Depression, diagnosis and management.

Depression is a common mental health disorder that affects millions of people worldwide. According to the World Health Organization (WHO), depression is the leading cause of disability globally and is projected to be the second leading cause of disability by 2020. Despite the prevalence of depression, it is often underdiagnosed and undertreated, making it important to understand the symptoms, causes, and treatment options for this condition.

Symptoms of Depression

Depression is characterized by persistent feelings of sadness, hopelessness, and a lack of interest in activities that were once enjoyed. Other symptoms may include changes in appetite, sleep disturbances, fatigue, difficulty concentrating, and thoughts of death or suicide.

Depression can also present differently in different individuals, and symptoms may vary depending on the severity and type of depression. For example, major depression is the most common type of depression and is characterized by the presence of symptoms for two weeks or longer. Other types of depression include persistent depressive disorder, bipolar disorder, and seasonal affective disorder.

Diagnosing Depression

Diagnosing depression requires a thorough evaluation by a mental health professional, such as a psychiatrist or psychologist. The evaluation may include a review of medical history, a physical exam, and laboratory tests to rule out other medical conditions that may mimic depression symptoms.

The mental health professional may also use diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to assess the presence and severity of depression symptoms. The DSM-5 criteria require the presence of five or more symptoms of depression for two weeks or longer, with at least one of the symptoms being either depressed mood or loss of interest in activities.

Causes of Depression

Depression is a complex disorder that is likely caused by a combination of genetic, environmental, and psychological factors. Some of the risk factors for depression include a family history of depression, a personal history of other mental health conditions, chronic medical conditions, and stressful life events.

Stressful life events, such as the loss of a loved one, a job loss, or a divorce, can trigger the onset of depression in some individuals. Chronic medical conditions, such as cancer, diabetes, and heart disease, can also increase the risk of depression. It is important to note that depression can occur without any obvious trigger or cause.

Treatment Options for Depression

There are several treatment options for depression, including psychotherapy, medication, and lifestyle changes. The choice of treatment depends on the severity and type of depression, as well as individual factors such as age, medical history, and personal preferences.

Psychotherapy

Psychotherapy, also known as talk therapy, is a type of treatment that involves talking to a mental health professional about thoughts, feelings, and behaviors. Psychotherapy can help individuals with depression to identify negative patterns of thinking and behavior and develop coping strategies to manage symptoms.

Some of the most common types of psychotherapy used to treat depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and psychodynamic therapy. CBT is a type of therapy that focuses on identifying and changing negative patterns of thinking and behavior that contribute to depression. IPT is a type of therapy that focuses on improving relationships and communication skills to reduce the symptoms of depression. Psychodynamic therapy is a type of therapy that explores unconscious thoughts and feelings to help individuals gain insight into their emotions and behavior.

Medication

There are several types of medications that are commonly used to treat depression. These medications work by increasing the levels of certain neurotransmitters in the brain that are involved in regulating mood.

1. Selective serotonin reuptake inhibitors (SSRIs): SSRIs are the most commonly prescribed type of antidepressant medication. These medications work by increasing the levels of serotonin, a neurotransmitter that is associated with feelings of well-being and happiness. Some common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).
2. Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs work by increasing the levels of both serotonin and norepinephrine, another neurotransmitter that is associated with mood regulation. Some common SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).
3. Tricyclic antidepressants (TCAs): TCAs were some of the first antidepressant medications to be developed. They work by increasing the levels of several neurotransmitters, including serotonin, norepinephrine, and dopamine. TCAs are not used as often as SSRIs and SNRIs because they have more side effects, such as dry mouth, constipation, and drowsiness. Some common TCAs include amitriptyline (Elavil) and imipramine (Tofranil).
4. Monoamine oxidase inhibitors (MAOIs): MAOIs are an older class of antidepressant medication that work by blocking the activity of an enzyme called monoamine oxidase, which breaks down neurotransmitters such as serotonin and norepinephrine. MAOIs are not used as often as other types of antidepressant medication because they can have serious interactions with certain foods and medications. Some common MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate).
5. Atypical antidepressants: Atypical antidepressants are a group of medications that do not fit into any of the other categories of antidepressant medication. They work by increasing the levels of various neurotransmitters, including serotonin, norepinephrine, and dopamine. Some common atypical antidepressants include bupropion (Wellbutrin) and mirtazapine (Remeron).

It is important to note that antidepressant medication may take several weeks to start working, and it is important to continue taking the medication as prescribed, even if symptoms improve. Additionally, it is important to talk to a healthcare provider about any side effects that may occur while taking antidepressant medication. In some cases, medication may need to be adjusted or switched to a different type to better manage symptoms.

Dr.A.Arrazaghi.MD,FRCPC