Depression: Suicide’s precursor

The recent media reports of celebrated suicide cases make a case for a peep-analysis of depression on this edition of the column.

Depression is quite common; although many cases are poorly diagnosed or simply refused to seek professional help. It is a spectrum of illness that is composed of severe feeling of low (depressed) mood, unhappiness, intense disappointment which may be accompanied by sleep difficulty, change in appetite, intense feeling of hopelessness, persisting or recurrent emotional and affective sadness, pathological pessimism and suicide thoughts. The end-result of severe depression often manifests itself either as a frank psychosis (madness) or in suicide/attempted suicide.

My concern as usual is to reiterate that depression per medical understanding goes beyond the feeling of low mood that may be appropriate for the time and situation in most people; it involves other symptoms occurring together over a period of time, which affects the normal functioning of the individual. It is conceded that some events in our life often make us feel momentarily “depressed” but this depressed feeling soon passed away and we start to function perfectly well again without any undue and consistent distraction of the inner mind as occurred in classical depression.

My intention as always is to further raise the public awareness and broaden the knowledge base on this common but nevertheless easily treatable illness.

Tell-tale signs

Major signs and symptoms of depressive illness include: that could be occurring with the classical depression symptoms of low mood and persistent feeling of sadness is as follows:

• Early waking from sleep at night
• Excessive sleep and feeling of low energy
• Poor appetite with weight loss
• Daytime mood variation
• Psychomotor retardation
• Decrease in libido and sexually less active
• Ideas of worthlessness
• Tearfulness and inappropriate crying
• Self-reproach
• Delusion of guilt
• Thought of death/suicide and suicide attempts

The occurrence of some of the above symptoms together on a consistent basis will qualify an individual to be diagnosed as suffering from depressive illness. Categorisation into mild, moderate and severe depression will depend on the severity of the signs and symptoms manifesting.

In a different setting, what are exhibited in a depressed patient are somatic symptoms (basically physical complaints and signs), which do not correspond to the clinical findings, laboratory tests and other investigations like the X-ray report. For an example, the affected person might consistently be complaining of a chest pain or a disturbing headache that persist in spite of taking pain relieving drugs and no abnormality detected aftermath of medical investigations.  In some other cases  the complaint on recurrent basis is about ‘hotness’ or crawling sensation on the body in the absence of measurable high body temperature or crawling element respectively; usually the laboratory tests as well as radiological investigations will point to no physical abnormality.

For the aforementioned cases, it takes an extra doggedness on the part of the attending doctor to realize the fact that he is dealing with a case of depression, which is not exhibiting the classical symptoms listed above. Usually with appropriate antidepressant therapy, these recalcitrant somatic symptoms like the chest pain, hotness and ‘invisible’ crawling sensation mentioned above soon go away. This variant of symptomology in depressed patients is particularly common in African Blacks.

Why We Get Depressed

Various reasons have been put forward as possible explanation for depressive illness, and these include the following:

Genetic – this postulation says that the tendency to be depressed has a hereditary basis. In other words, children of persons with a history of depression are themselves more prone to depression than others whose parents do not have a history of depression. This is supported by a research work with the result that there is 60% more concordance for depression in identical twins reared apart than is the case with the un-identical twins.

Biochemical – some chemicals in the brain known to be involved in the pathophysiology of depression have been shown to be more in severely depressed persons. An example of these chemicals is serotonin, shown to be more than average in the brains of some suicide victims.

Also implicated is the observance of abnormal values of the stress hormone – cortisol – in depressed patients.

Vulnerability factors – above all, it is known that any of the above postulations are not absolute on their own. For depression to manifest in individuals, it will take an appropriate and adequate ‘dose’ of external event (stimulus) to confront the mind of the person before the mind surrenders to depression.

Factors that can lead to depression in vulnerable individuals include: physical illness, particularly chronic ones; pain, more so when it is persisting; lack of intimate relationship, depression is common in introverts and in people without love partners and close pals that they readily share their minds with.

In the same vein and like in most other mental illnesses, depression readily sets in when major stressful events occur in our lives e.g. the loss of loved ones, properties and jobs including major socio-economic policies that readily rendered us useless. Thus, it will be saying the obvious mentioning the fact that on a regular basis in our “capitalist society of everyone for himself and the ‘invisible’ God for everybody” the unresolved social and economic crises make majority of us potential victims of depressive illness.

Treatment options

It should be stressed that there is no clear-cut distinction between the low mood we all get, now and then, and illness requiring treatment; notwithstanding this, however, the lower the mood and the more mark the slowness, the more serious is the treatment required.

Treatment options vary from drugs usage i.e. pharmacotherapy to psychotherapy and physical therapy. The option taken will depend on the nature of illness and the severity of the symptoms.

Last line: I should add that the intention of this write-up is not to serve as a substitute for a proper direct interaction with doctors, specialists and trained professionals in psychiatry and human psychology but as piece of encouragement for those who are prone or seen to be prone to seek help.