Depression encompasses a spectrum of disease states where the person suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced. (The ICD-10 classification of mental and behavioral disorders; WHO, 1992)
The World Health Organization (WHO) reports in 2017 that 322 million people suffered from depression worldwide (Global Health Estimates of World Health Organization, 2015). Depression is currently the commonest mental disorder among adults. WHO has predicted depression to be the 2 nd major cause of morbidity, only after cardiovascular diseases throughout the world by 2020.
Sri Lankan statistics
According to the WHO there were 802,321 reported cases of depression in Sri Lanka in the year 2017 with a quantified loss of approximately 103,113 of life years due to major depressive disorder in 2015 alone. Therefore, apart from personal impact on patients and families, depression also harms the economy of a given country with escalating health cost for the government, lower productivity and employee absenteeism.
The symptoms of depression
- Depressed mood
- Loss of interest and enjoyment
- Reduced energy and decreased activity
- Reduced concentration
- Reduced self esteem and confidence
- Ideas of guilt and worthlessness
- Thinking that the worst can happen in everything
- Ideas of self harm
- Disturbed sleep
- Reduced appetite
The number and the severity of symptoms from above will classify the depressive episode into mild moderate or severe. The thoughts are of worthlessness, pessimistic and guilt. These ideas of hopelessness is accompanied by thoughts that life is not worth living thus leading to suicide.
The person will not enjoy in the activities and hobbies he/she earlier enjoyed. They would skip social encounters as they do not see any pleasure in it. Most of the day they will feel lethargic and leave tasks unfinished. There is slowness of activities associated with it which will also be reflected in their speech. Anxiety and irritability may be seen in some people suffering from depression.
Sleep disturbance is characteristic and is of early wakening type. The person will wake a few hours earlier than his normal waking time and dwell on the pessimistic and the depressive thoughts. Weight loss occurs and is mainly due to the loss of appetite.
Depression can occur at any age but more than half of the cases occur before the age of 21. Depression occurs due to an imbalance of the chemicals in the brain which when given from outside can relive the symptoms thus making depression a treatable disease. These chemical containing drugs are known as antidepressants which is the drug class of choice for treatment.
People who suffer from severe depressive episodes will need to be treated with electroconvulsive therapy (ECT). Psychotherapy such as cognitive behavioral therapy and interpersonal therapy is used to provide education, reassurance and encouragement to people suffering from depression.
Rtr. Dinu Horadugoda