Periodical Depression

Fits of periodical depression, familiarly known as "the blues," occur

in the experience of practically everyone. In some people they are

only slight and passing. In others they last for hours and make the

individual quite miserable. In still others, without actually running

into melancholia, they produce serious discouragement and continuous

discomfort which persists even for days and makes life intolerable.

They come nd go quite unaccountably. During their occurrence all

vitality is lowered, appetite lessened, aches and pains are

emphasized, sleep may be disturbed, exercise becomes distasteful, and

they usually present an interval when health is at a low ebb.

Ordinarily when described as "the blues" they have no definite

connection with any known physical cause. They are passing incidents

which seem to recur at irregular intervals. When connected with

physical ills they are thought of directly as symptoms of these ills.

All forms of disease may be associated with such fits of depression

and many physical symptoms seem to be due to the fact that during

these periods there is a distinct lowering of physical vitality so

that the nerve impulses which ordinarily enable functions to be

performed without interference are interrupted, or at least are

inhibited, to a noteworthy degree. While to a certain extent the

condition is a mental disease, it may be modified by the correction of

physical derangements, by stimulation and, above all, by suggestion

and a change in the point of view.





Serious Pathological Conditions.--Of course, such periodical fits of

depression are associated with various serious progressive ailments

and then are primarily physical, and are only secondarily psychic.

From the standpoint of psychotherapy it is important to remember that

certain serious organic lesions may show their first signs in the

patient's mental state. It is not unusual, for instance, for the

disposition of a patient suffering from kidney disease to change so

materially that the attention of friends is called to the change

before any physical symptom of the nephritis has been noted. Sometimes

for a year there will be a progressive clouding of what had previously

been a rather happy disposition. Decisions will be made more slowly

than before. The judgment will be impaired. There are some striking

examples of this in history, of which the unfortunate Athenian

general, Nicias, put to death for incapacity that was undoubtedly

pathological, is one. Pleasures will be taken half-heartedly; men who

have been bright and jovial will now become saturnine. Men who have

been the life of parties will try to hold the place they acquired

before, though all around them will perceive how difficult it is for

them to maintain the role they have set for themselves. Whenever there

is a notable change in disposition, it is well not to attribute it to

some passing mental condition and, above all, not to dismiss it

as a peculiarity unamenable to treatment, but to look for the

underlying pathological basis of the new condition.



In this way physical disease will sometimes be discovered long before

it otherwise would be. This must be particularly noted when there have

been a series of worries. Occasionally it seems enough to many people

to ascribe a change of disposition to the troubles that have come over

a patient. If a business man fails or passes through a crisis in his

affairs in which failure is very near, or he has many business worries

over a prolonged period, these are sometimes thought to be quite

enough to explain a change of disposition. They are, but not to the

degree that is often noted, for, in excess, melancholic tendencies are

always pathological, that is, they have some basis in a serious mental

or physical change. If there is an insidious nephritis already at

work, its symptoms will be much exaggerated and its progress

accelerated by the worries and disquietude of such a time. If a wife

loses her husband, or an only son, or a favorite child, the occurrence

of a prolonged period of depression should lead to a careful

investigation of physical conditions and of the underlying mental

state in the hope of guarding against serious developments.





Heart Disease.--Periods of depression are also common in heart

disease and are often the first symptom of the beginning of a break in

compensation. This effect is not so simple and direct, however, as in

the case of the kidneys. Probably the first physical symptom of a

break in compensation, where there is real valvular heart disease, is

a decrease in the amount of urine. This points to an insufficient

elimination of the products of metabolism and to the retention in the

circulation of toxic substances. The reason for this is the lessened

circulation through the kidneys because of the diseased heart. There

is also a lessened circulation through the brain. This impairs the

function of the brain and quite naturally leads to mental depression,

slowness of decision, and unwillingness to occupy one's self with many

things. Besides, because of the lessened function of the kidney the

circulating blood not only does not nourish so well but it tends still

further to depress the brain cells by the toxic substances that are in

it. Depression in such cases is rather to be expected and at the

beginning is not continuous but comes in ever longer periods with

shortening intervals as the disturbance of the circulation progresses.

At first, like other diminutions of function, it is conservative in

order to spare the heart work.





Respiratory Affections.--Very curiously an affection of the lungs

has exactly the opposite effect and is likely to create in the patient

an artificial sense of well-being. Spes phthisica, the

characteristic hope of consumptive patients, is well known, and has

been described by many a careful observer from Hippocrates and Galen

to our own time. A lessened amount of oxygen in the blood produces a

certain sleepiness, but this seems to be preceded by a period of

slight excitation. The most familiar example of this occurs at the

beginning of the inhalation of laughing gas. Practically the only

direct physical effect of the inhalation of nitrous-dioxide is to shut

off our oxygen and it is a slight period of deoxygenation that

produces the anesthesia by this agent. Whether we have not in this the

explanation of the feeling of the consumptive, so that often on the

day before his death he plans a number of things that he is going to

do next year, may require more careful investigation, but the

suggestion may serve to show how much disposition, both lively and

serious, depends on physical factors as well as on the natural state

of mind.