Depression

This essay has a total of 2895 words and 13 pages.

Depression

Everybody's mood varies according to events in the world around them.
People are happy when they achieve something or saddened when they fail a
test or lose something. When they are sad, some people say they are
'depressed', but the clinical depressions that are seen by doctors differ
from the low mood brought on by everyday setbacks. Psychiatrists see a
range of more severe mood disturbances and so find it easier to
distinguish these from the normal variations of mood seen in the
community. General practitioners (GP's) need to be sensitive enough to
distinguish emotional reactions to setbacks in life from anxiety
syndromes, somatisation and clinical depressions. The general idea is
that anxiety disorders, depressive episodes, somatisation and adjustment
reactions are all different entities, but in practice it is not always
that clear-cut. Major depression, as defined by psychiatrists, is
unfortunately relatively common. What is depression? The term "affect"
refers to one's mood or "spirits." "Affective disorder" refers to changes
in mood that occur during an episode of illness marked by extreme sadness
(depression) or excitement (mania) or both. Depression is a disorder of
affect. Affective disorders are predominantly disturbances of mood that
are severe in nature and persistent despite the influence of external
events. Depression is characterized by severe and persistent low mood,
which is often unresponsive to the efforts of friends and family to cheer
the sufferer up. Patients who suffer with repeated episodes of depression
have a Recurrent Depressive Disorder. Depressive episodes can be
classified into mild, moderate, and severe types, with or without
psychotic symptoms. To be classified as depression, an episode must last
more than two weeks. A condition where the mood is persistently low, but
does not quite fulfill all the criteria for a depressive episode, is
sometimes called "dysthymia." Community studies have found that
depression is prevalent between 5 and 20% of all people. About 10% of
people over age 65 will have a major depressive episode. The incidence of
depression is higher in women and in urban settings rather than rural
settings. Clinical features of depression Mild depressive episodes
typically include features such as: ?Sadness and crying, ?Loss of
interest in and loss of enjoyment of life (anhedonia), ?Poor attention
and concentration, ?Low self-esteem and ideas of unworthiness, ?A bleak
view of the future and the world in general, ?Poor sleep and appetite.
People with mild depressive episodes find it difficult to continue with
their work and social lives, but usually continue to function, although
less than normal. Moderate depressive episodes have a wider range of
symptoms, which are present usually to a greater degree. Sufferers find it
very difficult to function normally at work or home. Severe depressive
episodes typically may also include features such as: ?Great distress and
agitation, ?Slowed thought and movement (psychomotor retardation),
?Ideas of guilt, ?Suicidal fantasies or plans which may be acted upon,
?Pronounced somatic symptoms, ?Psychotic symptoms. People with severe
depressive episodes find it impossible to continue with their work,
domestic and social lives, and usually cease to function in these areas.
Depression is often accompanied by slowing of thought processes and
biological features of everyday life which differ from a normal sense of
sadness. Crying is a frequent symptom, although some individuals are
reluctant to admit this, and others feel so depressed it that is as if
they have 'gone beyond crying'. Suicidal ideas occur in most depressed
people, and asking about these is a crucial aspect of their assessment.
Depressed patients often find it a relief to talk about these ideas with
their doctor. Asking about suicidal ideas is a sequential process,
beginning with questions about the severity of the low mood. The doctor
can then ask if the patient has ever felt that life is not worth living.
A 'yes' could be followed by inquiring whether the patient has ever felt
like ending their own life. Finally the doctor needs to assess if the
patient has any particular plans in mind. Case History: Janet Janet
Gordon was aged 35 when she lost her job as a manager of a department
store. At first she looked on her period of unemployment as an
opportunity to try out activities she had previously no time for. She
went hill-walking and painting every day. Two months later she had lost
interest in these things and was despairing that she would never work
again, although she had an exemplary work record. Her sleep at night was
poor and she had started going to bed during the day. Janet cried almost
daily and had lost interest in the food she cooked. All food tasted
bland, she said to her mother (who was concerned when she saw how much
weight Janet had lost). At her mother's suggestion Janet went to her
family doctor where she complained about how tired she always felt. She
asked for some sleeping tablets to help her sleep at night. Case
History: Alan Alan Benson was brought to the accident and emergency
department by his son. Alan had tried to hang himself from the banisters
at the family home. Fortunately the clothes' line that he had chosen to
hang himself with had broken under his weight. When he was seen by the
psychiatrist Alan had a red weal mark around his throat from the noose. He
was staring at a fixed point on the floor. Now and then he would groan
deeply and whisper to himself. He kept repeating the words 'I'm for
it..I'm for it now.' He would not make eye contact with the doctor and
initially refused to answer questions. His son said that the previous
week his father had stopped going to work as a bailiff after he found out
that his wife was having an affair. He had watched her obsessively for two
days, not letting her out of his sight. Then a few days ago he had taken
to his bed, and lain there for hours and hours not moving, not speaking,
not eating and not drinking. He had talked about how everything was his
fault and had at times been pleading with an unseen person to forgive
him. He felt that he had committed some unpardonable crime and that he
should now be punished. Armed with this information the psychiatrist
talked to Mr. Benson again. This time Mr. Benson replied, even if only
briefly. He said that God was telling him that his wife had to find
another man because her husband had been so evil. He confessed that he had
once had an affair himself many years before, and that God had told him
in the last week that He had punished Mr. Benson with syphilis. His wife
could be spared from the syphilis only if he killed himself. Once he was
dead, he thought, his wife could begin a clean life with another man.
Differential Diagnosis Many physical disorders can be present with
depressive illness. They include: hypothyroidism, hyperthyroidism,
Addison's disease, Cushing's disease, electrolyte disturbances,
alcoholism, drug abuse, carcinoma and dietary deficiencies (B12, B1, and
folic acid). Various drugs can cause depression. Psychological disorders
that may mimic depression include adjustment reactions, anorexia nervosa,
bulimia nervosa, anxiety disorders, substance abuse, obsessive-compulsive
disorder, dysthymia, seasonal affective disorder, and abnormal bereavement
reactions. Panic disorder commonly co-exists with or pre-dates
depression, (Andrade et al, 1994). Diagnosing and treating underlying
physical causes must be attempted and are key factors in the correct
prognosis of the actual cause of a persons depression. Risk factors for
depression ?In Young Adults: ?Urban dwellers, ?Unemployment,
?Physical ill-health, ?Previous affective illness, ?Family history of
depression, ?Childhood abuse/trauma, ?Loss of mother before age 11,
?Looking after several young children, ?No confidence, ?Bereavement. In
Older People: ?Bereavement of a close figure in last six months,
?Loneliness (but not living alone), ?Lack of Satisfaction with Life,
?Female Sex. The risk factors for older people identified above have some
predictive value in identifying people at risk of depression three years
later. Life satisfaction and bereavement help predict recurrences of
depressive illness. The higher prevalence of depression amongst women
could be because women are more prone to depressive illness biologically
or because of their social roles, or could be because male depression is
under-recognized, or incorrectly labeled. However, suicide is more common
among men than women. It is worth remembering that only 50% of depressed
patients who present to their GP are correctly diagnosed as suffering
with depression. Most depressed people in the community do not receive
treatment. Over 90% of depressed elderly people in the community suffer
without treatment. Armed with knowledge of its prevalence, causes and
common features, one might assume that it is a simple task to diagnose
depression in general practice settings. Unfortunately it isn't.
Certainly having a high index of suspicion and a professional willingness
to consider the possibility of depression are important factors in our
ability to diagnose depression. Additionally patients also have a
Continues for 7 more pages >>




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