Doctor, I need a stress leave!

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

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. The normal cycle of human existence is to have good days 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 towards depression. In medicine, depression is considered a treatable disease entity. Feelings of worthlessness, guilt about everything and lack of hope consume us. Our mood becomes flat and we lose interest in activities that are usually enjoyed. Our concentration is affected and as a result, we forget simple things, have trouble reading or even watching a complete program on 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 recurrently intrude into our consciousness. In addition to the 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 deplete 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 them 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 and Dentists seem to be afflicted more so on the 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 HR person will suggest a person see me for 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, being yelled at a great deal and generally not enjoying a poorly paying job. We doctors need to make a medical diagnosis such as “depression” 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 undervalued 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.

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