Depression - Research Paper Example

? Depression 29-02-12 Depression The paper focuses on providing information regarding different aspects of Depression, a condition affecting 30% of the primary care patients. At the end the paper contains information regarding future research on the disorder. Introduction: For more than 2000 years, depression has been recognized as a clinical syndrome but unfortunately its paradoxical features andcharacteristics have not yet been fully comprehended. Depression is defined as “A term used to designate a complex pattern of deviations in feelings, cognition, and behavior”. (Beck et al 2009). Physical health, relationships, and cognitive performance are adversely affected by clinical and subsyndromal depression. In industrialized counteries, depression would be the second leading cause of mental illness by 2020 and is currently the major contributor to total disease burden. Depression not only confers misery upon the sufferers but also poses tremendous problems for their loved ones. (Sharpley et al 2010). In accordance with DSM-IV, “depressive disorders” are classified into three types, namely: major depressive disorder (further classified as single or recurrent), bipolar affective disorder (formerly known as manic depression), and subdromal mood disorders such as cyclothymia and dysthymia. History: The natural history of a disorder cannot be completely defined until the homogenous disorder hasn’t been clearly understood and similar has been the case with depression. Bipolar affective disorder (manic-depressive disease) was placed in a different category from unipolar depressive disorder (depressive disease) in the year 1966. The separation led to the identification of distinguishing characteristics of the two disorders. Accordingly, it was recognized that bipolar disorder is characterised by the expression of both mania and depression, whereas, unipolar disorder only consists of depression. Depression is not a spontaneous disorder but is a cumulative effect of various factors such as childhood trauma and sexual abuse. Throughout the 1700s, depression was known as Dealth Syndrome because of the fact that many sufferers’ achieved death by committing suicide. During the 1700s, Depression was perceived as a stigma and sufferers’ were usually hidden by their family members in an effort to avoid the ramifications of societal stigmatization surrounding depression. (Winokur et al 1996). Causes of Depression: In accordance with DSM-IV, males have a probability of 5-12% of developing depression at any point in their lives, whereas, females have a higher probability of 10-25%. In accordance with various recent studies, it has been revealed that childhood exposure to traumatic events has a strong positive correlation with the development of comorbid disorders such as depression. Moreover, it has been recognized that the effects of chronic abuse in children are devastating and such children have an increased tendency to develop posttraumatic disorder and depression later on in their lives. Other causes of depression include: suffering from a disfiguring or a debilitating disease, failure to excel in school, college, or professional life, lack of social support, alcohol and substance abuse, unemployment, and financial problems. (Nixon et al 2010). Treatment: The major treatment strategies utilized in the management of depression are as follows: A. Medical: Depression associated with reactive disorders is relatively easy to manage and in most cases does not require drug therapy. In such cases, management strategies usually involve psychotherapy. Anti depressant drug therapy yields excellent results in severe cases which are characterized by symptoms persisting for several weeks coupled with significant vegetative signs. Three groups of anti depressant medications are available, which are as follows: i. SSRIs and Atypical Antidepressants: These drugs are considered to be one of the frontline drugs in the treatment of depression. The popularity of SSRIs and atypical antidepressants is due to their ability of producing an antidepressive effect without causing significant cardiovascular and anticholinergic side effects. Furthermore, when to TCAs, these drugs have a lower incidence of lethality asociated with overdose. Some of the drugs inlcluded in SSRIs are fluoxetine, sertraline and citalopram. Atypical antidepressants include bupropion, venlafaxine, and duloxetine. (McPhee et al 2011). ii. Tricyclic antidepressants: For many years, TCAs were regarded as the mainstay of drug therapy for depression and were also extensively used in the treatment of panic disorders, pain syndromes, and anxiety states. The therapy is characterized by lag in clinical reponse for several weeks. The lag is chiefly the result of anticholinergic side effects which limits an increase in dose. Some of the drugs inclded in TCAs are amitriptyline and atropine. (McPhee et al 2011). iii. Monoamine Oxidase Inhibitors: Due to dietary restrictions and other restrictions required during therapy, the Monoamine oxidase inhibitors are considered as third line medications in the treatment of depression. Drugs included in this group are phenelzine, tranycypromine, and selegiline trasdermal. (McPhee et al 2011). B. Psychological Treatment: During an acute stage of a severe depression episode, it is not possible to coax a sufferer into attending a penetrating psychotherapeutic endeavor. Psychological therapy is taken into consideration when antidepressive medications are taking effect. The therapy serves as a supportive approach to strengthen existing coping mechanisms and to enhance the efficacy of the medication being administered. (McPhee et al 2011). C. Social Therapy: Appropriate social services can be flexibly used to yield effective results in the treatment of depression. Alcohol has been reconized as a major contributor to depression, therefore, early enrollment in social therapeutic programs such as Alcoholics Anonymous must be seeked to eliminate depression associate with alcohol dependency. (McPhee et al 2011). Prevention: Nowadays, Computerized Cognitive Behavioral Therapy is employed in the prevention of depression. The cCBT is not only capable of effectively treating and preventing depression in adults but can also eliminate anxiety. The growing evidence about encouraging results of CBT in the prevention of depression has increased the demand for this form of psychotherapy. (Richardson et al 2010). Relapse of depression can be prevented by taking the prescribed medications regularly, undergoing mindfullness-based cognitive therapy, and interpersonal cognitive therapy. (McPhee et al 2011). Cross Cultural Issues: Research on cross cultural issues pertaining to depression has been sparse and little comprehensive information is available. The rainbow of ethnic minority groups residing in the United States of America exihibit varying susceptibility to depression and anxiety. Particularly Latinos and immigrants from developing countries have a higher probability of suffering from depression episodes at any point of their lives. (Beck et al 2009). Conclusion: In modern medically advanced society, depression continues to plague the health of millions of individuals’ across the globe. In accordance with the latest statistics provided by the American Journal of Depression, the disorder is far mre common in females than in males regardless of the cross cultural differences. Early diagnosis of depression is of key importance in determing the time duration of prognosis. The earlier the disorder is diagnosed the faster the prognosis is, provided the patient adheres to the prescribed regime. The treatment and prevention of depression involves the simultaneous utilization of a number of strategies. In most cases, medications alone just not yield effective long term results so the therapy is supported by psychological approaches. The utilization of Electroconvulsive therapy in the treatment of depression has provided effective results characterized by decreased incidence of depression associated agitation and delusions in elderly patients. (McPhee et al 2011). Certain aspects of depression have not undergone thorough research despite the fact that depression is extremely common and is a major contributor in the development of mental illness. The issues relating to cross cultural differences in the susceptiblity of depression need more investigation in an effort to target the vulnerable individuals before the disorder actually develops. Furthermore, the effectiveness of treatment strategies is another aspect that needs more reseach in an effort for the development of new and more efficacious treatment strategies. References: Is Depression “Evolutionary” or just “Adaptive”? A comment by Christopher F. Sharpley and Vicki Bitska. Hindawi Publishing Corporation 2010. McPhee, S. J., & Papadakis, M. A. (2011). Current medical diagnosis & treatment 2011. New York: McGraw-Hill Medical. Winokur, G., & Tsuang, M. T. (1996). The natural history of mania, depression, and schizophrenia. Washington, DC: American Psychiatric Press. Beck, A. T., & Alford, B. A. (2009). Depression: Causes and treatments. Philadelphia: University of Pennsylvania Press. Screening and Predicting Posttraumatic Stress and Depression in Children Following Single-Incident Trauma Reginald D. V. Nixon, Alicia A. Ellis, Thomas J. Nehmy, and Shelley-Anne Ball School of Psychology, Flinders University, 2010. Computerised Cognitive Behavioural Therapy for the Prevention and Treatment of Depression and Anxiety in Children and Adolescents: A Systematic Review Thomas Richardson, Paul Stallard, Sophie Velleman, 2010. Read More