Depression is a common problem in advancing years. It causes enormous human suffering and interferes with normal day-to-day life. It causes pain and suffering not only to the patients but also to their carers, much of which is unnecessary. Most people with a depression are unaware of the availability of treatment, though a majority of the sufferers can be helped. Depressive disorders are not the same as a passing sad mood and just cannot be wished away. Without treatment, symptoms last for weeks, months or years.

Depressive disorders come in different forms just as do other illnesses. Major depression is a combination of symptoms which interfere with one’s ability to work, sleep, eat and enjoy pleasurable activities. These disabling episodes of depression can occur several times in a lifetime. A less severe type of depression involves long-term chronic symptoms that do not disable but prevent one from functioning at one’s full capacity or from feeling good. Episodes of major depression can also occur during the course of illness. The third type of depression is manic-depressive psychosis or bipolar disorder. It involves cycles of depression and elation. Sometimes the mood changes can be rapid, though most often they are gradual.

Symptoms of depression are

• Persistent sad, anxious or “empty” mood.
• Feelings of hopelessness and pessimism.
• Feelings of guilt, worthlessness and helplessness.
• Loss of interest in hobbies and activities that were once enjoyed, including sex.
• Insomnia, early-morning awakening or oversleeping.
• Loss of appetite and weight loss or overeating and weight gain.
• Decreased energy, fatigue and being “slowed down”.
• Thoughts of death or suicide and suicide attempts.
• Restlessness, irritability, difficulty in concentrating, forgetfulness and indecisiveness.
• Persistent physical symptoms that do not respond to treatment such as headaches, digestive disorders and chronic pain

Psychological make-up is an important determinant of vulnerability to depression. People with low self-esteem and pessimism, or those who are quickly overwhelmed by stress are prone to depression.

A serious loss, chronic illness, difficult relationship, financial problem or any other unwelcome change in the life pattern can also trigger a depressive episode.

Often a combination of psychological and environmental factors is involved in the onset of a depressive disorder

Diagnosis and treatment

A complete physical and mental examination, and psychological evaluation are the most important steps in diagnosing the presence of a depressive illness and its categorization. Certain medications and medical illnesses can cause depression and should be ruled out by examination, interview and lab tests

There are several treatment choices, which depend on the outcome of the evaluation. There is a variety of anti-depressant medications and psychotherapies that can be used to treat depressive disorders. There are several groups of anti-depressant medicines such as tricyclic anti-depressant, monoamine oxidase inhibitors (MAOIs), lithium and selective serotonin receptor inhibitors (SSRI). Some people respond to psychotherapy while some do well with anti-depressants, but the best treatment is probably a combination of both.

Electroconvulsive therapy (ECT) is the third option which is useful to individuals whose depression is severe and life-threatening, who cannot take anti-depressant medicines and whose response to medications is inadequate.

Patients often stop medication too soon after symptomatic relief. It is important to keep taking the medicines until the physician advises to stop. Some medicines can be stopped gradually while in bipolar disorder or chronic major depression, treatment is life-long.

Anti-depressant drugs are not habit-forming, so one need not be concerned about that. However, as is the case with any type of medication prescribed for more than a few days, anti-depressants have to be carefully monitored to see if one is getting the correct dosage. Many of the anti-depressants interact with other drugs. So the doctor must be consulted before starting a new medicine.

Anti-depressants can cause mild and temporary side-effects in some people which are annoying but not serious. Unusual and serious side-effects or those that interfere with normal functioning should be reported to the doctor. The most common side-effects usually associated with tricyclic anti-depressants are: dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness and drowsiness. The newer anti-depressants have different types of side-effects such as: headache, nausea, nervousness, insomnia and agitation.

Several forms of psychotherapy are available for depression. Psychotherapy by trained counsellors is of immense help

Severe depressive illnesses, particularly those that are recurrent, will require medication and/or ECT along with psychotherapy for the best outcome.

Helping the depressed person

• The most important thing anyone can do for the depressed person is to help him/her get appropriate diagnosis and treatment, and offer emotional support.
• Do not accuse the depressed person of faking illness or of laziness or expect him/her “to snap out of it.” Eventually, with proper treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person that with time and help he/she will feel better
• Remain alert about the risk of suicide.
• Encourage participation by the depressed person in pleasure activities and by providing him/her company

Where to get help

• Family doctor.
• Mental health specialists and counsellors in government or private hospitals.

Non-governmental organizations providing mental health counselling and helpline.