Depression

Words: Dr Rajgopal NIDAMBOOR

Sadness and other negative feelings are all normal reactions to a serious loss and/or tragic event. Also, everyone suffers, now and then, from a mild case of ‘blues.’

Medical research says that there may be a biochemical foundation to such responses. Or, depression, the topic in question, may be ‘biologically- or genetically-based.’

Neurotransmitters in the brain are another likely cause of depression. Neurotransmitters are chemicals released across a small space between a neuron, the basic unit of the nervous system and the receptive site of another neuron [synapse]. Low levels of one neurotransmitter — norepinephrine — at the receptor sites are suggested to trigger, or cause, depression.

Sometimes, the origin of depression may not be known. Certain conventional medications — like anti-hypertensives, or medications, used to treat high blood pressure [hypertension] — may be a likely trigger.

Likewise, a severe decline in one’s mood may also occur as a reaction to lack of sunlight, through the winter months, or changes in the inner biological clock that runs us all — especially during new, or full, moon nights. This is called SAD [seasonal affective disorder].

Symptoms

  • Negativity in all aspects of life: a feeling of pessimism, or belief that nothing can make your life better
  • Changes in sleep patterns: sleeplessness; disturbed sleep, getting up too early, or sleeping more than is necessary
  • Changes in eating patterns: lack of, or change in appetite, or eating too little, or too much
  • Fatigue; difficulty in concentrating, or making decisions
  • Isolation, withdrawal from people, and neglecting your appearance
  • Persistent sadness; self-disgust
  • Reduced libido
  • Failure to experience pleasure [‘anhedonia’]
  • Social withdrawal, digestive disturbances, gloom and, in certain cases, suicidal behaviour.

Depressive symptoms are among the most common complaints in medical practice. Surveys suggest that depression is extremely widespread, with many cases never coming to the attention of doctors.

Statistics suggests that the risk of depression over a lifetime is approximately 7 out of 10 for women; and, 4 out of 10 in men.

There is also more than an iota of conflict between ‘normal’ depressive symptoms and ‘milder’ forms of depressive disorders. This is because it is only the more severe forms of depression that present with a qualitative distinction from normality and get treated.

This is also one major reason why for any treatment to succeed it is always important to know how long the depressed mood has been present, or whether it has been present all the time. Or, for how long has it prompted the individual to ‘hide themselves away.’ Or, there are thoughts of ‘self-harm’ or suicidal tendencies. Or, whether anything relieves, or worsens it. Or, whether one’s moody blues shows any ‘unprompted’ dissimilarity in severity.

The Fallout

Depression may also affect one’s memory. Although recall of information is unaffected, registration of new material may be difficult.

Depression may also affect one’s speed of thinking, as also movement. This is referred to as psychomotor retardation. In severe cases, depressed individuals may not so much care about their appearance. This may lead to crumpled clothes, or want of dressing sense.

The depressed individual often presents with a sad and dejected countenance, or facial expression. But, not always — because in certain severe cases, the person may put up a brave face and attempt to ‘appear’ normal. This is sometimes referred to as smiling depression. It is, therefore, imperative for someone in the family, or close circle, to make an objective judgment on the basis of ‘covered outward show’ and solicit medical attention for the depressed individual.

A weeping tendency may also be looked into against the background of recent life happenings, the patient’s cultural and social context and gender. There is a possibility, that in some depressed patients, the most perceptible emotion may not be utter despair, but just bad temper, or aggression.

Other Things To Note

There may emerge on the face of things, viz., poor self-esteem, feelings of worthlessness, or guilt. The depressed individual may also impulsively make self-demeaning comments — “I’m just not good enough.” It may help if one in the family, or close circle, could carefully tap into suicidal thoughts, if any. This can help to reassure patients, whose feelings about ending their own life may have aroused them to also feel that they were going crazy, or foolish.

If a depressed individual responds favourably to a question such as, “Have things gone wrong so badly that life is not worth living?” one may get some inkling as to whether a means of suicide has been measured. If this is so, one should find out what plans have been made to carry out the attempt, or whether they will act on such intentions. Yet another ‘peek’ is to figure out whether the person has any hope for the future. The conviction that all is fruitless and that there is no getting away from the present despair, when accompanied by suicidal thoughts, indicates a high risk that such intentions may, after all, be acted, or followed through.

Abnormal beliefs and perceptions in depression in some dejected individuals may lead to delusional intensity, or extremely depressive moods. This may include delusions of worthlessness, along with self-delusory ideas. There may also be feelings of guilt or blame, along with continual worrying over real, or imagined past behaviour. In some cases, depressed individuals may think that they are ‘worse than devils.’ Some — especially depressed, or traumatised soldiers — may also, likewise, think that they are responsible for certain disasters — including deaths during war.

Sometimes, beliefs such as these may lead to persecution of the self. In such instances, the depressed person may feel that they deserve to be tormented and punished. In certain cases, the delusory individual may believe that some part of one’s anatomy has disappeared, withered, or ‘flushed out’ while passing motions.

There may also be hallucinations — these may, however, not be vivid as in schizophrenia — where individuals can hear certain voices in the ear [déjà entendu] clearly.

Psychomotor Issues

Psychomotor disturbance in the form of slow speech and depressive daze may manifest — with loss of appetite. There may also be agitation, with repetitive facial appearance of pain and gloom. Physical movements such as wringing of hands, pacing up and down the aisle, along with self-castigation, such as banging the head against a wall, or pulling hair [trichotillomania], may be present.

In certain instances, but not in all cases of depression, there may also be symptoms of anxiety with ‘reversed functional shift.’ In other words, the individual will not show the ‘classical’ early morning waking, reduced appetite and weight loss. Instead, they may show symptoms of drowsiness, a tendency to sleep all through the day, along with increased appetite and weight gain.

Treatment

Ayurveda

Following the completion of an in-depth analysis of the relevant research, one can reach the conclusion that Ayurveda management has the potential to be an efficient method for the treatment of vishada [depression]. According to the research that were analysed for this review, Ayurvedic therapies such Brahmi Ghrita, Shirodhara, Sudarshan Kriya Yoga [SKY], and Medhya Rasayana formulations may be useful in lowering the symptoms of depression, boosting cognitive function, and improving quality of life.

These therapies have been the subject of a number of favourable studies that have found positive effects, including a significant reduction in depression ratings, improvement in Ayurveda Management of vishada [Depression], mood, and reduction in anxiety levels. In addition, the studies have only identified a small number of unfavourable effects associated with these therapies, which suggests that, on the whole, they are risk-free and well-tolerated. The quality of the research that were incorporated in this review was, however, somewhat variable, with some of the studies having a significant potential for bias. In addition, the sample sizes of the trials were not very large, and the length of the interventions were sometimes only a few weeks.

To demonstrate the efficacy and safety of Ayurveda treatments for depression, it will be necessary to conduct trials that are more extensive, better designed, and that continue for a longer period of time.

In conclusion, the management of vishada through Ayurveda practices has the potential to be an effective method to its therapy. To give more compelling evidence to support the use of Ayurveda in the management of persistent depressive disorder, however, further studies are required to define the appropriate interventions, dosage, and length of treatment. Nevertheless, the available evidence suggests that Ayurveda therapies can be a beneficial complement to the therapy options for depression, particularly for persons who prefer a natural and holistic approach to managing their mental health. This is especially true for those who have a preference for natural and holistic approaches.

  • Sudha Rani Verma et al, “Ayurvedic Management of Vishada [Depression]: A Systematic review,” European Chemical Bulletin, 2023, 12 [Special Issue 6], 165-180.

Homeopathy

Eighteen studies assessing homeopathy in depression were identified. Two double-blind placebo-controlled trials of homeopathic medicinal products [HMPs] for depression were assessed. The first trial [N = 91] with high risk of bias found HMPs were non-inferior to fluoxetine at 4 [p = 0.654] and 8 weeks [p = 0.965], whereas the second trial [N = 133], with low risk of bias, found HMPs was comparable to fluoxetine [p = 0.082] and superior to placebo [p < 0.005] at 6 weeks. The remaining research had unclear/high risk of bias. A non-placebo-controlled RCT found standardised treatment by homeopaths comparable to fluvoxamine; a cohort study of patients receiving treatment provided by GPs practising homeopathy reported significantly lower consumption of psychotropic drugs and improved depression; and, patient-reported outcomes showed at least moderate improvement in 10 of 12 uncontrolled studies. Fourteen trials provided safety data. All adverse events were mild, or moderate, and transient. No evidence suggested treatment was unsafe.

  • Petter Viksveen, et al, “Homeopathy in The Treatment of Depression: A Systematic Review,” European Journal of Integrative Medicine, Vol 22, September 2018, pp 22-36.

Nutrition

There is increasing evidence about the role of nutrients in mental health. An adequate intake of nutrients contributes to better overall health and mental health in particular. Major depression is a severe mental illness with a high prevalence for which effective treatments exist, but not in all cases the patient’s remission is achieved. Therefore, it is increasingly aimed at optimising the supply of nutrients necessary for adequate brain functioning as adjunctive therapy to antidepressant treatment in depressive disorders. The nutrients that have been related to depression are — omega-3 fatty acids, B vitamins, s-adenosylmethionine, tryptophan, magnesium, zinc and probiotics.

  • Mónica Martínez-Cengotitabengoa, et al, “Nutritional Supplements in Depressive Disorders,” Actas Españolas de Psiquiatría, 2017 Sep; 45 [Supplement] 8-15.
Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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