Monday, May 8, 2017

Deconstructing Depression

Colombo Telegraph
By Annahl Anbini Hoole –May 4, 2017
Dr. Annahl Anbini Hoole (MD)
Sadness is a normal emotion we all feel reacting to difficult events in our lives. Sadness usually passes with time. Clinical depression, however, is a mood disorder. It is harder to deal with and can interfere with your everyday life. An often taboo subject in our country, it was recently brought into the limelight at WHO Sri Lanka’s and the Ministry of Health, Nutrition, & Indigenous Medicine’s Depression: Let’s Talk – an advocacy campaign commemorating World Health Day 2017. Depression is an illness, stigmatized by fear and ignorance; our cultural stoicism encourages us to either hide these symptoms or socially exclude those who cannot. Understanding depression is important to finding its cure.
WHO says 300 million worldwide suffer from depression with over 800,000 from Sri Lanka – compared to 400,000 in 2006. Although 1 in 8 Sri Lankans suffers from a mental illness, only 40% receive treatment. In 2014 WHO reported Sri Lanka as having the 4thhighest suicide rate among 172 countries.
Like many Sri Lankans, Americans, and millennials, I grew up thinking “depression” was a fancy term for ingratitude or self-pity. The stigma surrounding mental health disorders leads people to hide their symptoms and refuse treatment. Mental wellness is not only important to each individual but to the whole country. Depression is associated with lower workplace productivity, increased mortality from suicide and other illnesses, and a higher risk for other mental disorders and substance abuse.
Major Depressive Disorder (MDD) is defined as experiencing 5 or more of these symptoms continuously for at least 2 weeks:
  • Feeling sad or anxious or hopeless;
  • Sleep changes –sleeping too much or too little;
  • Losing interest or pleasure in hobbies/daily activities ;
  • Change in activity –more or less active than usual;
  • Feeling guilty or worthless;
  • Decreased energy or fatigue;
  • Trouble concentrating or remembering, inability to complete activities;
  • Appetite or weight changes;
  • Thoughts of death or suicide.
If you are experiencing any of the symptoms above, please visit your doctor – diagnosis is best made by a mental health professional. Symptoms may present differently in different people. In women more typical symptoms might be sadness-anxiety with decreased energy; whereas men are more likely to be easily irritable, have difficulty concentrating, and more likely to turn to alcohol/cigarettes/drugs. Females are affected more than males. Elders are less likely to complain of being sad but more likely to feel worthless and complain of body aches/pains. Depression is common in older people, who are at higher risk for suicide. It is most common among25-44 year-olds; incidence decreases with age.
There are different types of depression: MDD, dysthymia (symptoms of depression that last 2 years with episodes of major depression and periods in-between of less severity), perinatal/post-partum-depression (depression associated with child-birth), etc..
Post-partum (meaning after-childbirth) depression affects 1-in-6 women. Along with symptoms above, you may experience feeling overwhelmed/unprepared, inability to bond with your baby, guilt, or feeling irritated/angry/resentful towards your baby or others.
Depression is caused by chemical imbalance, but also a combination of genetic, biological, psychological, and environmental factors. Physical/emotional abuse, certain medications, death of a loved one, family history of depression, major life changes/stress (e.g. divorce, moving, losing a job), social isolation, medical conditions, seasonal changes, or substance abuse. Chronic conditions like heart disease, obesity, AIDs, dementia, Alzheimer’s disease, and cancer contribute.