Benefits of Psychiatric Care

Signs and Symptoms Of Major Depression

August 4

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There are many reasons that put us at risk for depression including; genetic makeup, medical conditions, chronic fatigue, circumstances in life that trigger chronic distress, fear, and shame, faulty conclusion making styles, a tendency to brood about the past, and dwell on bad thoughts, difficulty accepting losses, and disappointments in life, overly harsh judgment of oneself, unrealistic expectations of oneself, and giving too much of yourself in certain relationships.  The emotion of depression is a blend of the feelings of distress, fear, shame, and sad thoughts and memories.

Patients often wonder how their doctor reaches a conclusion that they have a major or clinical depression, that may require medical treatment. Using the acronym; A,B,C,D,E,F, we can name the categories in which symptoms are grouped to reach a diagnosis of major depression:

  • Affective Symptoms: anxiety, fear and panicky feelings, guilt and shame, anger and rage, anhedonia (the loss of ability to feel happiness or joy), quickness to startle, apathy (the loss of ability to feel interest in things), loss of enthusiasm, feelings of contempt and disgust, sadness, tearfulness, empty feelings, detached feeling, loss of ability to feel empathy or sympathy for others, cynical feelings, loss of sense of humor.
  • Behavioral Changes: difficulty starting tasks, procrastination, difficulty maintaining effort, difficulty finishing tasks, difficulty setting goals, difficulty setting priorities, inability to shift to more urgent or meaningful tasks, lack of spontaneity, overreaction, or under reacting to people and situations, agitation, withdrawing from family, friends, or favorite activities, feeling lonely, avoidance of activities, inactivity, clumsiness, accident proneness.
  • Cognitive Changes: decreased concentration and attention span, distractibility, forgetfulness, absentmindedness, cloudy fuzzy thinking decreased sharpness of thinking, pressure feelings in the head, detached and spacey feelings, confused and perplexed feelings, decreased sharpness of vocabulary, name, and word finding, difficulty with problem solving, and reasoning things out, feeling lost, difficulty with or avoidance of making decisions, impatience.
  • Drive Changes: the drive to eat, sleep or have sex may be greatly decreased increased, or fluctuate frequently.
  • Energy Changes: a loss of energy or stamina to do things, easy fatigability, limbs feeling heavy, moving too slowly, feeling slowed down, and tired all the time, despite getting enough sleep, a wish to frequently lie down, relax, and rest, jitteriness, restless energy that can’t be controlled.
  • Functions of the Body Changes: headaches, backaches, multiple muscle and joint aches, sighing often, or difficulty getting one’s breath, increased heart rate or bounding heart sensations, sweating more, dryness or mouth, difficulty swallowing,  dry itchy skin or hives and skin rashes, upset stomach and bowels, increased or decreased urination. change in menstrual functioning, difficulty maintaining erection, lubricating, or achieving orgasm, blurry vision or ringing in the ears, lightheadedness and dizziness, clumsiness, awkwardness, and less graceful movements.

The Five R’s Of Treatment Of Depression

Until recently, very little was known about what happens to depressed patients if they are not treated. Research has now revealed that most untreated episodes of major depression last 6 to 24 months, and may resolve on its own without treatment.   Up to 5 to 10% of untreated patients have episodes that continue for more than 2 years. Many individuals who come into treatment for the first time, will ultimately discover that they have a history of one or more prior unrecognized, and untreated episodes of depression, often dating back to adolescence or late childhood.

Three terms, beginning with the letter “R”, are used to describe the improvement in symptoms in a depressed patient, after treatment has begun with an antidepressant medication.  They are:  Response, Remission, and Recovery.

  • The term Response means that a depressed patient has experienced at least a 50% reduction in symptoms.
  • The term Remission means that all of the symptoms of depression have gone away. The patient is not only better, but actually well.
  • The term Recovery means that the period of wellness has lasted 6 to 12 months. The Remission is now considered a Recovery.

Two terms, beginning with the letter “R”, are used to describe the worsening of symptoms in a depressed patient, after treatment with an antidepressant has been continued : Relapse, and Recurrence.

  • The term Relapse means that a patient worsens before full Recovery.
  • The term Recurrence means that a patients worsens after a period of complete Recovery.

Predictors of  possible Relapse include:

  • Multiple prior episodes of depression.
  • A history of severe episodes of depression.
  • Long-lasting episodes of depression.
  • Episodes of depression with psychotic (loss of reality thinking) features, or that are followed by manic episodes.
  • Incomplete recovery back to normal between two depressive episodes, also called, poor inter-episode recovery.

Patterns of different depressive conditions include:

  • Dysthymia - a minor, or low grade depression, which lasts for two years or more.
  • Double Depression - a depression pattern where there is an alternation between   occurrences of major depression, and episodes of incomplete recovery, or dysthymia.
  • Mixed Episode Depression - occurs in some bipolar disorders, when elevated mood, and depressed mood occur at the same time, creating a confusing and particularly distressing experience.
  • Rapid Cycling Bipolar Disorder - occurs when mood changes between low-grade mania, full-blown mania, dysthymia, major depression, mixed episode depression at least four times in twelve months.  In some patients, these type of changes can occur several times per day.

Almost every available antidepressant medication will produce a response rate of 67% in depressed patients, and 33% of depressed patients will not respond to any antidepressant medication treatment.  Interestingly, 33% of depressed patients will show a response to placebo pill treatments.

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