Depression, Know When You or A Loved One Has Depression

1 in 5 women, and 1 in 8 men have experienced depression, during their lifetime.

Depression may start in childhood, but it has a peak onset at age 40 years among women, and age 55 years in men.

Depression is different from the usual fluctuations in mood, and also those short-lived emotional response to challenges in everyday life. Symptoms of depression last longer than 2 weeks

WHAT CAUSES DEPRESSION?
Possible Biologic, Social and Psychologic factors are involved in causing Depression. They include:

• Faulty mood regulation in the brain
• Genetic vulnerability
• Stressful life events
• Chronic medical problems
• Certain medications

Several of these factors may interact to bring about depression.

WHO IS AT RISK FOR DEPRESSION
Females
A family history of depression
People with prior history of depression
Those with chronic illness like asthma, sickle cell, heart disease, diabetes, hypertension

• People with chronic pain
• People with Traumatic brain injury
• Single, divorced or widowed
• People with low self esteem
• People with low income or job loss

WHAT ARE THE SYMPTOMS OF DEPRESSION?
A.) SPECIFIC SYMPTOMS OF DEPRESSION
These symptoms, based on the 5th edition of the Diagnostic and statistical Manual of Mental disorders, DSM-V. are used to diagnose depressive disorder. The symptoms have persisted over a 2week period, and occur nearly, every day.

A person with depressive disorder has any 5 of the symptoms, including either symptom number(s) 1 and/or 2.

1.) Depressed mood, which is either self-reported, or observed by others. Example, feeling sad, feeling hopeless

2.) Marked loss of interest or pleasure in almost or all activities

3.) Significant weight loss or weight gain due to poor appetite or overeating

4.) Insomnia or Hypersomnia.
5.) Psychomotor agitation or retardation
6.) Fatigue or loss of energy.
7.) Feeling worthless, or excessive inappropriate guilt

8.) Diminished ability to think or concentrate
9.) Suicidal ideation, suicidal attempt, or recurrent thoughts of death

B.) NONSPECIFIC SYMPTOMS OF DEPRESSION
Pain: headaches, Abdominal pain, Backache, Joint pain, Neck pain

Constipation
Fatigue, weakness
SCREENING FOR DEPRESSION.
Who needs screening for depressive disorder?
All Children between 12-18 years old
All adults. (Screening for depression is harmless).

WHAT IS THE SIGNIFICANCE OF SCREENING FOR DEPRESSION

In general, we screen for treatable conditions. If a condition is not treatable, there should be no use screening for such a condition.

Depression is treatable. However, only 10% of persons with depression get adequate treatment.

Let us examine the cost of not treating depression.

A.Major Depression in a Young person
There is difficulty in making progress in life, once a person becomes depressed, early in life. The problems faced by the young person, may include:

1.) Low educational attainment.
2.) High risk of teen childbearing, due to increased sexual activities.

3.) Drug abuse, including alcohol, marijuana, cocaine.

4.) Low probability of marrying and
5.) Unstable marriages (a premarital history of mental illness predicts future divorce)

B. Major Depression starting in a well, established Person.

Among those who are already in special and productive roles, there is significant decrease in role functioning:

1.) Low marital quality: Domestic violence is common, and the depressed person may be the either the victim or perpetrator of such physical violence in marital relationships

2.) Poor Parental functioning: Parental depression, adversely, affects the child's emotions, affects and interactive development. This leads to maladaptive interactions that impede normal childhood development.

3.) Low work performance
People with depression may miss days from work (absenteeism) or may be at work, but they have reduced productivity, while at work(presenteeism). This low performance eventually leads to low earnings, Job loss, and unemployment.

C. Depression is associated with Increased risk of physical illnesses, like Cancers, Diabetes, Hypertension, Respiratory disorders and chronic pain.

D. Persons with Depressive disorder do have an Increased risk for Early mortality due to:

Suicide and
Risky behavior including their very high rates of:
Smoking,
Drinking,
Obesity and
Low Compliance with treatment, behaviors that lead to comorbidities and early mortality.

By the way, Suicide is the 2nd leading cause of death in 15-29year old.

SCREENING TOOLS FOR DEPRESSION:
Self-administered Patient Health Questionnaire (PHQ-2, & PHQ-9)

The Questionnaire are based on the DSM-V criteria
Patient Health Questionnaire-2 (PHQ-2 )
The questionnaire consists of 2 questions, based on the first 2 criteria of DSM-V. It goes like this:

Over the past 2 weeks, how often have you been bothered by any of the following problems:

Little interest or pleasure in doing things?
0= Not at all
1= Several days
2= More than half the days
3= Nearly every day
Feeling down, depressed, or hopeless
0= Not at all
1= several days
2= More than half the days
3= Nearly every day
The score ranges from 0-6
A score of 2 or more yields a positive screening for depression. The full questionnaire PHQ-9 is then administered.

PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
1.Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3.Trouble falling or staying asleep, or sleeping too much

4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself, - or that you are a failure or have let yourself or your family down

7. Trouble concentrating on things, such as reading newspaper, watching television

8. Moving or speaking slowly, so that other people could have noticed. Or the opposite- being fidgety or restless that you have been moving around a lot more than usual

9.Thoughts that you would be better off dead, or of hurting yourself

The scoring system is the same as that of PHQ-2:
Not at all=0, several days=1, more than half the days=2, Nearly every day =3

For PHQ-9, the total score ranges from 0-27, a score of 10 or more, detects Depression

Based on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate and severe.

Total Score: 1-4 Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression
An individual with mild depression will have difficulty in continuing ordinary work and social activities, but will probably not stop functioning completely.

During a severe depressive episode, it is very unlikely, that the sufferer will be able to continue social job, or domestic activities, except to very limited extent

There are several subtypes of Depressive Disorders. These include:

PERSISTENT DEPRESSIVE DISORDER
When depressed mood persists for over 2 years, (with symptoms not abating for more than 2 months)

SEASONAL AFFECTIVE DISORDER
This is common in women. For 3 or more consecutive years, they have experienced psychomotor retardation, overeating and hypersomnia, during the rainy/wet season, and winter. Their symptoms improve, during spring and dry seasons.

PREMENSTRUAL DYSPHORIC DISORDER
3-5% of menstruating female, do have this problem.
A week before menstrual flow, they become irritable, angry with interpersonal conflicts, and anxious, They in addition, experience Breast tenderness, Bloating, Weight gain. Their symptoms improve, few days after menses

PERIPARTUM DEPRESSION
50% of females would develop depressive symptoms during their pregnancy.

Peripartum Depression affects 10-15% of women within 6months after delivery. They exhibit most of the classic symptoms of depression.

Family members are encouraged to monitor for this problem, up to 1 year after child birth

Single and poor mothers are at greatest risk
PERSISTENT COMPLEX OF BEREAVEMENT(PCB)
Grieving, after the loss of a loved one, should not last, more than 12 months.

Any grieving that lasts for more than 12 months, (or, 6months in children) is abnormal.

Person who develop this disorder may have persistent Yearning, Sorrow, or Preoccupation with the deceased, and this disrupts their normal functioning or social relationships.

Risk factors for PCB: Pre-existing psychiatric illness

Excess caregiver burden
Concurrent significant life stressors
MANAGEMENT OF DEPRESSION
Depression is managed with either Psychotherapy, and or Pharmacotherapy.

MEDICATIONS
It may take from 6-8 weeks, after starting the Antidepressants, for improvement in mood, to be noticed.

Selective Serotonin Reuptake Inhibitors(SSRI), Example Paroxetine, Fluoxetine, Sertraline. These medications are safe. Main side effects are decreased libido, and delayed orgasm. Paroxetine is contraindicated in pregnancy

Serotonin-Norepinephrine reuptake inhibitors, (SNRI) Examples are Venlafaxine and Duloxetine

Miscellaneous group of medications includes
Bupropion which is contraindicated in those with seizures

Trazodone, the main side effect being priapism and orthostatic hypotension.

Antidepressant drugs should not be stopped abruptly, they should be tapered off gradually, to avoid rebounds.

SUMMARY
Depression results from the interactions of biologic, social, and psychological factors.

People who have gone through adverse life events like unemployment, bereavement, psychological trauma, are more likely to develop depression.

Depression can, in turn, lead to more stress and dysfunction, and worsens the affected person's life situation and the depression itself.

Also, there are interrelationships between depression and physical health. Take heart disease, for example. Heart disease can lead to depression and vice versa.

Treatment of depression can reverse many of the adverse effects.

So, do not wait, see a doctor once you have several of the symptoms of depression

Ideally, every household must have a copy of the self-administered screening tool for depression, at home. Print this "Patient Health Questionnaire-9" (PHQ-9) on the internet, for use, when necessary.

Here is the link:
PHQ-9 Depression Test Questionnaire | Patient

https://patient.info/doctor/patient-health-questionnaire-phq-9

ALEX ARKODIE, MD
[email protected].

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