Category Archives: Awareness

How do I know if it’s just a phase or if it’s something serious?

Psychiatric diagnosis are not made on the basis of checklists  – even though the checklists are very helpful

Depression and related mental health problems are complex and have multiple “causes”. This is important to understand before anyone is to answer the question of whether some is simply dejected due to the life events or is depressed as in ill. The current understand of depression and related mental health condition is that they are Bio-Psycho and Social in nature. This means that they have causes and effects in each of these three realms namely biological, psychological and social.

Let me explain this further with a few examples with depression as the core illness category. There are individuals who experience symptoms of depression such as continuous low mood that does not improve in any situation, crying spells, lack of interest in all activities, changes in sleep and appetite, energy levels and so on and so forth in the absence of any clear environmental precipitating event. Here we would consider a diagnosis of Depression (i.e. biological cause) if the symptoms cause sufficient dysfunction. Now on the flip side, persons with depression (whether life situation related/ biological) have a tendency to be more sedentary (or be less active overall compared to previously). This leads them to have a higher risk of developing certain lifestyle related disorders including elevated blood pressures, risk of cardiac disease and so on. Here the diagnosis has changed certain aspects of biology. There are similar effects and causes in the psychological and social realms.

A diagnosis of depression is made after understanding the context of the emergence of symptoms, the symptoms themselves and the degree of impairment in functioning afforded by the symptoms.

Now, how do we integrate this knowledge with what we already know. The first thing is that psychiatric diagnosis are not made on the basis of checklists (even though the checklists are very helpful). A diagnosis of depression is made after understanding the context of the emergence of symptoms, the symptoms themselves and the degree of impairment in functioning afforded by the symptoms.

Impairment is the core of what psychiatry would aim to reduce.

What is this impairment? Of the many definitions available, the easiest to use is that impairment is the difficulty that mediates the long term outcome related to the illness. Basically what does this illness do that prevents the person fulfill his/ her role. In order to reduce the impairment (again which is Bio-Psycho-Social in nature), treating the underlying symptoms will be essential in a biological, psychological and social fashion.

So, the long and short of it would be that the degree of dysfunction/ impairment, in the context of the presence/ absence of sufficient number of symptoms while keeping in mind the context in which the symptoms emerge determine whether a label of depression is applied to a person or not.

Finally the person who is suffering does not care about whether they have a label or not, all that they care about is not suffering as much – whatever the person who is willing to help can do.

-Dr. Shiva Prakash

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Age Groups Vulnerable to Depression?

Depression is a common problem throughout an individual’s lifespan. Statistics suggest that about one in 20 individuals would have suffered depression at some point of time in their life. But this data is not representative of all individuals. There are some common risk factors that increase the risk of having depression. One of the most common risk factors is experiencing interpersonal violence in any form. This may be

  • physical and emotional abuse and neglect in childhood,
  • bullying during school ,
  • social ostracism in teenage and college,
  • domestic and workplace related violence of any sort in middle and older adulthood.

risk-factors

Other common risk factors include academic difficulties, physical illnesses, loss of significant relationships, financial difficulties, family history of depression and social isolation.

Typically, people in the age group of 40-60 years have the highest rates of depression possibly due to accumulation of stress over their lifespan. The risk of attempting suicide is higher in teenagers and young adults especially in situations of acute crisis while the risk of committing suicide is much higher in the elderly.

Over 60% of the calls to suicide help hotlines are made by people in the age group of 35-54

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Therefore, rather than asking if certain age groups are predisposed to depression, it would be more helpful to think in terms of “Are certain groups of individuals facing various life events more likely to develop depression?”  An important thing to keep in mind is that all these are risk factors and not causative for depression. Ideally this information should be used in the context of helping individuals in various life situations that may predispose them to depression.

Once again, it is important to realize that not all those who face the situations mentioned above suffer depression. Also not all those who suffer depression face these issues.

The most important thing to remember is to try and have a non-judgmental outlook and to offer our support to those going through a tough time.

-Dr.Shiva Prakash

Image Credits: Google

In what ways can Depression manifest?

Continuing from the previous discussion, we have noted that depression as an entity is different from sadness or grief. It has some clear biological underpinnings that differentiate it from the others. But, what is evident is the symptoms. Major depression/ clinical depression typically presents with a characteristic cluster of symptoms:

  • Persistent and all-encompassing low mood
  • Fatigue and decreased energy or increased restlessness
  • Loss of interest in all pleasurable activities of the past
  • Difficulty concentrating, remembering details,
  • Associated anxious/ empty feelings or irritability
  • Pessimistic thoughts of helplessness, hopelessness, guilt, or worthlessness
  • Thoughts related to death, suicide and suicide attempts
  • Changes in sleep patterns, appetite (usually reduced) and increased physical complaints

While these are the common symptoms, over the lifespan, depression may present itself in many ways. This may accidentally lead to people stating that they don’t have clinical depression even though they are suffering and at times finding it difficult to function. Symptoms of depression in childhood may differ from the above mentioned symptoms in that there may be features of aggression, anger, excessive crying. Children may also manifest a more reactive mood as compared to the persistent and all-encompassing low mood seen in older individuals.

As children age into preadolescence and adolescence, there may be an increase in irritability associated with reduced social interactions and isolation, reduced or increased sleep, sometimes associated with increased appetite and craving for high carbohydrate diet. Typically, this is more than “adolescent problems” and is associated with dysfunction typically in the form of academic decline, conflict with authority, use of drugs or alcohol. Typically college going people manifest symptoms that include characteristics of symptoms found in both adolescents and adults with a general increase in exposure to drugs and alcohol use, and an increase in self injurious behaviors. As people age, there is a greater likelihood of emergence of physical symptoms of depression.

Keep in mind, that while knowing the symptoms of depression is important for you to seek help, self -diagnosis of mental health issues may do more harm than good. A detailed clinical evaluation by a clinical psychologist or a psychiatrist is essential to make a diagnosis and start treatment.

-Dr. Shiva Prakash

Image credits: Anna Borges / BuzzFeed

What is the difference between Sadness and Depression?

Human beings experience emotions. The most common emotions that we experience are happiness, sadness, fear and anger. Of this sadness is a normal human emotion that we all experience in life when we experience something unpleasant – this could be related to a loss, or a disappointment or the like. It is important to recognize that sadness happens to all people but, it does resolve itself over a period of time.

On the other hand, depression is a complex neurobehavioural disorder characterized by a cluster of symptoms. Persons suffering with depression usually have problems that affect their feelings, behaviors, physical health and overall functioning. Typically persons with depression do not spontaneously feel better as in the case with sadness.

The symptoms of depression are varied – the most characteristic being persistent low mood that would appear to pervade all activities of the individual, a lack of interest in all pleasurable activities and a general sense of tiredness. Physically persons suffering with depression may experience problems with sleep, reduced appetite, increased fatigue, increased physical aches and pains. This may be accompanied by varied thoughts of a negative nature in the form of low self-esteem, not having a hope for the future, a sense of helplessness and so on.

Sadness is natural and fleeting. Depression is a medical disorder that will respond to treatment of a psychological and medical nature. Depression is one of the leading cause of disability as per the WHO. It is associated with significant problems with functioning in the form of not being able to do their work, chores or even studies. It can however be treated with proper help allowing people to lead a normal life once again.

                                  – Dr. Shiva Prakash

Image credits:White Swan Foundation for Mental health