with medicines.
- Vision problems- Feeling of dizziness and decreased clarity of vision or contrast.
- Others- Unexplained generalized itching.
ANXIETY WITH DEPRESSION
Often anxiety is also present with depression. A depressed person can have intermittent periods of anxiety or even panic (severe anxiety and fear). Symptoms of anxiety include fast breathing/feeling breathless, nervousness, fear, feeling stressed, nausea, sweating, palpitations, obsessive or disturbing thoughts, light-headedness or dizziness, and feeling a sense of weakness without any actual physical weakness. Anxiety symptoms or attacks can come and go for a day or two lasting from 5-10 minutes to 30-45 minutes at a time.
Some activities which provide relief from anxiety symptoms or attacks include –
- calming and reassuring words and behavior by loved ones/caregivers
- taking slow deep breaths
- engaging in activities like going for a walk
- doing stretching exercises
- listening to relaxing and positive music
- reading or watching something interesting/amusing
- getting good sleep or rest
- eating a nutritious tasty meal.
Depression and anxiety set in due to a change and imbalance of the levels of chemicals (called neurotransmitters) in the brain. A decrease in the neurochemical serotonin and sometimes noradrenaline has been studied to be associated with causing depression. These mediators are increased by antidepressant medicines. Chemicals like GABA (gamma aminobutyric acid) have a calming effect in our body, and some drugs for anxiety and panic act by increasing this effect.
Precipitating and Exaggerating factors:
- Stressful life events and circumstances like abuse or mental trauma, relationship disturbances, loss of a close one, professional failures/pressures, or financial problems.
- Social isolation or lack of social interaction
- Inadequate physical exercise and a sedentary lifestyle
- Long hours spent on gadgets like smart-phones, tabs, and laptops and the absence of outdoor physical activities and socializing (especially in children).
- Reduced exposure to fresh air and sunlight
- Reduced sleep in either duration or quality
- Dietary factors like more dependence on refined and packaged foods, and low amounts of nutritious items (this can contribute to a reduction in the good gut bacteria).
- Physical illnesses like long-standing or chronic pains due to arthritis and neuropathy, digestive conditions like IBS (irritable bowel syndrome) and functional dyspepsia, Alzheimer’s or Parkinson’s disease, cancer, thyroid dysfunction, physical disability, and some immunological multi-organ chronic diseases.
- Family history of depression or genetic predisposition can increase risk of developing depression especially in response to life event triggers.
- Hormonal changes especially during pregnancy, menstruation, or menopause, in women.
- Substance abuse (recreational or narcotic drugs, alcohol) and some medicines like long term use of steroids.
TACKLING DEPRESSION AND ANXIETY, AND IMPROVING QUALITY OF LIFE
Depression is tackled by the triad of lifestyle therapy, counseling and support therapy, and medical therapy. This approach also helps to improve anxiety when co-present.
DIET AND LIFESTYLE THERAPY
This includes –
Adequate and regular sleep – 8 hours of undisturbed sleep should be ensured on most nights, along with regularizing sleep and wake timings, modifying bed-time habits, and improving sleep conditions and environment.
Regular physical exercise – At least 30-45 minutes of physical exercise should be part of the daily routine on most days (like brisk walking, jogging, cycling, swimming, stretching, aerobics and yoga with breathing techniques).
Social and family interaction – Spending quality time with family members, and also discussing one’s depression problem, symptoms and apprehensions, is important. It is also equally important for the family members to accept depression as a ‘real’ condition and extend support, understanding, and reassurance to the suffering individual. Joining a social group and participating in voluntary activities can help build an interactive circle and improve depression symptoms.
Cultivating hobbies – Engaging in or taking up self-fulfilling hobbies like music, dance, painting/drawing, gardening, crafts, reading, writing, cooking, sewing, or playing a game/sport, can greatly help in keeping away depression, improve moods and managing stress.
Routine creation– Charting a daily routine including all the above in addition to house/professional/ educational work with time allocation and reasonable goals can help reduce stress, depression, and anxiety.
Diet and nutrition – Diet should have foods rich in vegetables, fruits, nuts, yogurt, whole grains, olive oil, and proteins (legumes/beans/fish/eggs) along with plenty of water (at least 10-12 glasses) a day. Limited consumption of alcohol to not more than one glass twice a week, and decreasing the intake of high sugar foods/drinks, packaged/junk foods, caffeinated and aerated drinks, high-fat dairy items, and deep-fried foods, is recommended. A structured weight-loss plan in obese people with depression can also contribute to alleviating symptoms.
Improving surroundings– Making the house more ventilated, with adequate sunlight exposure is recommended. De-cluttering and keeping oneself and the surroundings clean can also improve low moods.
COUNSELING, PSYCHOTHERAPY AND SUPPORT GROUPS
Counseling sessions and psychotherapy (cognitive and behavioral therapy) by trained and experienced psychologists enables people with depression to share and speak out their issues, move on from the past and also understand perceptions and reality. It also helps to impart positive attitudes, and modify responses and behaviors.
There are a number of depression support groups that help such people to come together, aid interactive group therapy, shed inhibitions, and improve day to day functioning, quality of life, and confidence. People with substance abuse and addictions should seek help through deaddiction therapy programs. Suicide helplines are available in all countries, and family members should be guided on recognizing signs suggestive of severe depression and suicidal risk.
General medical evaluation and examination should be done along with blood tests (like complete blood counts CBC, blood sugar, thyroid function, and iron, vitamin D, B12 levels), where required, to rule out underlying medical conditions that may be causing or increasing depression.
Antidepressants are medicines that act by correcting the imbalance of neurochemicals and increasing the levels of serotonin and sometimes also noradrenaline in the brain. The more commonly used ones include
- selective serotonin reuptake inhibitors (SSRIs) –fluoxetine, escitalopram, paroxetine, sertraline.
- serotonin noradrenaline reuptake inhibitors (SNRIs) – duloxetine, venlafaxine, desvenlafaxine, milnacipran.
- tricyclic antidepressants (TCAs) – amitriptyline, nortriptyline, doxepin, clomipramine)
- atypical antipsychotics (as add on in more severe resistant cases) – olanzapine, aripiprazole.
Antianxiety medicines may be appropriately added on a regular or as-needed basis in cases with coexistent anxiety. The most common class of antianxiety medicines include the benzodiazepine group (alprazolam, clonazepam, oxazepam, diazepam, chlordiazepoxide) that act by enhancing the effects of GABA.
Medicines to regularize and improve sleep may also be prescribed in the initial part of treatment.
All these medicines should be taken only under the prescription and monitoring of a qualified medical practitioner in the recommended dose, frequency, and duration, as their effectiveness and side-effects can vary between people.
Vitamin-mineral supplements and probiotics (supplementing good gut bacteria) may be added in case of unsatisfactory/restricted diet, or in lab documented deficiency.
With a combination of lifestyle, counseling, and medicines, along with family-social support, depression with or without anxiety, can be effectively managed for most people to lead a fulfilled life.
The global COVID pandemic and its resultant economic and social impact have greatly affected the mental health of many, which would need timely diagnosis and management. Several support groups and organizations have now come up for the same.
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