Depression

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Nadine Risman from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Depression is defined according to Goodman and Fuller as a morbid sadness, dejection, or a sense of melancholy distinguished from grief.  Depression falls under the broader category of Major Depressive Disorders which are characterized by a single isolated episode lasting weeks to months.  Major depressive disorders are viewed as an adjustment disorder which occurs due to external circumstances such as stress, trauma or loss.  Other major depressive disorders include dysthymia and seasonal affective disorder. 

Prevalence

Depression is the most commonly seen mood disorder within a therapy practice and is often associated with other physical illnesses and psychological conditions (Goodman and Fuller).  In 2006, the Center for Disease Control conducted a study looking at the prevalence of depression.  They found that approximately 15.7% of people reported being told by a health care provider that they had depression at some point in their lifetime.¹  Men and women ages 25 to 44 have the highest occurance of depression with the elderly population being the next highest age group affected. 

Characteristics/Clinical Presentation

It is important to note that as many as one third of people experiencing depression do not feel sad or blue.  Many experience somatic symptoms such as fatigue, joint pain, headaches, gastrointestinal disturbances, or chronic back pain.  In Goodman and Synder, they report that 80 to 90% of the most common gastrointestinal disorders are associated with depressive or anxiety disorders.  People with depression commonly have trouble sleeping, including early morning and frequent nocturnal awakenings.  In the elderly population, sleep disturbances are the first symptom of depression especially when linked with acute confusion, falling, bowel and bladder problems or syncope.  Clinical signs and symptoms can include:

• Persistent sadness, low mood, or feelings of emptiness
• Frequent or unexplained crying spells
• A sense of hopelessness
• Feelings of quilts or worthlessness
• Problems in sleeping
• Loss of interest or pleasure in ordinary activities or loss of libido
• Fatigue or decreased energy
• Appetite loss (or overeating)
• Difficulty in concentrating, remembering, and making decisions
• Irritability
• Persistant joint pain
• Headache
• Chronic back pain
• Bilateral neurologic symptoms of unknown cause (e.g., numbness, dizziness, weakness)
• Thoughts of death or suicide
• Pacing and fidgeting
• Chest pain and palpitations

There may also be associated behavior changes that can include: compulsive, reckless or violent behavior, argumentative or oppositional behavior, patients may have a preoccupation with themselves, be critical toward family members (fault finding) or be unaffectionate with their partner or spouse.

Associated Co-morbidities

Cardiovascular

Atherosclerosis

Hypertension

Myocardial Infarction

Angioplasty or Bipass Surgery

Central Nervous System

Parkinson's Disease

Huntington's Disease

Cerebral Arteriosclerosis

Stroke

Alzheimer's Disease

Temproal Lobe Epilepsy

Postconcussion Injury

Multiple Sclerosis

Miscellaneous Focal Lesions

Endocrine, Metabolic

Hyperthyroidism

Hypothyroidism

Addison's Disease

Cushing's Disease

Hypoglycemia

Hyperglycemia

Hyperparathyroidism

Hyponatremia

Diabetes Mellitus

Pregnancy (postpartum)

Viral

Acquired Immunodeficiency Syndrome (AIDS)

Hepatitis

Pneumonia

Influenza

Nutritional

Folic Acid Deficiency

Vitamin B6 Deficiency

Vitamin B12 Deficiency

Immune

Fibromyalgia

Chronic Fatigue Syndrome

Systemic Lupus Erythematosus

Sjogrern's Syndrome

Rheumatoid Arthritis

Immunosupression (e.g., Corticosteroid Treatment)

Cancer

Pancreatic

Brochogenic

Renal

Ovarian

Miscellaneous

Pancreatitis

Sarcoidosis

Syphilis

Porphyria

Corticosteroid Treatment

Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Causes

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

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