17-23 October 2014 #728

The depression battle

Estimations reveal that about a fifth of the world’s population will experience at least one episode of depression.
Dhanvantari by Buddha Basnyat, MD

It is estimated that about a fifth of the world’s population will experience at least one episode of major depression in the course of their lives, making major depression or clinical depression a common mental health disorder.

In the Western world, depression accounts for the largest burden of disease when measured by disability adjusted life years (DALYs). DALYs take into account both absolute years of life lost because of the disease (premature death) as well as productive years lost due to disability.

Major depression is at the top of the list of the burden diseases trumping all other common diseases like alcohol abuse, chronic obstructive pulmonary disease, diabetes mellitus, and even ischemic heart disease.

Although accurate statistics regarding depression are hard to find for low-income countries like Nepal, many of us have probably experienced first-hand the impact of depression in ourselves or our near and dear ones.

Major depression does not mean just feeling sad for a day or two. The term denotes a more disabling condition which can last from few weeks to months to even years, and adversely affects a person’s work and school life, sleeping and eating habits and general health. The depressed person may also suffer from low self-esteem. There is also loss of interest or pleasure in normally enjoyable activities.

People with depression often mask their illness. Even those who appear to be cheerful and lively from outside maybe suffering from depression, as evidenced by the suicide of actor-comedian Robin Williams who had been battling depression for a long time.

The good news, however, is that depression can be treated in most cases. Besides counselling, there are many effective antidepressant drugs that can help depressed patients. There are also newer and more expensive antidepressants in the market, but there is no evidence to prove that these drugs are more efficacious than the older ones like the tricyclic anti-depressants. About 75 per cent of patients will respond to any antidepressant if given in a sufficient dose for about 2 months.

In a country like Nepal where health insurance is a privilege enjoyed by few, it is best to use an effective but least expensive drug with an acceptable side effect profile.

Typically these antidepressants take about two to three weeks to show their salutary effect. If after two months of medication, there is no significant response to treatment, the doctor may decide to increase the dosage. Once the control of the symptoms is established, then the medicine is taken for about six to nine months to ensure there is no relapse at this stage.

For many, this length of therapy may be good enough for cure. However, there are patients who may suffer from additional episodes of major depression and in those cases, the doctor may consider putting the patient on an indefinite maintenance therapy.

Read Also:

The war on minds, Badri Poudel

Suicide rates are rising, Aarti Basnyat

Post-conflict stress syndrome, Taylor Caldwell

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