Depression

General Illness Information

Common Name:
Depression

Medical Term: Major mood or affective disorder

Description:

Depression is a continuing and persistent feeling of deep sadness, despondency or hopelessness, with accompanying symptoms of depression. (See DSM IIIR Criteria below). It may follow a recent loss or a sad event, but is out of proportion to the event and persists beyond an appropriate length of time.

Depression, however, may occur without any precipitating event.

Depression is the most common psychiatric illness, only second to anxiety. It affects approximately 15% of the general population. Onset of first depressive disorder usually occurs in the thirties and forties. People born in the later part of the twentieth century seem to have higher rates of depression than those of the previous generation, partly because of higher rates of substance abuse.

Typically, an episode of depression (untreated) usually lasts 5 to 6 months. However, in 15 to 20% of people it may last 2 years or more. A small number of patients may suffer from chronic unremitting depression. Half of all patients experiencing a first episode of depression will go on to a recurrent course, with a second episode occurring within 2 years. A family history of mood disorder is common, and tends to predict a recurrent course.

It often presents in the form of somatic complaints with a negative medical work-up.

Causes: The causes of depression are essentially unknown, though intensive research continues. It is postulated that depression is the result of a combination of genetic and environmental factors, mediated by complex neurotransmitter (hormonal) systems.

Depression may be a final expression of:

1. Genetic factor – neurotransmitter dysfunction;
2. Developmental problems – personality defects, childhood events;
3. Psychosocial stresses – divorce, unemployment.

Women are twice as likely as men to experience depression, though reasons are not entirely known. Hormones and changes in their levels may be a factor. This may account for the mood changes that occur pre-menstrually, postpartum (after child birth) and with the use of oral contraceptives. Abnormal thyroid function, which is fairly common in women, may also be a factor.

Depression that follows a traumatic event, such as the death of a loved one, is called situational depression. Depression occurring without an apparent precipitating event is called endogenous depression.

Depression may also occur with, or be caused by a number of physical illnesses or disorders. Physical disorders may cause depression directly – such as in thyroid disease or indirectly as a result of pain and disability from a chronic illness.

Some psychiatric conditions may predispose a person to depression, including certain anxiety disorders, alcoholism and other substance abuse disorders, schizophrenia, and early phase of dementia.

Prevention: Depression may not be always preventable but the following measures may be helpful:

• Supportive psychotherapy;
• Communication with family, close friends;
• Preparing for major life changes whenever possible;
• Educating families and partners about the disorder;
• Becoming an expert in your own disorder.

Signs & Symptoms

• Depressed (sad) mood. Many people with depression cannot experience emotions (including grief, joy and pleasure) normally. In severe cases, the world appears to have become colorless, lifeless and dead;
• Markedly reduced interest or pleasure in all, or almost all activities of the day;
• Weight loss or weight gain when not dieting;
• Increase or decrease in appetite;
• Insomnia or disturbed sleeping;
• Agitation or slow activities. Some people with depression are very restless – wringing their hands and talking continuously and they are experiencing agitated depression. A person who tends to withdraw, speak little, stop eating , and sleep little is experiencing vegetative depression;
• Tiredness;
• Feelings of worthlessness or excessive guilt;
• Inability to concentrate or difficulty making decisions;
• Irritability;
• Aches and pains. Some depressed people complain of having a physical illness, with various aches and pains and believe that they have a very serious illness and that it may be incurable;
• Thought of death, guided ideation;
• Severe depression may be associated with hallucinations (seeing or hearing things) and /or delusions (false beliefs).

Risk Factors

• Family history of depression;
• Alcoholism;
• Failure in occupation, marriage or other interpersonal relationships;
• Compulsive, rigid, perfectionist or highly dependent personalities;
• Unexpressed anger or other emotions;
• Death or loss of a loved one;
• Loss of something important (job, home, investments);
• Job changes or move to a new area;
• Surgery, such as mastectomy for cancer;
• Major illness or disability;
• Passing from one life stage to another, such as menopause or retirement;
• Use of some drugs, such a reserpine, beta-adrenergic blockers or benzodiazephines;
• Withdrawal from mood-altering drugs, such as narcotics, amphetamines or caffeine;
• Some diseases, including diabetes mellitus, cancer of the pancreas and hormonal abnormalities, such as thyroid disorder and Cushing’s disease.

 

Diagnosis & Treatment

Diagnosis of depression is usually made from it’s signs and symptoms. A previous history of depression or a family history of depression helps in confirming the diagnosis.

There are two types of standardized questionnaires that are used to measure the degree of depression. These are the Hamilton Depression Rating Scaleб conducted verbally by an interviewer, and the Beck Depression Inventory, a self-administered questionnaire.

Blood tests should be performed to rule out any physical causes of depression. This is particularly useful in women, in whom hormonal factors could contribute to depression.

In difficult cases, other tests may be performed to confirm the diagnosis of depression. One of these tests is the sleep electroencephalogram – which is used to determine the time it takes for rapid eye movement sleep (period during which dreaming occurs) to begin after a person falls asleep. In a normal person it takes 90 minutes, but in a person with depression takes less than 70 minutes.

General Measures:

• Psychotherapy or counseling along with drug treatment gives the best results;
• Hospitalization or inpatient at special treatment center may be required for severe depression;
• Seek support groups. Contact social agencies for help;
• Call your local suicide-prevention hot line if you feel suicidal;
• Electro convulsive therapy (use of electric shocks to produce a seizure) used in severe cases, particularly when the person is psychotic, is refusing to eat or is threatening to commit suicide. It is effective and safe and may be life-saving because it can relieve depression quickly, unlike most antidepressants, which can take up to several weeks;
• Electro-convulsive therapy is performed (under general anesthesia) by placing electrodes on the head and an electric current is applied to induce a seizure. It is not yet understood how this procedure alleviates depression. Usually a total of  five to seven treatments are given , every other day. Electro convulsive therapy may cause some temporary memory loss.

Medications:

• Antidepressant drugs for persons with prolonged or moderately severe depression. Several types of drugs are available, such as selective serotonin reuptake inhibitors, tricyclic anti-depressants, mono-amine oxidase inhibitors, and psycho stimulants However, these drugs have to be taken regularly for at least 4 to 6 weeks before they begin to work. The chances that any given antidepressant will work for a particular person are approximately 60 to 70%;
• Lithium for alternating mania and depression;
• Anti-anxiety drugs may be prescribed;
• Sedatives may be prescribed temporarily for insomnia;
• St. John’s Wort (a herbal supplement) is being increasingly used for the treatment of mild depression.

Activity:

• No restrictions. Maintain daily activities and interests even if you don’t feel like it. Attend social functions, concerts, athletic events, plays and movies. Keep in touch with friends and loved ones;
• Engage in regular, strenuous exercise. This helps relieve depression.

Diet:

• Eat a normal, well-balanced diet even if you have no appetite;
• Vitamin and mineral supplements may be necessary;
• Persons on monoamine oxidase inhibitors should not eat foods or beverages containing tyramine, such as beer, red wines (including sherry), liqueurs, over-ripe foods, salami, aged cheeses, fava or broad beans, yeast extracts (marmite), and soy sauce. Certain over-the-counter medications such as dextromethorphan  and phenylpropanolamine should be avoided because it can cause a sudden and severe rise in blood pressure. Other drugs to be avoided are tricyclic antidepressants, selective serotonin reuptake inhibitors, and meperidine (a pain killer).

Possible Complications:

• Suicide;
• Hallucinations or psychotic behavior;
• Manic behavior, characterized by inappropriate over activity and comic or irresponsible behavior;
• Withdrawal from family and friends.

Prognosis

• Depression is a chronic illness;
• If treatment plan set up by your doctor is followed high chances of improvement and recovery;
• Recurrences occur, and must be treated.

Other

Nothing Specified.

Posted by RxMed