Depression a major burden in social life

 Introduction

Globally, the total number of people with depression was estimated to exceed 300 million in 2015, equivalent to 4.3% of the world’s population. In India, the National Mental Health Survey 2015-16 revealed that nearly 15% Indian adults need active intervention for one or more mental health issues and one in 20 Indians suffers from depression. It is estimated that in 2012, India had over 258 000 suicides, with the age-group of 15-49 years being most affected. Depression is ranked as the single largest contributor to global disability (7.5% of all years lived with disability in 2015). At its worst, depression can lead to suicide; over 800 000 people die due to suicide every year. It is the second leading cause of death in 15-29-year-olds. Government of India’s commitment is reflected in the National Mental Health Programme (NMHP), which encompasses life-skills training and counseling in educational institutions, workplace stress management and suicide prevention services, among others. At the primary care level, the Health and Wellness Centres under the Ayushman Bharat program have a provision for mental healthcare services1. 

Understanding Depression

Depression is perhaps the cause of more grief and misery than any other single disease to which human kind is subject. This view, expressed by Kline more than 40 years ago, is still shared by everyone in the field of mental health. The several forms of depression taken together are the most frequent of all psychiatric illness. In a general hospital, depression accounted for an estimated 50 percent of psychiatric consultations and 12 percent of all admissions. Although depression has been known for more than 2,000 years (melancholia is described in the writings of Hippocrates), there is still uncertainty as to its medical status as a disease state (kraepelinian concept) or as a type of psychologic reaction (meyerian concept). In other words, it is basically a biologic derangement or a response to psychosocial stress. An electric position is that both are correct that is there are two basic forms of depression: exogenous and endogenous, and that there may be both interplay between them and biologic susceptibility to either one. Of considerable consequence for clinical work, depressive states are often associated with obscure physical symptoms. For this reason they are likely to come first to the attention of general physicians than are other psychiatric entities. All fields of medical speciality, however, have depressive equivalents; the physical symptoms frequently are mistakenly attributed to anaemia, low or high blood pressure, hypothyroidism, migraine, tension headache, chronic pain syndrome or chronic infection are are casually attributed to emotional problems, worry and stress. Neurologists are most likely to encounter depressed patients who complain of fatigue and weakness, chronic headache and difficulty in thinking or remembering. Another important reason why all physicians should be knowledgeable about depressive illness in all its forms is the danger of suicide, which may be attempted and successfully accomplished before the depression is recognized. Timely diagnosis may prevent such a tragedy- one that is all regrettable as most depressive illness can be successfully treated 2. 

Impact of life style factors on depression
According to WHO, Healthy living is a way of living that helps you enjoy more aspects of your life. It is a way of living that lowers the risk of being seriously ill or dying early. Health is not just about avoiding a disease or illness.  Using a broader definition, lifestyle factors generally include, level of physical activity, use of tobacco smoking, amount of food consumed, level of obesity, consumption of healthy/unhealthy food, level of alcohol consumption, use of illicit substances, sexual health and access to 'healthy' environment. The number and types of lifestyle diseases are rising with increasing contribution of psychiatric diseases. Whilst depression and type 2 diabetes may appear to be widely apart in their nature and presentations, they are not only linked, but are likely to have same underlying pathology. Indeed, there is growing evidence that the common underlying pathology for both type 2 diabetes and depression is chronic inflammation as is the case in many chronic diseases3 .

"In Ayurveda Vishada and Avsada are two conditions which have close resemblance to depression. Charaka Samhita mentions “Vishada” as one of the vataja nanatmaja vikaras2 and it is further said that, Vishada is the main factor that increases the range of all the diseases. Sushruta has mentioned it under the Mano vikaras (Mental diseases). Further he mentioned that Vishada is common among the Tamasika Manasa Prakruti people. Whereas Vagbhata has stated that person with predominant Tamasa guna is more prone to suffer from Vishada"4 .


 Working Environment and Depression
"More than half the world’s population is currently in work and 15% of working-age adults live with a mental disorder. Without effective support, mental disorders and other mental health conditions can affect a person’s confidence and identity at work, capacity to work productively, absences and the ease with which to retain or gain work. Twelve billion working days are lost every year to depression and anxiety alone. Furthermore, people living with severe mental health conditions are largely excluded from work despite this being important for recovery. Mental health conditions can also impact families, carriers, colleagues, communities, and society at large"5. 
    It is generally accepted that ‘work is good for you’, contributing to personal fulfilment and financial and social prosperity (Cox et al., 2004; Waddell & Burton, 2006). There are economic, social and moral arguments that, for those able to work, ‘work is the best form of welfare’ (Waddell & Burton, 2006) and is the most effective way to improve the well-being of these individuals, their families and their communities. Moreover, for people who have experienced poor mental health, maintaining or returning to employment can also be a vital element in the recovery process, helping to build self-esteem, confidence and social inclusion (Perkins, Farmer, & Litchfield, 2009). A better working environment can help improve employment rates of people who develop mental health problems. Not doing this puts additional costs on governments who have to provide social welfare support for people who would prefer to be in employment. There is also growing awareness that (long-term) worklessness is harmful to physical and mental health. However, there has also been increased awareness that work is generally good for your health and well-being, provided you have ‘a good job’ (Langenhan, Leka & Jain, 2013; Waddell & Burton, 2006). Good jobs are obviously better than bad jobs, but bad jobs might be either less beneficial or even harmful. A substantial body of evidence is now available on work-related risks that can negatively affect both mental and physical health with an associated negative effect on business performance and society (WHO, 2008). Although risks in the physical work environment can have a direct negative effect on mental health, that is accentuated by their interaction with risks in the psychosocial work environment. In addition, psychosocial hazards (also often termed work organisation characteristics or organizational stressors have been shown to pose significant risk and have a negative impact on mental health and physical health, mainly through the experience of work-related stress (WHO, 2008, 2010). As a result, a growing incidence of work related mental diseases has been observed, and as well as increased absence from work and early retirement due to mental illness in most European countries (European Framework for Action on Mental Health and Well-being, 2016). Promoting mental health at work has become a vital response to these challenges since the workplace is both a major factor in the development of mental and physical health problems but also a platform for the introduction and development of appropriate preventive measures. Starting with existing evidence on mental health problems in particular, evidence from the WHO suggests that nearly half of the world’s population is affected by mental illness at some point of their life with an impact on their self-esteem, relationships and ability to function in everyday life. While the Mental Health Foundation (2007) states that mental health problems directly affect about a quarter of the population in any one year. Global estimates by WHO (2017) indicate that 4.4% of the global population suffer from depressive disorder, and 3.6% from anxiety disorder 6 .

Maternal Depression:-

Maternal psychiatry emphasis a great field of research in medical system. The truth is very known that maternal behavior and mental status reflects a great role in the growth and development of a child. The morbidity rate is also prevalent in modern world due to usage of alcohol, cigarette and other form of narcotics during pregnancy period due to depression and other anxiety related disorders. The genetic pre-dispositions cannot be over look in the present context. The relation between mother and child become insecure leading to the increased risk of anxiety among offspring.

              Maternal behavior during pregnancy and Post Partum period plays an important role in the health of the offspring and is influenced by many factors. Home environment, caring of the pregnant lady during pregnancy period and Post Partum period, complication during pregnancy, low birth weight of the baby, preterm delivery greatly affects the mental stability of a pregnant lady and may be a mechanism by which anxiety and depression results 7. 

  Post Partum psychosis can be divided into 3 categories-

1.      Post Partum blues:- Emotional disturbances with crying, confusion, mood labilty, anxiety and depressed mood. The symptom appears during the first week of post partum period and lasts for a few hours to a few days.

2.      Postpartum psychosis:- Severe disorders during the four week of post-partum leading to hallucination, delusion etc.

3.      Post Partum depression:- Core feature include dysphoric mood, fatigue, anorexia, sleep disturbances, anxiety and suicidal thoughts.

 The consequences of maternal depression are not restricted to infancy age but can extend to even school age 8.

  Depression among adults

The young people in the age group of 10-24 are characterized by immense growth and development. It is a stage of vulnerability often influenced by several risk and protective factors that affect their health and safety. Feeling lonely, ethnicity, using drugs, being bullied and lack of parental supervision were highly correlated with depression among adolescents. Higher levels of depression were found to be related to external locus of control and a tendency to attribute outcomes to cause which are internal, stable and global. Socio-demographics, life events, sexual abuse, physical abuse and exposure to violence were found to be associated with depression among adolescents.

            Depression during adolescence is associated with academic difficulties, risky behavior engagement, and non-suicidal, self injury in later in adolescence and lower income levels, higher divorce rates, suicidality in adulthood. More distressingly 75 % of individual undergoing depression during adolescence will make a suicide attempt in adulthood 09. 

It has been evident for several years that the biogenic monoamines (nor- epinephrine, serotonin and dopamine) are in some way involved in the biology of depression. However, most of the neurochemical theories of depression suffer from the weakness that they have been the result of backward reasoning from the effects of antidepressants on various neurotransmitters to the putative mechanisms of the disease. Following the observations that the tricyclic antidepressants and the monoamines oxidase inhibitors exerted their effect by increasing norepinephrine and serotonin at central adrenergic receptor sites in the limbic system and hypothalamus and that depression-provoking drugs deplete biogenic amines at these sites, it was proposed that naturally occurring depressions might be associated with a deficiency of these substances. Furthermore, depressed patients and their first degree relatives, as well as healthy individuals, develop a depressed mood after dietary depletion of the monoamine-precursor tryptophan and concentrations of 3-methoxy-4-hudroxyphenylglycol, a metabolite of norepinephrine, are reduced in the cerebrospinal fluid during indigenous depression and the levels are elevated in manic states. Some neurochemical imaging studies corroborate these findings and others do not. Along similar lines, 5-hydroxyindoleacetic acid, a deaminated metabolite of serotonin, is reduced in the cerebrospinal fluid of depressed patients.

            Certain of the newer anti-depressants act as selective serotonin reuptake inhibitors and apparently produce their salutary effects by increasing the amount of serotonin that is functionally active in the synapse. For these reason, serotonin and its neuronal pathways are also currently implicated in the genesis of depression. It is also not clear which neurochemical alterations are primary and which modulate other systems. Reports suggest that substance P plays an important role in the causation of depression and that blockade of substance P receptors had anti-depressant effects.

            At the present time, it must be conceded that there is no reliable biologic test for depression. One must resort to clinical analysis not only for diagnosis but also for the differentiation of special types of depressive reactions 10 . 

Source:- 

1. (https://www.who.int/india/health-topics/depression).

2. Adams and Victor's Principles of Neurology, Tenth Edition, Allan H. Ropper, Martin A. Samuels, Joshua P. Klein.

3.https://www.researchgate.net/publication/335589969_Lifestyle_Factors_and_Mental_Health.

4. https://www.researchgate.net/publication/335172591_Depression_-_An_Ayurvedic_review.

5.https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/mental-health-in-the-workplace.

6.MENTAL HEALTH IN THE WORKPLACE IN EUROPE by Stavroula Leka, Aditya Jain, https://health.ec.europa.eu/system/files/2017-07/compass_2017workplace_en_0.pdf.

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141357/.

8.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724169/

9. https://www.researchgate.net/publication/316989694_A_Study_on_the_Prevalence_of_Depression_among_Young_Adults_in_South_India.

10. Adams and Victor's Principles of Neurology, Tenth Edition, Allan H. Ropper, Martin A. Samuels, Joshua P. Klein.

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