Defeating Depression

 Prof. Dr. Shyam P Lohani


Healthy life encompasses all dimensions of physical, psychological, social and spiritual health. We often give more emphasis to physical health and ignore the other aspects of a healthy life. It is natural for a person to become sad or feel bereaved to a loss of someone which is mostly short-lived. The problem arises when a person becomes persistently sad, loses interest in activities once enjoyable and becomes unable to carry out daily activities continuously for at least two weeks. The condition is called depression. This debilitating condition affects a large number of people in the world. Many people suffer from such a condition at least once in their lifetimes. Majority of those people do not get appropriate treatment and suffer it silently and among them, many also succumb to suicide.

Epidemiology
Globally, more than 300 million people of all ages suffer from depression (WHO, 2018). It is a serious mental condition in which a person's feeling, interest and thinking all are affected. It can affect both psychological and physical aspects and lead to a decrease in the ability to perform a task at home and work. The symptoms of depression may include feeling sad or having a depressed mood, loss of pleasure in activities once enjoyed, changes in appetite resulting in weight loss or weight gain and trouble sleeping or sleeping too much. Other symptoms are feeling worthless or guilty, loss of energy or increased fatigue, difficulty in thinking patterns, lack of concentration or poor decision-making ability, increase in purposeless physical activities and thoughts of death or suicide. Depending on the severity it can range from mild to severe.
One in 15 adults (6.7 per cent) is affected by depression in any given year, and one in six people (16.6 per cent) will experience depression at some time in their life. The first episode of depression occurs at late teenage to mid-20s (American Psychiatric Association, 2017).  Females are more likely to suffer from depression than males and studies have shown that about one-third of females suffer an episode of depression at least once in their lifetimes. Every person experiences adverse events in their lives. Loss of loved ones, termination of a job, and loss in business, the breakup of a relationship and prosecution of relatives for criminal activities are some of the adverse life events which can trigger a feeling of sadness which mimic the some of the symptoms of depression. Both grief and depression share some of the symptoms such as sadness and withdrawal from usual activities but are different. Painful feeling in grief is usually abated within two weeks of event and self-esteem is usually intact. Grief and depression are usually co-existing and the duration of grief is longer when co-existed with depression.  
Depression can affect anyone, of all ages and gender and even of people with high financial condition. There are many risk factors for depression. Biochemical, genetic, personality and environment factors may predispose depression.  Alteration of certain chemicals in the brain, familial history, person with low self-esteem who is pessimist may suffer from depression. The continuous exposure of environmental factors such as violence, poverty, neglect or abuse leads vulnerable people to depression.
There is a strong relationship between depression and physical health. People suffering from chronic diseases such as diabetes, cancer, cardiovascular and respiratory diseases are more likely to develop depression. This type of mental health problem, in turn, may predispose a person to many of the chronic diseases such as diabetes and, cardiovascular disease. The person with depression usually has unhealthy lifestyles such as eating habits, smoking, alcohol abuse, less exercise and weight gain which are potential risk factors for non-communicable diseases such as diabetes and cardiovascular diseases. Depressed people are also less likely to manage their chronic conditions. The good news is that there are treatments for both chronic diseases and depression. The treatment and management of chronic diseases may have a positive effect on depression.
There has been a stigma associated with many of the mental illnesses including depression. The large majority of people with those mental illnesses do not get much-needed treatments. It has been estimated that up to 85 per cent of people in low and middle-income countries do not get the required treatment for mental illnesses. The exact burden of disease due to depression among the Nepali population is not known. However, its relation with physical health such as non-communicable diseases cannot be ignored and a significant proportion of which might have caused due to depression and other mental health conditions.

Research
A large national-level research on mental health has been initiated in Nepal (NHRC, 2017). The result of which is expected to provide background information required to develop national policy and guidelines for effective management of those conditions. There is a dearth of needed manpower for managing those conditions in Nepal. The country needs to emphasise the training of psychosocial counsellors, clinical psychologists, and psychiatrists. Preventive programmes have been found effective in reducing the prevalence of depression. The school-based counselling programmes for enhancing positive thinking, parenteral counseling of children having behavioural problems in school as well as the promotion of yoga, meditation and exercise for those with chronic diseases and elderly population can be effective preventive measures.
There are effective treatments for moderate and severe depression. The cognitive-behavioural therapy (CBT), individual psychotherapy or antipsychotic medications or both are treatment modalities depending upon severity. Mild depression can be managed with psychosocial counselling without medication. It is recommended that government develop large scale promotional programmes throughout the country targeting families and community to identify people in need of help and avail facilities for psychological interventions.

(Prof. Lohani is the Clinical Director of the Nepal Drug and Poison Information Centre and can be reached at [email protected]) 

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