Aditya Modi *, an entrepreneur in his mid-50s, is married, with two teenaged children, and runs a successful retail business in New Delhi. In 2005, Modi’s firm suffered a serious financial setback. The events that unfolded, and the subsequent damage to the firm, were not something Modi had control over, yet he felt he had failed personally. The events triggered a depressive illness. He did not have the usual symptoms that would indicate depression: He didn’t feel sad or have crying spells. But what he did suffer from was a loss of energy, a lack of sexual desire and insomnia. He would tire after just a couple of hours of work and would often head home to rest. Modi was experiencing somatic, or bodily, symptoms of depression rather than emotional ones.
His family took him to a number of doctors and he underwent a variety of tests, all of which confirmed that he was physically healthy. His family doctor then suggested a visit to the psychiatrist since he suspected that Modi was clinically depressed and needed medical help.
The psychiatrist diagnosed him with Major Depression (MD) and prescribed a selective serotonin reuptake inhibitor, or SSRI, antidepressant. SSRIs help to keep serotonin, a neurotransmitter in the brain, around longer; this in turn facilitates better communication between brain cells and lifts the mood. After taking SSRI regularly for eight weeks, Modi began to feel better but was still not completely well. At that point he was asked to see a psychologist for cognitive behavioural therapy (CBT), which the psychiatrist thought necessary along with the medication. Though Modi was initially reluctant, at the family’s insistence he went to therapy. As the sessions went along, he found that he felt more energetic, and became more willing to talk to the psychologist and follow his advice. Three months later, and about six months after his first appointment with the psychiatrist, Modi felt like himself again. His energy levels were back, he was sleeping better and he was in the office full time.
Symptoms and complexities
Everyone grieves or feels sad and lonely sometime in their lives. Life has its setbacks and challenges, and the feelings that accompany those experiences are part of being human. These feelings usually resolve over time, leaving people more experienced and resilient than before.
Sometimes, however, the resolution seems hard to attain. Feelings of sadness may linger for weeks and months despite efforts to overcome them.
When a person starts having difficulty concentrating, so that office work which used to be a breeze now seems impossibly challenging, when he or she no longer enjoys playing his or her favourite sport or spending time with friends, when exercise becomes an even bigger chore than usual, when tiredness becomes a way of life—these could be signs that the person is suffering from MD, or Unipolar Depression. Another common form of depression is Dysthymia or Dysthymic Disorder. This is a milder cousin of MD, and people with Dysthymia often take a negative or discouraging view of themselves, their future and life events.
Other forms of depression include manic depression, seasonal affective disorder, post-natal depression and psychosis. The symptoms of these disorders differ from MD and Dysthymia.
Brushed under the carpet: Doctors say a very small percentage of men suffering from Major Depression seek treatment.
MD is not a disease of the 21st century, it has been around for at least 2,000 years. Hippocrates and his followers (300-400 BC) documented the symptoms of depression, anxiety and dementia. But MD is on the increase now. The World Health Organization (WHO) has forecast that by 2020, depression will be the second leading contributor to the global disease burden after heart disease. Andrew Solomon, in his book Noonday Demon, an Anatomy of Depression, writes: “Fortunately, we have developed systems for coping with the problem. We have medications that address the organic disturbances, and therapies that address the emotional upheavals of chronic disease. Depression is an increasing cost for our society, but it is not ruinous.”
Treatment and cure
MD is caused by a complex interaction between our genes, the environment in which we grew up and our present environment. More than 120 million people suffer from MD worldwide and it is the leading cause of disability among men and women between 15 years and 44 years, according to the WHO. MD has traditionally been considered a woman’s disease but it is common among men too, says Shamsah Sonawalla, associate director, psychiatry research and consultant psychiatrist, Jaslok Hospital and Research Centre, Mumbai. Yet globally—India included—only a small percentage of men suffering from MD seek treatment, says Dr Sonawalla.
MD is a disorder of the brain, and a depressed brain is a brain in neurochemical imbalance. Sandeep Vohra, senior consultant, department of psychiatry, Indraprastha Apollo Hospitals, New Delhi, says that 20 years ago psychiatric treatment of MD usually meant that the patient was given sedatives called benzodiazepines, which could produce dependency and lead to addiction. Now psychiatric medicine has advanced to a point where medicines other than benzodiazepines (though these too are still in use today) are prescribed; these are not addictive. These medicines do have minor side effects but most people develop a gradual tolerance to them, says Dr Vohra.
Apart from the psychiatric drugs, therapy with a licensed and trained clinical psychologist is an important part of recovering from MD. A review published in the 6 January 2010 issue of the Journal of the American Medical Association—written by Jay C. Fournier and colleagues—found that the magnitude of the benefit of antidepressant medication increases with the severity of the symptoms of depression. In other words, the usefulness of the medication depends on the extent of disease. Therapy, on the other hand, is known to work for all levels of depression.
Therapy can involve a combination of CBT and psychodynamic therapy, says Ashima Puri, clinical psychologist with Aashlok Hospital, New Delhi. CBT is based on the concept that your thoughts make you feel a particular way and these feelings make you act in a certain way. With CBT, you are armed with the tools to think differently and over time the intensity and frequency of negative emotions reduce. Usually, psychologists use a combination of CBT and psychodynamic therapy to treat MD, says Puri. In some cases of Dysthymia, therapy alone is sufficient to cure the patient. However, for MD, Dr Sonawalla, Dr Vohra and Puri concur that what works best for most people is a combination of medication and therapy.
Some psychiatrists and clinical psychologists are also prescribing yoga as part of the treatment plan. Dr Sonawalla and Anjali Chabbria—a psychiatrist who runs MindTemple, a counselling centre in Juhu, Mumbai—are both of the opinion that bringing yoga in as a lifestyle change when the patient is on the path to recovery can go a long way in empowering the patient and reducing the chances of a relapse. Dr Sonawalla, however, cautions that the patient should be open to yoga and not feel pressured into doing the asanas.
To conclude, the point that Solomon makes in his book is an important one: MD is a disease like any other and it can be treated effectively. While the experience of it may leave you feeling hopeless, there is relief right around the corner.
THE SIDE EFFECTS OF MD
A study by M.M. Weissman and his colleagues, published in the ‘American Journal of Psychiatry’ in June 2006, observed the children of depressed parents over a span of 20 years. The study found that by the age of 35, children with one depressed parent had a threefold risk of developing MD and a sixfold risk of abusing drugs, compared with children whose parents hadn’t suffered from depression. It is important to seek treatment not only for your sake, but also to secure the mental health of your children.
THE MD MYTHS
A few ideas that keep people from seeking treatment for depression
If you are suffering from MD, you’ll feel sad and low for months, even years.
THE TRUTH:Anywhere between 60% and 80% of those who seek treatment improve over time—most of these people will feel better in a couple of months.
Major Depression is the sign of a weak will.
THE TRUTH: Willpower has as much to do with MD as it does with heart disease— absolutely nothing.
Depressive disorders can be cured with positive thinking and prayer.
THE TRUTH: Positive thinking and prayer are very important elements in recovering from any disease, but they are not substitutes for sound medical help.
Source: www.who.int, Dr Shamsah Sonawalla, Ashima Puri and Dr Anjali Chabbria.
*Name changed to protect privacy.
Sujata Kelkar Shetty writes on public health issues and is a research scientist trained at the National Institutes of Health in Bethesda, US.
Write to us at