Depression Need For Awareness

The mystery of depression is not that it exists — the mind, like the body, may, at times, malfunction. Instead, the paradox of depression is its prevalence. While most mental illnesses are rare, depression is everywhere, as common as the flu. Every year, approximately 7 percent of us will be affected to some degree by this awful mental state that novelist William Clark Styron in his book 'Darkness Visible' described as a 'gray drizzle of horror.' Plagued by our pain, we will retreat from everything we otherwise enjoy. Some of us will stop eating while others will start eating too much. Sex will lose its appeal; sleep will become a frustrating pursuit. We will always be tired, even though we will do less and less. Life will lose its meaning. We will often think about death. For reasons not fully known to us, the human mind is sometimes tilted toward sadness and, as it turns out, needs medicine to rescue itself.
Dr Omar Rahman, US board certified psychiatrist, formerly faculty at Harvard Medical School and Harvard School of Public Health, now Vice Chancellor of Independent University, Bangladesh, says, “Like diabetes, depression is a disease. It is a biological problem. There are medicines and therapy for it. Mental illnesses are not any different than physical illnesses. Grief is not depression.”
It was love at first sight for Anan, a graduate student of engineering in a Texas University and Faria, an undergraduate business major in Sydney, Australia when they met at a Bob Dylan concert at the zoo amphitheatre of Oklahoma City on August 15, 2001. Upon graduation in 2003, she immigrated to the US and moved in with him in June, 2004. They planned on getting married after buying a house. A modern day fairy tale couple, their friends called them.
Not quite.
A few months later, Anan felt that something was missing from their relationship. Faria did not like to do things she previously enjoyed doing—watching movies, eating out, shopping, cleaning, cooking and spending time with her partner. It was as if demons had possessed her soul. Anan thought that her 'bad mood' would go away with time and a change of circumstances. It didn't. They found themselves in a recursive loop of woe. Unable to make sense of her behaviour, Anan took her to a psychiatrist in 2010. She was diagnosed with chronic depression. Faria was in denial. They broke up in 2012.
Faria blames Anan for everything.
Dr Rahman says, “Depression affects all facets of our life. It not only affects the person, it affects family members and work.”
Faria believed that she could get well with motivation and will power. But in reality, depression is an ailment that concerns both physical and emotional sides of a person.
“They cannot will themselves to become better and come out of depression. They need help,” says Dr Rahman.

Depression is an ailment that concerns both physical and emotional sides of a person.

When a person's mood fluctuates and he or she goes through short lived emotional response to challenges in everyday life, people around him or her often mistake it for depression. Kamal U. A. Chowdhury, Associate Professor and Clinical Psychologist, Department of Clinical Psychology at University of Dhaka says, “Depressed people have great difficulty performing daily life activities; their work performance takes a serious dip and in case of students, academic performance starts to get low. Their relationship with friends, colleagues, relatives and even family members also gets seriously affected as it becomes increasingly difficult for others to communicate with a person with a negative attitude towards self and world.”
It is a common illness worldwide, with an estimated 350 million people affected. Dr Rahman says, “If a person has been experiencing low mood for most of the time of the day for two weeks, we can say he or she has depression. Besides we have to see if the person is having any apathy. The patient has irregularity in sleep and appetite. Depression is not subtle in nature.”
According to professor Chowdhury, 16.1 percent of the adult population and around 18 percent of children and adolescents suffer from different forms of mental health problems with varying levels of severity. Among this population 4.6 percent are found to be suffering from depression making it one of the most prevalent mental health problems in Bangladesh. In case of children and adolescents, a study reports a prevalence of 0.95 percent among the younger population.
“Depression can be genetic as well as the result of life experiences,” says Professor Chowdhury. “A person may develop depression if he or she undergoes certain traumatic life experiences such as parental abuse, parental discord, lack of social support etc. A person with a certain biochemical predisposition may also become vulnerable to depression. Women tend to suffer from it more than men and it is common across all cultures and races irrespective of geographic location.”
Depression occurs in two forms— Unipolar and Bipolar. Dr Rahman says, “Unipolar is more common and it is not genetic. Bipolar is being hyper or manic. The prevalence of bi polar is quite high. It is a serious illness. Often it is too late when it is diagnosed. Bipolar is almost certainly genetic. However, latest medicines are available in Bangladesh and they are cheaper and more affordable here than in other countries.”
The two mainstream methods of treatment are medical and psychological. Psychiatrists are trained to do both while psychologists do counselling or therapy. Therapy enables and empowers the person to better manage his or her difficulties including depression, anxiety disorders, eating disorders, and substance abuse, among others. A therapist works with the patient to identify problems and solve them. Research shows that therapy combined with medicine is the most effective way for managing depression.
In Bangladesh, the number of mental health professionals is very low compared to the demand. “There are only around 200 psychiatrists and 40 clinical psychologists most of whom work in Dhaka. Professional training in Psychiatry for medical graduates is offered only in BSMMU while professional training in Clinical Psychology is only offered at the Department of Clinical Psychology in the University of Dhaka,” says professor Chowdhury.
Although one in every six persons in the country has some form of depression, there is very little awareness about this mental illness. It is often seen as a character flaw by friends and family. Most men often do not seek treatment in fear of being stigmatised by the society. Women are more conscious. A lot of young people suffer from societal and mental pressure. In some cases, it turns into depression. Young people who feel depressed sometimes get addicted to drugs to feel good for the time being, but it makes their case worse. Dr Rahman believes that counselling can play a huge role at the university level.
“Maternal depression is quite significant in South Asian countries. Right after having a baby, a lot of young mothers feel depressed because they get overwhelmed with the day to day running of the household. Family members do not understand it and often misunderstand her for being sad at such a joyous occasion,” says Dr Rahman.
The prevalence of depression in old and young people is more than in middle aged people. There is no significant difference in the depression rate in developed countries and developing countries. “Contrary to popular belief, there is no historical data to suggest that depression is on the rise. We do not have statistics to support it, but I would say that the suicide rate in our country is not as high as in other countries such as Japan and Eastern European countries,” says Dr Rahman. “It is an interesting fact that people who have suffered rape, torture, ethnic cleansing or disasters are not the ones with the highest rates of depression.”
Asked about some challenges of treating depression, Dr Rahman says, “A lot of people try to self medicate. But it is dangerous. And sometimes they get impatient. After one week they expect a drastic change. It takes at least two to three months to show signs of improvement. Polypharmacy (the use of multiple drugs without any rationale) is also a major problem in Bangladesh.”
Dr Rahman believes that since it is a biological disorder, those who have a tendency for it, will have it. But reduction of external stress in one's life may help. According to WHO, effective community approaches to prevent depression include school-based programmes for the prevention of child abuse, or programmes to enhance cognitive, problem-solving and social skills of children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly are also effective.
Some evolutionary psychologists have tried to find out if depression has any upside. Particularly interesting to them is Darwin, widely believed to have depression, who wrote in his autobiography, “Pain or suffering of any kind, if long continued, causes depression and lessens the power of action, yet it is well adapted to make a creature guard itself against any great or sudden evil... it is the sadness that informs as it leads an animal to pursue that course of action which is most beneficial.” For Darwin, the darkness was a kind of light.
As preposterous as it may sound, the idea that depressive disorder may come with some mental benefits — has a long intellectual history. Aristotle wrote in the fourth century BC “that all men who have attained excellence in philosophy, in poetry, in art and in politics, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease.”
But ancient aphorisms aside, depression is a disease that severely affects the lives of a large number of people. The good news is, a solution is often at hand. Awareness must be raised on the individual, community and national level to educate ourselves about depression and support those who are suffering from it.
Faria now realises that she has a medical problem that needs to be treated. She is back in Australia and is seeing a psychiatrist.