Depression

Depression Criteria for DSM 5

Depression is greater and more serious than just having a “bad day” or “rough times”. It’s not only one of the most common mental disorders, but also the number one factor when someone commits suicide. It’s also insidious since people can suffer from horrible depression without displaying classic signs and symptoms.

Depression is primarily caused by a combination of genetic, biological, environmental, and psychological factors. Substance abuse and co-morbidities can also complicate the plan of care. Treatments are usually geared towards correcting these imbalances, but sometimes the depressive symptoms can turn into a chronic or permanent illness with many trials and errors.

The time it takes for someone to finally seek treatment or a care provider can cause a person to not have the patience and tolerance to wait for an improvement.  Therefore, the practitioner should regularly assess for suicidal behaviors, rule out serious medical causes, and the efficacy of treatment.

Onset of Depression

An Overview of Depression

Overall the goal is to remain hopeful, encourage a support system, and restore a person’s quality of life. Depression may continue to linger but track (with screening tools or other means of documentation) even the littlest changes because the treatment of depression is a process towards avoiding something more serious:

  • Depression is one of the main causes of disability worldwide. Globally, an estimated 300 million people are affected by depression. Women are more affected than men -World Health Organization…& most of the time depression is unreported.
  • Categories of depression: bipolar depression (BPD), major depressive disorder, persistent depressive disorder (also called dysthymia), postpartum depression, psychotic depression, seasonal affective disorder.

Signs and Symptoms

  • Depression is characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness, and poor concentration.
  • People with depression may also have multiple physical complaints with no apparent physical cause.
  • Depression can be long-lasting or recurrent, substantially impairing people’s ability to function at work or school and to cope with daily life. At its most severe, depression can lead to suicide.

-World Health Organization

Etiology of Depressive Symptoms

Although a serotonin deficiency plays a role in depression, there’s no way to directly measure levels in the brain. However, serotonin selective reuptake inhibitors (SSRIs) are considered the standard treatment because serotonin’s main function is mood control and happiness. Overview About Serotonin

It’s manufactured in the brain but most of the serotonin supply is found in the digestive tract, hence the side-effect of SSRIs is GI upset but it’s one of the safest medications among anti-depressants (especially if overdosing is a concern).

2 hypotheses related to depression and its treatment:

  1. Monoamine: depression is caused by a deficiency of serotonin, norepinephrine, or both. Think of a chemical imbalance or dysregulation.
  2. Neurotrophic: depression is associated with loss of neurotrophic support in key brain regions such as the hippocampus. Think of the monoamines as the roots, in which a decrease of activity results in a withering tree (brain structures and activity).

-Stahl, 2013

How serotonin can be depleted with anti depressants
When serotonin has “bottomed out” the receptors are NOT as available as they were before the SSRI medication…

depression etiology

Additional Key Points

  • Monoamine neurotransmitters are neurotransmitters and neuromodulators that contain one amino group.
  • Classic neurotransmitters include Adrenaline (Ad; Epinephrine, Epi), Dopamine (DA), Noradrenaline (NAd; Norepinephrine, NE), & Serotonin (5-HT2).
  • Drugs used to increase (or reduce) the effect of monoamine neurotransmitters are used to treat patients with psychiatric and neurological disorders
  • Clinical presentation depends on the pattern and severity of neurotransmitter abnormalities and is predominated by neurological features (encephalopathy, epilepsy, and pyramidal and extrapyramidal motor disorders) that are primarily attributed to a deficiency of cerebral dopamine, serotonin, or both.
  • Many neurotransmitter disorders mimic the phenotype of other neurological disorders (eg, cerebral palsy, hypoxic-ischaemic encephalopathy, paroxysmal disorders, inherited metabolic diseases, and genetic dystonic or parkinsonian syndromes) and are, therefore, frequently misdiagnosed.
  • Early clinical suspicion and appropriate investigations, including analysis of neurotransmitters in CSF, are essential for accurate clinical diagnosis.
  • Treatment strategies focus on the correction of monoamine deficiency by replacement of monoamine precursors, the use of monoamine analogs, inhibition of monoamine degradation, and the addition of enzyme cofactors to promote monoamine production.

-Pub Med

Medications That Alters Mood as Side-Effects: Steroids, Estrogen, Antihypertensives (Bete-Blockers i.e.), Anti-Parkinson’s Agents, Antineoplastics, Antifungal/Antibacterials, Analgesics, Isotretinoin (Accutane), & Benzodiazepines -ANCC

Further Considerations

  • People with depression have more favorable outcomes with behavioral therapy than with medications alone.
  • There are many factors and circumstances related to depression, therefore it may take some trial and error to find the best treatment.
  • If the depression is becoming treatment-resistant or the symptoms are not improving, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore. Also, consider using genetic testing.
  • Frequently assess for improvements and suicidal thoughts. Screening tools are also helpful to determine how often someone should follow up or if switching medication is indicated.

depression in older adults

Additional Information & References

Beyond Treatment, What Else Help Depression? 

  • Try to be active and exercise.
  • Set realistic goals for yourself.
  • Try to spend time with other people and confide in a trusted friend or relative.
  • Try not to isolate yourself, and let others help you.
  • Expect your mood to improve gradually, not immediately.
  • Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
  • Continue to educate yourself about depression.

Free Booklets and Brochures

  • Chronic Illness & Mental Health: This brochure discusses chronic illnesses and depression, including symptoms, health effects, treatment, and recovery.
  • Depression and College Students: This brochure describes depression, treatment options, and how it affects college students.
  • Depression and Older Adults: Depression is not a normal part of aging. This brochure describes the signs, symptoms, and treatment options for depression in older adults.
  • Depression: What You Need to Know: This booklet contains information on depression including signs and symptoms, treatment and support options, and a listing of additional resources.
  • Postpartum Depression Facts: A brochure on postpartum depression that explains its causes, symptoms, treatments, and how to get help.
  • Teen Depression: This flier for teens describes depression and how it differs from regular sadness. It also describes symptoms, causes, and treatments, with information on getting help and coping.

Federal Resources

Multimedia

National Institute of Mental Health

Quick Links 

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