depression what is this?

 Ravi, a 20 year old second b.com student , son of a civil servant was brought to me for treatment. He was reluctant to speak to me infront of his father.as soon as his father went out he started  narrating his problems.

He was a good student in his college and he scored a distinction in his first year .He wanted to pursue chartered accountancy course and he had been pursuing an extra course for that too.but off late he observed that he is losing interest in studies , he feels disinterested to mix with friends, feels very tired to travel to and fro in his bike.he would earlier take pride in updating his facebook profile and would often chat on his WhatsApp with his friends.but now a days he finds this disinteresting .he sleeps late , wakes up late..doesnt feel like mixing with his friends, doesn't answer to their calls or messages.what is bothering him off late is few unusual thoughts he gets..like thinking of putting an end to his life..he gets these thoughts repeatedly, usually when alone.he says he tries his best not to think of this..but these thoughts haunt him.he does not want to tell this to anyone and he often thinks of committing the act.he showed me his previously typed statuses on his whatsapp which read " the end @ 2.30" .he did not get the courage and he changed it to " attempt averted, better luck next time"..he was telling all this , without blinking his eyes..he was telling it taking his own time..

I just heard him , noted down few points as he narratted. He sighed as he finished and said..at least you heard me without an interruption.

Yes, ravi was depressed..this is what we psychiatrists call as depression. 

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable.

 Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

Feeling sad or having a depressed mood,

Loss of interest or pleasure in activities once enjoyed,Changes in appetite — weight loss or gain ,

Trouble sleeping or sleeping too much

Loss of energy or increased fatigue

Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)Feeling worthless or guilty

Difficulty thinking, concentrating or making decisions

Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression.

Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.

Several factors can play a role in depression:

Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.

Genetics: Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.

Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.

Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression

WHAT WERE THE OPTIONS LEFT TO RAVI?

Depression is among the most treatable of mental disorders. Between 80 percent and 90 percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.

Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and possibly a physical examination.

In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem OR vitamin deficiency.

Medication: Brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry. These medications are not sedatives, or tranquilizers. They are not habit-forming. Generally antidepressant medications have no stimulating effect on people not experiencing depression.

Antidepressants may produce some improvement within the first week or two of use. Full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute another antidepressant. In some situations other psychotropic medications may be helpful. 

Psychiatrists usually recommend that patients continue to take medication for six or more months after symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk of reccurence.

Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, psychotherapy is often used in along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on the present and problem solving. CBT helps a person to recognize distorted thinking and then change behaviors and thinking.

Psychotherapy may involve only the individual, but it can include others. For example, family therapy can help address issues within these close relationships. 

Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions.

Here ravi was talking of suicide..he was showing his preparation for suicide.would above options help or something more was needed ?

such patients are considered for electroroconvulsive Therapy (ECT) which is a medical treatment most commonly used for patients with severe major depression or bipolar disorder who have not responded to other treatments. It involves a brief electrical stimulation of the brain while the patient is under anesthesia. A patient typically receives ECT two to three times a week for a total of six to 12 treatments. ECT has been used since the 1940s, and many years of research have led to major improvements. Its not as barbaric as shown in our indian films.

Self-help and Coping

There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improve mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

Depression is a real illness and help is available.

First step in treatment of depression is encouraging a person to talk.Making a person motivated to talk. Is the first step. ravi had taken the first step ..talking about his problems..and as a doctor i was allowing him to ventilate as all these options for him  browsed across my brain..

Please understand that there are many ravi's in and around us who need help.let us propagate the message that " depression is a medical disease" and lets talk about it.let us spread the message of treatment for depression.

Dr.P.V.Bhandary,Psychiatrist, udupi

This article was written by me for an internet magazine youth zone in April 2017. Modified a bit.