Depression

Depression is a mental disorder characterised by some very specific core symptoms. Unfortunately, nowadays, there are still people that think Depression is not a real illness but a sign of weakness or something that can be sorted out by the individual if she/he really wants. They are terribly wrong. Depression is a psychiatric illness with defined and well-known symptoms.

Depression affects people of every age and can happen to anyone. Many successful and famous people battle with this problem every day. Living with Depression is difficult for those who suffer from it as well as for their family, friends and colleagues.

 

What does depression feel like?

Depression affects people in different ways and causes a wide range of symptoms. In a Depressive Episode people may experience: persistent low mood; diminished interest or pleasure in activities; low energy; feeling of worthless or guilt; low self confidence; diminished ability to think or concentrate; agitation or slowing of movement; poor or increased appetite; poor or increased sleep; suicidal thoughts or acts. Symptoms of depression range from mild to severe, depending on the number of symptoms present and on their intensity.

 

When should I seek help for depression?  Suffering from clinical depression is different from feeling low in mood or sad. In fact, feeling sad from time to time is a common experience for human beings and does not require specialist input. When your mood is persistently low, you think that life is not worth or there are other symptoms that make it difficult to cope with your daily activities, it is important to discuss it with your family members, GP, and Psychiatrist. There are people that usually wait before seeking help for Depression, however it is best not to delay. Asking for help and support if the first step to recovery.

 

Why did I get depressed? There is not a single cause of Depression. Many factors are deemed to be responsible. Depression has been linked to an imbalance of neurotransmitters in the brain, such as Serotonin, Norepinephrine, and Dopamine. The use of neuroimaging has shown which brain regions regulate mood and how other functions, such as memory, may be affected by Depression. Areas in our brain that play a significant role in Depression are Amygdala, Thalamus, and Hippocampus. Researches showed that the Hippocampus is smaller in some depressed people.

Stressful life events, such as bereavement, divorce, illness, financial worries, unemployment, can have an important role in the emerge of Depression. At the same time some personality traits, such as being overly self-critical or having low self-esteem, can make people more vulnerable to develop Depression.

Having family members that have suffered from Depression increases the risk of developing the same illness. However, due to the fact that Depression is a result of several concomitant factors, genetic predisposition cannot be considered the only cause. Also social isolation plays an important role in the genesis of Depression, which shows the importance of having support from family and/or friends. Some women are particularly vulnerable to Depression after pregnancy. The hormonal and physical changes, as well as the added responsibility of a new life, can lead to what is called Post-natal Depression.

When life is getting people down, some individuals try to cope by drinking alcohol or taking drugs. This can result in a spiral of depression.

A higher risk of Depression has been seen in longstanding or life threatening illnesses, such as cancer, coronary heart disease, head injury and chronic pain.

 

Treatment. Treatment for Depression can involve a combination of lifestyle changes, psychological therapies and medical treatment.

Medication is not the first choice if Depression is mild. In this case, it may be worth considering life style changes and psychological sessions.

Medical treatment is used for moderate and severe Clinical Depression. Antidepressants are a type of medication used to treat Depression. They work by increasing the levels of neurotransmitters, such as Serotonin and Noradrenaline, in the brain.

Antidepressant medications are a first line treatment for Major Depressive Disorder and for sub-threshold Depression that has persisted for 2 years or more. Antidepressants are an option for short duration Major Depressive Disorder if there is a history of moderate to severe depressive episodes or if Depression has persisted for more than 2-3 months.

Antidepressants usually exist in tablet form. When prescribed, the medication is started at the lowest dose possible and it takes about 2-3 weeks before the benefits are felt. It is very important to take the medication consistently, every day, and not to stop it if you experience mild side effects. These can be easily discussed with your specialist and are mostly temporary. A course of treatment lasts at least six months.

 

Caring for someone with Depression.  The support of friends and family can play a very important role in someone who is suffering from Depression. The best thing that relatives and family members can do is to simply listen, which makes people feel less lonely and isolated.

It is important to support the people we love to get medical help and be open about Depression. It might be hard for the people we love to have the energy to keep up contact, so carers may want to try to maintain in touch.

Caring for someone suffering from Depression is not an easy task and can be overwhelming at times. Therefore, it is always important that carers keep a balance in their life and maintain some spare time in order to look after theirselves. Carers that feel burnt out are encouraged to talk to their GP and find out if there is support they can access, such as counselling, family therapy or carers’ support network.

 

 

 

illustration by Benjamin Lacombe

Psychiatry throughout history

Throughout history, there have been several changes in how people suffering from mental illness have been seen and treated.

In ancient cultures, such as Persian, Egyptian, Indian, Greek and Roman, mental disorders were believed to be caused either by demons or by deities. There is evidence that in the 5000 B.C. one of the treatments for mental illness was drilling holes in the skull in order to release the evil spirits.

It was only after the 5th century B.C. that in Greece a different approach to mental illness was adopted. A greek philosopher named Hippocrates started talking about mental illness as a problem of the body rather than a punishment sent by the god. Hippocrates’ treatment focused on changing the patient’s environment or occupation, administering certain substances as medications, and using different other techniques, such as phlebotomies, bloodletting, purging, and diets. The principle that the body was affected by the mind or, more commonly called “soul”, became common by the time Galen was writing in the second Century A.C.

Unfortunately, the vast majority of cultures still believed in supernatural causes of mental illnessness and used treatments such as amulets, talismans, and sedatives to “ease the torment” of the afflicted. In countries that had strong ties to family honour, such as China, people suffering from mental illness were hidden by their families so that the society would have not thought that the condition was the result of an immoral behaviour displayed by the individual or the family.

During the Middle Ages, people suffering from mental disorders were believed to be possessed or in need of religion. Negative attitudes towards mental illness persisted throughout the 18th Century, which led to stigmatisation and confinement of patients. As a result of the social stigma, many people were forced to either live in confinement or on the street. Any of those that were abandoned to live on the street, were also considered dangerous, and were often put in jail or dungeons, “out of the public eye”.

The arrival in the Western world of institutionalisation as a solution to the problem of mental disorders was very much an event of the 19th Century. The first public mental asylums were established in Britain. The passing of the County Asylums Act 1808 empowered magistrates to build rate-supported asylums in every county to house the “pauper lunatics”. The first public asylum opened in 1812 in Nottinghamshire. In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 made the construction of asylums in every country compulsory with regular inspections on behalf of the Home Secretary. The Act required asylums to have written regulations and to have a resident physician. The treatment of people in the early “lunatic asylums” was sometimes very brutal and focused on containment and restraint.

Late in the 19th Century views were influenced by the evolutionary theories of Charles Darwin and Herbert Spencer. Francis Galton, who coined the term “nature versus nurture”, developed theories of inherited disease which held that mental and physical conditions were caused by organic abnormalities that might be transmitted across generations. Collectively, these ideas had in turn been influenced by the apparent failure of asylums and “moral therapy”.

The influence of gender on the presentation and understanding of mental illness is longstanding. In the late 19th Century, the views of Darwin and Spencer emphasised core differences between men and women. Men were considered to be rational while women were, in contrast, considered biologically inferior to men, dominated by their reproductive system and prone to irrationality.

The new term Hysteria was coniated to indicate various symptoms, often associated to women. Women who spoke out were seen as the “shrieking sisterhood”, and were advised to withdraw and rest. Symptoms of hysteria included: convulsions, paralysis, sensation of respiratory obstruction, speech and mood disorders. By the late 19th Century, the influential French neurologist Jean Martin Charcot proposed that hysteria was an inherited disease of the nervous system triggered by trauma in vulnerable people. Although he promoted a neurological cause, he still focused largely on women and especially their ovaries.

Early psychological theories of hysteria came from Pierre Janet who worked under Charcot. He believed that emotional trauma weakened or injured an individual’s psyche. However, it was Sigmund Freud’s psychoanalytical theories that became most influential. Freud proposed that hysteria was a psychological illness caused by the repression of traumatic memories and that traumatic memories were often sexual in nature, and the trauma would be converted into somatic manifestations, such as hysteria. Freud also proposed psychotherapeutic intervention as main treatment.

Before the First World War, Psychiatry did not have its own clinical/medical recognition to the point that symptoms of mental illness were frequently confused and associated to a broad range of problems like crime, alcoholism and homelessness. Psychiatric patients were being managed in the asylums together with people presenting with other conditions or circumstances. Some of the reasons for admission to an asylum included: alcohol dependence; frigidity, homosexuality and masturbation; late stages of syphilis; unmarried pregnant women; epilepsy; and disables.

Soon after the onset of the First World War (1914–18), soldiers started exhibiting unspecified somatic and psychological symptoms, which were initially explained as a result of damage to the central nervous system from heavy artillery explosions. Symptoms included blindness, deafness, palpitations, paralysis, muscle tremor and anxiety, and were gathered together in the term “Shell shock”. This condition seriously challenged previously accepted views about the causes of mental illness and talking therapies. There was also considerable official and public concern about the number of executions for cowardice. The Report of the War Office Committee of Enquiry into shell shock in 1922 aimed to examine the nature and treatment of the condition. The committee consisted of doctors, military men and parliamentarians. The outcome of the report reflected in shifting ideas about mental illness as it was accepted that the origin of the condition was “a war trauma” and psychological therapies would have been beneficial.

During World War II, the term shell shock was replaced with “battle fatigue” or “combat exhaustion”. Approximately one million men suffering from battle fatigue were admitted to hospitals and a large number of them were returned to battle afterwards. Their military leaders consequently received accolades for this success. The somatic features of battle fatigue shifted to gastrointestinal symptoms. Mirroring a rise in ulcers in the general public, and concerns about the risks of gastrectomy (the only cure at the time), historians suggest that conversion disorders were influenced by popular health fears and the limits of medical science.

During the 1950s and ‘60s, asylum care was gradually replaced by mental healthcare in the community. Prior to the 1960s, it was difficult to accurately gauge the number of people suffering from depression and anxiety, and any cases remained undiagnosed in the community. The gender distribution of mental disorders continued to be more common in women, being approximately 2:1 female to male.

During the Post-war period, a strong cultural association developed between neurotic and depressive illnesses and middle-class married women. Feminist authors and commentators in Britain and the United States began to suggest that, for women, new suburban housing estates built following the Second World War were causing a range of psychological and psychosomatic disorders. The image of the “desperate housewife” began to resonate in our culture where the isolation, boredom and banality of domestic life was increasingly portrayed as pathogenic.

Suicide statistics from the mid-20th Century onwards have repeatedly showed that men are more likely to end their own lives and they are more likely to fail seeking help. Historically, ideas about masculinity and the association between weakness and psychological disorders have been suggested as an underlying explanation for men’s reluctance to visit their doctor. Men were more likely to present with physical or psychosomatic symptoms affecting, for example, the stomach, digestion, musculoskeletal system, sleep and general wellbeing compared to a more typical presentation seen in women, i.e. lack of motivation, sadness etc. Physicians writing in the medical literature during the 1960s and 1970s reported that many male patients maintained a defensive denial of mood disturbances. GPs noted that somatic symptoms were a mask and an “excuse with which to come to the doctor”, because they were viewed as more acceptable to the patient, his family and employer. Alcohol abuse appeared to be more prevalent in men than women: one explanation was that men “self-medicated” when suffering from mental illness. Alcohol problems were under-diagnosed and often presented in the late stages of liver disease. Stigma about alcoholism prevented official diagnosis and accurate recording of the illness on sickness certification.

During the Post-war period, General Practitioners were usually male physicians who were themselves influenced by prevailing attitudes towards masculinity and inclined to identify psychosocial problems more readily in women. Physicians were also socialised into a culture of heavy social drinking at medical school and a significant problem with alcohol, drugs and mental illness existed in the profession. By 1982, the standardised mortality ratio for cirrhosis in doctors was three times that of the general population.

From the 1950s onwards, the field of psychopharmacology developed rapidly as new antidepressants and tranquillisers were discovered, developed and introduced into clinical practice. These developments are often referred to as the pharmacological revolution in psychiatry. Echoing earlier associations between femininity and mental disorders, tranquilliser use became strongly identified with women, particularly housewives, who, it was argued, were prescribed drugs in order to adjust them to a role with which they were dissatisfied.

Unfortunately, in our society mental illness is still stigmatised. People often feel ashamed of talking about how they feel and about psychiatric symptoms they may experience. Somehow, we still feel personally responsible and guilty if we suffer from mental disorders. We think they are less real than any other clinical condition and we (optimistically? fantastically?) believe we can control them and move on. The truth is that there is still a lot of disinformation around mental illness and its treatment. Psychiatric medications are often rejected by patients that are prone to think they may become “zombies”, addicted, or for some magical reason, their personality may change. One of the reasons for it is that old fashioned psychotropic drugs used to cause unwanted side effects and some of them still do. Generally speaking, psychiatric medications are not any different from other medications used in clinical practice. The vast majority of drugs in medicine cause side effects. However, these can be controlled and minimised, and different medical options can be considered. A good compromise between clinical effectiveness and reduced side effects can and needs to be found. It is important to maintain a scientific and biological approach.

Mental disorders likewise other disorders need treatment and the goal is always to get better. If there are doubts in regards to what the best approach to treat an illness is, the optimal attitude is to discuss it with a doctor. Google, Yahoo are not good sources of information as there are far too many articles, people express opinions rather than facts and it is difficult to know what we can trust. Psychiatric symptoms and conditions can be treated. People do get better and they take their life back.

#nohealthwithoutmentalhealth #it’soknottobeok

 

 

Image by Nicoletta Ceccoli

Brief Introduction to Mental Health

It is very common for people to have mental health concerns from time to time. A mental health concern becomes mental illness when the intensity of the symptoms causes significant distress and/or it has an impact on daily activities and social interactions.

Good mental health means being generally able to think, feel and react, while poor mental health is characterised by a certain level of difficulty in those areas.

 

Mental illness is a broad term that refers to a wide range of medical conditions involving changes in thinking, emotion and/or behaviour.

The ICD 10 and the DSM V are the two manuals that are used by professionals to define and classify mental disorders in a territory such as Psychiatry where there are no blood tests, no imaging investigations or anatomical pathology results to support diagnoses.

The main mental health conditions are: Neurodevelopmental Disorders; Anxiety Disorders, including Obsessive Compulsive Disorder; Mood Disorders; Psychotic Disorders; Trauma related Disorders; Eating Disorders; Personality Disorders; Substance related Disorders; and Neurocognitive Disorders.

 

The distinction between mental health and physical health sometimes leads to an erroneous belief that mental health is not “a real illness” and can be controlled with “the power of the mind”. In all honesty, I don’t think we would ever ask someone who suffers from Hypertension (high blood pressure) to stop taking Antihypertensive medications but instead to “think positive and try to get better”. We would not encourage someone who suffers from Diabetes to not take Insulin but to “be strong and cope with it”. We would not blame a person who broke his/her leg for not using that leg to walk. Wisely, I’m pretty certain we would not tell any of those people phrases such as “it is all in your mind. It depends on you and what you want to do with your life. Get over it”.

On the other side, when a person is depressed or experiences other types of psychiatric conditions, sometimes we are erroneously brought to think that the person can resolve the condition if he/she wants to. Experiencing psychiatric symptoms is often scary, confusing and frightening. People may feel anxious and preoccupied most of the time, or they may experience sudden and intense attacks of fear. They may find themself ruminating about things, not being able to stop thinking, and having to perform specific actions in order to feel in control. They may experience mood swings, low mood, poor energy or an inexplicable feeling of wellbeing, strength, and elevated mood. They may have unusual thoughts or experiences. Also sleep and appetite may be affected.

 

Being mentally unwell may be considered a sign of weakness or shame. It may be considered a decision rather than a condition. Unfortunately, social media and the Internet often reinforce these negative messages. This can easily lead to a delay in seeking help, which is likely to increase the level of distress and sense of isolation that a person is already experiencing. People cannot recover from anxiety by just staying calm. They cannot recover from depression by being positive. They cannot recover from psychosis by deciding to stop hearing voices and being paranoid. They cannot recover from anorexia nervosa by just eating more. If mental illnesses were that simple no one would ever struggle in the first place.

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Probably the most poisoning and dangerous elements in our society are ignorance and people that talk about things that they don’t really know. Prejudice, stigma, and erroneous judgments are possible consequences of such a dysfunctional attitude.

I don’t want to diverge from the main topic of this post. I don’t even believe that in this context it is useful to speculate on the reasons why human beings think they can control their brain.

I would rather like to point out that from an anatomical and physiological point of view, our brain is probably the most complicated organ of the entire human body. Pathological alterations of the brain are the cause of mental illnesses. Therefore, in order to treat psychiatric conditions a medical approach is an essential requirement and psychotropic medications are often necessary.

In reality, mental health problems are very common and can be treated. The most important step to take is to recognise we need help and/or to trust people that encourage us to seek support from a specialist.

 

 

Image by Nicoletta Ceccoli