Depression : It’s More Than ‘Just A Bad Day’

William Styron, in his memoir Darkness visible, has vividly explained about his tryst with depression, comparing the pain and agony of mental health as that of a heart attack. He defines depression as the ‘grey drizzle of unrelenting horror’.

Depression is no longer a dark, terrible secret which you need to hide from the world. More and more people are now ready to break their silence about this perennial plague of the human mind which had been concealed by cultural baggage all these years. The earliest understanding of depression was a spiritual condition caused by demonic possession. It was Hippocrates who described it as a disease named ‘melancholia’, but he included all kinds of quiet insanity under this term. This concept was repeatedly moulded and reconceived, to give rise to our current understanding of depression.

What is Depression?

Depression is a mood disorder that causes distressing symptoms with a persistent feeling of sadness, pessimism, guilt, or hopelessness that can last for weeks, months, or years.

According to WHO, depression is the leading cause of disability in the world. It comes in various forms, but as it is intangible and imperceptible, it is a lot difficult to diagnose, empathise, and understand the situation. It is important to understand the difference between clinical depression and feeling sad. Almost everyone feels blue from time to time; failing an examination, an illness, losing a loved one, or even an argument can make you sad. This is completely normal and as the situation changes, we learn to cope with our emotions and return to normalcy.

Clinical depression on the other hand is a debilitating medical condition that continues for at least two or more weeks consecutively, significantly affecting physical, emotional, social wellbeing and interfering with the ability to work. Sometimes it may also be accompanied by anxiety, as both of them stem from the same vulnerability. Because of its complexity, understanding depression has been elusive, yet even in the most severe cases, depression is highly treatable.

Causes

Neuroscientists still don’t have the real answer as to what exactly causes depression. It is a result of a complex interaction of genetic, biological, and psychological factors that may be caused by faulty mood regulation by the brain and triggered by a negative experience or a stressful condition. We all have to encounter stressful events at some point in life, and we all feel sad, but not everyone develops a mood disorder. Our genetic makeup influences how we react to the situation. Negative life events or stress set-in a negative thought pattern or a habit of ruminating on the experience, that lead to a downward spiralling of mood. Depression is often cyclical and subsequent episodes may occur without any trigger.

Changes in hormonal levels like menopause, childbirth or thyroid disorders, or seasonal variations can also lead to the onset of depression. 

Symptoms of depression 

Symptoms of depression may occur only once or recurrent and sometimes, last a lifetime. It might occur without any reason or may be precipitated by a life event. The severity of symptoms varies widely from person to person, but there are some standard symptoms, which affect the way you act and thereby impact your relationships. 

•  Low mood and feeling sad almost every day.
•  Lack of interest in activities previously enjoyed.
•  Change in appetite; overeating or eating too less.
•  Feeling of worthlessness, hopelessness and guilt.
•  Sleeping disorders; sleeping too much or too little.
•  Having trouble concentrating or making decisions.
•  Gain or loss in weight of more than 5% in a month.
•  Being restless or being too slow.
•  Loss of energy or fatigue almost every day.
•  Recurrent thoughts of self-injury or suicide.

Structural alterations of the brain are evident in the MRI of people suffering from depression, including reduction in hippocampal volume and abnormal inhibition and excitation of prefrontal cortex of the brain, the part of the brain which governs cognitive control.

Depression is associated with abnormal transmission or depletion of neurotransmitters like dopamine, serotonin, and norepinephrine, altered circadian rhythms with changes in REM, and slow-wave parts of the sleep cycle or hormonal abnormalities like high cortisol levels or deregulated thyroid levels.

Types of Depression

Depressive disorders can affect anyone, and can come in many forms. The severity of symptoms varies according to the type of depressive disorder. 

•  Major depressive disorder/ Clinical depression- is marked by persistent sadness and low mood that can have profound effects on the ability to function properly, and may persist every day for at least two weeks and may last for months or years. It can occur several times or only once in a lifetime. During a major depressive episode, the person might exhibit psychotic symptoms like irritability, delusions or false beliefs and hallucinations, or false perceptions.  The person may lose touch with reality, in which case it is termed as mania, or in milder cases as hypomania. Major depressive episodes may occur within the first two to three months of the childbirth, which is termed as postpartum depression.
•  Persistent Depressive Disorder- also called ‘dysthymia’, it is a chronic form of depression, with less intense symptoms as compared to major depression, but the duration is longer. The symptoms are constant, lasting for years and the person might start believing that this is a part of his or her character, thus they may not seek help.
•  Seasonal Affective Disorder- is a type of depression related to changes in seasons, making one feel lethargic and moody. It occurs every year at the same time.  It is usually seen in winters when days are shorter and a less common form of SAD causes depression in summer months. The reduced warmth, sunlight, and colour of winter gives a sense of melancholy and speculated to be a possible trigger for SAD. Winters disrupt the circadian rhythm, leaving you to feel disoriented, groggy along with reduced production of melanin and serotonin which regulate mood and alertness. This might be the cause for feeling depressed in colder climates. For a clinical diagnosis, these cyclical symptoms should appear for two or more consecutive years. 

How to cope with depression?

•  Set daily goals and try to engage yourself in fun activities that you enjoy doing.
•  Try to follow a routine and avoid alcohol, drugs, and caffeine.
•  Keep a journal and note down the pleasant things that you experience daily. Figure out things that trigger stress and find ways to tackle it and regain control.
•  Take good care of yourself and sleep, eat healthy, and exercise regularly.
•  Reach out to family and friends when you feel down. The nature of depression makes it hard to reach out for help and you may feel exhausted to talk about your situation, but understand that it’s just the depression talking. Staying connected with people who care will make a difference in your outlook towards life and uplift your spirit.
•  Never hesitate to seek professional help and continue medications according to the doctor’s directions. Never stop medications without consulting with your doctor, if you start feeling good. Depression causes mood to fluctuate and a few good days don’t necessarily mean that it has passed.

How to help a person with depression?

If someone you know is suffering from depression, caring for them can be overwhelming at times. But your companionship and support can play a crucial role in your loved one’s path to recovery. The first thing you can do is to talk openly to your friend or family member who is facing symptoms of depression.

•  Depression is a treatable yet a serious condition. Don’t expect that the person will just come out of this on his own. Explain that it is not a personal flaw or weakness and it will get better with treatment.
•  Listen to your friend, and understand their concerns. Instead of assuming, ask questions, validate their feelings, show empathy, and don’t try to advise them.
•  Help them to find a therapist and help them prepare a list of things they need to discuss with their health care professional. If they feel particularly depressed on days and speak of skipping medicines or therapy, be supportive but encourage them to talk about this to their doctor.
•  Do not minimise their pain or label them as being weak. If you have not experienced depression yourself, avoid telling a depressed person that you understand how it feels.
•  If you suspect that the person is going to harm himself, directly confront them and ask if they are having thoughts of self-injury. A direct approach will help them overcome these thoughts. Try to make the environment safe and separate them from anything they could use to hurt themselves. Seek professional help as soon as possible and discuss the situation with the doctor.

Depression and suicide

The sadness, despair, and hopelessness that comes along with depression can make one believe in the fact that death is the only escape. Depression is a major risk factor for self-harm and suicide. Look out for warning signs if any of your friends or loved ones suffer from depression:

•  Frequently talking about harming or killing oneself
•  Acting recklessly
•  Talking about feeling hopeless and being in intense, unbearable pain
•  Sleeping too much or too less
•  Isolating themselves all of a sudden
•  Having extreme mood swings
•  Unusual preoccupation with death
•  Preparing for death; like updating a will, saying goodbye to others
•  Suddenly acting calm and happy

Ayurveda and depression

Ayurveda believes that good health is the result of the equilibrium of a happy mind and a healthy body. Mind along with body and consciousness form the three pillars of life, the balance of which determines one’s health. The basic philosophy of Ayurveda is to maintain this balance and thus promote a peaceful and fruitful life. Depression, stress, anxiety, and sadness although experienced by all, have different triggers and outcomes according to the mental and body constitution of the individual and this is why a highly customized health system like Ayurveda has immense potential in strengthening the mind and spirit to help fight depression. Understanding and gaining consciousness about self is the first step in Ayurveda, which will not only help in bringing in mindfulness but also help you decide and find out what will work best for you. From lifestyle changes to following routines and dosha specific diet, Ayurveda helps to soothe mind, body, and spirit. Ayurveda like the tridoshas of the body has described three manogunas or qualities of mind- sattva (balance or harmony), rajas (restlessness), and tamas (chaotic), which determine the personality and state of mind of an individual.

Depression is mentioned in Ayurveda as Vishada, which is a condition arising from the apprehension of the future, resulting in the incapability of mind and body to function properly and it increases the range of all diseases. It happens mainly due to vitiation of kapha dosha although vata and pitta dosha vitiation is also seen.

•  Vataja depression may be caused by traumatic events, lack of sleep, habitual consumption of dry food items, or other vata provoking habits. The symptom includes excessive guilt, anxiety, restlessness, and distraction.
•  Pittaja depression is characterised by anger, irritability, and violent outbursts. Suicidal tendencies and chances of substance abuse are higher in pittaja depression and they have low self-esteem.
•  Kaphaja depression will cause lethargy and sluggishness along with eating disorders and feelings of worthlessness.

Depression is more common among those with Tamasika manasa prakruti or a chaotic mind. Unlike shareera prakruti or somatic constitution, manasa is highly unstable and quickly fluctuates. The predominant manoguna at the time of any event will affect our perceptions and so practicing self-observation and will-power to consciously shift our thoughts and actions from tamas and rajas towards sattvic balance is the aim of Ayurveda.

Ayurveda helps in understanding the nature and cause of depression and strengthening the mind utilising natural, simple and effective measures that promote psychological health and inner contentment and peace. Planning daily habits with an awareness of one’s own body, choosing the right food, appropriate use of time while finding time for leisure activities and rest are all essential to maintain a healthy state of mind. 

Practicing Yoga, Pranayama and meditation, helps in coping with accumulated stress, brings in mindfulness, and develops a positive outlook towards life. Focusing on the breath will not only help to distract one from negative emotions, but it will also build up coping mechanisms and adaptive strength of mind. Yoga and meditation will help to reconnect and understand the needs of mind and body better and improve control over your negative thoughts. Yoga is a natural method to increase serotonin and lowers cortisol levels which helps in improving mood and modulates the stress response system. This decreases physiological arousal, reducing heart rate, and improving the body’s ability to respond to stress.

Depression, although a very difficult disease, is very easily treatable. What we as a society need to create is an environment where anyone can openly talk about mental health and seek help without the fear of being mocked and judged. We need to be more empathetic towards anyone who is having a difficult time and support them, so they don’t feel isolated and worthless. Mental health is as important as physical health and we should never hesitate to communicate. Life is precious and we have all right and duty to enjoy and preserve life.