The suicide death of comedian Robin Williams a few days ago was attributed to depression. This highlights the importance of understanding this mental illness and how to deal with it.
What is depression?
Depression is a state of emotion where the individual has some or all of the following senses, feelings or moods: downhearted, unhappy, anxious, irritable, unable to concentrate, socially withdrawn, empty inside, has inordinate fatigue and reduced interest in activities which used to be fun, hopelessness, indecision, impaired sleep, misery, helplessness, confusion, monosyllabic speech or abnormally quiet.
What is morbid mood?
The morbid mood in depression may be so severe that the patient is unable to cry (tears dry up) or to feel the usual emotions like pleasure, grief or joy. The whole world appears lifeless and colorless to the patient, who could be pre-occupied with a sense of guilt and self-denigrating and destructive ideas.
What is Melancholia?
It used to be called endogenous depression. Its features include marked slowness in thinking and activity, agitation, worthlessness, weight loss, restlessness, wringing of the hands, inability to experience pleasure or well-being, difficulty falling asleep and has insomnia, following arousal from sleep, with diminished or loss of sexual desire. The patient usually has the feeling of guilt that he/she has committed a grave crime, with hallucinations (voices of people accusing the patient of bad deeds, or condemning him/her to death. Others believe that they have incurable diseases like cancer or AIDs). Very rarely, the patient with this psychotic depression kill family members (“to save them from future misfortunes in life”) and kills himself/herself.
How rampant is depression?
In the United States, depression affects about 17 million Americans. More than 2/3 or 75 percent of them do not benefit from proper therapy because of patient’s inability to seek counseling, misunderstanding of the condition or misdiagnosis. Most people do not seek professional help because the condition is very common and many of them mild or subclinical (with no obvious symptoms). Sometimes, even physicians miss making the correct diagnosis in earnest, thinking the patient’s complaints could be due to some medication interaction.
Are there screening tests for depression?
Yes, there are. Mental health specialists can administer preliminary tests such as the BDI (Beck Depression Inventory), or the HRS (Hamilton Rating Scale), which is composed of 20 questions to screen the patient. Today, computerized phone interviews are gaining effectivity as a screening tool. These tests are only a small part of the evaluation process, because the specialists have the symptoms of the patient and other criteria to aid them make the correct diagnosis.
Don’t we all get depressed sometimes?
To some degree, when the situations demand it, normal people develop a mild form of depression, which is transient, self-terminating, and not a disease. As long as the resultant symptoms are trivial and temporary, and do not debilitate the person, the condition does not need any medical treatment.
What foods relieve depression?
Foods that are high in tryptophan, an amino acid involve in serotonin production, provide relief to some people with depression. Niacin (Vitamin B3), which is essential in the production of tryptophan, can be found in dried peas, beans, whole grains, dried fortified cereals, and especially in oily fishes like salmon and mackerel. It is reported that Omega-3 polyunsaturated fatty acids in fish oil may actually reduce depression. PMS Escape, a high carbohydrate drink, is claimed to increase tryptophan level and may control the depression related to pre-menopausal syndrome for about 3 hours. However, there are impurities in the L-tryptophan diet supplements that are associated with EMS (eosinophilia-myalgia syndrome), which increases the white blood cells and causes muscle pains. In 1989, there was an epidemic of EMS.
Does calcium help alleviate depression?
Calcium supplements and Vitamin B-12 have been reported to reduce pre-menstrual depression. Also, some studies showed that among depressed people who drink caffeinated beverages have a lower incidence of suicide, which seems to suggest that coffee or tea reduces depression.
How about exercises?
Believe it or not, physical exercises may be as effective as psychotherapy in the management of mild to moderate depression. Prolonged aerobic workouts lead to higher levels of serotonin, adrenalin, endorphins and dopamine in the brain (producing the popular term “runner’s high”). Physical exercises, brisk walking, ballroom dancing, yoga, tae-bo, etc. lead to better emotional health. As an extra bonus from physical exercises, weight loss and improved muscle tone lead to the sense of well-being and higher self-esteem.
What about the spiritual venue?
This is one great aid in the management of depression, especially the mild and moderate ones. Those individuals with strong spiritual faiths have a relatively lower predisposition to depression. These people might benefit from meditation, yoga, and other techniques for obtaining spiritual security, inner peace and happiness.
What are the therapy guidelines?
Among adults who suffer from major or chronic depression, a trial of antidepressant drugs is used, together with psychotherapy that is designed for the particular patient. For those who do not improve with this strategy, ECT (electroconvulsive therapy) have been found to be effective and safe. If this fails, psychosurgery might be indicated.
How about for children?
Children and adolescents with major depression have been found in clinical studies to respond as well to placebos (sugar pills) as to tricyclic antidepressants, especially the newer ones, the SSRIs (selective serotonin reuptake inhibitors. For these group of young patients, a trial of psychotherapy (cognitive-behavioral or supportive therapy) is preferred before they are placed on antidepressant drugs.
Do you have depression?
If you do, it is most prudent to seek medical help, not necessarily psychotherapy. The first thing to do it to consult your family physician, who can help guide you. With early proper medication and/or advice, depression in most cases can be managed effectively and eliminated faster than one can imagine. Physicians today have invaluable tools in their armamentarium for the diagnosis and treatment of depression. Many individuals with depression, who have sought medical care, are so “cured” with simple oral medications that they look, behave, function and live as normally and happily as anybody else, lost in the sea of anonymity.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
