Critical Analysis of Clinical Depression - Essay Example

Clinical Analysis of Clinical Depression Name Institution Date Table of Contents 1. Introduction 3 2. Clinical Depression 3 a. Description of Clinical Depression 3 b. Diagnosis 4 c. Risk Factors 5 d. Comorbidities 8 e. Trends 9 3. Treatment 10 a. Treatment Options 10 b. Evidence for Treatment Options 10 c. Barriers to Help-Seeking or Accessing Treatment 11 5. Impact of Clinical Depression 11 6. Implicit Bias 12 7. Conclusion 13 8. References 14 1. Introduction Depression is a mental illness that that affects about 20% of Australians. Depression is a leading cause of suicide and disability. Because paramedics are usually the first medical personnel to respond to medical emergencies such as suicide attempts, it is important to have these health providers actively engage in preventing and managing clinical depression. This essay will critically analyse clinical depressions, focusing on aetiology, diagnosis, treatments, and impacts of the condition to the individual, society, and the healthcare system. Depression is one of the most difficult clinical conditions to diagnose because it does not rely on lab tests. The criteria for diagnosis mostly involves observations over a period of time. Similarly, the aetiology of clinical depression is also complex and may involve several factors such as genetics and environmental predisposition. Depression is treatable through various interventions that vary on the state of the patient and the severity of the condition. Finally, this essay will also look at the impacts of depression of society and the healthcare system with an in-depth analysis on reactions from different perspectives so as to offer recommendations for better coping strategies. 2. Clinical Depression a. Description of Clinical Depression Clinical depression is a mental disorder also known by other terms such as major depressive disorder and unipolar depression. The condition is characterised by an insistent sadness, low mood and general disinterest in outside stimuli[Kan15]. An individual experiencing depression, therefore, undergoes prolonged periods of low mood that may last from two weeks to several months. Clinical depression negatively affects an individual’s life such as work and social relationships. The condition affects how an individual feels, thinks, and acts. However, these impacts vary depending on the level of the condition. Clinical depression comes in various stages, which include mild, moderate and severe. When depression become severe, it may be categorised as melancholic or psychotic. Melancholia is severe depression in which the individual loses pleasure in almost everything and becomes noticeably slow while psychotic depression occurs when the individual loses touch with reality. psychotic depression is, therefore, characterised by hallucinations and delusions [Bey16]. It is also common for severely depressed people to be paranoid. In severe cases, depressed individual may even become suicidal. A depressed person may experience sleep disturbances and insomnia, which may involve irregular sleep patterns[Ber17]. b. Diagnosis Unlike other clinical conditions that can be diagnosed easily using lab tests, depression cannot be diagnosed conclusively using these methods. Instead, talking with the patient has produced better results. Regular screening is recommended in the process of diagnosis. For one to be diagnosed with major depressive disorder, one must meet certain criteria. The two mostly used criteria in clinical settings are Diagnostic and Statistical Manual of Mental Disorders (DSM) and ICD. Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria states that one must present at least five major symptoms of depression nearly every day, most of the day or for a period of at least two weeks for clinical diagnosis to be reached. During this period, the individual must have at least shown symptoms of loss of interest or depressed mood [Nat161]. These symptoms to look for using DSM criteria are: Depressed mood that lasts for extended periods such as several days as reported by the patient using symptoms such as feeling empty or sad, or as observed by others. A decrease in pleasure or interest in usual daily activities. Significant loss or gain in weight characterised by change in appetite. Sleep disturbances such as hypersomnia and insomnia. Change in activity that results in retardation or psychomotor agitation. Persistent fatigue. Feelings of worthlessness or inappropriate guilt. Diminished capacity to concentrate or think characterised by indecisiveness, Persistent suicidal thoughts or thoughts of death. These symptoms must be severe enough to result in disruption of daily life such as social relationships. ICD uses a combination of ten depressive symptoms for diagnosis. The criteria categorise depression into mild, moderate, and severe. It identifies depressive mood, at least two weeks of symptoms, and loss of interest as the three major symptoms. Any two of these symptoms are needed for diagnosis to be reached [Nat161]. The other seven symptoms are: Low self-esteem and loss of confidence. Irrational feelings of guilt and self-reproach. Recurrent suicidal feelings and thoughts of death. Diminished concentration and ability to think, indecisiveness, and vacillation. Changes in appetite Sleep disturbance. Alterations in psychomotor activity. c. Risk Factors Depression is one of the most complex mental conditions because sometimes, the causes are never clear. Sometimes, a person may know the reason for feeling depressed; however, sometimes, depression can occur without even the individual knowing that he/she is depressed. According to researchers, depression, in most cases, results from a combination of factors that may be genetic, psychological, and environmental in origin[Nat16]. Biological Factors: researchers have found evidence of chemical imbalances in the brain during episodes of depression, confirming that depression is a medical condition. It has been established that there is a string link between neurotransmitters and major depressive disorder [Nut08]. Nutt (2008) identified the neurotransmitters norepinephrine, dopamine, and serotonin to have correlation with symptoms of depression. These findings are supported by the current use of antidepressant medications, which target these brain systems. Genetics is also identified as a major risk factor in depression, especially for severe cases such as severe major depression and bipolar depression[Nat16]. However, biological vulnerability alone does not seem to cause depression, and it is believed other trigger factors play a role in the onset of depression. It is also believed that nerve cell growth, nerve circuits functioning, and nerve cell connections have a great impact in depression, but their neurological connection to depression is not yet fully understood. Stress: stress, which is the body’s automatic physical to stimulus that needs adjustment [Har17], is one of the major risk factors for depression. Stress can be psychological such as academic demands or environmental such as social isolation. Unwelcomed life changes such as family crisis, work stress, relationship problems, chronic illness, or major loss can cause depressive episodes even among individuals who lack genetic predisposition. When the body brain stress, the hypothalamus releases corticotropin-releasing hormone (CRH), triggering the secretion of cortisol, which readies the body to respond to the stimuli. It is believed that CRH follows various neural pathways and affects systems such as emotional reactions. It also affects the concentration of neurotransmitters. Studies have shown that depressed people often have high levels of CRH, predisposing them to depressive symptoms. One study by the Journal of the American Medical Association showed that women who suffered trauma such as sexual abuse during early childhood had higher levels of ACTH and cortisol, which are stress response hormones[Far16]. Psychological conditions: psychological make-up can predispose one to depression. Studies have found that individuals with low self-esteem are prone to depression because they are often pessimistic about themselves, making them highly disposed to stress[Har17]. Alcohol and Drug Abuse: drug abuse is identified as the major risk factors for depression among young people. The relationship between drug abuse and depression is complex because any could lead to another. Some people turn to drugs and alcohol to escape from depression while other enter into depression as a result of alcohol and drug abuse (Farrer et al., 2016). Medical Conditions and medication: according to the National Institute of Mental Health (2016), certain drugs used for various diseases affect chemical balances in the brain and may lead to depression. For example, the medication Accutane, used for the treating acne, has been linked to depression. In fact, dozens of drugs have been found to have putative depressive effects[Rog08]. d. Comorbidities Depression often occurs alongside other health conditions, majority of which are psychiatric in nature[Tha14]. In a research study by Thaipisuttikul et al. (2014), the researchers found that patients with clinical depression also had anxiety disorders (21.1%), dysthymia (19.5%), panic attacks [6.8%], agoraphobia [5.8%], obsessive–compulsive disorder [4.7%], post-traumatic stress disorder [4.2%]), social phobia [3.7%], psychotic disorder (1.6%), antisocial personality (1.1%), and alcohol dependence (0.5%). Anxiety disorders occurring alongside major depressive disorder has been reported by various other studies such as Tiller (2012) who note that at least 85% of depressed patients also have anxiety disorders and about 90% of people diagnosed with anxiety also develop depression. However, comorbidity of depression is not limited to psychological conditions. High comorbidity also exists between depression and physical illness. Kang, et al., (2015) established that depression is highly prevelent among people with severe physical conditions such as cancer, acute coronary syndrome, and stroke. In midlife adults, depression is a common comorbid factor of heart disease, Parkinson’s disease, and diabetes [Nat16]. [Hof12] associated comorbidity with increased treatment, severity, and greater chronicity. This means that those who suffer from severe, chronic conditions that require extended periods of treatment are at greater risk of developing major depressive disorder. Sometimes, these conditions alone initiate or worsens depression. However, some conditions such as cancer may require treatment with medications that can cause depression (National Institute of Mental Health , 2016). e. Trends Depression affects about 20% of the adult population in Australia[Man12]. Nonetheless, depression is a condition that can affect anyone regardless of age, social economic status, education, gender or background. However, studies have shown that major depressive disorder is prevalent in certain groups than in others. Recent studies have shown that clinical depression is most prevalent in people between the ages of 35 to 44 years[Man12]. Major depressive disorder is the third most prevalent form of mental disorder after ADHD and anxiety disorders among children between four years to 17 years, affecting more than 112,000 children in this age group[Aus16]. According to the report by the Australian Institute of Health and Welfare (2016), the prevelence of MDD is on the increase among young people. However, this increase has been questioned by other researchers who argue that over two-thirds of 4-17 year olds use suport services currently compared to only one-third ten years ago [Ley15]. This means that the recorded change could be associated with increase in reporting rather than increase in the incidence. In older adults, research shows that groups such as women, homosexuals, bisexuals, and people from low-income backgrounds face increased risk of depression (Farrer et al., 2016). Studies have also shown that depression is more common in women than males. In women, depression is linked to biological risk factors such as giving birth, which predisposes them to Postpartum depression (PPD), while in men, depression is highly associated with working long hours and drug and alcohol use[Nat162]. 3. Treatment a. Treatment Options Depression can be treated regardless of its severity; however, treatment is more effective when began early. The major treatment regimens involve medication and psychotherapy. The two interventions can be combined depending on the state of the patient[Nat16]. In case these approaches do not produce desirable results, brain stimulation therapies such as electroconvulsive therapy (ECT) can be explored[Nat16]. Medications: depression is normally treated using antidepressants. These medications are known to enhance the way in which the brain uses the chemicals that control the mood. Medication does not result to immediate alleviation of symptoms, instead it takes about two to four weeks before changes can be noticed[Nat16]. Psychotherapies: counselling, or talk therapy, can help reduce depression. Common psychotherapies used include problem-solving therapy, interpersonal therapy (IPT), and cognitive-behavioural therapy (CBT)[Nat16]. Brain Stimulation Therapies: the latest research has shown that electroconvulsive therapy (ECT) may work where medication has failed. However, in cases of severe depression where the safety of medications cannot be trusted, ECT can be a first-line treatment option. ECT treatment of often conducted on outpatient basis three times a week for a period of one month. b. Evidence for Treatment Options Evidence shows that while antidepressants are useful in containing depression, one may try several medications before finding one that works[Nat16]. The effectiveness of certain medications also depends on the age of the patient. For example, a recent study established that tricyclic drugs are not effective on young individuals [Nat162]. Thus, because of the side effects associated with drugs, it is important for the healthcare providers to conduct a thorough analysis before issuing prescription. Both medication and ECT are known to have side effects[Nat162]. For instance, antidepressant usage may trigger suicidal thoughts among individuals below the age of 25 years, especially during the first weeks [Nat16]; hence, such patients should be monitored closely. ECT, on the other hand, is known to cause disorientation, confusion, and memory loss. While these effects usually disappear in a few weeks, memory loss may persist for several months. However, it is generally safe for the majority of patients[Nat162]. c. Barriers to Help-Seeking or Accessing Treatment Despite the disabling effects of depression, seeking help for depression has remained a challenge. Studies show that only 34% of depressed people seek medical help[Gul10]. One of the major barriers to seeking help is stigma. For example, many young people feel embarrassed to seek help because they would be perceived as weak. This is attribute to society’s negative perception of mental health conditions. Trust and confidentiality is also cited as another barrier. The majority of men, for example, do not wish for other people to know that they are facing depression because they feel it may affect how people view them, especially at the workplace (Farrer et al., 2016). 5. Impact of Clinical Depression Depression come with immense social and economic burden. The Australian healthcare system spends an average of $12.6 billion per year on depression alone[Man12]. There is also associated loss of productivity. Anger and irritability caused by depression also affects social relationships, especially with family members. In addition, the resulting anxiety, panic attacks, and disability may lead to high dependence on family members. To the individual, depression also comes with risk of suicide, risk of relapse for those healing, and violence[Man12]. These conditions definitely result to stress not only for the family, but for the society in general. According to Lipton (2005), 60% of suicide cases are diagnosed with major depressive disorder. As emergency medical servceis are normally the first to respond to such cases, this places paramedics at the centre of providing critical interventions. Paramedics can easily diagnose the underlying casue of attempted suicide and tranfer the patient directly to a mental helath facility for the right treatment as opposed to emergency departments (Sullivan & Sullivan, 2016). Paramedics also need to ensure that there is therapeutic communication and adequate patient safety. During an emergency call, the patient may be in a mental crisis. However, respect and compassion should be accorded regardless. Paramedics also need to understand that they may need to transfer the patient against his/her will and they require chemical or physical restraint for agitation (Sullivan & Sullivan, 2016). This places a great burden of emergency intervention on paramedics. As the number incidence of major depressive disorder continues to rise, it is expected to stretch health services, especially EMS. 6. Implicit Bias Implicit bias is a critical subject in mental health studies. Implicit bias occurs when thoughts and feelings leads to stereotypes without an individual being conscious to the process. Society generally forms attitudes towards people with depressive mood disorder without actually being consciously aware of it. Research psychologists have found that most of human actions actually occur without conscious thought. This means that people’s behaviour is directed more by implicit bias than conscious values. Studies have shown that people’s implicit beliefs render them to believe that people with depression or other mental health illnesses are blameworthy, bad, and helpless [Per08]. It is important to obliterate such bias because it affects effective treatment of depression. 7. Conclusion Depression is a prevalent mental health illness that affects millions of Australians. There are various causes of depression, which range from biological, to environmental and psychological. Regardless of the cause, diagnosis for depression needs to be done early for effective treatment. Diagnosis mainly follows two criteria, which are DSM and ICD. These criteria rely mainly on observations and reported evidence to make a diagnosis. Only after a conclusive diagnosis is reached should treatment be recommended. Major treatments interventions are medication, psychotherapy, and brain stimulation therapies. Depression has great impact on the individual, society, and the healthcare systems. Thus, paramedics have an important role to play in preventing and providing out-of-hospital interventions during emergencies. As researchers learn more about the biology of depression, there is hope for better, individualised treatment for people suffering from depression. 8. References Australian Institute of Health and Welfare. (2016). Mental Health Services in Australia: Prevalence, impact and burden. Canberra: AIHW. Retrieved from https://mhsa.aihw.gov.au/background/prevalance/. Berkeley University. (2017). What is Clinical Depression? Retrieved from University Health Services: https://uhs.berkeley.edu/health-topics/mental-health/clinical-depression. Beyond Blue. (2016). Depression: Signs and symptoms. Retrieved from Beyond Blue: https://www.beyondblue.org.au/the-facts/depression/signs-and-symptoms. Farrer, L. M., Gulliver, A., Bennett, K., Fassnacht, D. B., & Griffiths, K. M. (2016). Demographic and psychosocial predictors of major depression and generalised anxiety disorder in Australian university students. BMC Psychiatry Journal, 16(241), Published Online. doi:10.1186/s12888-016-0961-z. Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(113), Published Online. doi:10.1186/1471-244X-10-113. Harvard University. (2017, April 11). What causes depression? Retrieved from Harvard Medical School: http://www.health.harvard.edu/mind-and-mood/what-causes-depression. Hofmeijer-Sevink, M. K., Batelaan, N. M., van Megen, H. J., Penninx, B. W., Cath, D. C., van den Houte, M. A., & van Balkom, A. J. (2012). Clinical relevance of comorbidity in anxiety disorders: A report from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders, 137(1-3), 106–112. Kang, H.-J., Kim, S.-Y., Bae, K.-Y., Kim, S.-W., Shin, I.-S., Yoon, J.-S., & Kim, J.-M. (2015). Comorbidity of Depression with Physical Disorders: Research and Clinical Implications. Chonnam Medical Journal, 51(1), 8–18. Ley, S. (2015, August 7). Youth self-harm, suicide & depression rates ‘confronting’: Ley. Retrieved from Commonwealth of Australia: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley096.htm. Lipton, L. (2005). mergency Responders Management of Patients Who May Have Attempted Suicide. The Internet Journal of Rescue and Disaster Medicine, 5(2), Published Online. Manicavasagar, V. (2012). A Review of Depression Diagnosis and Management. Australian Psychological Society, punlished online. Retrieved from https://www.psychology.org.au/publications/inpsych/2012/february/manicavasagar/. National Institute for Health and Care Excellence. (2016, April 12). Depression in adults: recognition and management. Retrieved from National Institute for Health and Care Excellence: https://www.nice.org.uk/guidance/cg90/chapter/introduction. National Institute of Mental Health. (2016, October 22). More. Retrieved from NIMH: https://www.nimh.nih.gov/health/topics/depression/index.shtml. National Youth Mental Health Foundation. (2016, August 23). Understanding depression – for health professionals. Retrieved from National Youth Mental Health Foundation: https://headspace.org.au/health-professionals/understanding-depression-for-health-professionals/ Nutt, D. J. (2008). Relationship of neurotransmitters to the symptoms of major depressive disorder. Journal of Clinical Psychiatry, 69(1), 4-7. Peris, T. S., Teachman, B. A., & Nosek, B. A. (2008). Implicit and explicit stigma of mental illness: links to clinical care. Journal of nervous and mental disease, 196(10), 752-60. doi: 10.1097/NMD.0b013e3181879dfd Rogers, D., & Pies, R. (2008). General Medical Drugs Associated with Depression. Psychiatry, 5(12), 28–41. SULLIVAN, B., & SULLIVAN, S. (2016, March 15). An EMS Guide to Depression and Bipolar Disorder. Retrieved from EMS Reference: https://www.emsreference.com/articles/article/ems-guide-depression-and-bipolar-disorder. Thaipisuttikul, P., Ittasakul, P., Waleeprakhon, P., Wisajun, P., & Jullagate, S. (2014). Psychiatric comorbidities in patients with major depressive disorder. Dove Medical Press, 2014(10), 2097—2103. doi:https://doi.org/10.2147/NDT.S72026. Tiller, J. W. (2012). Depression and anxiety. Medical Journal of Australia, 1(4), 28-31. doi:10.5694/mjao12.10628. Read More

Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria states that one must present at least five major symptoms of depression nearly every day, most of the day or for a period of at least two weeks for clinical diagnosis to be reached. During this period, the individual must have at least shown symptoms of loss of interest or depressed mood [Nat161]. These symptoms to look for using DSM criteria are: Depressed mood that lasts for extended periods such as several days as reported by the patient using symptoms such as feeling empty or sad, or as observed by others.

A decrease in pleasure or interest in usual daily activities. Significant loss or gain in weight characterised by change in appetite. Sleep disturbances such as hypersomnia and insomnia. Change in activity that results in retardation or psychomotor agitation. Persistent fatigue. Feelings of worthlessness or inappropriate guilt. Diminished capacity to concentrate or think characterised by indecisiveness, Persistent suicidal thoughts or thoughts of death. These symptoms must be severe enough to result in disruption of daily life such as social relationships.

ICD uses a combination of ten depressive symptoms for diagnosis. The criteria categorise depression into mild, moderate, and severe. It identifies depressive mood, at least two weeks of symptoms, and loss of interest as the three major symptoms. Any two of these symptoms are needed for diagnosis to be reached [Nat161]. The other seven symptoms are: Low self-esteem and loss of confidence. Irrational feelings of guilt and self-reproach. Recurrent suicidal feelings and thoughts of death. Diminished concentration and ability to think, indecisiveness, and vacillation.

Changes in appetite Sleep disturbance. Alterations in psychomotor activity. c. Risk Factors Depression is one of the most complex mental conditions because sometimes, the causes are never clear. Sometimes, a person may know the reason for feeling depressed; however, sometimes, depression can occur without even the individual knowing that he/she is depressed. According to researchers, depression, in most cases, results from a combination of factors that may be genetic, psychological, and environmental in origin[Nat16].

Biological Factors: researchers have found evidence of chemical imbalances in the brain during episodes of depression, confirming that depression is a medical condition. It has been established that there is a string link between neurotransmitters and major depressive disorder [Nut08]. Nutt (2008) identified the neurotransmitters norepinephrine, dopamine, and serotonin to have correlation with symptoms of depression. These findings are supported by the current use of antidepressant medications, which target these brain systems.

Genetics is also identified as a major risk factor in depression, especially for severe cases such as severe major depression and bipolar depression[Nat16]. However, biological vulnerability alone does not seem to cause depression, and it is believed other trigger factors play a role in the onset of depression. It is also believed that nerve cell growth, nerve circuits functioning, and nerve cell connections have a great impact in depression, but their neurological connection to depression is not yet fully understood.

Stress: stress, which is the body’s automatic physical to stimulus that needs adjustment [Har17], is one of the major risk factors for depression. Stress can be psychological such as academic demands or environmental such as social isolation. Unwelcomed life changes such as family crisis, work stress, relationship problems, chronic illness, or major loss can cause depressive episodes even among individuals who lack genetic predisposition. When the body brain stress, the hypothalamus releases corticotropin-releasing hormone (CRH), triggering the secretion of cortisol, which readies the body to respond to the stimuli.

It is believed that CRH follows various neural pathways and affects systems such as emotional reactions.

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