Depressive disorder: More than sadness and depression

Dr. M.S.Reddy, M.D (Psy) at Christian Medical College (CMC) Vellore, Health Care Management at Indian School of Business (ISB), Director, Asha Bipolar Clinic (ABC) Hyderabad, Hony' Secretary of Society for Bipolar Disorders, India (SBDI)

Depression, sadness, depressive disorder are the common terms that everyone is aware of it. A depressive disorder is something much more than sadness and depression. It is estimated that approx. 5% of the total population on this planet suffers from depressive disorders. More than 40% of the cases, it occurs in the population aged less than 20 years that is teenager, adolescent and youngsters suffering from depression. Their education, jobs, marriage all get disturbed. This is the time where the high risk of self-medication with substance abuse. If one of the parent had depression, risk goes up to 10-15%. This tells that there is genetic risk of developing depressive disorder. This play a secondary role in majority of the depressive disorder cases. Postpartum depression is twice more common in women. Postpartum depression is one the most severe thing. Premenstrual depressive disorder which occur during the period of menstruation which often called as miniature of major depressive disorder. There are two main features or symptoms of depression which include diurnal variation that is a significant group of patients with depressive disorder feel miserable in the morning, but in the evening they feel much better. This is something, which is unexplained in the internal neurochemical substance balance-related. Second is that they wake up early in the morning, 1’o clock, 2’oclock, 3’o clock and they feel miserable often. So there are two cardinal features of depression.

Depression is treatable. Depressive disorder occurs in episodes. Depression is treatable, the episode is curable, and treatment is reasonably simple. World Health Organization declared that more than 50% of the patient with depressive disorder do not get adequate treatment. The obvious reasons behind this is lack of awareness. This is so called major morbidity disability with depressive disorder. The reason behind this is heritability that is depressive disorder is genetic. The second thing is neurochemical disturbances in the brain which is supposed to be one of the major reasons. Now the question arises that how do the depressive disorder get treated?  For the treatment, there is an excellent medicine right now which is known as Selective Serotonin Reuptake Inhibitors (SSRIs).

SSRIs have been used for almost for two-three decades. With the use of this group of drug, some patients do well and recover symptomatically. However, some patients have tremendous kind of misconceptions about these drugs. So much of nothing about the side effects, I tell you SSRI is one of the save drugs. Yes, drugs have side effects. But results of clinical studies showed that SSRIs have no long term side effects. Therefore, SSRIs can be given over a long period of time. SSRIs is effective, but the patient should have awareness about it. There is a need to talk about depression and create awareness among the patients so that the patients get the treatment properly. The most important thing in the treatment is that the drug starts acting after about 3-4 weeks. So the patient has to wait to get the effect of the drug.

To summarize, a depressive disorder is something more than simple sadness. To a large extent, it is genetically and neurochemical disturbances in the brain. Approximately, 5% of the population is affected. Depression treatment is very simple. SSRIs are effective drugs for the treatment of depressive disorder. Psychosocial counseling definitely helps but somewhere it is not being done, and that’s the exactly the reason to create more awareness about this particular illness. Because it creates so much morbidity, so each and every patient who is affected by depressive disorder must get proper treatment and should recover, get back into society because social reintegration is going to be the most important thing.

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