Understanding Depression Part 1
Unfortunately, there is lack of understanding about what is depression. I hope to use my many years experience as a psychiatrist to bring some clarity to this confusion.
Let me begin with an anecdote. Many years ago, when I was working in a mental hospital, a woman in her 40s, was brought in on a stretcher. She was in a stuporose condition. She could barely be aroused. She had not eaten or drunk anything for several days. Her life was in danger. I diagnosed as having a stuporose depression. I ordered an immediate electroconvulsive therapy treatment (E C T). Within 20 minutes she was awake, eating and sleeping. Of course that was not the end of her treatment, but it was a very dramatic beginning. This was a clear case with her depression had a neurobiological basis and responded well to physical treatment.
I frequently received referrals which said in effect “This patient is depressed and the medication is not working.” Generally when I took a careful history I uncovered childhood trauma (including sexual and physical abuse) that had not been talked about.
One such example, was a man in his fifties who had been on different antidepressants for ten years. No one had elicited the salient history. As a boy he had been sexually abused . As a result he carried a deep sense of shame and distrust, at times bordering on paranoia, of others. Helping him deal with this relieved a good deal of his depression,. However, his recovery was not complete.
On another note, a young woman was brought in having slashed her wrists. She had a fit of pique and anger at her boyfriend and cut her wrists to let the blood drip onto his new white carpet. This could be labeled a suicide attempt or more commonly, a suicidal gesture. While it might be thought that she had a depression I do not believe that this was really the case.
Depression with a clear biological basis.
There are group of patients who exhibit a characteristic symptoms. These include psychomotor retardation (a slowing of bodily functions movement, thought processes), diurnal variation where the patient feels worse in the morning and may improve towards the evening. There’s also disturbed sleep with a characteristic of getting to sleep, but waking early in the morning. There’s commonly a loss of appetite and weight, although in some cases there may be increased appetite and weight.
These biological symptoms are accompanied by a depressed mood, commonly with excessive feelings of guilt, worthlessness, and a degree of hopelessness. There may also be suicidal ideation.
In some instances, there may be delusions either of bodily dysfunction such as a belief that their body is rotting orthat they have some incurable disease.
This group of patients previously identified as having an endogenous depression. These patients generally have a favorable response to treatment with antidepressant drugs and ECT. However, the condition may relapse, and may become more refractory treatment.
In some cases this depression is the first sign of a bipolar disorder and giving antidepressant medication may precipitate the patient into a mania. We will be discussing mania