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"Depression." by Dr Deryck Pattron | Article ID: #D002
In any given
year about 18.8 million American adults, suffer from a depressive illness.
The economic cost for this disorder is US $40 billion per year, but the
cost in human suffering cannot be estimated. Depressive illnesses often
interfere with normal functioning and cause pain and suffering not only to
those who have a disorder, but also to those who care about them. Serious
depression can destroy family life as well as the life of the ill person.
But much of this suffering is unnecessary. Most people with a depressive
illness do not seek treatment because they do not recognize that
depression is a treatable illness.
WHAT IS DEPRESSION?
is a mental illness that involves the body, mood and thoughts. It affects
the way a person eats and sleeps, the way one feels about oneself, and the
way one thinks about things. Depression is not the same as a passing blue
mood nor is a sign of personal weakness.
TYPES OF DEPRESSION
manifest itself in different forms, but there are three common types of
depression. However, within these types there are variations in the number
of symptoms, their severity and persistence.
Major depression is manifested by a combination of
symptoms that interfere with the ability to work, study, sleep, eat and
enjoy once pleasurable activities. Such a disabling episode of
depression may occur only once but more commonly occurs several times in
Dysthymia is a less severe type of depression. It
involves long-term, chronic symptoms that do not disable, but keep one
from functioning well or from feeling good. Many people with dysthymia
may also experience major depressive episodes at some time in their
Bipolar disorder, also called manic-depressive
illness. Not nearly as prevalent as other forms of depressive disorders,
bipolar disorder is characterized by cycling mood changes: severe highs
(mania) and lows (depression).
SYMPTOMS OF DEPRESSION AND
who is depressed or manic experiences every symptom. Some people
experience a few symptoms, some many. Severity of symptoms varies with
individuals and also varies over time.
Persistent sadness, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and
activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight
Thoughts of death or suicide; suicide attempts
Persistent physical symptoms that do not respond to
treatment, such as headaches, digestive disorders, and chronic pain
CAUSES OF DEPRESSION
a combination of genetic, psychological, and environmental factors is
involved in the onset of depression.
Environmental e.g. possibly stresses at home, work,
Drug use and abuse
Psychological predisposition associated with one or
more of the above combinations.
DEPRESSION IN WOMEN
Women experience depression about twice as often as
Many hormonal factors may contribute to the increased
rate of depression in women, particularly such factors as menstrual
cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause
Many women also face additional stresses such as
responsibilities both at work and home, single parenthood and caring for
children and for aging parents.
DEPRESSION IN MEN
Men are less likely to suffer from depression than
3 to 4 million men in the United States are affected
by the illness.
Men are less likely to admit to depression, and
doctors are less likely to suspect it.
The rate of suicide in men is four times that of
women, though more women attempt it. In fact, after age 70, the rate of
men's suicide rises, reaching a peak after age 85.
Depression can also affect the physical health in men
differently from women.
Although depression is associated with an increased
risk of coronary heart disease in both men and women, only men suffer a
high death rate.
Men's depression is often masked by alcohol or drugs,
or by the socially acceptable habit of working excessively long hours.
Depression typically shows up in men not as feeling
hopeless and helpless, but as being irritable, angry, and discouraged;
hence, depression may be difficult to recognize as such in men.
Even if a man realizes that he is depressed, he may
be less willing than a woman to seek help.
DEPRESSION IN THE ELDERLY
Some people have the misconception that it is normal
for the elderly to feel depressed. On the contrary, most older people
feel satisfied with their lives.
Sometimes, though, when depression develops, it may
be dismissed as a normal part of aging.
Depression in the elderly, undiagnosed and untreated
causes needless suffering for the family and for the individual who
could otherwise live a fruitful life.
Loss of interest in normally pleasurable activities,
or extremely prolonged grief after a loss.
DEPRESSION IN CHILDREN
The depressed child may pretend to be sick, refuse to
go to school, cling to a parent, or worry that the parent may die.
Older children may sulk, get into trouble at school,
be negative, grouchy, and feel misunderstood.
Because normal behaviours vary from one childhood
stage to another, it can be difficult to tell whether a child is just
going through a temporary "phase" or is suffering from depression.
In such a case, if a visit to the child's
pediatrician rules out physical symptoms, the doctor will probably
suggest that the child be evaluated, preferably by a psychiatrist who
specializes in the treatment of children. If treatment is needed, the
doctor may suggest that another therapist, usually a social worker or a
psychologist, provide therapy while the psychiatrist will oversee
medication if it is needed. Parents should not be afraid to ask
questions: What are the therapist's qualifications? What kind of therapy
will the child have? Will the family as a whole participate in therapy?
Will my child's therapy include an antidepressant? If so, what might the
side effects be?
DIAGNOSTIC EVALUATION AND
The first step to getting appropriate treatment for
depression is a physical examination by a physician.
Certain medications as well as some medical
conditions such as a viral infection can cause the same symptoms as
depression, and the physician should rule out these possibilities
through examination, interview and lab tests.
If a physical cause for the depression is ruled out,
a psychological evaluation should be done, by the physician or by
referral to a psychiatrist or psychologist.
A good diagnostic evaluation will include a complete
history of symptoms, i.e., when they started, how long they have lasted,
how severe they are, whether the patient had them before and, if so,
whether the symptoms were treated and what treatment was given.
The doctor should ask about alcohol and drug use, and
if the patient has thoughts about death or suicide. Further, a history
should include questions about whether other family members have had a
depressive illness and, if treated, what treatments they may have
received and which were effective.
A diagnostic evaluation should include a mental
status examination to determine if speech or thought patterns or memory
have been affected, as sometimes happens in the case of a depressive or
Treatment choice will depend on the outcome of the
There are a variety of antidepressant medications and
psychotherapies that can be used to treat depressive disorders.
Some people with milder forms may do well with
People with moderate to severe depression most often
benefit from antidepressants.
Most do best with combined treatment: medication to
gain relatively quick symptom relief and psychotherapy to learn more
effective ways to deal with life's problems, including depression.
Depending on the patient's diagnosis and severity of
symptoms, the therapist may prescribe medication and/or one of the
several forms of psychotherapy that have proven effective for
Electroconvulsive therapy (ECT) is useful,
particularly for individuals whose depression is severe or life
threatening or who cannot take antidepressant medication.
There are several types of antidepressant medications
used to treat depressive disorders. These include newer medications,
namely the selective serotonin reuptake inhibitors (SSRIs), the
tricyclics, and the monoamine oxidase inhibitors (MAOIs).
The SSRIs and other newer medications that affect
neurotransmitters such as dopamine or norepinephrine generally have
fewer side effects than tricyclics.
Sometimes the doctor will try a variety of
antidepressants before finding the most effective medication or
combination of medications.
Sometimes the dosage must be increased to be
Although some improvements may be seen in the first
few weeks, antidepressant medications must be taken regularly for 3 to 4
weeks (in some cases, as many as 8 weeks) before the full therapeutic
of psychotherapy therapies exist which may be used to help depressed
people resolve conflicting feelings. Some of these psychodynamic therapies
are given below:
"Talking" therapies help patients gain insight into
and resolve their problems through verbal exchange with the therapist,
sometimes combined with "homework" assignments between sessions.
"Behavioral" therapies help patients learn how to
obtain more satisfaction and rewards through their own actions and how
to unlearn the behavioural patterns that contribute to or result from
Interpersonal therapies focus on the patient's
disturbed personal relationships that both cause and exacerbate the
HOW TO HELP YOURSELF IF YOU
Set realistic goals in light of the depression and
assume a reasonable amount of responsibility.
Break large tasks into small ones, set some
priorities and do what you can as you can.
Try to be with other people and to confide in
someone; it is usually better than being alone and secretive.
Participate in activities that may make you feel
Mild exercise, going to a movie, a ballgame, or
participating in religious, social, or other activities may help.
Expect your mood to improve gradually, not
immediately. Feeling better takes time.
It is advisable to postpone important decisions until
the depression has lifted. Before deciding to make a significant
transition change jobs, get married or divorced discuss it with others
who know you well and have a more objective view of your situation.
People rarely "snap out of" a depression. But they
can feel a little better day-by-day.
Remember, positive thinking will replace the negative
thinking that is part of the depression and will disappear as your
depression responds to treatment.
Let your family and friends help you.
HOW FAMILY AND FRIENDS CAN
HELP DEPRESSED PERSONS?
The most important thing anyone can do for the
depressed person is to help him /her get an appropriate diagnosis and
Encouraging the individual to stay with treatment
until symptoms begin to abate or to seek different treatment if no
Offer emotional support. This involves understanding,
patience, affection, and encouragement.
Do not ignore remarks about suicide. Report them to
the depressed person's therapist.
Encourage participation in some activity that once
gave pleasure e.g. hobbies, sports, religious or cultural activities,
walks, outings, etc.
Keep reassuring the depressed person that, with time
and help, he/she will feel better.
WHERE TO GET HELP
Mental health specialists, such as psychiatrists,
psychologists, social workers, or mental health counselors
Community mental health centers
Hospital psychiatry departments and outpatient
Family service and social agencies
Private clinics and facilities
Employee assistance programmes
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ABOUT THE AUTHOR
Dr Deryck Pattron is a Public Health Scientist attached to the Ministry of
Health in Trinidad.
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