Depression examined
Depression is a touchy topic. Whenever I mention it
I can almost guarantee hearing from a correspondent that I do not know
what I am talking about.
The argument has two sides, and it is sheer cowardice
to avoid touching on a subject that tends to arouse fierce controversy
because it is intensively subjective in nature. Similarly, anyone mentioning
the Taliban, Islam or Northern Ireland politics stands to raise someone's
hackles. Nevertheless these topics must be openly debated, or they will
continue to rankle in secret. The thing to do is to gird up one's loins
like the old prophets and wade in regardless. The thing to avoid is arrogance.
There is inevitably much written and spoken about
depression, since it has become a disability affecting many millions of
people to a lesser or greater degree. The term is used in everyday conversation
to describe a downswing of mood, something to which all of us are liable
during our social interactions. When it involves severe emotional upsets
producing deep sadness and hopelessness, with a lowered self-esteem, behavioural
disturbances, loss of interest in the environment and possibly loss of
sleep and appetite, depression calls for remedies. In the ultimate case
suicidal thoughts and even attempts at self-harm must be taken extremely
seriously.
Why women are two to three times as likely to suffer
clinical depression as men is uncertain. It may reflect social and employment
disabilities, which remain a common injustice of our social organisation.
It seems certain that one depressive episode in a woman is often the forerunner
of more, whereas in men this is not usual.
Arguments over the best way of combating depression
have multiplied in recent years. One approach now thoroughly discredited
is to tell the sufferer to pull himself or herself together and cheer
up. This does not work. It is agreed that pharmacological intervention,
though perhaps effective for a short period, is usually ineffective and
sometimes hazardous. A paper published in the Journal of the American
Medical Association for 10 October emphasises the frequent relationship
between depression and certain other medical illnesses. Clinicians have
in the past been inclined to attribute the patient's feeling of despair
to a sense of vulnerability, fear and diminished self-esteem. But this
view needs reconsideration in the light of evidence that depression may
be an independent risk factor that contributes to the development of ischaemic
heart disease and increased cardiac mortality. Indeed, depression may
be part of the aftermath of a myocardial infarction, and need not be severe
in order to play its part in the syndrome. Depression coexisting with
other illnesses may impair recovery and rehabilitation as well as increase
the risk of chronic morbidity and mortality
An editorial in the British Medical Journal
for 27 October comments that a World Health Organization study of psychological
disorders appearing in general health care in 14 countries shows that
patients suffering major depression may be treated with sedatives as well
as antidepressants, despite a finding that antidepressant treatment usually
brings better results. It is argued that prescribing drugs is not the
solution, but that the whole process of health care needs to be enhanced.
Improved general care from co-operative primary care workers enhances
the patient's ability to function in society, which is the main objective.
It is to be hoped that those organisations providing patient care will
respond to the urgent problem of millions of individuals world-wide who
are affected by major depressive illness.
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In
1595 Queen Elizabeth sent Sir Francis Drake in charge of an expedition
to the West Indies, with Sir John Hawkins as his second-in-command. Hawkins
was a sick man, and when the expedition had reached a position near Porto
Rico he died. Drake, too, was taken sick with dysentery, and he died while
in the bay off Porto Bello, on his ship the Defiance, on 28 January
1596. Next day his body, confined in a lead casket, was buried at sea
a few miles off shore.