Understanding Depression: Symptoms, Causes, and Treatments
Normal Sadness vs. Pathological Grief
Normal sadness is proportionate in duration and intensity to the situation, doesn’t affect job performance or intellectual functioning, and maintains a normal somatic presence with a motive.
Pathological grief is disproportionate in duration and intensity, affecting behavior and performance at work, family, and intellectually. It presents altered somatic operation, such as headaches and dizziness.
Depression: Symptom, Syndrome, Disease
Depression is a mood disorder characterized by somatic symptoms and pathology. It is a prevalent and significant disorder, especially among the elderly. Effective treatments exist to improve the quality of life for those suffering from depression, necessitating focused attention on detection and treatment.
Subclinical or minor depression, also known as silent depression, exists.
Unconscious Defense Mechanisms in Depression
- Introjection
- Identification
- Displacement
- Isolation of emotion
- Denial
- Manic reaction
Screening Mechanisms of Depression
Depression involves genetic, pathophysiological, and psychological factors, all contributing to biochemical and neurophysiological disorders.
Somatic Factors: Genetics/Pathophysiological
- Personality with a predisposition to depression
Psychic Factors: Psychic/Sociocultural
- Melancholy personality: Exaggerated desire for order, high responsibility, honesty, conscientiousness, scrupulousness, self-demanding nature, intolerance, inflexibility, uncertainty, exemplary work ethic, pessimism, dependence on others, and susceptibility to influence.
Genetic Factors: Personal and family history.
Pathophysiological Factors: Pharmacological, toxic, and deficiency states, chronic hypothyroidism, debilitating conditions, physical exhaustion.
Psychic Factors: Chronic frustration, exhaustion, helplessness.
Sociocultural Factors: Family and social marginalization, loss of values, job changes, job failure.
Psychological Trauma Preceding Depression
- Bereavement
- Retirement
- Termination of tension
- Exhaustion
- Work promotion
- Loss of support
- Stressors (Holmes and Rahe scale)
Symptoms of Depression
- Psychic: Affective, thought and language, behavior.
- Somatic: Rhythms, vegetative.
Mental Symptoms of Depression
Affective Disorders
- Sadness, displeasure, loss of interest
- Anxiety, fear, cowardice
- General discomfort, moodiness, irritability
- Anesthesia of feelings, emptiness, apathy
Thought and Language Disorders
- Slowing, low productivity
- Difficulty concentrating, decreased attention, memory loss
- Concerns, useless ruminations, pessimism, low self-esteem
- Hopeless thoughts of death or suicide
- Delusions (hypochondria, guilt, ruin)
Behavioral Disorders
- Excessive crying or inability to mourn
- Agitation or inhibition
- Privacy
- Strange or antisocial behavior
Somatic Symptoms of Depression
Vital Rhythms Disorders
- Circadian (worse in the morning)
- Sleep/wake disturbances (early waking with hypersomnia)
- Seasonal (relapse in Spring/Autumn)
Autonomic Disorders
- Asthenia, fatigue, headache, muscle aches, generalized joint pain
- Constipation or diarrhea, gastralgias, loss of appetite and/or weight
- Loss of libido, impotence, frigidity
- Dry mouth, dizziness
Depressive Symptoms Across Lifespan
- 0-2 years: Analytical first depression, separation depression (school phobia), induced depression (child becomes responsible), overload depression (maintaining scholarship studies).
- Early Childhood: Eating disorders, irregular sleep rhythm, hypoactivity, psychomotor retardation, general somatic decay.
- Second Childhood: Intellectual delay, poor school performance, lack of initiative, isolation, crying spells, aggression, phobias (darkness, loneliness, school), night terrors, sleep apnea, thumb sucking, sphincter disorders, psychosomatic disorders (pain).
- Adolescents: Masked depression (antisocial behavior, exaggerations, aggressiveness-opposition, flight, homelessness, drug addiction, thefts, Charlie Brown syndrome, psychosomatic disorders).
- Involutional Age: Anxiety, restlessness, agitation, complaints, excitement, hypochondria, pathophobia, cenestopathies, paranoid events (damage, persecution, guilt, plunder), hysterical attitudes (plays, dumbness, opposition), very high risk of suicide.
Depression vs. Anxiety
Depression: Inhibition, hopelessness, pessimism, ideas of death, worse in the afternoons, weight loss, appetite loss, libido loss, early awakening, focus on the past.
Anxiety: Restlessness, crying with consolation, fear, panic attacks, improvement in the afternoons, phobias, reduced weight, appetite, libido, premature awakening, future projection.
Antidepressants take effect in 3 weeks and are not addictive. Anxiolytics work in 20 minutes.
Dysthymia
Dysthymia, or dysthymic disorder, is a chronic, less severe form of depression, often resembling clinical depression. Individuals with dysthymia may experience major depressive episodes.
Diagnosis of Depressive Episode
a) Duration of at least two weeks.
b) Not attributable to substance abuse or organic mental disorder.
c) Somatic syndrome (melancholic and endogenous symptoms).
Investigations
Biochemical tests, hemogram, TSH, cortisol, urinalysis, wall image.
Signs of Likely Exploration
- Medical symptoms rarely found in mood disorders.
- Onset after age 40 (pancreatic cancer consideration).
Depression Comorbidity
Depression can coexist with other conditions, affecting mortality rates, hospitalization duration, and healing of physical ailments.
Medea Syndrome (Parental Alienation Syndrome)
Manipulation of children to hate one parent.
Depression in Pregnancy
Symptoms overlap with normal pregnancy changes, affecting both mother and child.
Premenstrual Syndrome (PMS)
Symptoms include behavioral, somatic, and cognitive changes. Differential diagnosis is crucial to distinguish PMS from other psychiatric and medical disorders.
Suicide: The Enemy of Depression
Suicide risk is significant, especially in the elderly. Prevention involves systematic assessment, risk factor identification, and effective treatment.
Motivations for Consumption
Alcohol is a depressant, and its combination with depression is common.
Evolution of Antidepressants
Development of antidepressants has progressed, with newer medications offering improved efficacy and fewer side effects.
Depression in the Elderly
Supportive psychotherapy is often used. Objectives include avoiding negative consequences, managing symptoms, and preventing relapse.
Errors in Treatment
Unrealistic goals, major changes, challenging delusions, criticism of conduct.
Successes in Treatment
Activities, tolerance, integration of results, explanation, confidence therapy, understanding biological changes.
Pharmacology
Pharmacokinetics and pharmacodynamics are affected by aging.
Emotional System Aging
Depression decreases quality of life, shortens lifespan, and increases risk of suicide and somatic illness.
Institutionalized Persons
Increased risk of depression due to isolation, loss of autonomy, and feelings of disability.
Symptoms and Signs
Emotional, cognitive, physical, and volitional symptoms and signs are observed.
Risk Factors
Age, physical illness, chronic pain, adverse experiences, poor relationships.
Etiology
Losses, psychological factors, personality factors, genetic factors, structural factors, depressinogenic drugs, somatic factors.
Treatment
Psychotherapy and pharmacotherapy for at least 6-12 months, especially for recurrent depression.