Depression

Depression is one of the major syndromes in psychiatry. The person is unable to experience any joy of life.

This condition can become so severe that the person wishes to die. Thoughts of suicide can be accompanied by thoughts of killing one’s loved ones in order to save them from the cruelty of this life. The sufferer has a deep sense of guilt, inadequacy, a feeling of being sinful. He believes that he is the cause of all bad that has happened. In this self-blaming world of his he has serious difficulties concentrating on the external world. He is forever preoccupied. There is no “future” and “presence”, he lives in the past. He is unable to keep his attention on what is happening, he suffers from attention and memory problems. The disengagement from the real world can progress to delusions and hallucinations. He may hear voices that accuse him, or have various unreal thoughts connected to his emotional state. Lack of appetite, inability to sleep and a marked reduction in sexual desire are other elements of the picture. In fact, to recognize depression just by an visual inspection should be easy for an experienced doctor, his shoulders are dropped, he frowns and avoids eye contact.

We can say that it is a common condition. Even if studies reveal other results, approximately 1 out of 10 people has experienced depression at least once in his life. The occurrence rate is slightly higher in women than in men.

There are a number of alleged causes. Some of these are based entirely on biological facts. Others claim psycho-social origins. I believe that the data obtained through both of these approaches should be combined and the disorder assessed in its bio-psycho-social entirety. Biological data first drew attention to itself from in the 1950’s. A large number of depression cases were seen in people who used a hypertensive drug to lower the noradrenalin level in the brain. This formed the beginning of understanding the brain chemistry of depression.. The role of other chemical substances was investigated and a link was established between serotonin insufficiency and depression. Later a link was established between various neurotransmitters (chemical substances that act as transmitters between two nerve cells) and depression. Reviewing all the data together reveals that the brain’s chemistry leaves a certain state of balance and enters another state of balance, during which time there is an overproduction or underproduction of chemical substances in the brain in an effort to return to the original state of balance. Psychosocial data started coming together even before 1950. After a large number of studies it became apparent that in depression the individual internalizes his anger, in other words directs his anger towards himself. One of the basic foundations of this perspective is the picture presented by grief when people have lost a loved one. The lost person (object) is introjected, internalised. The attempt to get rid of this painful internal presence is done entirely unconsciously. Although the person appears as if he is trying to get rid of himself, his main impulse is to free himself of the object that is causing him pain. Reviewing both approaches together reveals that biological parameters become subservient to psychic scenarios. Just like in dreams … It seems impossible to resolve this picture unless both biological and psychological factors are considered together.

There are various treatment methods that are used in depression. These can be classified as drug therapy, psychotherapy, electroshock therapy, and others. If the picture presented by the disorder is very severe, if there is a risk of suicide, or if for reasons that are impossible to define here, the doctor considers it indicated, then ECT is a very effective intervention. The effects of the drugs start showing themselves a few weeks after commencement. The response to treatment can be monitored with the help of certain scales; a 50% improvement 4-8 weeks after commencement of treatment means that the patient is responding to treatment. The effect of psychotherapy takes longer to show itself. The use of behavioural-cognitive therapy in conjunction with drug therapy yields better results than other approaches. Other treatment options can be considered in cases where there is no response to the treatment methods I mentioned above. One of these treatment options is transcranial-magnetic-stimulation.