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