Depression
Original Editors - Nadine Risman from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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
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Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
Medical Management (current best evidence)[edit | edit source]
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