CHECKEDFEATURESeeping into depressionBy Dr Leow Chee SengIs depression knocking on your door? Understanding how this malady slowlytakes over your whole life is the best way of addressing it.A lot of people are not aware that they have depression. Emotional changes include mood swings like feelings of sadness, gloom, pessimism and fear. This is generally accompanied by bouts of crying andThe simple fact is that depression has become tearfulness.one of the most common psychological disordersaround the world today. It has now reached Depressed people feel the world is boring andepidemic proportions in industrialised societies meaningless. The world is colourless and the onlyand is increasing at a very high rate in developing colour in their mind is gloomy black.countries too. Motivationally, the depressed person loses interestThe main symptoms of depression include changes in doing anything. He or she may find greatin emotional states, changes in motivation and the difficulty getting out of bed in the morning or beingway you function, and also cognitive changes. motivated to go to work.42 MAR/APR 2009 • OH!
CHECKED FEATUREThey have diminished interest or pleasure in all ormost activities, most of the day, nearly every day.Nothing spurs their interest.So, functionally they become greatly impaired,failing to do things they previously excelled in.This decreased ability of functioning is also relatedto cognitive changes. The depressed finds difficultyin concentration and clear thinking. Their thoughtsare dominated by negativity, guilt and lack of self-esteem.They may also seem to have become retarted in theirmovements and may sleep too much or too little,generally waking up too early or too frequently –with difficulty in falling asleep again.ClassificationClinically, there are different types of depression.Psychiatrists usually classify them into threecategories: normal depression, reactive depressionand endogenous depression. To give you, readers a personal example, I will mention the case of my mother. She came downThese types have since been renamed in most with depression after my dad passed away.modern classifications of mental illness but the earliertypology is clearer and probably more accurate. When we bought her a new mattress, she kept complaining that the previous one was softer andNormal depression is the more common type that the new mattress was too hard and she couldn’tafflicting most people. Most of us, from time to sleep at night. Of course, insomnia was one of thetime pass through periods of sadness. We feel symptoms of her depression.down in the dumps and lack our usual ability ofconcentration and creativity. We once brought her out for lunch but no matter which restaurant we went to, she felt that theHowever, this change in mood passes away quickly food was not delicious. The negative thoughts sheand we return to our happy hard-working selves experienced because of the grief over my father’seventually. So, if you find yourself in a dejected or death was in fact generalised to everything.sad mood, with no interest in everyday activities thatyou usually enjoy, do not jump to the conclusion Fortunately, this type of depression is treatablethat you are suffering or are beginning to suffer by taking anti-depressant drugs such asfrom depression. fluoxetine, paroxetine, doxepin, phenelzine and tranylcypromine. Cognitive therapy by itself or inThe second type is known as reactive depression. combination with drug therapy may also help.It is caused by a catastrophic incident in one’s lifesuch as the death of a close relative, failure in an The third and most severe form is termedexam or loss of money. Sadness, pessimism and endogenous depression. In modern terminology,negative thoughts are more severe and can last for this may also be identified by terms like majormuch longer. depression or uni-polar depression. MAR/APR 2009 • OH! 43
CHECKEDFEATUREThe symptoms that we have mentioned earlier are Identifying depressiongreatly exaggerated in this form of depression and To be sure whether it is actually depression that isthe patient suffers from them during most of his knocking on your mental door or not, you must bewaking hours. able to differentiate between normal sadness and depression.This disorder may be fairly sudden in onset and mayhave no clear causes or the cause may be too trivial Both sadness and reactive depression are caused byin comparison to the major depressive response. your loss of something or someone dear to you orThat is why it is believed to have biological roots of your inability to get an object or position you havechanges in the chemistry of the brain. been aspiring for.People who are suffering from this type of You may lose some money, fail to get the profit youdepression are unable to perform their usual duties expected in a business deal, fail in an examinationand are often treated as in-patients in hospitals. in college or lose an old aunt by her death. In all these experiences, people would feel sad or very sad but they will eventually return to their normal selves in a few days. I have conducted a survey in “Yahoo! Answers” and I realised that a lot of people had symptoms of this form of sadness or normal depression. However, when the loss involves the death of a close relative or the failure in the pursuit of a higher degree or the breakdown of a love affair – and when it is accompanied by negative thoughts, guilt and self blame such as “I am a failure or no body loves me” – and if this state does not diminish over time, you should not dismiss it as normal sadness. The metaphorical knock on your mental door then should be that this may be a reactive type depression. You may need the help of a cognitive psychotherapist or some uplifting anti-depressant drugs. The sooner you receive such treatment the better would be your prognosis. But if the onset is rather sudden with very severe symptoms that overwhelm you without any real serious cause, and if you find no pleasure at all in any activity, and life seems to be intolerable and you contemplate suicide, then you should realise that a major depression has probably sunk into you. There is no way out of it unless you submit yourself to intensive treatment by major tranquilisers or even electro-convulsive therapy. If the abovementioned do not work, you may need the assistance of your relatives or close friends. OH!44 MAR/APR 2009 • OH!