| name: | Depression |
| also known as: | Major Depression; Sadness; Sad; Blue; The Blues; Mood Disorder; Anhedonia; ICD 296.20, 311 |
| also see: | Mood Disorder; Dysthymia; Schizophrenia; Seasonal Affective Disorder; Bipolar Disorder; Suicide; Psychiatric Disorder; Hallucination; Postpartum Depression; Baby Blues; ICD; CPT |
| description: | Depression is a primary mood disorder characterized by a depressed mood, lack of interest in things that once gave pleasure termed anhedonia. Depression is a part of many people's biorhythm, a normal part of living, or, it can result from life changes, such as deaths, births, marriages, divorces, financial expenditures and losses, chronic illness and even certain medications reserpine, beta blockers, benzodiazepines. Some forms of depression may be inherited. Risk is increased in those who internalize their anger, compulsive behavior personalities, repeated failure in life, devastating injury, extensive illness or surgery, substance abuse. Major depression is depression that takes on certain clinical features that are of more concern, including impaired ability to interact with people, school, work and the environment, accompanied with physiologic changes. It is believed that the underlying problem in major depression is a altered brain neurotransmitter function, such as dopamine and serotonin, presumably at the level of the limbic system within the brain. Depression affects anywhere from 5-20% of the US population and more common in females. Risk increased with family history, female, migraine headache, chronic illness, stress, chronic pain syndrome, chronic back pain, recent heart attack, insomnia, gastric ulcer, duodenal ulcer, teenage, elderly, retirement, menopause, drug abuse and addiction, attention deficit disorder. Schizoaffective disorder is pyschotic depression with features resembling schizophrenia, but the primary disorder is one of depression, not schizophrenia. |
| signs & symptoms: | Includes depressed mood, sadness, hopelessness, helplessness, sleep disturbance, fatigue, disinterest, listlessness, decrease energy, poor concentration, digestive problems, poor appetite, weight loss and crying, loss of sex drive (poor libido), social isolation, insomnia, anxiety, and suicidal ideation. The insomnia is characterized by an easy ability to fall asleep at night but associated with middle of the night or early morning awakening and not being able to go back to sleep. The mood is characterized by a flat affect and slow thought processes. |
| diagnosis: | Based on signs, symptoms, history, physical exam and occasionally psychological evaluation. Suicidal ideation needs to be determined. Since hypothyroidism is relatively common and has features similar to major depression, a thyroid test should be performed on all patients with depression prior to commencing prescription drug therapy. The Minnesota Multiphasic Personality Inventory (MMPI), which is a formal psychological testing tool, can be used especially if the diagnosis is in doubt. Differential diagnosis includes dementia, delirium, diabetes, chronic renal failure, liver failure, chronic fatigue syndrome, various drug side effects as well as medication overdose, drug withdrawal, alcohol withdrawal, alcoholism. |
| treatment: | Treatment varies from self care for mild cases to psychotherapy for more severe cases, including possible hospitalization. Prescribed medications may be indicated, such as: First Line: 1. SSRI are often the first of the first line drugs. Major side effects include insomnia, anxiety, headache, sexual dysfunction. SSRI drugs include citalopram (celexa), fluoxetine (prozac), sertraline (zoloft), paroxetine (paxil), fluvoxamine (luvox) 2. Venlafaxine such as effexor are also a first line drug, and is a SSRI. Can cause insomnia, anxiety, poor appetite. 3. Atypical antidepressants such as bupropion (wellbutrin, zyban), trazodone (desyrel) are effective but can increase seizure risk. Second Line 1. Tricyclic antidepressants (TCA) are often 2nd line drugs. Side effects are more significant and fatal overdose more likely. TCA drugs include amitriptyline (elavil, endep), desipramine (norpramin), imipramine (tofranil), maprotiline (ludiomil), nortriptyline (aventyl, pamelor), clomipramine (anafranil), amitriptyline/chlordiazepoxide (limbitrol), amitriptyline/perphenazine (etrafon, triavil), doxepin (sinequan), protriptyline (vivactil), amitriptyline/perphenazine (etrofon), trimipramine (surmontil), amoxapine (Asendin), mirtazapine (remeron) 2. MAOI such as phenelzine (nardil), isocarboxazid (marplan), tranylcypromine (parnate). Have significant drug-drug interaction and also drug-food interaction. 3. Lithium can be used as an antidepressant but is generally used in bipolar disorder. Patients who fail medication, either because the drugs don't work or the side effects are too significant or the patient is not compliant, might benefit from ECT or electric shock treatment. Self care measures might include walking and exercising regularly (exercising increases the levels of natural opiates in the body called endorphins and enkephalins which are mood elevators), establish a routine wake/sleep cycle, avoid sugar and caffeine including coffee, tea and chocolate, avoid alcohol and smoking. Herbal treatment for mild depression might include St. John's Wort, valerian, black cohosh, ginseng or ginkgo. |
| prevention: | Things that might prevent or reverse mild depression include daily exercise, trying something new and different, associate with positive up beat people, associate with people who accept you for who you are, talk to friends and co-workers, help someone else which in turn will make you feel better about yourself, avoid drugs and alcohol, go on or take a vacation or a change in scenery, exercise regularly, and go to the movies. |
| outcome: | Depression can be cured, and if not, at least successfully managed with counseling and/or medication. Unchecked depression can result in deepening depression, despair and in suicide. |
skynetMD suggests the following:
| if: | If the person is suicidal, has attempted suicide or is contemplating and planning a suicide |
| go to: | Go to the hospital for emergency care |
| if: | If the person has lost interest in most activities, been depressed for several weeks and can not snap out of it, has a change in appetite, loss of concentration, trouble sleeping, tired, fatigue, headache |
| go to: | Go to the doctor |
| if: | If the person has become depressed after beginning a new medicine, or, if they have become withdrawn and if the depression is associated with gloomy weather |
| go to: | Go to the phone and call the doctor. |
| if: | If the person would like a depression Internet Resource |
| go to: | Go to American Psychiatric Association www.psych.org/public_info/depres~1.htm |
| if: | If the person would like a mental health Internet Resource |
| go to: | Go to National Alliance for the Mentally Ill www.nami.org |
Last updated 4/20/2009