The Point Of Depression

There has been a great deal of speculation about the evolutionary significance and origins of depression. What selective advantage does it confer?

Does it allow the patient to concentrate on complex and important problems? Is it a type of pain that, like physical pain, causes us to pull back from danger? Is it a type of behavioral quarantine, causing us to hole up in a safe place while dangers stalk around outside? Perhaps it reduces our libido and our appetite for social interaction in order to stop us getting or giving infectious disease? Is it a simple signal that we need help? Is it a sort of threat to others in our community that, unless they do something to help us, they will have a liability in their midst that could endanger them? Is it a sort of fuse, switching us off and causing us to back down when we are outgunned – so saving us from risky and costly conflicts with our peers?

These suggestions, and the many others in the literature, may seem insulting and insensitive. Isn’t it like asking the point of a disabling road traffic accident?

Well, possibly. But much disease is the result of the malignant transformation or manifestation of a physiological response that is usually useful. Auto-immune illness and allergy, for instance, are damaging consequences of facilities without which we would be dead. So the desire to squeeze depression into the neo-Darwinian paradigm is not necessarily misconceived. What is misconceived, I suggest, is the sheer fancifulness of many of these suggested explanations. Their authors are too clever, ingenious, and imaginative.

Here’s an alternative suggestion, which at least has the advantage of not being so smart.

We need to start by deciding what depression really is. It is, I suggest, an ontological disorder. The main pathology in depression is the erosion or truncation of the Self. Depression robs us of the characteristics that make us us. ‘She’s not herself’, we’ll shrewdly say. The job of a psychiatrist is to ‘put the patient back in their right mind’. Depression makes us sit all day in our bedrooms, facing the wall: cutting ourselves off from all the relationships which define us and make our lives our lives. And if the depression isn’t treated, the threat to the Self can become desperately dangerous. We might annihilate the Self with razor blades or by jumping off a bridge.

Usually, though, the danger isn’t mortal. Most manifestations of depression, for most of us, most of the time, are premonitory signs. They tell us that the Self is vulnerable: that it needs some urgent TLC – or else.

Perhaps it doesn’t need to be stated (it’s really tautological), but of course a sense of Self is vital to our biological survival (which is Darwin’s main interest). It’s my sense of Self that makes me compete for a mate; which makes me look for my next meal; which makes me avoid harming myself.

So: most of the time, depression is acting to preserve the self. It doesn’t just cause us to run away from nasty stressors, as some of the other theories suggest. It acts too as a health education program, teaching us about effective therapies. Once you’ve had a small dose of depression, you recognize the symptoms next time, and reach more quickly for the remedy (whether it’s pills, a holiday, a walk in the sunshine, or a massive dose of friendship).

Depression, then, is a thief of Self which has been cunningly recruited by evolution to frustrate its own burglarious project.


Taken From Blog.OUP.Com





Depression: Why Talking About It Is The First Step To Cure

One person commits suicide every 40 seconds, with suicide accounting for 800,000 deaths around the world each year. In India, suicide was the tenth biggest cause of early death in 2016, reported the Global Burden of Disease Study 2017, mostly because of undiagnosed and untreated depression.

Globally, depression is the most common mental health disorder, accounting for around 40.5 % of cases, followed by drug and alcohol abuse, schizophrenia and bipolar disorders, reported The New England Journal of Medicine

Depression affects 322 million people across ages worldwide, estimates the World Health Organisation (WHO), with 58 million living with depressive disorders in India. More women (5.1%) are affected than men (3.6%), yet women are less likely to seek support and treatment. Even when they do, they are less likely to get treated.

While symptoms vary, most people with depressive disorders experience social withdrawal, low self worth, disturbed sleep, changes in appetite, fatigue, listlessness, poor concentration and irritability. It affect a person’s ability to work, form relationships and function independently, making it the most common cause of disability after heart disease, infections, neonatal disorders and cancers.

Widening net

Increasing social isolation and the changes in the way the world communicates are increasingly leading to the signs being missed. Bollywood actress Deepika Padukone, whose own struggle with depression in 2014 has turned her into a relentless crusader against stigma around mental health, says it took a visit from her mother for them to realize she was experiencing more than simple mood swings and needed diagnosis and treatment.

Close to 50% mental illnesses manifest by age 14 but signs of depression in young people are often missed because they are more likely to display symptoms of irritability, anger and withdrawal than sadness. That these signs of depression are often overlooked is evident from the more than a dozen lives that have been lost over the past few months to the blue whale challenge, the online game that goads vulnerable teens to commit suicide.

The shift in how people, especially the young, are communicating is also fuelling isolation in people with underlying depression. Online interactions are superficial than interpersonal bonding that make it more difficult to mask emotions, say experts, leading to increasing social withdrawal and dependence on online social support from groups and administrators who can then potentially make or break young minds.

Depressive disorders are caused by a complex interplay or biological and psycho-social factors. People who have been or are going through adverse life events – chronic illness, unemployment, bereavement, psychological trauma, etc – are at higher risk of depression, but the disorder also affects highly-functional people who may be battling feelings of emptiness and inadequacy without a causing ripple in their well-ordered life.

Drugs and treatment are a must if the condition is chronic and lasts for more than four weeks, or recurrent, when bouts of depression occur three to four times a year, or when mental demons interfere with normal function for more than two weeks.

Psychological treatments such as behavioural activation, cognitive behavioural therapy and interpersonal psychotherapy are recommended for mild depression. Antidepressants – such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) – are effective against moderate-severe depression, but are not recommended for treating depression in children and as the first line of treatment for mild depression in adults and depression in adolescents. New drugs, such as ketamine, are offering promise for the 30% people who do not respond to available treatments.

Mood lift

Rising awareness is prompting more people to seek treatment than ever before in urban and peri-urban towns. Physicians wrote more than 9.4 million new prescriptions for antidepressants in 2016, up 12% from 8.4 million in 2015. Antidepressants sales in value in India have shot up by more than 30% over the past four years, up from Rs 760 crore in 2013 to Rs 1,093 crore in 2016.

What has helped to destigmatise mental illnesses is India’s reformist The Mental Healthcare Act 2017 that decriminalises suicide and empowers people with mental health disorders to choose a mode of treatment, refuse institutionalization, nominate a person to ensure their wishes are carried out, and bans the use of degrading treatments, including shock therapy for treating children and using it only under anaesthesia for adults after approval from the district medical board.

Despite policy support and increasingly destigmatisation, psychosocial stressors – social attitudes, discrimination and deprived opportunities – continue to exclude people with depression from treatment, with well-meaning family keeping them locked inside home to protect them from the world. They don’t need protection, they need treatment so they can get on with their lives.


 

Taken From Hindustantimes.com




 

Can A ‘Depression Nap’ Actually Improve Your Mood?

Maybe you’ve taken one and didn’t know there was a name for it. Or you rely on yours and can’t go a day without it. Either way, the depression nap, a relatively new meme-worthy trend all over social media, has made it to Urban Dictionary and Reddit—so it’s officially a thing.

But is it a good thing? Most of us (except maybe defiant toddlers) would love to squeeze in a nap during the day. But experts aren’t so sure a depression nap—or a quick snooze when you’re feeling like the world is just too much right now—is actually a smart idea.

“If [napping] is being used to avoid doing or confronting difficult things or is being done excessively while connected to depressed feelings or low energy, then it may be a symptom of a psychological disorder such as depression, anxiety, or insomnia,” says Simon Rego, PsyD, chief psychologist at the Montefiore Medical Center and Albert Einstein College of Medicine in New York City.


 

Some people who swear by depression naps might feel tired all the time, sleep more than usual, and sleep as a way of escaping what’s bothering them. The need to take a depression nap could signal clinical depression, as excessive sleepiness is one symptom of the disease.

On the other hand, sleeping too little can also be a sign of depression. Some people with depression feel restless and wound-up, leading to trouble falling or staying asleep. If you have a hard time dozing off at night, napping is probably off the table for you: Any daytime shut-eye may only make that process more difficult.

But napping can be good for other people. According to the National Sleep Foundation, a quick nap can improve alertness, strengthen your performance at work and cut back on mistakes and accidents, and, of course, help you feel relaxed and rejuvenated for the rest of your day. Some research even suggests a midday nap can lower blood pressure.

Waking up refreshed and ready to tackle a difficult task is different than using sleep to ignore that challenge entirely, though. “If you’re napping to avoid a task that is difficult, in many cases, that’s not an adaptive way of coping,” says sleep psychologist Kelly Baron, PhD, assistant professor in the department of behavioral sciences at Rush University Medical Center in Chicago. “Rather than confronting what’s making you feel anxious and getting it over with, you’re procrastinating, which can make anxiety feel worse.


 

While it’s totally normal to feel a little sleepy during the day—especially in the afternoon, when there’s a natural dip in our circadian rhythms, Baron says—it’s probably not so good if you feel like you need a nap to get through the day, every day. “In these cases, it’s important to seek help from a licensed mental health professional,” Rego says. He or she may even point you to a sleep specialist, Baron adds, in case an undiagnosed condition like sleep apnea could be causing your daytime drowsiness.

If you need an occasional depression nap, there’s probably no real harm to taking a little break from it all once in a while, as long as you’re using that snooze to feel more alert and more productive when you wake. “While napping itself is not necessarily a problematic behavior,” Rego says, “it’s important to be clear on why you’re napping.



Taken from Health.Com