Depression is a difficult entity to measure let alone accept, but the frequency of diagnosis on the frontlines of family medicine continues to creep upward. Normal human existence occurs in cycles of good and bad days. When those bad days accumulate and start to interfere with daily functioning, then we may start to consider a possible diagnosis of depression. It is not an exact science. The classical signs of depression have been felt by all of us at one time or another, but when it all happens at once and repeatedly, then we enter the grey zone toward depression.
Depression is considered a treatable disease. Feelings of worthlessness, guilt and lack of hope consume us. Our mood becomes flat and we lose interest in activities that are usually enjoyed. Concentration is affected and as a result, we forget simple things, have trouble reading or even watching television. Even speech slows down as we take longer to gather and express ourselves. In more serious instances, negative thoughts about our existence tend to intrude recurrently into our consciousness. In addition to self-esteem being battered, physical symptoms also begin to appear. We become plagued with body aches, various pains appear and we lose energy. Things slow down and we get frustrated, often short tempered and agitated. Sleep is more difficult, and its rejuvenating effects diminish. The symptoms wax and wane, and some days you feel fine, but most days you don't.
Physically, we tend to explain the symptoms by referring to depleted transmitter levels in the brain. Others often notice the change in our function before we realize it. Diagnosis starts by ruling out numerous other conditions that can cause depression. Various questioning techniques have been developed to help with the diagnosis. The diagnosis comes a little easier if the patient is well known to me. The risk of harm to oneself and those around him or her significantly increases when clinical depression is present.
Suicide is a feature sometimes associated with depression. It is not the norm, but more of an extreme. There is some evidence for clusters within families to occur. Vocation seems to be a factor. Doctors, soldiers and dentists seem to be more afflicted on average. Depression can also be the result of other disease states such as cancer and the frailty that sometimes comes with age. Even sunlight is a factor, since we see more depression when the days get shorter. We are all at risk.
Occasionally, an over-helpful Human Resources person will suggest a "stress-leave." Stress is a symptom and not a diagnosis. It is extremely difficult to define, but goes far beyond the inability to get along with co-workers, or being yelled at a great deal, or generally not enjoying a poor-paying job. A medical diagnosis like "depression" is needed before an insurance company will consider paying time away from work.
Depression is a global entity, which means it affects many spheres of our lives. Screaming kids and spouses should theoretically be as noxious as screaming co-workers. It cannot be turned on and off by punching a time card. When depression is diagnosed, many family practitioners are trained to commence short-term interventional psychotherapy along with medication. Ideally, a referral to a psychiatrist is in order, but very difficult in reality. Psychiatry is under-valued in our health care system and there continues to be a shortage of available psychiatrists.
Depression is a real entity, and sufferers often feel the misguided anger of those around them. It can result in disastrous consequences and was the prevailing theme of the last suicide investigation that I conducted! There are no negatives in sitting down with your doctor and doing an occasional reality check.
● Predicting Depression. This depression risk calculator has been developed with support from the Canadian Institutes of Health Research (CIHR), using data collected from a representative sample (over 10,000 individuals) of Canadian population. The calculator is to be used by people who are currently NOT experiencing a major depressive episode and who are aged 18 years or older. By answering the questions, the calculator will generate a probability of developing major depressive episode in the next 4 years.
● Major depressive disorder from Wikipedia, the free encyclopedia.
● What Is Depression? Cause, Signs & Symptoms, Diagnosis, Treatments, from National Institute of Mental Health (NIMH).
● Depression from Canadian Mental Health Association.
● What is Depression? From Public Health Agency of Canada. "There are different kinds of depressive mood disorders, including bipolar disorder (manic-depressive illness), post-partum depression and psychosis, but clinical depression, or "unipolar disorder" is the most common depressive disorder ... one in 7 adults (13.4%) identified symptoms that met the criteria for a mood disorder at some point during their lifetime, including 12.2% for depression and 2.4% for bipolar disorder. Studies have consistently documented higher rates of depression among women than among men: the female-to-male ratio averages 2:1."
● Depression. Overview and Facts, Causes, Prevention from Depression Health Center, WebMD.
● Depression. What is Depression? Symptoms, Treatment, Finding Help, Resources, from Centre for Addiction and Mental Health (CAMH). Adapted from Depressive Illness: An Information Guide © 1999, 2008 Centre for Addiction and Mental Health??.
● Depression Symptoms & Warning Signs How to Recognize Depression Symptoms and Get Effective Help by Melinda Smith, M.A., Joanna Saisan, M.S.W., and Jeanne Segal, Ph.D. Last updated: February 2014, from HelpGuide.org.
● Say it ain't so: Study links chocolate to depression from The Baltimore Sun: Picture of Health.
● Depression from the Canadian Mental Health Association. What are the signs of depressive illness? What causes depression? How long does depression last? How is depression treated?
● Depression: Causes, Treatment, Symptoms, Types and Diagnosis from MedicineNet.com.
● Depression from National Institute of Mental Health (NIMH). What Is Depression? What are the different forms of depression? What are the signs and symptoms of depression? What illnesses often co-exist with depression?
● Depression from MedlinePlus.
● Depression Is Common from Kids Health. "Some people mistakenly believe that depression is just an attitude or a mood that a person can shake off."
● Depression in Children from MedicineNet.com
● Children and Depression from Canadian Mental Health Association.
● Dealing With Depression: Antidepressant Skills for Teens by Dr. Dan Bilsker, Dr. Merv Gilbert, Dr. David Worling, and Dr. Jane Garland.
● Depression in Adolescents / Teenagers from Psychology Info.com. "Approximately 4 out of 100 teenagers get seriously depressed each year." Other topics: What is depression? Symptoms of Depression. Symptoms of a Manic Episode. Treatment for Depression. What About Suicide? Why do people get depressed? Alcohol, Drugs and Depression. Myths About Depression.
● Depression: A Guide for Teens from Young Women's Health. Who gets depressed? What are the symptoms of clinical depression? What are the effects of depression?
● Adolescent Depression from MedlinePlus.
● Factsheet: Depression in Teens from Mental Health America (NMHA) - formerly known as the National Mental Health Association.