The sneaky disease of depression

We are becoming more and more aware of the effect of mental illnesses and conditions that are affecting our community and perhaps it is time to discuss the most underdiagnosed condition in the U.S. mainland as well as here.

Depression is a mental expression of a physical illness.

Your brain relies on chemicals known as neurotransmitters to relay information and to keep the body and mind in a state of homeostasis (meaning a steady state).

Over time, especially with unaddressed stressors in life, the brain begins to “run out” of certain neurotransmitters. This imbalance can lead to many physical manifestations.

For example, a lack of the neurotransmitter dopamine can cause the symptoms of Parkinson’s disease.

A lack of the neurotransmitter serotonin causes depression.

In order to treat either disease we use medications that help to restore either a healthy balance or we make the available neurotransmitters hang around longer.

For depression, these medications are sometimes used with counseling to restore the homeostasis in the brain and therefore the body.

The surprising thing to most folks is that being depressed is not just about sitting around crying all the time.

The early signs of depression are very subtle and many practitioners fail to ask about them.

Some things that indicate that you may be suffering from depression are as follows: (Thanks and credit to Web MD for the listing):

-Trouble concentrating, remembering details, and making decisions

-Fatigue

-Feelings of guilt, worthlessness, and helplessness

-Pessimism and hopelessness

-Insomnia, early-morning wakefulness, or sleeping too much

-Irritability

-Restlessness

-Loss of interest in things once pleasurable, including sex

-Overeating, or appetite loss

-Aches, pains, headaches, or cramps that won’t go away

-Digestive problems that don’t get better, even with treatment

-Persistent sad, anxious, or “empty” feelings

-Suicidal thoughts or attempts

One would notice right away that the sadness portion of the diagnosis is a very small part of the issue. That is what makes it so hard to pinpoint.

Everybody gets sad or feels down every now and then. It is life. However when your body and mind cease to function normally it becomes an issue.

People who are under significant stress for a long period of time will likely develop at least a minor depression. When I have patients that are, for instance, sole caretakers for a loved one I try to ask them how they are doing. They keep busy to ignore the signs and symptoms and signals their bodies are sending them.

Also, particularly on our island, people consider this taboo. You don’t talk about your “feelings” and you don’t dare admit that there may be a weak point in your defenses.

This is a true shame. Treatment is so successful and beneficial nowadays that it should never be an issue. You don’t have to wear a scarlet “D” on your forehead to be treated for depression. It is a private thing between you and your doctor.

And people with depression really do suffer. It is, for some, a living hell. People may feel that there is always a cloud following them. That they can never do anything right. That things are never going to get better and this is just how it is.

Often they have prayed to no end for relief. Some wish they were dead. Some just sit in the house and refuse to go out. They don’t enjoy company. On their best day they “just don’t feel good.”

Guess what?

They are not “crazy.” They are suffering from a medical illness known as depression. It is very common.

According to the National Institute of Mental Health: An estimated 16.2 million adults in the United States had at least one major depressive episode. This number represented 6.7 percent of all U.S. adults. The prevalence of major depressive episode was higher among adult females (8.5 percent) compared to males (4.8 percent).

That is a pretty high number. That is also only those that self-reported or were diagnosed. Up to 10 percent of the population suffers from depression and maybe more.

And even though we live on a beautiful island and are blessed with fellowship, friendship, close family ties and solid religious background our numbers are at least just the same. Maybe higher.

This island has been through some rough times and, although things are brighter, the damage still remains. We see it in our disease rates and the maladies that strike our people. Stress is bad. Cumulative stress is debilitating.

So how does one treat depression?

Many times one cannot know the triggers that caused depression in an individual. There is somewhat of a familial connection as it may run in families. Regardless, the idea is to return your brain to a time when it functioned normally despite the stress. When you did not feel chronically ill regardless of your overall health and where you are able to feel happy alone, not relying on diverting your attention to keep your mind off your depression.

In other words, a time when you were at peace.

The modern medications for depression allow the neurotransmitters that allow homeostasis to stay around a little longer. They are known as re-uptake inhibitors. They allow the natural chemicals of the brain to remain in the connection areas for a little longer, thus allowing the brain to function the way it is supposed to.

Cognitive behavioral therapy, or CBT, in addition to medications or without can be very beneficial to individuals with depression. Counseling teaches you to deal with the stressors that lead to depression and teaches you to face issues that are bothering you head on.

As you can see, the combination is very effective in allowing one to get on stable footing and move forward.

I usually like to use a medicine plus or minus counseling depending on the source of the stressors.

I usually recommend a six-month course of meds and then we can back off and see how the patient does.

The medicines we use take about 6-8 weeks to reach full effect so when I see a good response at two weeks I know the patient is going to do well.

We have increasing availability of counseling available on island now so it is easier than in the recent past.

Gov. Torres has pledged his support for mental health treatment throughout the CNMI and we are increasingly able to deal with this and to raise the quality of life for our brothers and sisters.

Here is a link to the Hamilton depression scale that is used by clinicians to assess your level of depression.

It is a questionnaire that is valid in assessing for depression: https://www.psychcongress.com/saundras-corner/scales-screeners/depression/hamilton-depression-rating-scale-ham-d

If you feel that any of this applies to you then see your health care provider and discuss it with them.