What Is Depression?

From the desk of Susan J. Olson, MD

What Is Depression? Signs and Symptoms

Depression has numerous signs that accompany it and while not everyone will project those same symptoms in all cases, these indicators are typical. One of the more prominent features of depression is a loss of interest in activities that one typically enjoys taking part in, a condition known as anhedonia. In adults this may display itself by a loss of enthusiasm in ones work, a distancing of self from spouse, children, and friends, or apathy towards a favorite leisure time activity such as gardening or playing golf. Other symptoms often seen in those with depression include a change in eating and sleep patterns. With appetite in particular, a person may refuse to eat citing that food has no appeal and that they are just not hungry at all. On the other hand, a person may eat large amounts of food in an attempt to comfort themselves and relieve the misery of the depression. In either case there is likely to be a noticeable change in their weight either up or down. Changes in sleep patterns also occur. When depressed a person may virtually refuse to get out of bed and choose to sleep up to 14 hours a day or more. Or, despite being totally exhausted and in dire need of rest, the individual may only get 1-2 hours of sleep before waking up and not being able to go back to sleep.

Other symptoms of depression are a sense of hopelessness and/or helplessness, feelings of guilt, and ruminating over events of the past that the individual has no control over. Difficulty with making decisions, failure to bathe daily and maintain proper hygiene, crying spells, isolating one’s self, and poor energy level are additional signs that one may be having a severe bout of depression.

The key in distinguishing a severe case of depression from a brief reactive sadness or loss is a feeling of worthlessness, difficulty in being able to concentrate, and thoughts of suicide or death. These are important indicators that the person needs medical intervention. Inpatient treatment may be strongly recommended for those experiencing such symptoms for greater than two weeks.

Who Are Most At Risk?
Although depression in the elderly is thought to be most prevalent, statistics show that the mean age of onset is lower than in past decades. In the past the mean age of onset was from 28-30 years of age, however, current research is showing that in the last decade, onset typically occurs before the age of twenty-one and even as early as adolescence.

Rates of Depression and Risk Factors

The lifetime prevalence of depression is 2.8 to 5.8 per 100 individuals and a one-year prevalence of 2.7 per 100 people. In contrast to bipolar disorder, the increased risk of major depression in women is well documented in clinical and epidemiologic studies. Review of studies for more than 10 years concludes that the “gender gap” was not simply an artifact of women’s tendency to report stress or seek help more readily than men. Female to male ratios are nearly twice as high in women than men. The differences prove consistent across cultures, socioeconomic status and race.

Additional risk factors for depression are unemployment, being unmarried or divorced, and a family history of depression. There is a two to threefold elevation in risk among first degree relatives of those who suffer from major depression or bipolar depression for having depressive episodes themselves. There are a few ethnic distinctions between black and white in the prevalence of depression and socioeconomic status per se, however, there are no noticeable differences in the rates of depression between these groups. The most protective factor on rates of major depression is marriage. Specifically, married people have the lowest rates of major depression and divorced persons had the highest.

Medical Co-morbidities

Physical illnesses which can present with signs and symptoms of major depression are endocrine abnormalities such as hypothyroidism or adrenal insufficiency. There are no rheumatologic conditions such as osteoarthritis, rheumatoid arthritis and fibromyalgia which mimic the symptoms of depression. Autoimmune conditions can present with a chronic insidious course of depression and fatigue. These include such diseases as lupus and multiple sclerosis that often require careful diagnostic workup by a medical professional. Chronic pain from a motor vehicle accident and job related injuries can also present with co-morbid depression.

Treatment Paradigm

Research consistently demonstrates that treatment of major depression with antidepressants and cognitive behavioral therapy is more effective than placebo or no therapy. Pharmacologic research has presented clinicians with an array of medications with different pharmacologic profiles. A trained psychiatrist who understands the unique clinical presentation of the patient can best prescribe and monitor the side effects and titration of medication. The careful follow-up within two weeks of the initiation of treatment is strongly recommended. Sadly, 75 percent of individuals who start medication and therapy drop out of treatment due to lack of timely follow-up care. Inpatient psychiatric care is strongly recommended for those who have threatened suicide, made a previous attempt, have threatened others with violent bodily harm, and who possess or access to a firearm. Notably, most suicide attempts occur in the context of alcohol or other substance abuse disorders.

Personal Treatment Philosophy for Dr. Susan Olson, Psychiatrist

As a psychiatrist with 20 years of experience, I strongly believe that depression is most effectively treated with a combination of antidepressant medication, individual therapy, family involvement, and a strong network of support in the patient’s treatment and transition to a better state of health. This approach is known as the “holistic approach” as it requires input from multiple sources and not just the client. I also believe that faith and spirituality can and do play a significant role in aiding the individual’s recovery to an improved state of mental health. Hospitalization may be required to treat a deep depression, especially when there has been a suicide attempt or there is talk of ending one’s life. Cognitive behavioral treatment and learning new coping skills are a key to successful recovery and prevention of a relapse back into a severe depressive state. Providing help involves a caring physician and a compassionate treatment team focused on the unique individual needs of each patient. Listening to a patient and engaging in a dialogue is critical to the restoration of hope and mental health.