The black cloud of Depression.

Depression envelopes you like a black cloud. It fills you with sorrow, despair and hopelessness. I can remember many depressed persons who ultimately ended their lives. The last in the list is a class mate of my brother. He was qualified as a lawyer, but preferred to do agriculture in the small piece of land owned by his family. His story is similar to the tales usually reported by news papers (and cliched !). But black letters on white surface cannot express the innermost feelings of the survivors.

In most of such cases we see a combination of debt due to financial mismanagement / indiscipline, failure of the government and other agencies in providing adequate remuneration for their crops, alcohol misuse, impulsive and risk taking approach to life and a blind optimism that 'in the end God will save me as i mean no harm to others'. This optimism turns into total lack of hope and trust when things go wrong, and the person plunges into the abyss of despair. As I pointed out earlier majority of them suffer from Clinical depression towards the end of their life.
The prominent feature of the depression are
1) Sadness or depressed mood
2) Anhedonia or the inability to derive pleasure from things which were pleasureful earlier.
3) Lack of energy, tiredness and becoming easily fatigued.
Difficulty to fall asleep, or waking up after midnight or much earlier than usual is another symptom. Lack of sexual desire, pessimistic thoughts, poor appetite and weight loss are other prominent features.
Depression also can have other presentations. In some it may present as severe anxiety and worries. Some depressed persons self medicate themselves with alcohol as this boosts up their mood transiently.

Sometimes it wears the mask of a physical illness - 'masked depression'. Such patients consult many doctors with multiple bodily complaints. Doctors cant diagnose any illness as physical examination and investigations are 'within normal limits'. These patients are using the language of their body to express their emotional distress. May be due to a thought that doctors will only listen to bodily complaints. Sometimes the sufferer may not be clear about what is wrong. The fatigue and lack of energy due to depression may be thought of as a bodily problem. Doctors fail to ask questions about one's emotional state as they are not tuned to it or do not know what to ask.

As training offered in psychiatry is only namesake in most of the Indian medical colleges, they are ill equipped to deal with emotional problems. MB BS course does not have any examinations in Psychiatry. But paradoxically, both General Nursing and Midwifery and B Sc Nursing courses have theory and practical examination in Psychiatry. So it may be a better idea to go to a nurse when one feels depressed and is mortally scared of psychiatrists.

There are studies showing that 40% of people who attempt suicide had consulted their doctors within one week of the attempt. Probably with bodily complaints which were the masks of their depression. But doctors failed to penetrate beneath the facade of the symptoms and understand the cry for help. There is also evidence to show that the best way to reduce suicide rates is by educating general practitioners how to detect and treat depression.
Depression is an eminently treatable condition. Options available include antidepressant drugs and psychological methods. There is evidence to show that combination of both is beneficial in moderate depression than one modality alone.