Do I have depression?                                                  
Depression is a serious common medical condition that involves the mind and body. Many people do not realize that there are emotional and physical symptoms of depression. Depression significantly affects a person’s appetite, sleep, energy, thinking, self-esteem and physical well-being. The symptoms are persistent and not the same as a temporary blue mood or normal emotional experiences such as sadness or grief. Depression can have severe consequences in terms of suffering and disability.
How do I know if I have depression?
The symptoms of depression include:
· persistently sad, anxious, irritable, empty mood
· loss of interest or pleasure in activities that were once enjoyed, including sex
· trouble sleeping or sleeping too much
· significant appetite and/or weight changes
· difficulty thinking, concentrating, remembering, making decisions
· feeling tired, rundown, loss of energy
· feeling restless, agitated or physical slowing
· feelings of guilt, worthlessness, hopelessness, helplessness, emptiness
· persistent physical symptoms such as a headaches, digestive problems, chronic pain that do not respond to routine treatment
· recurrent thoughts of death or suicide, or suicide attempts
Not everyone with depression experiences every symptom. The number and severity of symptoms vary among individuals and over time.

What are the types of depression?
Major depression, also known as unipolar or clinical depression is one type of depressive disorder. Dysthymia is a chronic form of depression that keeps one from feeling or functioning well. Bipolar depression, the depressed phase of bipolar (manic-depressive) disorder, has similar symptoms as major depression but requires a different approach to treatment. Depression can also co-occur with other disorders including physical illnesses and other mental disorders such as anxiety and eating disorders.

You are not alone if you have depression!
Depression is common, with prevalence of 5-10% in primary care settings. It ranks fourth as causes of disability worldwide, and it has been projected that it may rank second by the year 2020. The prevalence of depressive symptoms may be as high as 30% in general population with women being twice as likely to be affected as men. The symptoms can last months to years if untreated. Half of those who experience a first episode of depression will have at least one other episode in their lives. One out of four young adults will experience a depressive episode by age 24 years.
Depression amongst the famous
As depression is common it is not surprising that famous people have had a depressive illness. However, there still remains a stigma attached to psychiatric illnesses and it is only recently that people have become more willing to publicly discuss their illnesses. A recent study examined the lives of almost 300 world famous men and found that over 40% had experienced some type of depression during their lives. Highest rates (72%) were found in writers, but the incidence was also high in artists (42%), intellectuals (36%), composers (35%), and scientists (33%).
 
Examples of some famous people who have publicly stated they have had depression:   
Anthony Hopkins, Harrison Ford,
Marlon Brando, Jim Carry, Paul Merton Actor, comedian    
Halle Berry and Winona Ryder Actress   
Barbara Bush            Former first lady(USA)   
Stephen Hawking Scientist, writer   
Germaine Greer, John Cleese Writer   
Billy Joel, Elton John, Janet Jackson,Alanis Morissette, Ozzy Osbourne, Paul Simon, Sheryl Crow, Sinead O’Conner, Marie Osmond, S.P. Morrissey, Lou Reed Musician and composer   
Monica Seles Athlete (Tennis)   
Paul Gascoigne Professional footballer   
Yves Saint Laurent Fashion designer   
Other famous people (deceased) known to have had a depressive illness:   
Kurt Cobain, Ernest Hemingway, Audrey Hepburn, Samuel Becket, William James, Franz Kafka, Cole Porter, Tennessee Williams, Judy Garland, Richard M. Nixon, Mark Rothko, Claude Monet, Laurence Olivier, Wilfred Owen, George S. Patton. 
How did I get depression?
The exact cause of depression is not completely understood. Biological, psychological and environmental factors may all contribute to its development. Imbalance of the chemical messengers (neurotransmitters) in the brain such as serotonin, norepinephrine and dopamine are thought to be involved in depression. Scientists also have evidence for a genetic contribution to depression. Depression runs in families and females have depression twice as commonly as males. All ethnic, racial, and socioeconomic groups are affected.
The following life events may play a role in the development, reoccurrence or accentuation of depression: chronic stress, death of a loved one, divorce or family separation, breakup of a friendship or romance, financial or academic problems, lack of a support system, trauma, assault, and alcohol or drug abuse. Some illnesses and medications may also trigger depression.
What are common myths about depression?
· Depression is a personal weakness -FALSE, it is a medical illness.
· Depression can be willed or wished away -FALSE, can you wish away asthma?
· People with depression can’t get better - FALSE, with proper treatment people recover.
· People should be able to snap out of it - FALSE, can you just snap out of diabetes?
So, the truth is....
Depression is a medical illness that gets better with proper treatment.

What is the treatment that will make me feel better?
Depression is highly treatable. The first step to getting treatment is a diagnostic evaluation for depression by a physician or a qualified mental health professional. A physical examination by a physician or health care provider can rule out other possible causes for the symptoms. A variety of treatments are available including medications, short-term talk therapy (psychotherapy) or a combination of both. Medications adjust the levels of the chemical messengers (neurotransmitters). It usually takes a few weeks of treatment before a therapeutic effect occurs.
How serious is depression?
Young adulthood is a critical period. Depression increases the likelihood of substance abuse, impairs school and work function and influences an individual’s subsequent development in a negative way. If left untreated depression can lead to suicide. Suicide is the second leading cause of death for those aged 15-35 and the second leading cause of death of college students. Depression is a major factor in around 50% of these deaths. The death rate amongst people with depression may be as high as 15%. Depression also contributes to higher morbidity and mortality when associated with other physical disorders (e.g. myocardial infarction) and its successful diagnosis and treatment has been shown to improve both madical and surgical outcomes.
How do I know if I need further evaluation and treatment?
A person may recognize the symptoms of depression themselves or others may notice persistent symptoms that cause distress and interfere with day-to-day functioning in school, work and other personal areas. Making an appointment for evaluation and treatment by a health care provider is an important step towards feeling better. If you are in a suicidal crisis, get help immediately by contacting mental health professional, health care clinician or emergency room.

(Writer Dr. Nirmal Lamichhane, MBBS, MD (Neuropsychiatry) works in Western Regional Hospital, Pokhara and Fishtail Hospital and Research Centre, Pokhara)

References:
1. Post F (1994) Creativity and psychopathollogy. A study of 291 world-famous men. BJP 165, 22-34.
2. Semple D, Smyth R, Burns J, Darjee R, Mclntosh A (2006) Depressive illness. Oxford Handbook of Psychiatry.Oxford University Press.
3. College Mental Health Fact Sheet: Depression. HealthyMinds.org © American Psychiatric Association.