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Expert Speak

Depression: Identifying and Coping with the problem.

Dr Peter Fernandez, MD, DPM, TDD, FCCP, FIPS is a practising psychiatrist based in Chennai and has a long and illustrious career to his credit. His constant interest in the dynamics of the human mind led him to do pioneering work in the rehabilitation of the mentally ill. At 70, he looks full of verve and energetically endorses the positive aspects of life. Dr Fernandez assures that depression is treatable …

The word depression is used by people pretty frequently, in varying contexts. What is, in medical terms, depression?

The low feeling that comes to all of us, varies in the duration and severity and type. It can be classified under the following heads:

  • Depressive mood:

    Everybody feels sad or blue at times and soon the feeling blows over. This is normal human behaviour.

  • Reactive depression:

    When a person loses a loved one, when a marriage breaks down, when there is financial loss, for a few weeks or even a few months a person could be feel low, show a loss of initiative and little interest in his daily routine. This feeling fades and the person returns to normal routines and outlook after that. This type of depression is associated with grief or loss and is temporary.

  • Dysthymia:

    This is a minor, lingering kind of depression. The person is frequently depressed and this persists over a year or two. This is associated more with the personality of the individual, rather than any specific event. The person shows poor concentration, fatigue and seems to enjoy life little. Because of this persistent low, he is unable to go full steam ahead with what he does.

  • Major Depression: This is more serious than the other kinds of depression. The person has a combination of symptoms that interferes with his ability to work, sleep, eat and enjoy pleasurable activities. These disabling episodes can occur once, twice, or several times in a lifetime. Sometimes this occurs at a particular time of the year. I even have patients who come almost on the same date of each year. ( This is called Seasonal Affective Disorder)
  • Manic Depressive Disorder: This is also called Bipolar disorder. Here the person is manic (highly elated talking and looking busy and important in an exaggerated fashion) for a while and then plunges into a low. This cyclical pattern keeps repeating.

What are the symptoms of Depression that needs psychiatric help?

A combination of any of the following symptoms can be observed:

  • Apathy
  • Insomnia: especially inability to sleep in the predawn hours, dreading the day to come.
  • Lack of Drive
  • Disinterest in Daily Routine
  • Low Empty Feeling
  • Crying Spells
  • Loss of Appetite
  • Constipation
  • Contemplation of Suicide
  • Attempt of Suicide.

When does a person know that it is not a passing phase but a medical condition that needs help?

When the some of the above symptoms persist everyday for over 2 weeks or more.

Who is at risk of depression?

  • Any one who has experienced loss can go into (reactive) depression.
  • People who experience too much stress and have poor coping mechanism lapse into depression.
  • If there is a family history of depression there is a chance that a person can have manic depressive disorder.

Is there any particular age group that is susceptible?

We notice that most patients are in their thirties or forties.

How should the family treat someone with depression?

When the family realises that someone is feeling low for abnormally long periods with a combination of the symptoms mentioned above, it must take the person for medical help.

It must not ascribe guilt to the patient with depression. Pull yourself up! You can’t simply crack up like this…This is all your fault..! is the wrong attitude to take.

When the person goes in for therapy, the family should follow up, helping the patient to take the medication regularly.

Is depression treatable?

Fortunately, yes. Unlike some other mental illnesses, depression is treatable. Treatment during the episode and preventive medication to diminish the possibility of future episodes are available.

What are the treatment options?

When the condition is self limiting, as in the case of reactive depression, not much by way of treatment is required.

When the patient is suffering from dysthymia psychotherapy is used.

For Manic Depressive Psychosis a combination of treatments may be required:

Medication: specific anti depressant drugs can be prescribed.

ECT or Electro Convulsive Therapy may also be used.

Psychotherapy is also given

What exactly is psychotherapy?

A psychiatrist talks and listens to the patient and tries to get to the root of the problem and help the patient recognise the source of the problem.

I use hypnotherapy for this.

Can you explain your technique?

I believe that All hypnosis is self hypnosis. The hypnotic state is an altered state of consciousness that comes on spontaneously when a person listens to bhajans, meditates etc. Or it can be induced by another as in hypnotherapy.

In a session I heighten the patient’s awareness of the past and help trace the act or event that could possibly have triggered off his present problem. Once this is identified, it is easy to treat the condition.

Dr Peter Fernandez, MD, DPM,TDD, FCCP, FIPS is a practising psychiatrist based in Chennai. He retired as Professor of Psychiatry at Madras Medical College and Superintendent, Institute of Mental Health, Kilpauk. He has founded a rehabilitation unit called Industrial Therapy Centre for chronic mental patients.(View website www.rehabfernandez.com).Dr Fernandez discovered the power of hypnosis by accident and has taken a deep interest in the subject. He interprets human behaviour with the help of this and directs it towards healthy attitudes. Dr Fernandez has been conducting courses on hypnosis for medical and paramedical professionals. He has also been giving lectures on Self Hypnosis for Stress Management for professionals from the corporate world.

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