Depression is a mood disorder that is characterized by a persistent feeling of sadness and loss of interest in activities. It is also called clinical or major depression. It is more than just about feeling low or blue. It affects one’s thoughts, feelings and behavior and sometimes makes day to day activities difficult. There is a sense of loss of control over one’s moods and one cannot simply snap out of it. Depression is not a ‘weakness.’ But depression is treatable, with a combination of medication, psychotherapy, newer treatments such as rTMS, and certain lifestyle changes.
During an episode of major depression, individuals may experience the following symptoms, for most of the day, nearly everyday, for atleast two weeks:
Feelings of sadness
Irritability or angry outbursts
Tearfulness or crying spells
Loss of interest or pleasure in most or all activities, such as social interactions, hobbies, sex, etc.
Difficulty falling asleep, difficulty staying asleep or sleeping excessively
Low energy and excessive fatigue
Decreased appetite and weight loss, or increased appetite with food cravings leading to weight gain
Diminished concentration and forgetfulness
Feeling anxious and agitated or excessive slowing down of movements
Feelings of helplessness and hopelessness
Feelings of worthlessness or excessive inappropriate guilt
Frequent or recurrent thoughts of death, suicidal thoughts or suicide attempts
Unexplained aches and pains such as headaches, backache, etc
Among children, depression can manifest as irritability, sadness, aches and pains, clinginess, school phobia and weight changes.
Among teenagers, depression can present as irritability or sadness, anger outbursts, negative thoughts, feelings of worthlessness, becoming extremely sensitive and feeling that no one understands them, diminished interest in usual activities, avoiding people, academic decline, increased sleep, increased appetite, alcohol or drug abuse, and even self-harm.
Among older adults, depression often goes undiagnosed, and can present with memory difficulties, aches and pains, fatigue, decrease interest in interacting with people and in severe cases, even suicidal thoughts.
Symptoms of depression vary from mild to severe, and affect one’s daily functioning socially, at work and at home.
The exact cause of depression is unknown. Several factors may be involved, including genetics, altered brain networks that regulate mood, altered neurochemicals, hormonal imbalances, past trauma, etc. Life stress events can act as triggers for depression in vulnerable individuals.
Among depressive disorders, major depression is the most common, affecting approximately 20% of the world’s population at some point during their lives. Women are more likely to experience depression compared to men. Depression can begin at any age, and often starts in one’s teenage years or young adulthood.
Depression can manifest differently in different people. Symptoms can vary from mild to severe, and episodic to chronic. A few subtypes of depression include:
Dysthymia: is characterized by a low grade, chronic depression lasting at least 2 years.
Depression with atypical features: is characterized by “mood reactivity” i.e. mood bjustifyens temporarily in response to positive stimuli. The individual may also experience increased appetite, significant weight gain, increased sleep, heavy feeling in arms or legs and extreme sensitivity to rejection.
Depression with anxious distress: depression with unusual anxiety, restlessness, worry about possible events or about loss of control.
Seasonal pattern: depression related to changes across seasons with reduced exposure to sunlight.
Melancholic depression: severe depression with lack of response to something that brought joy and pleasure earlier, associated with early morning awakening, worsened mood in the morning, major changes in appetite, and feelings of guilt and worthlessness.
Depression with peripartum onset: depression that occurs during pregnancy or in the postpartum phase i.e. in the weeks or months after delivery.
Depression is a serious condition that can take a massive toll on individuals and their families. It often gets worse if not treated and can result in severe emotional, behavioral, and health problems.
Some of the complications include:
Problems at school, college, or work
Interpersonal problems and relationship difficulties, including social isolation, family and marital conflicts
Excess weight or obesity, which in turn can lead to diabetes, heart disease, and other medical disorders
Alcohol or substance misuse or dependence
Self-harm behaviours such as cutting
Suicidal thoughts or suicide attempts
Premature death from suicide or other medical conditions
Depression is usually treated with medication (antidepressants) and counselling (psychotherapy). Antidepressants primarily work on brain chemicals (neurotransmitters), especially serotonin, norepinephrine, and dopamine. Several antidepressants are available with fewer side-effects compared to older medications. Some of these include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), and atypical antidepressants. Medication must be taken only under a doctor’s supervision and not stopped abruptly or taken irregularly. A discussion with one’s treating psychiatrist is helpful in selecting an antidepressant.
Some individuals may not respond to medication or may experience too many side-effects. Newer, state of the art, safe, and effective treatments such as Repetitive Transcranial Magnetic Stimulation (rTMS) are now available which can be helpful in treating depression. rTMS is a non-invasive treatment that uses a magnetic field administered externally on the scalp to stimulate specific areas of the brain to treat depression, anxiety, and other clinical conditions. No sedation is required, individuals are awake and alert during rTMS treatment and can even drive themselves home, or resume work immediately following treatment. rTMS was approved by the United States Food & Drug Administration (US-FDA) for the treatment of depression in 2008 and has been in use globally for over 20 years.
rTMS has replaced electro-convulsive therapy (ECT) in many individuals with resistant depression. However, in some very severe cases in which the safety of the patient is at risk (such as suicidal depression), ECT may be very helpful and may even be life-saving. For very severe depression, hospital admission may be required.
Psychotherapy includes techniques such as Cognitive Behavioural Therapy (CBT) or Rational Emotive Behavioral Therapy (REBT) which, in combination with medication, can be useful for some individuals with depression.
i) Educate yourself about depression and its treatment.
ii) Ensure that you follow your treatment plan.
iii) Lower your stress levels.
iv) Follow a healthy lifestyle: get enough sleep, exercise, follow a healthy diet, avoid alcohol and substances of abuse, including smoking.
v) Do not ignore early symptoms or warning signs of depression; get treatment immediately.
vi) Seek professional help when necessary.
vii) Harness support from your friends and family.
Bipolar mood disorder is a condition that affects an individual’s mood and behaviour. It is characterized by a distinct period of abnormal mood i.e. elated, expansive, or irritable mood (manic or hypomanic episodes) and depressive episodes. It is more than just feeling active or cheerful. It interferes with the daily functioning of the individual.
During a manic episode, the individual has a period of mood disturbance for most of the day, nearly every day, including the following symptoms:
Abnormally and persistently elevated, expansive or irritable mood
Abnormally and persistently increased energy and goal-directed activity
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual, pressure to keep talking
Easy distraction to irrelevant or unimportant things
Excessive involvement in activities that could lead to painful consequences (e.g. rash driving, rash spending sprees, sexual indiscretion, alcohol or drug abuse or addiction, etc.).
The diagnosis of bipolar disorder is made on the basis of whether the episodes are manic or hypomanic and whether or not clinical depressive episodes occur during the course of the illness. Symptoms vary from mild to severe, and affect one’s daily functioning at work and at home, and affect one’s interpersonal relationships (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). Arlington, VA, American Psychiatric Association, 2013).
Bipolar disorder manifests in mild, moderate, or severe forms. Symptoms can vary from person to person. Subtypes of bipolar disorder include:
Bipolar I disorder: This is characterized by the presence of at least one manic episode during a lifetime lasting for at least one week. Episodes of clinical depression or hypomania may occur before or after the manic episode.
Bipolar II disorder: This is characterized by at least one hypomanic (a milder form of a manic episode, lasting for 4 days or more) and one major depressive episode.
Cyclothymic Disorder: Few hypomanic symptoms and few some depressive symptoms occur for atleast two consecutive years.
Genetics play a major role in causing bipolar disorder and it has a high rate of heritability Impaired connectivity in brain networks regulating mood and imbalances in brain chemicals called “neurotransmitters”, among other mechanisms, lead to bipolar disorder. Life stress events can act as triggers in vulnerable individuals.
Upto 4% of individuals worldwide suffer from bipolar disorders during their lifetime (Nabavi et al., 2015). Men and women are equally affected by bipolar I disorder, whereas Bipolar II disorder may be more common in women than in men. It usually begins during adolescence or early adulthood. However, it can begin during later years and sometimes in children as well.
Bipolar is a severe disorder and its outcomes become progressively worse if it is not diagnosed and treated early. It takes a heavy toll on the individual and his family. Complications of untreated bipolar include disturbed interpersonal relationships, difficulties at work, indulging in potentially damaging and dangerous activities such as spending vast amounts of money, rash driving, sexual indiscretions, aggressive behavior, alcohol abuse, or misuse (which may lead to dependence and addiction), etc. In severe cases, suicide is a real risk.
Recognizing the symptoms early and diagnosing it correctly is the first step. Treating bipolar disorder requires a combination of medication (mood stabilizers), psychotherapy, and lifestyle changes to reduce stress such as adequate rest and regular exercise. Family therapy helps family members cope with their loved one’s illness, especially with their erratic moods and behaviours which can be disturbing to the family members.
Repetitive Transcranial Magnetic Stimulation (rTMS) is the most modern form of treatment that helps some individuals with bipolar disorder. rTMS is a non-invasive, painless, and no- anesthesia procedure, with few or no side-effects and quick onset of therapeutic effects. It uses an external magnetic field to stimulate nerve cells in the brain. The rTMS device delivers a focused magnetic pulse to the brain. The sessions are held daily for 2 to 4 weeks, for 30 minutes at a time. Several individuals with bipolar disorder benefit to a great extent from this treatment.
Research has shown that individuals with bipolar disorder can be exceptionally creative, as they can be dysfunctional. Many celebrities like news channel CNN founder Ted Turner, actress Catherine Zeta-Jones and Linda Hamilton have openly talked about being bipolar. All-time great artist Picasso’s “pink” and “blue” moods are also famous, as are van Gogh’s “high” periods. during which he rose first as an evangelist and then as an artist. Although this illness leads to immense suffering, many individuals bipolar live a productive and creative life.
Magnetic Stimulation Therapy or Repetitive Transcranial Magnetic Stimulation (rTMS) is a newer, state-of-the-art, non-invasive, safe, and effective treatment for depression, anxiety, bipolar disorder, obsessive-compulsive disorder, and other psychiatric disorders. It uses a magnetic field externally on the scalp to stimulate nerve cells in the brain. It was approved by the US-FDA in 2008 for the treatment of resistant depression. It became available in India over five years ago.
An electromagnetic coil is placed against the scalp at a predetermined site. The rTMS device then delivers focused, MRI-strength magnetic pulses to specific areas of the brain. Repeated sessions of rTMS progressively change brain activity, improving depression in some patients.
rTMS is non-invasive and painless and does not require anesthesia. Individuals can work normally immediately after treatment. No sedation is required, patients are awake and alert during rTMS treatment and can even drive themselves home, or resume work immediately following treatment.
It varies depending on the disorder but in general, daily administration of rTMS for four to six weeks is required. Each treatment session typically lasts between 20 and 30 minutes.
Metal objects in the head and neck region, cardiac pacemakers and implanted medication pumps, orthopedic implants, increased intracranial pressure, and serious heart disease. Prior history of seizures, family history of epilepsy, and individuals taking medication that might increase the risk of seizures.
Individuals with the following conditions can benefit significantly from rTMS treatment:
Major depressive disorder (US-FDA Approved in 2008)
Anxiety Disorders: including Post-Traumatic Stress Disorder (PTSD) & Obsessive-Compulsive Disorder (OCD)
Schizophrenia (certain symptoms)
Eating disorders – Anorexia Nervosa and Bulimia
Attention Deficit Hyperactivity Disorder
Maintenance treatment is usually required for chronic illnesses such as major depression and obsessive-compulsive disorder. This can most often be achieved using a medication, once the individual is better. Some individuals, however, can benefit from a repeat course of rTMS 6-12 months post-initial treatment; this is usually done after a re-evaluation and discussion of maintenance treatment options.
Research studies have shown that the therapeutic effect of rTMS in depression matches the effect produced by antidepressant medication. However, rTMS has a relatively rapid onset of action and the beneficial effects are usually noticeable in the second week of treatment, sometimes earlier. rTMS is especially useful among individuals who do not show a good response to antidepressant medication, who experience significant side-effects from medication, or in whom a rapid response is desirable. rTMS also has very few side-effects. The possibility of achieving remission is greater with the combination of rTMS and antidepressant medication than with conventional medication alone.
Electro-convulsive therapy (ECT) requires the administration of anaesthesia and the induction of a seizure. Its efficacy is well documented in the literature. However, the electrical stimulus to the brain is scattered (and not focused on precisely on the targeted brain regions), producing undesirable side effects, such as memory loss. Repetitive Transcranial Magnetic Stimulation (rTMS) does not involve anesthesia, electric shock or seizure induction. In rTMS treatment, the electromagnetic stimulus is focused on targeted brain areas, avoiding undesirable side-effects such as memory loss, as shown by research.
Detailed, personalized clinical assessments are conducted for every individual and for their families as required.
Psychometric testing involves the use of standardized tests that help assess various aspects of an individual’s functioning, including mood, thought, perception, intelligence, behaviour, personality, the current level of functioning, inter-personal relationships, and coping patterns.
We offer counselling and psychotherapy sessions to help individuals understand their clinical condition and devise effective coping strategies. These sessions also aid patients in reaching their optimal level of functioning and well-being once they are feeling better.