MANILA, December 14, 2003 (BULLETIN) “Melancholy is at the bottom of everything, just as at the end of all rivers is the sea. Can it be otherwise in a world where nothing lasts, Where all that we have loved or shall love must die?”

Henri-Frederic Amiel (1821-1881) Swiss philosopher, poet, Journal Intime. Nov. 16, 1864.

CHRISTMAS is lighting up the city. Balikbayans and their boxes are starting to pour in. Church choirs are brushing up on their Yuletide medleys. But while this is the season of seasons, some people are slowly, almost imperceptibly sliding into depression.

If you will ask a psychiatrist or psychologist, the good clinician will agree that Christmas is a classic trigger to a major depressive illness. In this season, there is the heightened expectation of happiness and excitement. After all, it is the time of reunions and non-stop parties. If the anticipation leads to nothing or disappointment, the depression-prone individual suffers. Christmas to her becomes miserable. Sensitive souls feel the emptiness of giftgiving and the crass materialism that goes with it. Still others find the wall-to-wall shopping and traffic unbearable.

I am not talking about the sadness that affects all of us now and then. This is not about “getting the blues” as a normal reaction to life’s blows and surprises. This is about a distinct entity that in the US alone affects more than 17 million each year: Clinical depression.

Symptoms. Are you depressed? In major depression, the person is affected to an extent that his work and private life are all but impaired. Duration is critical because normal dejection lasts for a few days before the person somehow snaps out of it. In real depression, the condition carries on for more than two weeks. A man or woman suffering from clinical depression must exhibit five out of the following nine symptoms, including one of the first two listed:

* depressed mood

* loss of interest and pleasure in usual daily activities

* loss of appetite and weight changes (loss or gain)

* insomnia or hypersomnia (too little or too much sleep)

* restlessness or sluggishness

* profound fatigue

* feelings of worthlessness or guilt

* inability to think clearly, make decisions, or complete tasks

* thoughts of death or suicide.

Aside from the major depression, there are other types to recognize. A bipolar mood disorder is found in a person who alternates between extreme “lows” (depression) and inappropriate “highs” (mania). Let’s follow Carla, a manic-depressive career woman in her early 30s, as she goes through a cycle. In the manic phase, she feels exactly like Leonardo di Caprio’s character in the “Titanic,” that is to say, they’re both on “top of the world!” While she’s at it, Carla talks rapidly and excessively, maxes out on the credit card shopping, or has a sexual fling all with apparent disregard for the consequences. In the depressive phase, she will display any or all of the symptoms of clinical depression as mentioned above. Another variant is dysthymia which is a chronic depressive state lasting up to two years.

Roots. There are organic, biological causes of depression. It’s unfortunate that our culture denies depression and trivializes it. “Kulang ka lang sa barkada!” (You need more time with friends) or “Kulang ka lang sa good-time!” (You just need some good time) are usual uninformed responses to depression staring us in the face.

Currently, researchers believe that in depression there is an imbalance of neurotransmitters norepinephrine and serotonin. These are natural chemicals needed in the communication of brain cells with each other. Genetics has been implicated. Scientists have shown that depression like diabetes and hypertension filter through generations. Finally, and this brings us back to the holidays, environmental cues can push a susceptible person into depression.

Treatment. There are two things to remember about conquering depression. First, there are no “happy pills.” Medications for depression are not “uppers” or stimulants. If that were so, there’s going to be a black market for Prozac (fluoxetine) or Zoloft (sertraline). Second, self-medication is out of the question. A person with true depression must be seen by a psychiatrist. Treatment comes in the form of medication, psychotherapy, electro-convulsive therapy (ECT) or a combination of these. The usual drugs used are from three groups: TCAs (tricyclic antidepressants), MAOIs (monoamine oxidase inhibitors) and SSRIs (selective serotonin reuptake inhibitors). Your doctor will determine what will be best.

It’s the holidays! Depression lurks. Be careful.

Billboard. Thank you to Merck Sharp and Dohme (MSD) friends Christine Liwanag and Lilet Driz-Potenciano for allowing me to lecture on arthritis at Powerbooks Greenbelt 4 a few weeks back. Thank you to Mr. Agustin Y. Go of Allied Bank for attending, and to Michelle and Miles of the Medical Observer.

Fact/Factoid. To remember the name of the person you’ve just met, do these: Look at him or her, say the name to yourself at least once, and then for a moment play with the name in your mind by associating it with some other word, phrase, or thing.

(Dr. Pujalte is an orthopedic surgeon. Contact numbers: 7270001 local 775/ 716-3946/ 7116626 and 711-4276. Write – Cardinal Santos Medical Center, Room 175 MAB 3, Wilson Street, San Juan, Metro Manila. Cellphone 0917-533-1557 E-mail — JSPujalte@broline.com.ph)

Reported by: Sol Jose Vanzi

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