DEPRESSION - MOOD DISORDER

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 DEPRESSION


Depression can be defined as a mental state characterized by feelings of sadness, despair, unhappiness, worthlessness, and hopelessness. 

Depression Characteristics
Everyone has mood changes: sometimes feeling great and at other times feeling a little down.  Usually, we can swing up out of our depressed states by ourselves.  

When a person's depression becomes such that the individual cannot function or is a danger to society, that depression has moved out of the normal range. The individual must have professional help.

Types of Depression
Depression may be classified as either Exogenous or Endogenous. 

Exogenous Depression is often referred to as situational depression because it comes from something outside the person. 

Possible causes include the loss of a loved one (death or departure of a parent or child); loss of self-esteem due to business failure, rejection, or divorce; or inability to express or admit anger toward others ("holding it in").  

Endogenous Depression, the type that comes out of the blue, is more severe than Exogenous depression.  

The patient may need to have psychiatric help immediately.

General Symptoms of Severe Depression
There are a number of signs and symptoms of General severe depression. An individual suffering from severe depression will usually have more than just one sign or symptom. He may have several signs/symptoms a cluster of signs/symptoms.

Symptom Clusters.  
o    Trouble with concentration and memory.
o    Feelings of guilt about inconsequential events. 
o    Insomnia or excessive sleepiness.
o    Feelings of hopelessness and worthlessness. 
o    Withdrawal from activities and interests.
o    Decreased interactions with family and friends. 
o    Decreased work productivity.
o    Decreased relationship with coworkers. 
o    Changes in bowel habits.
o    Weight loss or gain.
o    Decreased libido (sexual drive).
o    Slowed speech and/or motor activity.
Endogenous Depression Cluster Symptoms

• Retardation of thought and motion (thinks in "slow motion"). 
• Substantial weight loss due to very poor appetite.
• Feeling that depression "crept upon him" and "came out of the blue."
• Wakes very early in the morning and can't get back to sleep. 
• Feels worse in the morning and improves as the day goes on.
• Does not react to the environment.
Exogenous Depression Cluster Symptoms

• Precipitating event.

• Trouble getting to sleep at night.

• Feeling fine in the morning and getting worse as the day goes on. 

• Weight loss of less than 10 pounds.

• Reaction to the environment--if the person is with an "up" crowd, he will seem to come out of his depression for a while.
Evaluation

The evaluation of the symptom clusters requires you to inquire about specific symptoms such as weight loss and the amount of loss over a given period, sleeping patterns, and feeling of hopelessness.  

Arrange the symptoms into appropriate clusters if indicated.  

Patients may have components of more than one type of depression or other complicating mental illness.

Management of Depression
Types of medications used with severely disturbed depressive patients include Antidepressant, Tranquilizing, and Anti-anxiety drugs. 
Usually, drug treatment is combined with other forms of therapy such as individual or group psychotherapy. Medications given to treat depression are classified in three groups:  
Anti-anxiety Agents
·         Hydroxyzine (Atarax®, Vistaril®).
·         Meprobamate (Equanil®, Miltown®).
·         Chlordiazepoxide (Librium®).
·         Diazepam (Valium®). 
Antidepressant Agents 
Antidepressant Agents commonly used include the following: 
·         Imipramine (Tofranil®).
·         Amitriptyline (Elavil®).
·         Amitriptyline and Perphenazine (Triavil®).
·         Doxepin (Adapin®, Sinequan®). Central Nervous System depressants producing mild sedation are also included as antidepressants.  
Anti-psychotic Agents 
Thioridazine (Mellaril®).A
Haloperidol (Haldol®).


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