How heavy the days are. There is not a fire that can warm me, not a sun to laugh with me, everything base. Everything cold and merciless. And even the beloved clear stars look desolately down. (Herman Hesse, Steppenwolf) If there is a hell upon earth, it is to be found in a melancholy man’s heart.

(Robert Burton, Anatomy of Melancholy)

Depression is an inherent part of human condition, triggered off as a result of certain biological, biochemical and social forces that act detrimentally on the person’s nervous system. The depressed activity in tum adversely changes the person’s behavior, feeling tones and thoughts. The emergent behavior which a person may display for days or months is called the depressive illness,

Depression usually starts with lingering sadness, desolation, despair or utter weariness. Sluggishness, a feeling of biologically down over minor obstacles produces jitteriness, anguish, despair, self-disgust and hopelessness, At times, the sufferer wishes that he had never been born or could return to non-existence.

The level of psychic pain that a depressed person feels varies widely. He may lack emotional energy to make friends and enjoy activities. He may have a flat response to situations that stimulate others or, when the pain is acute he may burst into tears when someone so much as looks at him.

Sometimes the person is not aware that he is depressed. He may display his reactions, insisting that his moods result entirely from the tribulations of his job, his family situation, or other such circumstances,

Depression is an affliction that wears many faces. Physically, the individual may start suffering from inexplicable headaches, backaches, stomachaches, generalized aches, pains and fatigue.

Psychologically, the individual experiences reduced enjoyment and pleasure in those activities which make life worth living. When lack of enjoyment becomes deepened, the individual may find himself bored most of the time. He may start rejecting opportunities than come his way. It appears that the spirit of adventure or excitement has left the depressed person.

He may have difficulty concentrating, He may read a newspaper ‘or watch television program only to find that he has not been able to He may have difficulty making not only major decisions but even minor ones may seem almost unreachable.

Depressive illness may affect memory of recent events. It may produce retarded thinking, social withdrawal and neglect of personal appearance, Fatigue, insomnia, remorse, guilt may produce a desire of constant rumination an irritable need to chew over past events and to think of how they might have turned out differently. Extensive rumination may generate inertia in thinking and experiencing.

The inactivity of a depressed person produces loss of appetite and weight, reduced sexual activity, decreased love and affection for the family, general loss of interest, over-responsiveness to trivial events, precipitating a flood of uncontrolled emotions, tearfulness without any cause, gloominess about future, anxiety, irritability, suicidal thoughts, unusual thoughts about death and dying. People in depression are usually concerned about using up their resources. Their judgment about financial matters if often defective and some tend markedly to underestimate what they can effort to spend.

Dr. NS. Kline, MD., Clinical Professor of Psychiatry, New York University, author of the famous book From Sad to Glad, Ballatine Books, NY., 1974 (p. 15, has prepared the following table to graphically represent the early, midway and late symptoms of depression:

Early Symptoms

Anhedonia (absence of joy and pleasure)

Loss of interest in usual activities

Poor concentration

Indecisiveness

Chronic Fatigue

Decreased sexual activity

Carelessness about personal appearance

Anxiety, irritability

Midway Symptoms

Gloominess about the future.

Rumination & guilt about past mistakes

Defective recent memory

Insomnia (especially in early morning)

Loss of appetite or the reverse (bulimia)

Constipation Psychosomatic symptoms (headache, cramps, etc.)

Weight loss & anorexia Autonomic liability

Last symptoms

Retarded physical movements (thick speech, etc.)

Weakness

Delusions of fatal illness

Suicidal preoccupation

Isolation

Depersonalization

Nihilism

Hallucinations & delusions

Hopelessness

Feelings of sadness and depression increasing.

Genius and depression have been keeping company for at least five thousand years, Early Indian, Chinese and Greek literature associated creativity with epilepsy and melancholia or depression. Mood swings, depression, alcoholism, Suicide, drug taking have seemed to plague creative people. The number of modern writers that have experienced deep depression include Ernest Hemingway, Virgina Woolf, Hart Crane, Vachel Lindsay, John Berryman, Anne Sexton, Robert Lowell, Theodore Reothke, Graham Greene, Dylan Thomas, Brendan Bechan, Thomas Wolfe, and F. Scott Fitzergerald. The list is so long that one is at times lead to believe that there may be “correlation” between creativity and severe emotional disorder. It could be inferred that creative behavior is a response to existential pain which these writes experienced. It should be noted that during the bouts of depression the manic writer/artists have been ‘known to become staggeringly productive,

Depression has not spared the great man. Abraham Lincoln suffered recurrent periods of mental depression, Theodore Roosevelt spent most of his “White House” days in a hypo-manic-elation state, It is a known fact that Winston Churchill had varied fluctuating energy levels. It may be inferred that when circumstances, family background, modeling by parents, intelligence, and hypo-manic chemistry interact, these “Great Men” rise to greater heights than other individuals of similar background, who do not possess the internal manic drive.

Historically speaking treatment of mentally ill patients has come a long way. Euthanasia, imprisonment, chains, forceful restraints, bloodletting, electric eels, insulin coma, lobotomy, electro convulsive shock treatment, psychoanalysis, psychotherapy, synthesized tranquilizers, anti-depressants and lithium treatment have been used in an evolving awareness and search for the cure of the crippling disease,

Depression is sometimes termed as “the common cold of psychiatric ills”, It describes the pervasiveness of illness to which all of us are at least potentially subjected, In some of us the symptoms could be quite diffused and the disease may often hide behind other conditions, Also, the disease appears to be self-limiting and self-remitting, It is possible that after causing intense pain, the attacks may sometimes subside even without treatment.

Women are more subject to depression than men. As a general estimate, about one woman in six experiences a depressive episode at some point in her life. The estimate for men is about one in twelve, ‘Men more than women tend to cover depression with drinking and hence the male alcoholic population may contain a large number of undiagnosed depressives. In general, however, the women appear much more subject to depression due to the psycho-social oppression that they experience in this world where they are systematically “caged”, defined and controlled by the society. Their internalized anger and perceived powerlessness usually changes into depression.

Depression in the aged is often for senility or arteriosclerosis. The aged patient cannot write off yesterday’s mistakes and failures against tomorrow’s hopes and dreams, If he has not achieved his important life goals, he is faced with the facts that he never will. He may have to struggle to perform simple tasks he used to do with ease, He may have to endure their problems alone, and lonely, at times left stranded by the death of a mate or a friend.

Many existential conditions of the aged produce anxiety reactions. Loneliness is a very serious problem in our society. It becomes more acute for the aged. Group therapy if tried by a sensitive psychotherapist has produced very 00d results with this population.

In some cases, the depressed feels trapped in a slew of despondence. Life to him becomes flat, stale, and utterly wearisome, without any redeeming hope and purpose. Caught between intolerable tensions, the depressed sees death as a welcome relief. He thinks of ending his life because he can no longer endure it.

Alcohol is a crude form of medicine for the depressive illness. Eliminating depress in can at times eliminate dependence upon alcohol. Research also points to the fact that in families that are genetically prone to “depression”, females tend to become depressed, whereas males tend to become alcoholic. In any case, there seems to be a genetic relationship, between alcoholism, depression and the tendency for drug addiction.

We feel upset with the waste of human resources when precious lives are lost by students, wars, famine and violence. It is the belief of the present author that depression is one cause of human suffering that can be thwarted, once it is seen that, like other illnesses, it yields readily to the power of healing through medical or psychological methods. Some miracle drugs in psychiatry such lithium are producing a revolution in the mental health services. Lithium’s acceptances as a specific treatment and maintenance medicine for manic-depression marks for the first time in the history of psychiatry, that a simple, naturally occurring salt can control a major mental disorder. Lithium is producing the same effect in the mental health field as insulin produced in curing the diabetic patients.

Use of a natural salt (lithium carbonate) to stabilize a major mood swing strengthens the hypothesis of a genetically inherited biochemical defect (The “Missing ‘Mood Enzyme”!), Most mood swing patients want relief of their symptoms so that they can function effectively, Once the “miracle” drugs stabilize the inner chemical world of these people, total exploration and reconstruction of their personality should be undertaken using various methods of psychotherapy so as to avoid further highs and lows in their lives.

We must remember that depression is a coping mechanism that the individual uses to deal with his inner and outer ecological turmoil curing the inner alone may produce partial success.

Article extracted from this publication >> June 27, 1986