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| General
Illness Information |
Common
Name: |
Depression |
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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.
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| 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
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.1) Genetic factor - neurotransmitter dysfunction.
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2) Developmental
problems- personality defects, childhood events.
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3)Psychosocial stresses-e.g...... 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.
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| Prevention: |
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Depression may not be always
preventable but the following measures may be
helpful:
Supportive
psychotherapy.
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Communication with
family, close friends.
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Preparing for major life
changes whenever possible.
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Educating families
and partners about the disorder. |
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Becoming an expert
in your own disorder.
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| Signs
& Symptoms |
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| Risk
Factors |
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Family history of depression. |
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Alcoholism. |
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Failure in occupation, marriage or other interpersonal
relationships |
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Compulsive,
rigid, perfectionist or highly dependent
personalities. |
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Unexpressed
anger or other emotions. |
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Death
or loss of a loved one. |
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Loss of something
important (job, home, investments). |
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Job
changes or move to a new area. |
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Surgery, such as mastectomy for cancer. |
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Major illness or disability. |
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Passing
from one life stage to another, such as menopause or
retirement. |
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Use of some drugs, such a reserpine, beta-adrenergic blockers
or benzodiazephines. |
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Withdrawal
from mood-altering drugs, such as narcotics, amphetamines or
caffeine. |
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Some diseases,
including diabetes mellitus, cancer of the pancreas and
hormonal abnormalities, such as thyroid disorder and
Cushing's disease.
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| 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 Scale-
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: |
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Psychotherapy
or counseling along with drug treatment gives the best
results.. |
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Hospitalization
or inpatient at special treatment center may be required for
severe depression. |
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Seek
support groups. Contact social agencies for help. |
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Call
your local suicide-prevention hot line if you feel
suicidal. |
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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: |
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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%.. |
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Lithium
for alternating mania and depression. |
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Anti-anxiety
drugs may be prescribed. |
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Sedatives
may be prescribed temporarily for
insomnia. |
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St. John’s Wort (a herbal supplement) is being increasingly used for the treatment of mild depression. |
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| Activity: |
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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.
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Engage in regular,
strenuous exercise. This helps relieve depression.
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| Diet: |
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Eat
a normal, well-balanced diet even if you have no
appetite |
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Vitamin
and mineral supplements may be necessary. |
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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 : |
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Suicide |
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Hallucinations or psychotic behavior. |
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Manic
behavior, characterized by inappropriate over activity and
comic or irresponsible behavior. |
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Withdrawal
from family and friends. | |
| Prognosis |
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Depression is a chronic
illness.
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If treatment plan set up
by your doctor is followed high chances of improvement
and recovery.
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Recurrences occur,
and must be treated.
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| Other |
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