Clinical depression, the number one disease of the 21st century

Cllinical depression is a severe disease that has a very high incidence and a great impact on people and their family and friends. Unfortunately, in spite of the fact that many people have to cope with it, clinical depression is still a taboo subject in the Netherlands even today.

Definition and causes

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. However, true clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period of time. The two most significant symptoms of a depression are negative thoughts about one's self and life and loss of interest or pleasure in hobbies and activities that once were normal. Scientific research has shown that clinical depression is actually a disorder that has a massive impact on a person's normal functioning.

Clinical depression is a disorder that affects a person's moods. Our mood is responsible for cheerful and happy feelings at any moment in our life. Depressions occur during or after transitional stages in life when things are changing and we cannot cope with them. Experiencing feelings of loss, such as the death of a loved one, a divorce, dismissal and physical functional disabilities may play a key role in triggering a depression.

Health care in the past and the present

After a long period of poverty, want and misery in the Netherlands during World War II, there was a great demand for food, housing and all kinds of commodities to recuperate from the effects of the war. Authorities spent a lot of money on national health campaigns and vaccinations to improve the health of the Dutch people.

Though most of our primary needs are met and every citizen has health insurance today, problems in society are more of a psychological than a material nature. Since a few decades, from an early age on, growing individualization in society has compelled Dutch citizens to take their life into their own hands, make a lot of personal decisions and take responsibility for their career, family, health and success. These demands place a lot of strain on many people and take their toll, leaving them with a burn-out syndrome or clinical depression.

Capacity versus strain

As a rule, we have three important motives in our lives to keep us going, i.e. love, hope and persuasion. People having all three of them are well equipped mentally to cope with setbacks. Even a difficult situation like a broken relationship will not make them feel depressed instantaneously because they have sufficient strength and motivation left to recuperate and go on.

Unlike 'ordinary' people, persons with a predisposition for clinical depression often lack one or more of the motives mentioned above. When they are faced with distressing life events that they cannot come to terms with immediately, such as disappointments, serious loss or conflicts, there is too much strain on their mind. Their capacity to bear this heavy load is too limited, leaving them with insufficient options to fall back on in stressful situations. The load weighing on a human mind can be greatly relieved by social support, but, unfortunately, this does not work in a depressed person whose load is too heavy to bear.

Symptoms

• Loss of energy

• Depressed mood

• Deep mental or physical fatigue

• Trouble getting to sleep due to worrying

• Feelings of inappropriate guilt

• Avoiding other people

• Overwhelmed by sadness

• Nutritional deficiencies

• Recurring thoughts of death or suicide

• Great difficulty concentrating

• Feelings of worthlessness and self-hatred

• Loss of interest in work, hobbies or any acitivity

• Tendency to get into a panic

If these symptoms continue longer than a fortnight, they are indicative of clinical depression. People often need professional help for a long time to get over it.

Duration

The total duration of clinical depression is hard to predict, because it may take a long time before depression is diagnosed and its progress and treatment vary considerably from person to person. Nevertheless, on average, once a depression has been diagnosed, the period of recovery is likely to take a year at least. It is important for relatives and friends to realise that they should allow a patient to have plenty of time and elbow room for their recovery. Although unintentional, friends and loved ones may unknowingly say and do things that may be hurtful to the depressed person. Utterances like 'Isn't it over yet?' or 'Why don't you take control of your life!' are altogether wrong. Apart from that, a depression may return in somebody's life when they are faced with a stressful event once again.

Age and depression

Clinical depression can be triggered at any age. Throughout the years, statistics have revealed an increase in the rate of depression. This is related to the fact that psychiatry has made significant progress in diagnosing depression at an early stage and the growing awareness that it has a high incidence in young people.

Depression often starts when things are changing in people's lifes, like a new job, relationships, having children or experiences of serious loss.

Children

Just like adults, children may get depressed as well. The symptoms of depression in children are the same as in adults. As children are not yet able to express their feelings very well, it is important that their family and friends should stay alert for changes in their behaviour. A depression in children may be caused by parents who are too self-centred or give priority rather to their career than their family. As a result, the child feels unwanted and left out. Apart from that, children are prone to adopt depression or other stress disorders from their parents.

Generally, medical or other professional treatment will yield satisfactory results only if there is also attention for the causes or context of problematic behaviour. For instance, in case of a deceased parent, divorce or child abuse, it often happens that children at a very young age have to stand on their own feet and grow up under circumstances where they are traumatized. It is essential that the biological, psychological and social factors should be involved in making a diagnosis and giving treatment or social support.

Young people

Many young persons have difficulty in grasping the meaning of all the impressions they get of society and how to cope with them. They feel that there are many things they are 'forced' to do. The outside world has very high expectations of this generation and this puts a lot of strain on them, especially when it makes itself felt that they will not be able to live up to all of them.

There is a striking difference in symptoms between boys and girls: in boys we see rather high-risk behaviour, violence, alcohol and drugs abuse, whereas girls display rather sleep or eating disorders and physical pains.

Old people

Another vulnerable high-risk group are old people because they of all people are faced with life events that are at the basis of depression, such as loneliness, health problems, less independence and experiences of loss. Usually, symptoms of depression in old people manifest themselves as physical complaints, which may complicate an examination for doctors to assess their cause as mental.

Treatment of depression

A treatment is necessary to cure patients of serious depression, because depressed persons on their own are not capable of breaking out of the vicious circle that they have got caught up in. It is important that a plan of treatment should be drawn up that is focused on biological, psychological and social factors.

Antidepressants

The predominantly practised biological treatment for depression consists of administering antidepressants, which affect neurotransmitters and alleviate mood disorders. They solve the problem for a while because they enable depressed persons to deal with it more effectively. The downside is that patients become dependent on addictive medication, which is another problem because it perpetuates depression in many cases.

Antidepressants are suitable for minor depression and necessary for major depression. In case of a major depressive disorder, people are so depressed that psychological support is not an option. Though antidepressants are not effective until ten days after taking them, their side effects start immediately. Consequently, it is important that depressed persons should be given appropriate support and encouragement, because only taking antidepressants is inadequate to recover from depression and psychological or social factors have to be considered as well.

Apart from that, there is a good chance that depression symptoms return after a remission because some people feel so much 'better' once the antidepressant medications start working that they assume they no longer need them. Sometimes, after stopping treatment, they may have full-blown relapses within only a few weeks.

Light therapy

Bright light therapy corrects the misalignment of the internal biological clock through simulating the effects of daylight. Basically, patients with winter doldrums are exposed to artificial light for a couple of hours a day, stimulating the brain's production of the neurochemicals responsible for positive moods This may explain why people not getting the light they require feel lethargic, less motivated and experience the 'blues'.

Sleep restriction therapy

This treatment consists of little more than keeping oneself awake for half a night to a full night. During sleep, some depressed people have elevated glucose levels, which come down to normal after a sleep restriction therapy session, thereby theoretically relieving the depression symptoms.

Electroconvulsive therapy

In some cases, if whatever treatment that is given fails, electroshocks are administered. Electroconvulsive therapy (also called ECT or electroshock therapy) is a procedure used to help treat certain mental illnesses.

Electric currents are passed through the brain in order to trigger a seizure, a short period of irregular brain activity for about 40 seconds, which is believed to influence chemicals in the brain delivering messages from one brain cell to another. These chemicals, called neurotransmitters, can make the brain cells work better and improve a person's mood.

After ECT treatment, it is important to keep taking the prescribed medication to prevent a relapse into depression.

Psychotherapy

A depressed person wants to be heard and rather listens to someone who understands what they are going through than someone offering them ready-made solutions. Usually, the entire process takes a very long time. Psychotherapy is focused on finding answers to questions, solving problems, learning the ability to cope for oneself and gaining a clear understanding of what happened in the past. Examples of psychotherapy are psychoanalysis, client-centered therapy and behaviour therapy. For therapy to be successful, it is important that the therapist should show sympathy for patients and their situation. During therapy sessions patients are taught to cope with their emotional hang-ups and to become less dependent on other people.

Sometimes it may also be necessary to involve a partner or parent in the therapy, which is generally given in combination with antidepressants.

Prevention

Clinical depression has a major impact on the lifes of people and their family and friends. For this reason, the possibility of early intervention is essential. Just like in the case of AIDS, where billions of pounds or euros were reserved for research into AIDS inhibitors, this should be done for depression too. Pharmaceutical companies make substantial profits on antidepressants, whereas the rate of depression is still increasing. In Europe, more people die of depression every day than of AIDS. More than ever, it is important to stay alert for the signals people send. Only in this way it is possible to trace depression and start treatment in an early stage.

Living with depression is a difficult process of trial and error, stimulating a person to find inner power time and again to rise to their feet!

Sources: www.todio.nl