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