All of us go through cyclic variations in moods - sometimes happy and cheerful, and at other times, sad and depressed. Do we always need drugs when we are depressed? No, we don't. Drugs may be needed only when depression becomes persistent in the form of a disease called Endogenous (mental) depression, interfering with our capacity to cope with everyday life.

Symptoms of Mental Depression: A patient of mental depression suffers from a slow down of physical and mental processes. There is lack of interest in immediate surroundings. The thinking capacity and ability to concentrate gets impaired. There maybe complete or partial loss of memory, with only unhappy experiences being recalled. The appetite either gets inhibited or augmented; or the person suffers from a lack of energy and loss of weight. Sexual desire diminishes and the person may suffer from insomnia or early morning awakening. As the disease advances, the patient shows behavioural abnormalities and may complain of various mental and physical symptoms. He may, become tense and anxious as if something dreadful is about to happen, or may develop a fear of meeting people. In some patients there may be a feeling of self­deprecation, or unworthiness. Such patients are prone to committing suicide if not treated properly.

Types of Mental Depression: There are three broad types of mental depression - reactive, endogenous, and drug-induced. When it is associated with marked dejection, such as following the death of a near relative or friend, some major illness, failure in business or loss of job, or due to any other episode causing severe and persistent psychic trauma, it is called reactive depression (also called Transient situational disturbance, i.e. a reaction to a particular event). Another type of depression found in many cases is endogenous depression, which means that it is not due to any obvious external reason but comes from within the patient. Certain drugs may cause mental depression. This kind of mental depression is called drug-induced or iatrogenic depression. These drugs are propranolol, methyldopa, reserpine, oral contraceptives, cimetidine, indomethacin, long term use of corticosteroids and withdrawal of amphetamines.

Treatment and Drugs

In all kinds of depression, antidepressant drugs are used. It is quite important to note that mental depression is a self-limiting disease in more than 80% of cases, which means that it slowly gets cured by itself even if untreated. The extent of illness should be carefully evaluated before starting therapy with antidepressant drugs. These drugs take 2 to 3 weeks to take effect, and the patient should be so informed. If the patient has only a few symptoms of anxiety, anti-anxiety will give immediate relief and some patients get fully cured. However, if the depressive illness is very severe, the antidepressive therapy must be given to prevent the development of suicidal or homicidal tendencies. If drugs fail, then electroconvulsive therapy (ECT) may provide quick relief.