Life is a continuous process. It starts at conception and ends at death. Throughout our life, we have to go through ups and downs. We face bitter and sweet and dark and bright phases. The events that take place in our lives are very significant in determining our state of mind. They give us joy, sorrow, guilt, shame, courage, confidence, smile, tears, etc. These events may be catastrophic- and a series of them may follow.
Research has proved that these precede psychiatric and physical illnesses, mental problems and disorders. A study done by Rao and Nummular (1978) revealed a clustering of events during the two year period preceding the inception of depression along with an increased rate of accumulated distress from all events. The common life events included medical and surgical illness, obstetric events, bereavement, and critical interpersonal and social events. Studies have proved that early parental loss isn’t significant in case of depression. On the other hand, an association was found between early parental deprivation and onset of depression later. Depressive patients were found to have experienced a greater number of loss events (the death of a family member or a dear one). Family conflicts, financial losses, infertility, sexual problems, etc. were found to lead to depression.
A significant number of house-wives experience moderate or severe disturbance in their domestic efficacy. Females, in general, are more prone to depression and shy away from seeking psychiatric help. The investigators speculated that the reasons for higher rates of depression in house-wives and women in general were related to loss of freedom, the multiple roles (mother, wife, daughter-in-law, and organizer of duties) of women; and alternative sources of physical and emotional gratification outside the family. Males, on the other hand, have been found attending psychiatric clinics in large numbers.
This is where the role of society becomes important in recognizing the signs and symptoms of depression at an early stage and encouraging people (especially women) to seek help. Depression in females and widows is speculatively attributed to loneliness, lack of satisfaction in life, remarriage inhibition, social taboos, etc. They avoid social gatherings- meetings/parties, etc. The role of their relations, friends and of course the whole society becomes important. Migration factors have further added the depression rates both in males and females. Reports available on migration and psychiatric illnesses indicated that the rate of depression was very high in migrants than in non-migrants. Children nowadays move outside for study or work. The parents remain unattended or at the mercy of servants. It has also been found that depression occurs more frequently in nuclear families than in joint families. The problem is more when the parent is single. The society should have perception of depression as an illness that should be diagnosed early and treated immediately.    
Success, paradoxically, may become one of the causes of depression- this is due to the anticipation of loss of self-esteem if one does not live up to the expectations success entails. Certain drugs like beta blockers, anti-hypertensive agents, histamine 2 inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs). Twin, family, and adoption studies suggest a genetic predisposition and familial history of depression and other mood disorders.
There are seven types of depression: Transitory depression; Grieving; Dysthymia; Major depression; Bipolar disorder; Seasonal affective disorder; Mood disorder.
Many children today also face depression- some of the reasons may be family attitudes, broken/disturbed homes, inferiority complex, financial crisis, the dilemma of choosing a career path, job-hunting, etc. It is the responsibility of parents, teachers and govt. as well to guide and counsel the children. We have to help our children during crisis.
Here are some tips we can follow to overcome depression.
 Allow a person to express his feelings, spend time with them, talk to them, don’t leave him alone and maintain a safe, trusting and accepting attitude.
•        Stress reducing interventions should be taught to the depressed one.
•        At home or at a medical care unit, all potentially self-destructive stuff like sharp objects, glass containers, matches, cigarettes and ropes etc. must be removed.
•        Engage the person in group activities
•        Try to overcome their difficulties.
•        If doctor has prescribed certain medication, discuss rationale for medication. Make them understand the purpose of drugs.
•        Self-help must provide only the help he or she needs.
•        While their genuine demands are to be fulfilled, their whimsical demands should not be fulfilled. We should discuss openly and learn to refuse amicably.
•        During the recovery phase observe for change in mood. Family members have to maintain good relationship with the depressed.
•        Do not confront with the patient. Set firm, definite limits on patient’s behavior. Tell them that we are rejecting their behavior only and not them. Avoid arguments.
•        In India, certain patients are still looked after by the family members contrary to what we have in western countries. The patients need constant care, so the family members should make sure that the basic needs are met; bathing, shaving, dressing and serving food on time. Patient’s intellectual, emotional and spiritual activities need to be taken care of. Provide newspapers, magazines of their interest. Creative activities must be continued.
•        Encourage patient to attend social activities like talking, having tea or coffee together. Indoor and outdoor games must be advised- games help relieve anxiety.
•        If the patient is bed-ridden, caring becomes more important. Keep him/ her clean and dry. Regular exercise of limbs (to prevent contractures). Changing of position is important. In case the patient cannot be managed at home, then hospitalization becomes necessary. The patient should not be left alone at the mercy of the hospital. The family members and significant ones should pay visits.

(Zubeda Akhtar is Nursing Officer SKIMS)

Lastupdate on : Tue, 24 May 2011 21:30:00 Makkah time
Lastupdate on : Tue, 24 May 2011 18:30:00 GMT
Lastupdate on : Wed, 25 May 2011 00:00:00 IST