The Tribune

By DR MIKE NEVILLE

A terrible name for a terrible illness.

I would much prefer some name in Latin or Greek as I am sure a mysterious name would be much more acceptable.

The problem with the name ‘depression’ is that everyone thinks that they know what it is: “Unhappiness”, “Weakness”, “Snap out of it”, they say.

It is a bit like telling someone to snap out of diabetes. It sounds fine but close to impossible.

We know lots about this illness called depression and it is a nasty illness; just as things can go wrong with our hearts and lungs, our brains are also susceptible to major problems.

Our brains are pretty incredible, containing roughly the same number of cells as there are people in the world and then each cell connects to hundreds of cells around it. The messages pass along the cells by a form of electrical conduction and then at the junctions (synapses) chemicals are formed and pushed into the space, passing the messages to the next cells.

In this illness called depression there are not enough chemicals so the messages do not flow properly and as the brain controls the whole body everything goes out of balance. This explains the wide range of symptoms that may occur; from feelings of depression that gave the illness its name to headaches or stomach upsets.

A core symptom is the loss of joy. This differentiates it from having a bad day, when there are usually things that one can do to cheer up. With depression, nothing works. Feelings of guilt and hopelessness are common as are appetite changes and sleep disturbances. Daily living becomes a struggle and thoughts of ending it all creep into the mind.

Untreated depression is the main cause of mortality in psychiatry, suicide is all too real. Thoughts can become so negative that the belief that the world would be better off without you can become overwhelming and death seems to be the only option.

The causes of depression are like a jigsaw puzzle - many pieces conspiring together to throw your brain chemistry out of balance. There is a genetic vulnerability but anyone can get the illness; stress, hormone changes like childbirth or menopause can cause it. Thyroid imbalance, any major illness like cancer or surgical intervention, can set it off.

It is like one imbalance sets off another like cascading dominoes running through your body. The neurochemical imbalance may be small or very marked and, in this way, resembles diabetes or hypertension. A slight case of sugar can be treated by lifestyle changes but major problems would need insulin injections.

The same concept is true for depressive illness: a slight imbalance can be solved by positive thinking and lifestyle changes. A more marked imbalance will need some form of talking therapy to help correct these chemical imbalances. Cognitive Behaviour Therapy looks less at the past and works to retrain your brain to deal with thoughts and actions in the here and now.

There are times when the imbalance is so great that these therapies are not enough and medication is needed; the group of drugs known as antidepressants have transformed treatment. They work by gradually restoring the imbalance of the neurotransmitters in the brain; they are not ‘happy pills’ and can take up to six weeks to work as they gradually allow the level of these chemicals to build up and return to normal.

They have saved endless lives by preventing suicide but they are not without problems; about 20 per cent of people suffer side effects, some cannot even tolerate the medication and during the early weeks suicidal thoughts can even worsen.

The solution is to work with a doctor you can trust who can combine talking therapy and then the use of medication if necessary. You must feel that any difficulties will be taken very seriously because, if the illness is severe, it is potentially fatal.

Mental illness is still associated with the stigmas of fear and ignorance. So many people do not get treatment or do not believe that they can be helped. The costs of this illness are extraordinary - no research into cost has been done in the Bahamas but in the United States unfunded research was published in ‘Scientific American’ magazine in 2015, putting the cost of this and related problems like anxiety and Post Traumatic Stress Disorder at $210 billion a year.

As the great English Test cricketer Geoffrey Boycott said: “Until you have had depression I don’t think you are qualified to talk about it.”

• Dr Mike Neville is a forensic psychiatrist who has practiced for more than 40 years in The Bahamas, working at Sandilands, the prison and in private practice. Comments and responses to mneville@tribunemedia.net