THE DEPRESSED

It was only quite recently that I read about a study about depression being highly prevalent in most countries of the world in alarming proportions. It seemed that it is the fourth largest cause of morbidity in the world and Indians are also quite depressed.

It is not quite difficult to believe that. Recently, Dr. Nandamani, our surgeon was sharing about a patient who had an abdominal surgery and was slipping into depression that he was afraid that the patient would not make a normal recovery. It was too good of Nandamani to diagnosis depression in a post operative patient. However, when we sit in OPD, it is quite obvious that depression presents in different ways and it is very few generalists or non-psychiatrists who would be able to pick out a symptom of depression in the patient. Even, in a mission hospital like ours working in quite a remote area, depression is a diagnosis which we could find if we seriously look for it.

Couple of patients whom I wanted to share with you. The first one was a student who was brought by her father, a policeman - with the complaint that she was accumulating air in her body and it was preventing her from sleeping and eating enough. This happened during my first stinct at NJH. The 16 year old girl looked normal to me except for her forlorn face and sense of anticipation for some relief. I was quite fresh from college - and remembered someone teach us that if a patient does not eat well and sleep well - you need to rule out depression. The best part about this girl was that her father, the policeman was quite a talkative character. He was very sure of the diagnosis. He had been taking this girl to many places and someone had diagnosed bilateral pneumothorax. He was told by some quack that she was leaking air from both her lungs and there were permanent holes in her lungs. I was in charge of the TB department and that was the reason he brought her to me - he somehow concluded that since tuberculosis affects the lungs, I would be the best person to handle it.

Chest examination was normal - good air entry on both sides. Good heart sounds with no murmer. I asked the girl umpteen questions. One of her cousins was there along with her and he blurted out all her symptoms had started after her 10th standard results came. That revelation was quite a leading and I was definite that I was looking at a depressed person. I sat and talked with the family for quite long. Unfortunately, the father could not be drawn to the possibility that her daughter was having depression following her poor 10th standard results. He was just bent upon getting treatment for the 'holes in both her lungs'. I somehow tried to get her a prescription for anti-depressants and to follow her for psychotherapy - both of which were refused politely. I used to wonder what happened to her till recently when someone from the police station nearby made a passing reference of her having committed suicide about 4 years back. It was very unfortunate.

My second patient was luckier. She had 3 children - the elder 2 placed in the paramilitary forces. The youngest one was doing his graduation and had also made up his mind to enter the paramilitary/military force. The 55 year old lady lived along with her husband - a very calm person who was running a road side eatery. He told me that he did not run the eatery for a living. He used to have a government job as a peon. After he retired he took to cooking as a hobby and thought that he would pass his time cooking pakoras and samosas in a small tea shop and chatting with his customers. To his surprise, he was doing a roaring business and was having a good time. Unfortunately, his wife, my patient had a lot of free time. Her time was spent worrying about the children. The 2 paramilitary sons were always on the move pursuing Naxalites or militants. With her youngest son also opting for a career in military - it was a nightmare for her.

She hardly ate nor slept. She wanted to die, not wanting to see the death of her children. She was imagining bad things happening for her children. She went to a quack who told her that removing her uterus would solve all her problems. And that was the reason she came to us. After much talking with her husband, we were definite about what needed to be done. I talked to her children over the phone - first, the elder one and later the second one. I convinced them that their mother had depression. I told him that the best option would be take psychiatric consultation - since I was not a trained one. The answer I got surprised me. The elder one told me that if she is taken to a psychiatrist, the village and family would brand her as mad.

I gave him the option of us treating her with the help of one of our psychiatric colleagues in a sister hospital of EHA. The arrangement was very much acceptable to him. However, I got a written consent from him for the same. The lady has been taking treatment from us for quite a long time now. I see her occasionally. In fact, she brought couple of her acquintances who had some form of psychiatric complaints. We could manage them quite well. Meanwhile, her son changed his mind to go into the military and recently wrote exams to enter banking services. A lot of her symptoms have been relieved. I recently got a 'thank you' call from the eldest son. He being in paramilitary forces had consulted some psychiatrist and was told to continue the same treatment.

From the many cases of depression that have come to our OPD, I've realised the need for few things -

1. Need for integrating practical psychiatric training into the graduate medical education.

2. Sensitisation about mental illnesses in communities and the need for mainstreaming them.

3. Psychiatrists have always been seen as doctors treating mad people. Much needs to be done to bring them closer to the common man.

Studies all over the world have been constantly warning us of the impending epidemic of 'depression' within our communities. The jet set lifestyle, high expectations of parents from their children, materialism, breakdown of families etc which have the hallmarks of recent times would only accelerate this epidemic. The question remains about whether we would be ready to help the world out of depression. Or rather, would we be looking at options to prevent depression in the fellow beings?