Many faces of depression

In the absence of reliable data in the Third World, the World Health Organisation estimated the prevalence of severe mental illness to be 10 per cent in developing countries. In the late 1950s, the prevalence of Depressive Disorder was placed at two per cent of the population and in the 1970s, at three to five per cent. Recently, well documented studies have shown it to be five to seven per cent and lifetime expectancy of unipolar depression is 20 per cent in women and 10 per cent in men. Only a small fraction of cases is diagnosed and much less receives treatment.

The incidence of stress-related disorders is traditionally not included with mental disorders because it presents with somatic symptoms pertaining to the body — rather than psychological symptoms — and are treated by physicians. However, stress disorders may be masked by depression and remain undiagnosed.

Anxiety and depression are normal and frequently expressed emotions. They are useful in a way that without anxiety, enthusiastic goal-directed behaviour may suffer from apathy. Without reasonable concern — or anxiety — one may not be able to put his/her best in any task. Similarly, depression is a kind of withdrawal after minor or major setbacks. It tends to focus on the failure and with time, helps an individual recover and set a new course of action. However, depression that lasts longer than usual and interferes with every day activities needs attention. This is called clinical depression.

Stressful life events may or may not cause depression. Yet, the cumulative effects of stress have now been recognised. A stress inventory was prepared with appropriate scores assigned to various live events. For example, on the 51-item scale, a maximum score of 95 (out of 100) is assigned to the death of a spouse, ranked as the most stressful life event. A minimum score of 20 is assigned to going on a pleasure trip or on a pilgrimage. In between these two scores are events such as dismissal from job, lack of a child, martial conflicts, broken engagement, retirement and prophecies of an astrologer. The inventory is a method of quantifying stress loads objectively and the use of this method is to highlight stressful events and relate them to the present mental state of an individual. The stress symptoms resulting from these life events are generally repressed and thus, depression begins to express itself through various aches, pains and other bodily discomfort.

Several causes for and manifestations of depression occur, including maladaptive behaviour, which means that some people are more prone to anxiety or depression on minor provocation due to defective personality development or inability to cope with stressors of everyday life. This can be called a psychological reaction to stress and needs counselling and/or psychotherapy. Another cause for depression and anxiety is a chemical imbalance in the brain; hence, symptoms are not always psychological. Recent research has shown anxiety, depression, panic attacks or obsession may have their origin in the genetic and biochemical makeup of an individual. Sudden onset of depression in people with good previous personality has a better chance of recovery if diagnosed early.

It is now accepted that low mood associated with tiredness, lack of interest and disturbed biological functions (hunger, sleep and sex) which lasts for more than two weeks can be diagnosed as depressive disorder. It needs attention. Identifying masked depression — in anxiety disorder, panic disorder, obsessive-compulsive disorder, substance abuse, chronic pain, and gas syndrome — is a useful discovery in the diagnosis and treatment of depression.

Published in The Express Tribune, October 12^th, 2012.