Characteristics of true depression

Classically in true depression there is an overriding melancholy associated with physical behaviour changes such as lack of energy, lack of appetite for food, sex and everything else. Even the stomach and bowels get depressed and indigestion and constipation are common. The head often aches. In severe endogenous depression there is loss of judgement, feelings of persecution, feelings of guilt and worthlessness. Sometimes hallucinations occur, or at the least a firm engagement with reality is lost. The deepness of the depression varies – it is worse in the mornings. Sleep is disturbed in a highly characteristic way for the victim wakes early in the morning, or even in the middle of the night.

If you say that such a person is unlikely to want to learn to relax or to be gently coaxed along such a path by friends and relatives, I would be the first to agree with you. But on occasion depression – particularly the endogenous kind – can start with a period of anxiety and tension. Dr Arthur Watts, who has probably done more to educate doctors (psychiatrists included) in the true understanding of depressive illness, stresses that anxiety is a much more common and misleading camouflage for depression than is usually recognized. He feels that about half of the cases of incipient depression present a picture of chronic anxiety and agitation in the early stages. Here is where the relaxation response may be sought out and found wanting.

The centres in our brain that control the emotions and which are disturbed by depression are very close to those that control the automatic (autonomic) nervous system. This being so there is a considerable overlap in the symptoms of autonomic disturbance, like rapid heart beat (palpitation), uncontrollable shaking of the fingers (tremor) and excessive sweating, all symptoms that may well indicate that the relaxation response may be helpful. Unfortunately relaxation will not be helpful if it is a true depression that is expressing itself in this way.

Depressive illness can be present in so many forms that constant vigilance is prudent. A change in someone’s behaviour may be the earliest sign of an incipient depression. A woman may suddenly embark on a series of unwise love affairs; a man may become obsessed with a gambling spree, or may behave in an uncharacteristically dishonest manner. If, together with this rather unusual lead in to a depression, tension is present too, then ways of relaxation may be sought or advised. But, as emphasised previously, they will be doomed to failure in such circumstances.

Sometimes a depression can be spotted by a friend quicker than by a doctor. An early sign is someone becoming no longer interested in their appearance. Hair is left to its own devices, shoes are never cleaned, stockings are worn into holes and not changed, dandruff remains on the collar, make-up is haphazardly applied.

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