Mental Health

EFFECT ON BODY AND MIND

A person with depression lacks interest in activities, finds it difficult to concentrate, remember details and make decisions.
A feeling of guilt, worthlessness, helplessness, pessimism and irritability is common.
Loss of interest in activities once pleasurable, including sex, is common.
Around 15 per cent people with depression have suicidal tendencies.
Fatigue and lack of energy are the most common symptoms.
Sleep disturbances with early morning wakefulness or excessive sleeping, overeating or appetite loss, persistent aches or pains and headaches are the other common symptoms.
There is a reciprocal link between many ailments and depression. Obesity increases the risk of depression, which, in turn, is predictive of obesity.
The presence of depression or poor response to treatment doubles the risk of death due to heart disease.

Depression is among the most burdensome of mental illnesses. Psychosocial and biological factors predispose women for depression.

Traumatic events such as sexual assault account for higher prevalence of depression in women early in life. Social roles, too, are significant risk factors that explain higher rates of depression in women. Rapid fluctuation of ovarian hormones, increased cortisol (stress hormone) levels and postpartum period (up to six months after childbirth) are other common risk factors.

Symptoms like loss of appetite, sadness and hopelessness, and suicidal thoughts, are found more commonly in depressed women than men. The treatment poses differential challenges. In women, SSRI (specific serotonin reuptake inhibitor) has shown better results than tricyclic agents. Sex hormones, too, influence antidepressant drug metabolism in women, although it has little clinical effect.

Early detection and treatment are crucial in battling depression. Prematurely changing the dose or the drug itself is avoided unless disturbing side effects are seen.

Pregnancy and lactation, too, merit attention when treating depression in women. Though safe, reports caution rare lung consequences in the newborn if the mother uses antidepressants of the SSRI type. The risk of an untreated depression in pregnancy should be compared with that of such adverse consequence in an individual instance. Antidepressant drugs can safely be continued during breast-feeding. Though breast milk transfers the medicines to the infants, drug discontinuation is not recommended, given the risk of depression during the postpartum period.

CAUSES

Depression is a complex illness arising out of an interaction between genetic and environmental factors.
While a family history of depression increases an individual's vulnerability, unlike pure genetic diseases, the risk depends on a number of environmental influences.
Hormonal factors also play a role. Post childbirth, 10 to 15 per cent of women experience postpartum depression.
Stress hormone and thyroid abnormality also result in depression.
Other important factors include abnormalities in brain function and imbalance in brain chemicals.
Factors like negative life events (death or loss) and stress due to financial, work-related or personal factors also play a role, as do problems like social isolation and illnesses like cardiovascular disorders and cancer.
Around 20 per cent people with drug abuse problems have major depression and anxiety.

In women with milder depressive illness, psychological approaches, including yoga, are preferred unless there is a positive history indicating that they need antidepressant drugs.

Patients with depression can learn the yoga postures over 2 to 4 weeks and continue with it for better results. Clinical research points to the antidepressant effects of yogasana and pranayama in optimal combination. Yoga lowers cortisol levels.

Formal/ structured psychological therapies include cognitive behaviour therapy. This entails sessions spaced out over weeks.

In more severe cases of depression, wherein the patient doesn't respond to the above-mentioned treatments, other approaches are being tested. These are broadly called brain stimulation therapies.

The oldest and time-tested one among them is electroconvulsive therapy. This is administered under short-acting anaesthesia over 6 to 8 sessions spaced out to twice or thrice a week. Though this is by far the most potent antidepressant treatment, other brain stimulations have also attracted attention.

Transcranial magnetic stimulation uses high intensity magnetic pulses applied over chosen areas on the head. Its advantage is that it does not need anaesthesia and hence is a safer outpatient procedure. Likewise, attempts have been made to apply low-intensity direct current over select areas on the head to obtain antidepressant effects.

More recently, a low-field magnetic stimulation was tested to see if it had an antidepressant effect. Both these low-intensity brain stimulation therapies showed promising results.

While free of side effects, their superiority over the older treatment is yet to be demonstrated.

Ketamine, an anaesthetic drug that acts via a different neurotransmitter system (glutamate), has shown to have antidepressant effects. Nutritional supplements (like vitamin B12), hormonal corrections (thyroid replacement), correcting menstrual irregularity (treating polycystic ovarian syndrome) and lifestyle modifications (weight reduction where needed, practising yoga or doing exercise, regular food and sleep habits) play a significant role in treating depression.

Gangadhar is professor of psychiatry at NIMHANS, Bengaluru.

New finding

An alternative to medication

A British study published in the journal The Lancet found that mindfulness-based cognitive therapy (MBCT) is as effective as antidepressants in preventing relapses in people who suffer from chronic depression.

For the study, 424 adults who were taking medication for depression were randomly assigned to either wean off their antidepressants and receive MBCT or continue with their medication.

The 212 patients, who were in the MBCT group and had eight group sessions of mindfulness therapy, were given instructions to practise it daily at home and also the option of four follow-up sessions over the year.

At the end of two years, relapse rates were similar in both groups—44 per cent in the therapy group and 47 per cent in the medication group.

MBCT combines mindfulness practices with cognitive therapy to help people recognise and replace negative thoughts and feelings with positive ones to prevent a downward spiral into depression.

“While the study doesn't show that mindfulness-based cognitive therapy works any better than maintenance antidepressant medication in reducing the rate of relapse in depression, we believe these results suggest a new choice for the millions of people with recurrent depression on repeat prescriptions,” said the study author.

It is believed that 4 out of 5 people with depression will relapse if they don't continue on some therapy.

That sinking feeling

Around 16 per cent people suffer from depression during their lifetime. It is twice as common in women as in men

49% women who suffer from postnatal depression do not seek professional help
38% women who suffer from depression during pregnancy have suicidal thoughts
One in eight women develops depression during her lifetime
It is most common in women in the age group of 25 to 44

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