Depression, we all feel it, not all of us get through it.
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In the song fix you by Coldplay, they talk about trying and not succeeding and getting what you want but not what you need, Feeling so tired but not being able to sleep...What they call being stuck in "reverse".
In the song, they are trying to reach out to as many people as humanly possible in hopes that they can fix them all.
Check out Coldplays song here.
We all feel it
Source
I always feel like the sadness I feel at the moment is way worse than the ones I have gone through in the past or that it will never come to an end.
I remember failing in medical school and feeling like I was a worthless human being, fast forward to now and there was a patient who passed away, and... it's a lot to take in thinking about all I should have done and didn't do.
It comes in different ways
Being sad is different from being depressed. Saying it comes in different ways and first discussing sadness is very important because a considerable number of people who are depressed are sad.
Sadness The normal emotional response to feelings of disadvantage, loss, grief, etc. Sad events will make you sad.
Being depressed is way more than just a feeling. For some people, it's feeling nothing, no pressure, difficulty concentrating, sleeping problems, eating problems, deep anxiety, and sometimes actual physical symptoms of pain.
I remember when I failed that exam, it started with the feeling of sadness but it later kept me up at night.
The difference in medical school is that we often form support groups without knowing. We discuss how we feel for hours while trying to read to pass the exam.
Nothing like having someone who is going through what you are going through or has gone through it discuss it with you about it. You'll be fine with just that if your condition does not require drugs.
Not all of us get through it
I remember telling myself I wouldn't do it. This was after a long period of feeling worthless and feeling the world wouldn't need me.
Heartbreak can be such a lier even though it comes with such a heavy dose of reality.
For some people, suicidal thoughts don't end in just the thoughts, they start examining possibilities until they go ahead with what they felt was feasible for them.
Types of depression
Depending on the symptoms and the progression a person has, depression may be classified as:
- Major depressive disorder
- Persistent depressive disorder
- Bipolar depressive disorder
- Seasonal depressive disorder
- Psychotic depression
- Peripartum depression
- Premenstrual dysphoric disorder
- Situational depression
- Atypical depression
- Treatment-resistant depression
Major Depressive Disorder
This type of depression stays almost throughout the week and most of the time of the day.
According to the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), the following symptoms have to be present for 2 weeks. Among the symptoms 1 has to be a lack of interest in previously pleasurable activities or a sad mood.
- Bad mood or being highly irritable in adolescents or children.
- Lack of interest in previously pleasurable activities or all activities (anhedonia).
- Unexplainable change in appetite or weight change which could be weight gain or weight loss
- Insomnia or hypersomnia-meaning abnormality in sleep
- Feelings of agitation or psychomotor retardation
- Feelings of tiredness
- Feelings of worthlessness
- Suicidal ideation with or without plans or attempts at suicide
- Reduced ability to focus or think
- Feeling worthless
Mathematically there are up to 120 ways major depression can present (543*2).
Why do people become depressed?
Psychologically
People usually become depressed when they have a wrong perception of how life is going for them.
In these times, a lot of adolescents and young adults might feel depressed because of how they see other people living their lives. A lot of social comparison goes on without the realization that many people only show you the parts of their lives they want you to see.
Biologically
There is a pathway in the brain responsible for mood. These pathways can be affected by psychopharmacology (the use of drugs known as SSRIs NRIs, atypical antidepressants, etc)
Socially
Socially, our interaction with different people or society can lead to feelings of depression. Situations where a loved one dies, or a divorce or loss of a job. Relationship issues, workplace stress, family problems, etc.
Vertical decent
Getting to the root of depression and dealing with the main issue causing these feelings is beneficial.
You are trying to get to the root cause of the depression.
Let's say the patient says, I failed this exam so my life is over.
The patient then has to answer to that feeling by filling in the rest of this sentence...
If that were true, it would bother me because,
If that were true, it would bother me because I would have to repeat the class.
If I had to repeat the class it would bother me because people would think I am not smart.
If people think I am not smart, no one will listen to me as a doctor.
ETC...YOU CATCH THE DRIFT
It is never easy
It is also important to note that 2 people may experience the same thing and may not feel the same way. But just because you don't feel a certain way does not take away the validity of another person's experience.
Regardless it is equally important to be able to emphasize that the patient carries out every task they are given.
The task may include things like cleaning your room if you haven't done it in months or having your bath...maybe once a week.
You might be thinking once a week is such a low bar but depression hits that way.
With the advent of telehealth especially during the pandemic, it has become harder to have people get off the way themselves. The reason is, with Telehealth people are more likely to just sit at home and do nothing which is not so useful when compared to when people had to dress up and physically meet the therapist.
Conclusion
Depression is a common mental disorder and has been described in different ways by so many people in history. It is easy to neglect a person who is depressed because people perceive other people's problems differently.
Case study
The patient is a 28-year-old resident in internal medicine who was referred from the family medicine department.
She had complaints of
- Fatigue
- Inability to keep up with her pairs at work
- feeling depressed
She recently ended a long-term relationship with her boyfriend.
The family medicine physician thinks this might just be a normal reaction to ending the relationship.
The patient refuses to accept the diagnosis,
What are the next steps to managing this patient as a Mental health physician?
References
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