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Seeping into depression

By Dr Leow Chee Seng

Is depression knocking on your door? Understanding how this malady slowly

takes over your whole life is the best way of addressing it.

A lot of people are not aware that they have

depression.
The simple fact is that depression has become
one of the most common psychological disorders
around the world today. It has now reached
epidemic proportions in industrialised societies
and is increasing at a very high rate in developing
countries too.
The main symptoms of depression include changes
in emotional states, changes in motivation and the
way you function, and also cognitive changes.
Emotional changes include mood swings like
feelings of sadness, gloom, pessimism and fear. This
is generally accompanied by bouts of crying and
tearfulness.
Depressed people feel the world is boring and
meaningless. The world is colourless and the only
colour in their mind is gloomy black.
Motivationally, the depressed person loses interest
in doing anything. He or she may find great
difficulty getting out of bed in the morning or being
motivated to go to work.

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They have diminished interest or pleasure in all or

most activities, most of the day, nearly every day.
Nothing spurs their interest.

So, functionally they become greatly impaired,

failing to do things they previously excelled in.

This decreased ability of functioning is also related

to cognitive changes. The depressed finds difficulty
in concentration and clear thinking. Their thoughts
are dominated by negativity, guilt and lack of self-
esteem.

They may also seem to have become retarted in their

movements and may sleep too much or too little,
generally waking up too early or too frequently –
with difficulty in falling asleep again.

Classification
Clinically, there are different types of depression.
Psychiatrists usually classify them into three
categories: normal depression, reactive depression
and endogenous depression.
These types have since been renamed in most
modern classifications of mental illness but the earlier
typology is clearer and probably more accurate.
Normal depression is the more common type
afflicting most people. Most of us, from time to
time pass through periods of sadness. We feel
down in the dumps and lack our usual ability of
concentration and creativity.
However, this change in mood passes away quickly
and we return to our happy hard-working selves
eventually. So, if you find yourself in a dejected or
sad mood, with no interest in everyday activities that
you usually enjoy, do not jump to the conclusion
that you are suffering or are beginning to suffer
from depression.
The second type is known as reactive depression.
It is caused by a catastrophic incident in one’s life
such as the death of a close relative, failure in an
exam or loss of money. Sadness, pessimism and
negative thoughts are more severe and can last for
much longer.
To give you, readers a personal example, I will
mention the case of my mother. She came down
with depression after my dad passed away.
When we bought her a new mattress, she kept
complaining that the previous one was softer and
that the new mattress was too hard and she couldn’t
sleep at night. Of course, insomnia was one of the
symptoms of her depression.
We once brought her out for lunch but no matter
which restaurant we went to, she felt that the
food was not delicious. The negative thoughts she
experienced because of the grief over my father’s
death was in fact generalised to everything.
Fortunately, this type of depression is treatable
by taking anti-depressant drugs such as
fluoxetine, paroxetine, doxepin, phenelzine and
tranylcypromine. Cognitive therapy by itself or in
combination with drug therapy may also help.
The third and most severe form is termed
endogenous depression. In modern terminology,
this may also be identified by terms like major
depression or uni-polar depression.

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The symptoms that we have mentioned earlier are
greatly exaggerated in this form of depression and
the patient suffers from them during most of his
waking hours.
This disorder may be fairly sudden in onset and may
have no clear causes or the cause may be too trivial
in comparison to the major depressive response.
That is why it is believed to have biological roots of
changes in the chemistry of the brain.
People who are suffering from this type of
depression are unable to perform their usual duties
and are often treated as in-patients in hospitals.
44 MAR/APR 2009 • OH!
Identifying depression
To be sure whether it is actually depression that is
knocking on your mental door or not, you must be
able to differentiate between normal sadness and
depression.
Both sadness and reactive depression are caused by
your loss of something or someone dear to you or
your inability to get an object or position you have
been aspiring for.
You may lose some money, fail to get the profit you
expected in a business deal, fail in an examination
in college or lose an old aunt by her death.
In all these experiences, people would feel sad or
very sad but they will eventually return to their
normal selves in a few days. I have conducted a
survey in “Yahoo! Answers” and I realised that a lot
of people had symptoms of this form of sadness or
normal depression.
However, when the loss involves the death of a
close relative or the failure in the pursuit of a higher
degree or the breakdown of a love affair – and when
it is accompanied by negative thoughts, guilt and
self blame such as “I am a failure or no body loves
me” – and if this state does not diminish over time,
you should not dismiss it as normal sadness.
The metaphorical knock on your mental door
then should be that this may be a reactive type
depression. You may need the help of a cognitive
psychotherapist or some uplifting anti-depressant
drugs. The sooner you receive such treatment the
better would be your prognosis.
But if the onset is rather sudden with very severe
symptoms that overwhelm you without any real
serious cause, and if you find no pleasure at all in
any activity, and life seems to be intolerable and you
contemplate suicide, then you should realise that a
major depression has probably sunk into you.
There is no way out of it unless you submit yourself
to intensive treatment by major tranquilisers or
even electro-convulsive therapy.
If the abovementioned do not work, you may need
the assistance of your relatives or close friends. OH!