What is meant by the term
depressive disorder?
Depressive disorder is an illness. The term should not be confused with the term "depression". Simple depression is a normal emotion. All people have periods of being sad, miserable, unhappy or depressed. Often there is a reason, sometimes not. Usually these feelings don't last for more than a day or two, at most a week. It does not interfere too much with work or school. Recovery is spontaneous and no special help is necessary.
How is it different from depression?
Depressive disorder is a disease and has a number of other symptoms in addition to feeling depressed. The most important are lack of enjoyment of things the person used to enjoy previously and lack of interest in life. Other features are feeling tired, restless or agitated, loss of appetite and weight (some have the opposite - increased appetite and weight), insomnia and waking up earlier than usual, loss of interest in sex and irritability. Some may also feel that life is not worth living extending to thoughts of suicide.
You need not have all these problems to be diagnosed as having depressive disorder, but depressed mood, lack of enjoyment and loss of interest are considered the core symptoms of the disease. These problems are persistent and continue for more than two weeks.
What are the causes?
Sometimes there will be an obvious reason such as a disappointment or loss of a person you love. There is often more than one reason. If you are alone, have no friends, are physically run down, the risk of depression is higher.
Physical illnesses such as cancer and heart disease and chronic illnesses such as diabetes and arthritis also contribute. People can even become depressed after a viral infection such as flu, dengue or hepatitis. Some persons are more vulnerable to depression than others. This may be due to genes or bad experiences in early life. Regular heavy drinking makes you more likely to get depressed.
Women are twice as more likely to get a depressive disorder than men. Women are more likely to have the extra stress of work and looking after children.
Depression can also run in families. If you have a parent who has had a severe depressive disorder your risk of having a similar illness is eight times higher.
How do all these different causes
lead to one disease?
We don't know exactly how it does. We do know that all these causes lead to certain chemical changes in the brain. In the brain there are chemicals important in the transmission of nerve signals. These are called neurotransmitters.
The most important of these is serotonin. A few years ago an interesting study was done in Oxford. People were asked to drink a substance that caused an immediate drop in the serotonin levels in the brain. A number of these people became quite depressed for a few hours. This shows that these neurotransmitters are important in maintaining our mood. It is thought that all the factors we mentioned in the previous question lead to neurochemical changes in the brain which in turn cause depressive disorder.
Is it dangerous?
Yes, definitely. Untreated depression can lead to suicide. It is one of the leading causes of suicide. In some rare instances depressed parents have even killed their children. Even if it does not cause mortality it will definitely cause morbidity. A depressed person will not be able to work normally or go to school. They will not interact normally with other members of the family.
It is also known that depression increases the possibility of getting other illnesses. Depression can increase the possibility of getting heart attacks or high blood pressure. It can increase the chances of catching an infection. It will reduce the speed of wound healing. It has been shown that depressed people take longer to recover after surgery. They also have a higher chance of dying during surgery.
How can it be treated?
There are two main types of treatment: antidepressant medicines and talking therapy. Both are effective and the psychiatrist will be able to recommend which is better for you. It will depend on the type and severity of depression and the resources available.
What are antidepressants?
These are drugs that relieve the symptoms of depression. They were developed in the 1950's and have been used regularly since then. There are more than 30 different types of antidepressants in the market today. Most are available in Sri Lanka. They are thought to work by increasing the availability of serotonin and other chemicals in the brain.
After you start on a course of antidepressants there may not be immediate relief. Most take 2-3 weeks before they feel better. So do not give up on the medicine too soon. Even after recovery it is important to continue treatment for a further period of time to prevent a relapse of the illness. The usual treatment period is six to nine months but may be longer if the person has had depression before.
Are antidepressants dangerous?
No, it is depression that is dangerous. Some of the older antidepressants have caused death in overdose. The newer antidepressants are much safer. They are not addictive and can be used for months or years without ill-effects. I would say the cure in this case is definitely much safer than the disease.
What is 'talking therapy'?
The technical term is psychotherapy. There are three types of psychotherapy that have been proven to be effective in depression. They are problem-solving therapy, interpersonal therapy (IPT) and cognitive behaviour therapy (CBT). Problem-solving therapy is a form of counselling. It is useful when specific problems are causing the depression. The patient is helped to rationally deal with their problems. IPT is useful when the person has had longstanding difficulties in relationships. However, I am not aware of any person who practises IPT in Sri Lanka.
What is cognitive behaviour
therapy (CBT)?
CBT has two therapy parts. A cognitive therapy part and a behaviour therapy part.
What we think determines what we feel and vice versa. If we have sad thoughts we will feel bad and if we have cheerful thoughts we will feel happy. It has been shown that people with repeated attacks of depression have consistently more sad thoughts compared to normal people even when they are clinically not depressed. Cognitive therapy aims at changing the way people look at themselves, the world and other people.
To use another illustration let's take a glass of water filled 50% with water. The depressed person would look at the glass and say, 'it is half empty'. The more cheerful person might say, 'it is nearly half full'. What is the truth? Both statements are true but the latter is a more useful and 'happier' way of looking at things. Cognitive therapy helps a person to consistently look more positively at the world and drop their dysfunctional thoughts. Cognitive therapy does not distort the truth it merely helps you to change your attitudes to more useful ones.
The behaviour component of CBT is where the person is encouraged in new ways of interaction with people in the light of their changed attitudes.
Is CBT dangerous? Is it a
form of brain washing?
No, it is not. In fact unlike antidepressants it has no side effects at all. It is one of the most thoroughly researched of all the psychotherapies. In over 400 clinical trials it has proven its effectiveness in not only depression but in other disorders such as anxiety, obsessive compulsive disorder and addiction to alcohol and other drugs.
It is advocated as an effective therapy for depression by all leading psychiatric and psychological associations and leading textbooks on the subject. Most definitely it is not a form of brain washing. As I said before CBT does not distort the truth. It helps you to develop a healthier and more positive attitude to life and living.
(The writer is Senior Lecturer in Psychiatry, Faculty of Medicine, Colombo and hon. Consultant Psychiatrist, National Hospital of Sri Lanka) |
E-mail