According to the WHO, depression is the leading cause of ill health and disability worldwide
23 December 2018| Last updated on 24 December 2018
Globally, more than 300 million people of all ages suffer from depression.
Dr. Kuchibatla is a UK-trained psychiatrist and a member of the Royal College of Psychiatrists since 2010. He brings to the table more than 12 years of experience helping his clients heal in an environment of understanding, compassion and confidentiality.
Dr. Kuchibatla works closely with adults and adolescents. His areas of special interests include:
- Adults and adolescents with mild, moderate and severe emotional health issues including depression and anxiety disorders, phobias, panic disorder, personality disorders such as emotionally unstable or borderline personalities.
- Those with phobias including agoraphobia and airplane phobia, and other conditions that affect day-to-day living.
- Individuals going through trauma and Post Traumatic Stress Disorder (PTSD) and are unable to build and maintain relationships or lead a full emotional life.
- Individuals with Neuropsychiatric conditions such as depression or anxiety disorder due to Epilepsy, sleep disorders, mental health issues leading from Parkinson’s disease, etc.
- Adults and adolescents needing Complex Medication Management (Treatment Resistant Conditions)
We spoke with Dr. Shankar Kuchibatla, Dubai London Clinic’s top psychiatrists, about depression - its causes, symptoms, and treatments.
What is depression?
In day to day life, many people feel sad or low in mood. It is a normal reaction to loss, stress, and life’s struggles. But when these feelings become more intense, combined with other symptoms like lack of interest in pleasurable activities and feelings of hopelessness, which last for many days or weeks, this may be an indicator of something more than normal sadness. You might probably be experiencing depression - a treatable medical condition.
What are some symptoms of depression?
Depression can be identified in the form of symptoms reported by the client as well as observations of the clinician.
Some of the common symptoms of depression are:
- Low mood; which is consistent over a number of days
- Lack of interest; in the activities which were once pleasurable
- Feeling tired and lethargic; recent inability to cope with stressors
- Loss of appetite and weight loss
- Low sex drive; aches and pains which are not explained by any physical health reasons
- Recurrent thoughts of hopelessness and worthlessness
- Recurrent thoughts of death or suicide
- Lack of concentration;
- Inability to tolerate frustration leading to irritability, anger, etc.
How is depression diagnosed?
Depression is usually diagnosed by a psychiatric assessment carried out by a Psychiatrist. By listening to the history of the client a Psychiatrist will be able to identify symptoms and signs of depression. There are set criteria for diagnosing depression.
What are the root causes of depression?
Depression is a result of a combination of biological/medical reasons, psychological vulnerability or risk and social/ personal stressors. There are a number of triggers that may increase the risk of depression, including:
- Loss of a loved one through death, divorce, or separation
- Social isolation
- Major life events - moving, graduation, job change, retirement
- Personal conflicts in relationships
- Physical, sexual, or emotional abuse
- Certain medications increase the risk of depression - Corticosteroids (steroid hormones), isotretinoin (retinoid), interferon (antiviral)
Is depression hereditary?
Major depression can sometimes occur from one generation to the next in families, but often it may affect people with no family history of the illness. Perhaps it may be a combination of risk genes, chemical imbalance or low levels of chemicals in the brain, psychological predisposition to depression due to childhood issues and current stressors, or decreased ability to cope with the life events.
Are there different types of depression?
There are few types, mainly:
- Unipolar depression - low moods
- Bipolar depression - In addition to going through low moods or depression, individuals with bipolar disorder also have high moods known as hypomania/mania during which they may experience increased energy, feelings of euphoria and elation , insomnia (inability to sleep) and impulsive behaviors
- Dysthymia (persistent depressive disorder) - In this type there is an underlying chronic low mood lasting for at least 2 years.
- Disruptive mood dysregulation disorder – this is when children and teens get extremely irritable, angry, and often have intense outbursts.
- Premenstrual dysphoric disorder – this is when a woman has severe mood problems before her period, more intense than typical premenstrual syndrome (PMS)
- Substance-induced mood disorder (SIMD) – this is when symptoms happen while you’re taking a drug or after you stop a drug or after a prolonged use of alcohol.
- Depressive disorder due to another medical condition
- Depressive symptoms occurring in context of an adjustment disorder secondary to a life event.
Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.
Some clinicians also classify depression in to a “reactive” type which is purely secondary to a stressor or a triggering factor and “endogenous” type which is spontaneous with no known triggers identified.
What are current treatments for depression?
Treatment depends on the severity of depression. The psychiatric assessment usually leads to a treatment plan.
Usually for mild depression talking therapies are recommended first before medications are considered. Medications are usually indicated for moderate or moderately severe and severe depression types.
Antidepressant medications treat depression/depressive symptoms by restoring the chemical imbalance that could lead to depression. These medications increase chemicals (serotonin, Norepinephrine, Dopamine) in the brain. Serotonin helps transmit messages from one area of the brain area to another.
Antidepressants are not addictive in nature. They can be safely tapered down and stopped with a proper plan and support of the professionals. Anxiolytics and Benzodiazepines (ex: Valium, Xanax and Rivotril) are usually addictive.
Other treatments available include: Talking Therapies, Supportive Psychotherapy, CBT-Cognitive Behavior Therapy, and Interpersonal Therapy.
How long before you begin to see positive changes?
From my clinical experience, it usually takes 1 week to show some response to the medication - this may be usually a reduced anxiety levels. It takes around 4-6 weeks before you begin to see significant effects from the medication. However, the side effects of antidepressants are usually short lived - disappearing once the body adjusts to the levels of the medication.
Can you treat depression without medication?
Yes, of course.
For conditions like mild depression, chronic stress reaction, adjustment disorders of mild intensity can be treated with Cognitive Behavior Therapy (CBT).
Cognitive behavioral therapy (CBT) is a common type of talking therapy (psychotherapy). You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.
CBT can be a very helpful tool in treating mental health disorders, such as depression, anxiety, panic attacks, post-traumatic stress disorder (PTSD) or an eating disorder. It can be an effective tool to help anyone learn how to better manage stressful life situations.
For depression with moderate and severe intensity levels a formal CBT combined with medication is always recommended.
It is vital to know that a holistic approach combining medications, therapy and lifestyle changes like regular exercise, healthy diet, sleep hygiene and routine activities makes a significant difference an individual’s treatment.
When is medication necessary?
Medication is usually necessary when CBT/talking therapies or watchful waiting without intervention do not help and has led to a deterioration of the condition as observed by friends, family, colleagues, etc.
Observation is key. Different individuals react differently so it is always recommended to observe for signs of deterioration on a regular basis or if the depression gave rise to the development of new issues like suicidal thoughts or paranoia, hallucinations, intense anxiety and panic attacks, agitation, etc.
Can depression return after treatment?
Depression is a disorder so there is always a risk of subsequent episodes of depression. A recovery process which covers a holistic approach (combination of medication and therapy) including lifestyle changes makes a huge difference.
In my practice, in addition to medication management, I regularly use CBT strategies as part of monthly client follow ups. For my clients it has helped them recover and prevent subsequent episodes of depression.
Can depression be prevented?
Certain types of depression can be prevented by a range of things.
For example research findings shows that regular exercise can lead to increased levels of chemicals in the brain which could lower anxiety levels and improve coping abilities to stress.
Some therapists use an approach called mindfulness-based cognitive therapy (MBCT) to help prevent depression from coming back.
Moreover, good sleep hygiene, structured activities, regular breaks and relaxation from stressful work and occupation can reduce risk of relapse of depression.
What's the difference between a psychiatrist and a psychologist?
A Psychiatrist is a Medical Doctor, like a doctor in any other specialty, who has chosen to become an expert/specialized in the field of mental health.
A psychiatrist is able to carry out an assessment to diagnose conditions with medical information and a comprehensive look at the client including medications used results of blood tests, ECG (cardiac evaluation), EEG (Brain Waive Record), MRI scan, etc. Some psychiatrists can do therapies like CBT.
A psychologist is usually an expert in talking therapies.
What made you want to be a Psychiatrist?
The World Health Organization (WHO) constitution states, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. I believe that an important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities.
I am fascinated by the mind-body interaction and effect of thoughts on the emotions, feelings and physical symptoms and ultimately on the behaviors of an individual. An individual’s response to the treatments for acute conditions like anxiety and depression is remarkable and leads to a sense of satisfaction in my clinical work.
What does a typical day look like?
On a daily basis I analyze and evaluate patient data or test findings to diagnose nature or extent of mental disorder. I prescribe, direct, or administer psychotherapeutic treatments or medications to treat mental, emotional, or behavioral disorders.
In addition to my regular outpatient clinic, I also provide services in specialty clinics and hospitals and aim to work closely with experts from various other medical specialties.
What is your favourite aspect of the job?
One of the main responsibilities as a psychiatrist is to collaborate with physicians, psychologists, nurses, and other professionals to discuss treatment plans and progress. Mental health brings many disciplines together leading to a multidisciplinary approach to treatment. This is one of my favorite aspects of the job. Another would be gaining of knowledge through continuing education and conferences/seminars as well as sharing my knowledge with others.
Empathy without internalizing is one of the skills I learned over a period of time and stands as my career highlight in addition to my qualifications and academic achievements to date.