Depression: The Untold Story

By Basmaa Ali, MD

 

Poets refer to depression as malaise of the soul, or a grayness of being. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes it as “persistent depressed mood and/or pervasive loss of interest/pleasure” for most of the day, nearly every day, for at least two weeks accompanied by three of more of the following symptoms:

 

·                    Sleep disorder

·                    Change in weight or appetite

·                    Fatigue/loss of energy

·                    Impaired cognition, judgment, reasoning and/or decision-making

·                    Difficulty concentrating/indecisiveness

·                    Guilt/low self-esteem

·                    Recurrent thoughts of death or suicide

 

Depression is the most common mental ailment in the western world. However, it is the quantity rather than the quality of symptoms that separates those who need professional help from others who need a friend. About 20 percent of us will experience an episode of major depression during our lifetime, but almost all of us will experience depressive symptoms at some point.

 

We do not understand mood at a biochemical level very well, but we know that the composite effect of several neurotransmitters – chemicals that transmitmessages from one neuron to another – is felt as mood. External events affect these neurotransmitters. Depression is a predominance of sad neurotransmitters over happy ones for prolonged periods. It follows that depression inherently is of two types:

 

1.                  An absolute scarcity of happy neurotransmitters or abundance of sad neurotransmitters, or endogenous depression (affecting a small percentage of us)

2.                  A relative scarcity of happy neurotransmitters or abundance of sad neurotransmitters in response to an external event, or exogenous depression (affecting the vast majority of us)

 

People with endogenous depression need medication to recalibrate their neurotransmitter levels. These medications attempt to reset the chemical balance in the brain in favor of happy neurotransmitters. However, they cannot override stimulus from our emotional or cognitive centers and will not help in the long term unless the underlying issue is resolved. In fact, recent research suggests these medications may not help many people with depression, and they need to be used with great care in children and adolescents.

 

Medication is, therefore, a therapeutic tool but people still have to be willing to help themselves. This can be difficult because:

 

A.                 Popular culture tells us drugs alone can fix our problems.

B.                 Events giving rise to depression are traumatizing and the sufferer may have no interest in recovery.

C.                 True recovery requires a compassionate review of who the sufferer is. This introspection is not a group activity and loneliness is not easy to bear, especially when a person is depressed to begin with.

 

The work of self-examination can be made much easier with integrative medicine, or patient-centered care in which the patient and doctor together choose the best allopathic and complementary practices to preserve health, increase longevity and speed recovery from illness.

 

·                    Counseling: Find a psychiatrist or clinical psychologist who is invested in your recovery. This is by far the most important qualification of a counselor.

·                    Group therapy: Depression is very isolating and connecting with people who have or are suffering from the same issues can break through the wall of loneliness.

·                    Practices like yoga and meditation are invaluable in recovery. They need to be undertaken under the supervision of a teacher or physician familiar with integrative medicine techniques since symptoms can worsen before they get better.

·                    If symptoms are mild, herbal remedies like St John’s Wort are worth trying before moving onto medication. Supervision is the key.

·                    Friends and family: Lean on them.

 

Depression is a warning system that tells us all is not well deep in our hearts. It can be as simple and searing as the loss of a loved one, or as complicated as betrayal. Use the warning to carve out real change in your life.