Depression is one of the commonest Mental Health conditions affecting 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. There is a lack of mental health awareness and acceptance. Depression is 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. Depression is accompanied by Anxiety (in 60% or more cases). Mental Health conditions like Depression should receive timely and holistic treatment with a combination of diet and nutrition, lifestyle modification, medicines, psychotherapy, and counselling. This can effectively improve a person’s quality of life and physical-social well-being.
SIGNS AND SYMPTOMS
Depression can manifest both Psychological and Physical signs.
- 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 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.
- Increased 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, feeling of fullness, bloating, acidity, indigestion, nausea with no diagnosable cause or no significant improvement with gastro-intestinal medicines
- Vision problems- Feeling of dizziness and decreased clarity of vision or contrast
- Others- Unexplained generalized itching
The above symptoms may be seen in most people at some point in time. However, when they become persistent and are present on most days over a period of time, impacting day to day functioning, the person can be said to be suffering from clinical Depression.
Depression with Anxiety
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 attack 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 attack include –
- calming and reassuring words and behaviour 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 neuro-chemical Serotonin and sometimes Noradrenalin has been studied to be associated with causing depression. These mediators are increased by Anti-depressant medicines. Chemicals like GABA (Gama Amino Butyric Acid) have a calming effect in our body, and some drugs for Anxiety and Panic act by increasing this effect.
Precipitating and Exagerrating 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
- Diet dependent more on refined and packaged foods, and low on nutritious items (and reduction in the good Gut bacteria).
- Physical illnesses like seen in long-standing or chronic pains due to Arthritis and Neuropathy, and digestive conditions like Irritable Bowel Syndrome and Functional Dyspepsia. Conditions like Alzheimer’s, Parkinson’s, 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, Counselling 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 the 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 are 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.
Improve 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.
COUNSELLING, PSYCHOTHERAPY AND SUPPORT GROUPS
Counselling sessions and Psychotherapy by trained and experienced psychologists enables people with depression to share and speak out their issues and also understand perceptions and reality. It helps to impart positive perspectives and attitudes, and also modify behaviours. There are a number of Depression Support Groups that can help such patients 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 help-lines 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 Vitamin D, B12 levels), where required, to rule out underlying medical conditions which may be causing or increasing depression.
Anti-depressants are medicines that act by correcting the imbalance of neuro-chemicals and increasing the levels of Serotonin and sometimes also Noradrenalin in the Brain. The more commonly used ones include Selective Serotonin Reuptake Inhibitors (SSRIs -Fluoxetine, Escitalopram, Paroxetine, Sertraline), Serotonin Noradrenalin Reuptake Inhibitors (SNRIs -Duloxetine, Venlafaxine, Desvenlafaxine, Milnacipram) and Tricyclic Antidepressants (TCAs – Amitriptyline, Nortriptyline, Doxepin, Clomipramine).
In cases with coexistent Anxiety, appropriate Anti-anxiety medicines may be added on a regular or as-needed basis. The most common class of Anti-anxiety medicines include the Benzodiazepine group (Alprazolam, Clonazepam, Oxazepam, Diazepam and Chlordiazepoxide). 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, Counselling, and Medical therapies, along with family-social support, Depression with or without Anxiety, can be effectively managed for most people to lead a fulfilled life.
Further reading –
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