One of the most commonly asked questions about psychological problems is about the nature of the condition that is called depression. The concept of depression as understood (or misunderstood) by many, varies from person to person. For many, depression represents a reaction to setbacks or tragedies in life, and therefore, cannot be set right until the problem is solved. (Well that is right, isn’t it? Well, not quite! We shall discuss this in a bit.) For others, these are to do with ‘chemical changes in the brain’. So what is depression really? How is it caused and what can make it better?
We all know that a wide range exists in people’s abilities to cope with a given situation. Thus while one person is able to cope with a huge tragedy without much distress, another person may breakdown under seemingly minor stress. So what is it that makes this difference? To take this a little further, some people can breakdown and go into depression with almost no stress at all! In other words, feeling sad although there is nothing to worry about! So how do we make sense of all this?
Well, let me put it this way – Depression is a condition characterized by certain symptoms (such as sustained low mood, lack of interest in pleasurable activities, pessimism, poor confidence, tendency to self harm), the exact nature and duration of which is defined by experts from time to time. Depression is best seen as a set of co-occurring symptoms, and at a superficial level, seem to be very similar in different people suffering from it. In reality though, depression varies from person to person. In the case of a situation where a person is depressed with no obvious source of stress in life, it is perhaps that an internal abnormality in the chemicals in the brain has occurred spontaneously (due to inherent errors like genetics). These chemical abnormalities ‘activate the parts of the brain that trigger feelings of sadness’, making the sufferer feel sad! In such cases, medicines are likely very effective, as they can reverse the chemical abnormalities.
In other instances, depression emerges in the wake of a major tragedy (or any stress) that may be seen as causing certain changes in the brain. Thus, although medicines may be useful in this scenario, additional strategies such as counseling, in order to reduce the psychological impact of the tragedy and integrate it better, will be needed.
Let us take the help of an analogy to understand this better. A person having really weak bones due to old age suffers a fracture, without any trauma (what is called a pathological fracture), as he was just walking on the road. Another person, a young man, breaks a bone in an accident. In the former situation, merely resting and plastering will not help much unless the problem of weak bones is rectified; because otherwise, a re-fracture is likely – as the problem is within! In the second case though, resting the affected part and plastering it to mitigate the effects of the trauma will be the main intervention.
Between these two extreme descriptions, exist an entire spectrum of depressive conditions with causal contributions from both internal abnormalities as well as external sources of stress. Therefore, in the real world, a combination of medicines and counseling usually works best – Medicines correcting the internal abnormality, and therapy taking care of the handling and processing of external stressors.