Emotional equilibrium is a state of stable balance, such that any disturbance from outside tends to be corrected.
Letâ€™s assume that everyone has an internal â€˜regulating machineâ€™ that requires â€˜resettingâ€™ after an upsetting event, but the great majority return to emotional equilibrium within days (that is, they have a â€˜normalâ€™ depressed mood state). Some people, however, are unable to reset their mechanism easily, thus losing their â€˜emotional equilibriumâ€™. They remain essentially â€˜stuckâ€™. Their personality styles and ways of dealing with events â€˜sustainâ€™ the depression, rather than enabling them to â€˜get over itâ€™.
So how can equilibrium be lost? There are two main ways:
1.Â The machinery can fail; for example, if the keel on a yacht breaks off, the yacht will capsize.
2.Â A â€˜positive feedback loopâ€™ can develop. This means that two or more factors can influence each other to such a degree that a small disturbance leads to a further disturbance. This loop is sometimes also called a â€˜vicious circleâ€™. An example of feedback occurs when a microphone is put too close to a speaker. A small noise from the speaker is amplified into the mike, and further amplified by the speaker. While the feedback loop can be of use to create musical effects, such reverberation (mulling over and rumination) is not useful for humans.
â€¢Â Schizophrenia is a disease that is managed rather than cured. Although it may be effectively treated with medication and help from many quarters, it is usually a chronic disorder and the risk of a relapse is always present. After a first about of a schizophrenic illness, many people will be unable to pursue the job they were doing at a high level and many are at risk of becoming less functionally able than they were.
â€¢Â Although family and friends are the first to realize that the person has a mental problem, the sufferer is often relived to get medical assistance. If the person has sought help early, then medication may be enough, with family support, to restore a good level of normal functioning. Frequently, however, the first time the problem is faced head-on is when a crisis has occurred. The person may refuse to talk, or eat, or is constantly in fear, or is hearing voices. Under these circumstances, a doctor may feel that the person with schizophrenia requires hospitalization. The sufferer may have to be committed to hospital involuntarily under the mental health Act, after assessment by a consultant psychiatrist and approved social worker. In these circumstances, the safety of the sufferer and those around him is of paramount importance. During the early days in hospital strong sedation may be necessary to prevent dangerous situation arising and to enable the sufferer to sleep. Quite quickly people with schizophrenia view hospital as a safe place and agree to stay there voluntarily while receiving treatment.
â€¢Â On discharge a sufferer will need support from friends, relatives and often community psychiatric nurses. Talking to others with the illness and with community psychiatric nurses may be of great help. Doctors and psychiatrists will be available if relatives need assistance. Rehabilitation and adjusting to life back in the community take varying lengths of time, which is true of any illness.
Exercise is a very good relaxant and a way of helping restore normality. Relaxation therapies, especially tapes and music, yoga, aromatherapy, reflexology, and Indian head massage may also be of great benefit.
Most treatment guidelines suggest that antidepressants may take many weeks to work. It is argued that even if the current treatment seems ineffective, it should be persisted with for several weeks or even months. The Mood Disorders Unit interprets the evidence differently.
If medication is likely to be effective, evidence of at least some improvement should appear in the first ten days or so, whether it is an improvement in mood, sleep, or other features. For melancholic and psychotic depression, the rate of improvement is generally slower (but relatively constant). It may, in fact, appear painfully slow.
If no improvement is noted in the first two weeks after commencing an antidepressant, the dose of that drug may need to be increased, a change to another class of antidepressant may be required, or â€˜augmentingâ€™ strategies (the addition of quite differing drugs) may need to be introduced. Unfortunately, when changing from one drug to another, days to weeks may pass before success can be established. It might also be the case that non-drug strategies will be more effective in bringing the depression to an end.
Augmentation of antidepressant drugs
The effectiveness of some antidepressants can be increased by the use of adjunctive or augmentation drugs, for example, thyroid hormones or lithium.
There is increasing evidence to suggest that the new â€˜atypicalâ€™ antipsychotic drugs may also have augmenting effects on antidepressants, often working rapidly and also being able to be ceased rapidly in many instances. While not investigated formally, the benefits of such augmenting drugs may only be relevant to melancholic and psychotic depression.
SSRIs (antidepressants) have had somewhat of a panacea status with physicians prescribing the meds for all sorts of off label usage, particularly during the boom of the drugs existence over the past half decade. However, there has been a steady reporting of concerns related to the drugs as time progresses. Most people have heard about the adolescent suicide risk associated with the medication, and a new study is reporting that mothers taking the drugs put their newborns at risk for being under-weight and having respiratory problems.
â€There was a significantly greater incidence of respiratory distress (13.9% vs. 7.8%) and longer hospital stays for infants born to depressed mothers on SSRIs than those born to untreated depressed mothers, the team reports in the Archives of General Psychiatry.â€
Obviously, people should consult with their psychiatrists or health care providers for specific treatment information. I think the overall effect of some of these stories is going to be that people are more cautious about taking the drugs, and asking more pointed questions about their treatment.
For most people, depression (even the commonly occurring normal depression) is an unpleasant experience that often interferes with day-to-day functioning.
What then is the purpose of such a painful experience? This question can be linked to another one: what is the purpose of pain? Pain has one distinct advantage â€“ the unpleasant side effects of pain mean that most of us will go to considerable length to avoid it. For example, if we did not find heat painful, we might get too close to a fire and suffer the consequences. It is for such reasons that many nerves in our bodies have heat receptors.
In a similar way, it could be argued that normal depression can be an automatic defence response or a response cued by certain situations. Such a proposition has been explored recently by the American psychiatrist Randolph Nesse, in particular how normal depression may have offered a selective advantage to civilization over time. To the extent that ay of Nesseâ€™s interpretations have validity, they allow the individual to question the meaning of a depressed mood.
Is normal depression a plea or cry for help?
It is unlikely that normal depression is cry for help. If it is, then it is not a very useful or effective signal, as it is more likely to evoke negative response from others.