DEPRESSION: CAUSES AND REMEDY
Dear readers, we live in the 21st century where life change very fast and we are affected by it in one way or the other way. People from all walks of life are affected. In the fast changing world if one can not adjust/cope up then life will be really tough. But as the saying goes; “All things are possible for a willing heart”. We, as Christians, are lucky to have such a religious belief that holds good for life on this earth as well as eternal life. The Bible have all the answers to our problems. Please read these verses: Matt 6:33, James 1:5, Sam 37:7-8.
Before I come to the topic, let me ask you a simple question yet the answer is hard to to find: What is the purpose of life? Why we (human beings) live in this world? Everyone must have his own answer which will surely be varies from person to person. To me the answer is, “Self realization”.
Recently some of our youngsters took the extreme step and take their own life. It really shocking and painful to hear such incidents. There must be something we can do to avoid such thing from happening again. Firstly, one must be physically, mentally and spiritually healthy. Secondly, one must have a very strong foundation of good character lest he/she will be blown for anything in this materialistic world. Thirdly, strong family bonding is the need of the hour as the western culture of “self centered individualism’ has invaded our culture too. Let us remember that suicide is not the solution to any problem. Every problem has the seed of its solution in it. How we look at an event or situation make lots of difference in life. Life has so many facets, so we need to have holistic view. Look at life from different angles then you will be able to see a bigger and clearer picture. Now let us come to the topic.
Points to ponder:-
• Depression: an emotion or illness?
• Why you should bother about depression?
About depression:-
• Depression is common illness.
• Often undiagnosed.
• Can affect anyone.
• Not a weakness in personality.
• Effective treatment available.
Some facts about depression:-
• Depression is a mental health disorder - a disorder of mood.
• It affects many things - The way one eats and sleeps. The way one feels about self. The way one thinks about things.
• It is more than a passing mood.
• It cannot be willed or wished away.
Statistics (by WHO) :-
• Depression affects 121 million people worldwide.
• Severe depression can lead to suicide and is responsible for 850,000 deaths every year.
• By 2020, depression will be the second largest killer after heart disease.
Depression is caused by:-
• Psychological issues -
• Personality and its development integral to the occurrence and persistence of depression.
• Person's characteristic style of coping usually correlate with their resilience.
• Low self esteem and distorted thinking are related to depression.
• Biological vulnerability -
• Genetic factors: may run in families.
• Chemical changes in part of brain that controls mood.
– Prevents normal brain functioning.
– Causes symptoms of depression.
• Social context -
• Family breakdown: marital separation, divorce & lack of social support.
• Bereavement: death or loss of a loved one.
• Neglect/ Abuse.
* Depression can be triggered if too many changes happen in life too quickly.
How do we diagnose?
• Depressed Mood.
• Loss of interest and inability to enjoy.
• Reduced energy leading to increased fatigability and diminished activity.
• Reduced concentration and attention.
• Reduced self esteem and confidence.
• Ideas of guilt.
• Negative view of future.
• Ideas of acts of self harm or suicide.
• Disturbed sleep.
• Diminished appetite.
So depression may present as: –
• Physical symptoms.
• Psychological/ mood change.
• Behavioural abnormality.
Usual course:-
• Self remitting; last 6-14 months.
• 1/3 patient have single episode.
• Rest have a recurring course.
• Duration and severity of episodes increases due to frequent relapses.
• 10-15% patient commit suicide.
Management of depression:-
• Pharmacotherapy.
• Antidepressants – SSRIs, SNRIs, Tri & tetracyclics, MAOIs,others.
• Antipsychotics.
• Lithium/ mood stabilizer.
• Psychotherapy / counseling.
• Cognitive Behaviour Therapy.
• Interpersonal Therapy.
• Family Therapy.
• Psycho-education.
• Counselling/ supportive therapy.
• Other biological therapies.
• Electroconvulsive Therapy
• Light Therapy
• Biofeed back
• rTMS
• Vagal Nerve Stimulation
Let us focus on the psychological counseling aspect so that someone may benefit from it. If we can save one precious life by our intervention in time there is no greater service than that. So let us try to have some knowledge about psychological counseling.
What is counseling skill?
A skill: to develop professional relationship that assist the client to develop and implement strategies for changing so that they can attain life affirming goals.
WHO approach:
Confidential dialogue between a client and a care provider aimed at enabling the client to cope with stress and take personal decisions related to his/her disorder/situation
The counselling process includes:
(a) an evaluation process of person at risk. (b) facilitation measures.
Counselling basic issues:
– Most misinterpret as giving advice; but it is an enabling process.
– There are many things it cannot do, but it can offer hope.
– Enable the individual to adapt and utilize his psychosocial resources.
Counsellor’s skill:-
Display positive regard. Develop capacity of Empathy
Be : Aware of self, Non judgmental, Informed and objective, Culturally sensitive.
What you can offer:
• Empathic listening.
• Educate healthy lifestyle.
• Cognitive Restructuring and encourage Behavioral modification.
• Enable Psychological Resource Building.
Cognitive Factors in Depression; (how our thinking affects our mood):
• Thinking involved in self evaluation and evaluation of experiences:
• Automatic thoughts.
• Irrational Ideas/ distorted thinking.
• Overgeneralization.
• Pessimistic thinking.
Usual thinking style in depression:
• Self-evaluation in depressed individuals, is usually too critical, and feeds low self-esteem and a sense of failure. (I messed up I am not good at anything).
• Evaluation of Life Experiences will focus on minor negative aspects of what was otherwise a positive life experience. (Depressed person will remember the one day it rained, rather than the six days of sunshine).
Common self & automatic thoughts in depression:
• Self-talk - Negative self-talk
– prevents us from solving problems,
– and contribute to psychological problems, including depression
– Automatic thoughts - Automatic self-statements that we always say to ourselves in certain situations.
They can be positive or negative. Psychological problems develop when our automatic thoughts are consistently negative.
One has to analyze and change to alternative self talk
“in the big picture, this is pretty small. I will just make the best of it”
Common cognitive distortions:
– All or nothing thinking: if performance falls short of perfect, you see yourself as total failure.
– Overgeneralization: see a single negative event as a never-ending pattern of defeat.
– Labeling and mislabeling: instead of describing your error, you attach a negative label= “I am a loser”; “he is damn louse” - It involves describing an event with language that is highly coloured and emotionally loaded.
Irrational Idea and Belief:
I cannot be happy unless everyone likes me. Negative thinking about past, present and future. False assumptions.
Dysfunctional thoughts:
Majority of us live and act on assumption.
Our assumptions are not facts but opinions and can be challenge.
Encourage realistic appraisal.
“Events are not problem unless we appraise them as such”. e.g., traffic accident, Boss!, “idiot” etc.
Cognitive Restructuring: (How do we modify thinking).
• Identifying Automatic Thoughts/assumptions/ distorted or faulty thinking style - Ask questions that help clients think about these issues that contribute to his problem.
• Examine the Evidence - for and against.
• Apply and observe alternative thoughts.
Encourage:
• Healthy lifestyle choice - Avoid caffeine,Stop cigarettes, Balanced diet,
Exercise, Adequate sleep.
• Mantra of Acceptance - “ God give me the courage to change what can be changed, The serenity to accept what cannot be changed,and the wisdom to know the difference”.
• Psychosocial resource building including healthy thinking.
• Develop adaptive coping skills.
• Utilize buddy/ friends/family network/welfare measures.
• Time and anger management.
• Improve communication and assertiveness.
• Develop spiritual health/ hobby/ relaxation skill.
Take home message:
• Notice when a person seems upset, withdrawn or irritable.
• Encourage him to talk about his worries.
• Show you care by empathic listening.
• Help him to find his own solutions to problems.
• Get help/ consult professional.
Conclusion:
Knowingly or unknowingly we may perform the job of a cousellor or we ourselve may need someone to counsel. If some one benefit from this small write up the aim of the author is achieved. Psychology is a vast subject which can not be covered in this small article. There are lots and lots of important topic not included here, such as “Self Esteem, Perception, Inter/Intra-Personal Relationship, Value System, Behaviour, Emotional Intelligence, Anger Management, Coping Style/Skills,Transactional Analysis, Personality, Stress, Anxiety, etc. To conclude I request the readers just to remember; “ Your Perception → Thought Precess → Action/ Reaction → Habit → Your Personality”. All the best to all of you. Thank you.