Health Sciences and Medicine: Depression - Essay Example

? Health sciences and medicine: Depression The most common reason for which individuals are being treated these days is depression, it is not just the elders but also the young ones suffer from this widely prevailing ‘disease’. It has become a lifestyle disorder, and has been associated with the changing lifestyle of individuals which put them under higher mental pressure leading to depression. Depression is also associated with the higher number of suicide rates. Under the current scenario, it has become highly important to understand the issue of depression, to assess it as a clinical disease and then search for the appropriate therapeutic approach for the disease. This paper aims to concisely present the current scenario of disease, listing out the possible etiological agents for the disease and reviewing the possible treatments that have been suggested for the disease. Introduction: Depression can be defined as simply as feeling blue, and hence we often come across periods when we are depressed (Psychology today, 2012). It is a period when the person feels lonely, angry, there’s anxiety about the situation, the person is sad, does not feel like doing anything, the thoughts can range from being suicidal to being revengeful. However, depression becomes a clinical disorder when the person has these feelings for a long period of time or has recurrent bouts of depression that hamper with the normal daily functioning of the individual. Symptoms of depression: Depression is manifested by various symptoms and the degree of these symptoms varies in different patients according to the level of depression. Sometimes these can go unnoticed and it is important to realize the depth of depression of the patient. The major symptoms of depression include (Medical encyclopedia, 2012): Agitation, restlessness, and irritability Becoming withdrawn or isolated Difficulty in concentrating Dramatic change in appetite, often with weight gain or loss Fatigue and lack of energy Feeling of hopelessness and helplessness Feeling of worthlessness, self-hate, and guilt Loss of interest or pleasure in activities that were once enjoyed Thoughts of death or suicide Trouble sleeping or too much sleeping Persistent physical symptoms that do not respond to treatment, like headaches, digestive disorders and chronic pain Besides it has been observed that depression is not just about feeling down, but there can be marked anger and resentment leading to violent behavior. In severe cases of depression, there are psychotic symptoms resulting in hallucinations and delusional behavior. Depression in today’s society: Depression has become a major cause of concern in today’s society because of the increasing number of incidences among all age groups and of suicide as a result of depression. In America alone, more than 19 million people suffer from depression, and it is considered to be the primary cause of disability in the world (Hasselbring, 2012). Depression is more common among women than men; however, it should not be ignored among men either. It is said that about twenty five percent of women suffer from depression and need to take medical treatment for it at least once in their lifetime (Hasselbring, 2012). It has been said that around 1 in 20 people suffer from major or ‘clinical’ depression at any one time (Mind, 2012). Besides, the prevalence among young ones of the disorder has been on a rise. It has been said that at least 1 in 33 children suffer from depression (Marion, 2012). It is especially important in case of children because most cases go undiagnosed that lead to problems in development of children. It is easier for adults to deal with these problems compared to children. What is alarming is the fact that at an age when even the concept of death and life is not well developed depression leads to suicidal tendencies even among children. “Suicide is the sixth leading cause of death for children aged five to fifteen. Over the past thirty years the suicide rate has increased 300% and of those people who commit suicide, 60 to 80% of them have a depression disorder” (Marion, 2012). The problem is of more importance among young ones as if not treated it can become a chronic condition as an adult. Besides, the problems associated with depression can lead to complications in normal living as adults and development of bipolar disorder. Classification and Causes of Depression: Etiology: Depression can be a result of various causes, and the exact cause of depression is still not known. “It likely results from a combination of genetic, biochemical, environmental, and psychological factors(Psychology today, 2012)” It has been suggested that the possible cause of depression is related to abnormal functioning of brain. Magnetic resonance imaging of brain of people who were depressed showed that “the parts of brain responsible for regulating mood, thinking, sleep, appetite, and behavior to function abnormally” (Psychology today, 2012). Also, there’s an imbalance of neurotransmitters in people who suffer from depression. It has been said that the actual cause of depression is “chemical imbalance in the brain where certain mood controlling chemicals get out of balance” (Marion, 2012). These findings are common to all who suffer from depression regardless of the cause that led to depression. Depression can occur as a result of (Medical encyclopedia, 2012): Alcohol or drug abuse, however, it is to be noted that the relation is vice versa and depression can also lead to alcohol and drug abuse. In either case, people with a history of alcohol and drug abuse are found to be more prone to depression. It has been reported that around 112 million Americans aged 12 year or older (46% of population) have used drugs at least once in their lifetime (Georgii, 2009). Alcohol abuse among young ones is a major cause of concern since it is found that this leads to destruction of developing brain cells and hence impaired judgment, and a difficulty in adjusting in the society. This furthers the problem of depression. Certain medical conditions especially chronic ailments lead to depression. For e.g., hypothyroidism has been often related to depression, or patients undergoing cancer therapy are more prone to cancer, conditions with chronic pain also lead to depression. Traumatic experiences like loss of a loved one or breakup with a boyfriend or girlfriend, or failure especially when the person is extremely competitive, divorce, problems in family, childhood abuse or neglect, job loss or difficult work environment, social isolation whether for adults or young ones can be a major cause of depression. Post-trauma depression is a common cause for which patients seek therapy. Certain medications like steroids are associated with changes in mood and can lead to depression. Depression is also hereditary and has been found to run in family. However, as Yapko (2007) argues that depression is both hereditary and learned. “Genetics may serve as a predisposing factor to depression, but the evidence is growing that depression has a great deal to do with the ongoing and repetitive interactions within the family”(Yapko, 2007). Depression is more common in people who are more sensitive, or with other disorders like Asperger's syndrome and those under autistic spectrum. Under such circumstances even a small change can trigger depression. People with frequent mood change also suffer from depression. On the other hand, women can have periods of depression due to hormonal changes and some women are more prone to these changes than others. Classification of Depression: The classification of depression plays an important in categorizing the people with the disorder and an appropriate approach can be taken to treat the patient according to the category they fall in. However, having said that there is still very less known about the disorder itself not to mention neurological disorders in general and it is difficult to demarcate the categories clearly with people finding themselves in more than one category. Cole etal. (2008) have found that the some categories are so broad and unstable that they are highly unreliable. The general classification has been based on the symptoms and the etiological factors. The classification includes (MHiMA, 2012): 1. Major Depression (DSM-IV criteria): Symptoms of depression last the entire day, almost every day, for at least two weeks and significantly interfere with the normal functioning of the individual. 2. Major Depression with melancholia (DSM-IV criteria): Symptoms are more severe and episodes of depression are more common. There is loss of reactivity and the person cannot be even temporarily cheered up. 3. Dysthymic disorder: Chronic depression when the symptoms persist for more than two years. 4. Psychotic depression: There is major depression with or without melancholia along with presence of hallucinations, delusions or thought disorder. These are mainly manifested as feeling of hopelessness, guilt or even anger. 5. Adjustment disorder with depressed mood: There are mild symptoms of depression that are transient and are a result of some stress. 6. Depression with anxiety: Depressive symptoms are accompanied with anxiety and there is less resilience for stress. 7. Adult depression after childhood trauma: childhood trauma results in sensitization of hypothalamic-pituitary-adrenal (HPA) axis which makes such individual more susceptible to stress. 8. Depressive reaction to separation stress: this is a result of some psycho-social like divorce, job loss, breakup from partner. 9. Postpartum depression: is the most common sort of depression seen among women and is typically seen in the first three months post delivery. 10. Late-life depression: as the name suggests this form of depression occurs in elderly who suffer from social isolation and are dealing with some sort of disease. 11. Depression as part of bipolar affective disorder: Depression is often seen in individual who suffer from bipolar disorder and it is imperative to diagnose the individual as suffering from bipolar disorder and treat them accordingly. 12. Depression secondary to substance abuse or a medical condition: as has been noted substance abuse leads to depression that is manifested by various symptoms of depression. Similarly stressful medical conditions are also a major cause of depression. 13. Atypical depression: In this type there is reversed functional shift and instead of insomnia there is increased sleep, increased appetite, increase in weight and psycho-stimulation marked by anxiety, neurosis, anergia and mixed anxiety depressions (Paykel, 1983). Based on the above classification the patient should be categorized and treated accordingly. Diagnosis of Depression: A proper diagnosis of depression, understanding the root cause of depression, and differentiating the symptoms from other mental disorders is highly important. The diagnosis procedure includes being asked certain questions by the doctor and certain medical tests to come to a confirmatory diagnosis. The tests include a regular physical examination including regular clinical parameters, laboratory tests like complete blood count, thyroid function test to check normal functioning of thyroid, and finally a psychological evaluation to determine whether its depression or not. The psychological examination involves talking about the patient’s thoughts, feelings and other general conditions that may be bothering him, to determine how serious the problem is and whether the patient has experienced similar symptoms before. Diagnosis includes recognition of the symptoms as mentioned by DSM. The patient should exhibit five or more of the following symptoms, including at least one of the first two, for almost every day over a period of two weeks (Pfizer, 2012): 1. A depressed mood for most of the day, including feeling sad, empty or tearful. 2. Reduced interest in activities. 3. Significant appetite change or weight change. 4. Insomnia. 5. Fatigue. 6. Feeling worthless. 7. Difficulty concentrating and making decisions. 8. Slowed behavior or restlessness noticeable to others. 9. Recurrent thoughts of death and suicide. Treatment of Depression: Depression is treatable and is one of the easiest mental disorders that can be treated. The most common method of treatment includes medication and psychotherapy. Besides the two major methods of treatment certain other methods have also gained popularity. These include (Medical encyclopedia, 2012): 1. Psycho-education: As the name suggests, it deals with educating the patient and the family members about the disorder and its treatment. This is a type of supportive therapy that deals with helping the patient cope up with the stigma associated with mental disorders and helping the family members understand the situation and in turn help the patients deal with the situation in a better way. 2. Electroconvulsive therapy (ECT): Also known as shock therapy is known to be the only therapy that is effective in case of severe depression or in those with psychotic symptoms. This is used as the last resort when other therapies fail to work. 3. Light therapy: It is especially effective for people with SAD (seasonal affective disorder) that occurs during winter months due to lower levels of natural sunlight. The therapy includes spending thirty minutes daily in specially designed light boxes. 4. Herbal remedies: herbs like St. John’s Wort are known to treat depression. However, they are known to interact with other medications and hence it’s important to consult a doctor before taking these drugs. 5. Transcranial magnetic stimulation (TMS): Magnetic energy is used to stimulate parts of brain that are associated with depression. 6. Massage and acupuncture: These basically help in relieving certain symptoms of depression, using these along with medications can be helpful in treating depression. 7. Relaxation and stress management techniques: Are of importance in coping with the major issue that has led to development of disorder. Usually it is found that a combination of two or more techniques is helpful in relieving all the symptoms of the disorder and complete recovery. Elkin etal. (1989) found in their study that imipramine plus clinical management works best for treating depression and placebo plus clinical management worst. Besides, it is generally helpful to try and live a healthy lifestyle, and to avoid alcohol use. It is important that the person keeps a check on his changing moods and to try to cope with stressful situations by gathering more social support and involving in group activities. Medication as treatment for depression: Since depression is associated with imbalance in neurotransmitters, drugs associated with correcting this imbalance are used for treating depression. Drugs used for treating depression are known as anti-depressants. They are classified according to the neurotransmitters they affect in the brain to bring about an elevation in mood. Under the older class of drugs are (WebMD, 2012): 1. Tricyclic antidepressants (TCAs) like anafranil, adapin, norpramin are among the first antidepressants to be used. They work by increasing the level of norepinephrine and serotonin in the brain. However, they are known to have more side effects and are generally not used now. 2. Monoamine oxidase inhibitors (MAOIs) like nardil, emsam. They also increase the level of norepinephrine and serotonin in the brain. However, they react with certain substances present in food products and hence a specific diet has to be followed when using these drugs. Besides the two, there is a new class of drugs which are being commonly used these days. However, this class was also found to have the same efficacy as the older class of drugs and both are found to work better than placebo (Mulrow et al., 2004). This class includes (WebMD, 2012): 1. Selective serotonin reuptake inhibitors (SSRIs): They work by increasing the concentration of serotonin by preventing its reuptake. The group includes Prozac (fluoxetine), celexa (citalopram), Zoloft (sertraline), paxil (paroxetine). Among these Prozac is the most commonly prescribed drug that was once known as the wonder drug. 2. Serotonin and norepinephrine reuptake inhibitors (SNRIs) like cymbalta, effexor, remeron. They work by increasing the concentration of norepinephrine and serotonin. 3. Norepinephrine and dopamine reuptake inhibitors (NDRIs): This includes bupropion (wellbutrin). They increase the concentration of norepinephrine and dopamine in the brain. All of them are known to have some side effects like headache, nausea, sleeplessness or drowsiness, agitation, there can be sexual problems, lightheadedness. Tricyclic antidepressants can lead to dry mouth, blurred vision, increased fatigue, tremors, constipation, bladder problems and increased heart rate. Despite their frequent use, in recent times medications for depression have been criticized on the ground that the theory of neurochemical imbalance is itself highly doubted. As Mukherjee (2012) mentions how experiments conducted show that necropsy findings in people with depression show an increase in serotonin level, a decrease as well as no change in serotonin levels. Under such circumstances it is difficult to point out the role of these drugs as mostly these drugs have been misused in recent years. Besides, it has been observed that stopping them abruptly leads to withdrawal symptoms, the reason why some consider that people get addicted to these drugs. It has also been seen that antidepressants are linked with suicidal tendencies and that 4 percent of those taking antidepressants thought about or tried committing suicide. The problem is worsened in case of young patients. “In 2005, the FDA decided to adopt a “black box” warning label-the most serious type of warning-on all antidepressant medications” (NIMH, 2012). Another problem with anti-depressants is that there is a fast developing concept of treatment-resistant depression (TRD). Souery etal. (2006) have found that patients being treated for depression do not achieve complete recovery usually because they either stop responding to the treatment or because of partial action of drugs. However, most of the cases of TRD occur either because of improper dosage regimen being followed, or because of a misdiagnosis of the case. Most of the cases of TRD seem to be resolved by using a new medication or adding a second medication to the old treatment. Even though medications have their own disadvantages but their role in treating depression cannot be completely ignored. Despite the various controversies surrounding them they are known to uplift the mood of patients and have been used successfully since the first antidepressants came to market. Psychotherapy as treatment for depression: Psychotherapy involves talking about the issues that the patient is dealing with the psychotherapist. Psychotherapy can help people with depression by helping them understand their emotions and identify the symptoms that are characteristic to depression. Psychotherapy also helps by developing problem-solving skills and developing more resilience towards stressful situations. Thus by helping the person deal with the root cause of depression the disorder is treated. Usually this is used in combination with medications; however, mostly people find it helpful to just talk about their problems with their therapists. Psychotherapy can be done as individual or group therapy. Psychotherapy can include the following approaches (WebMD, 2012): 1. Psychodynamic therapy for depression: This therapy assumes that the patient has some unresolved, unconscious conflicts which lead to depression. These issues are generally thought to be childhood related. The patient is allowed to talk about these issues and taught to deal with them. The therapy is administered over a period of weeks to months to years depending upon the patient. 2. Interpersonal therapy for depression: The therapy is based on the communication skills of the patients and the repertoire the patients share with their family members, friends, and colleagues. Thus therapy basically works to improve the communication skills of the patients and to help develop social skills. It works when the depression stems from loss of a loved one or social isolation. The therapy is administered for a period of three to four months. 3. Cognitive behavioural therapy for depression: This therapy is based on changing the behavior of a person. The reaction of the person to situation is changed so that the person is able to deal with stress in a better way. This therapy includes rational emotive behavior therapy (REBT) which deals with how emotions affect a person’s response to a situation, and dialectical behavior therapy (DBT) which deals with acceptance of the emotions a person has in a certain situation so that the person becomes more self-aware and is able to help themselves. This therapy is administered over a shorter period of time. Psychotherapy has been found to be generally very effective in treating depression especially for young ones and adolescents who have a higher risk rate for antidepressants. A study conducted by Weisz et al. (2006) found that psychotherapy has significant effect in treating depression in case of young ones and adolescents. Further a study conducted by Cuijpers et al. (2008) found that in case of adults, psychotherapy is a good option and that all forms of therapy were equally efficacious and that interpersonal therapy worked best. Having said it is important to realize that psychotherapy generally takes longer than medications to treat depression and the treatment is also dependant on the skills of the therapist. A fall out rate is higher in case of psychotherapy since patients always need instant results. Further, the study of Weisz et al. (2006) states that these therapy show effect for only short term and that long term effects are visible only after a long time has been spent with the therapist, relapses are very common. Conclusion: Despite being said the most treatable mental disorder, there is very little known about how depression occurs and there is absence of a treatment that makes sure depression does not occur. On the other hand, it can be argued that the society is too obsessed with becoming happy and ignoring other emotions that are just as normal as feeling happy. Besides, due to decreased tolerance to stress and a changing lifestyle people experiences more blues and are more depressed. In such condition it is debatable whether we need to find a cure for depression and what should be the right treatment for it if it is a disease. Further research needs to be conducted in this area to gather a better understanding of the issue. References . Hasselbring, Bobbie (2012). How common is depression? Discovery health. http://health.howstuffworks.com/mental-health/depression/questions/how-common-is-depression.htm. Mind (2012). 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