Personality Disorder Support Community

Personality Disorder Support Community


Depression

Depression is chronic low mood that lasts at least two weeks, and includes feelings of hopelessness, low self esteem, lack of motivation, lack of energy, and sleeping problems. It is the main symptom of many psychiatric conditions, including Major Depressive Disorder and Dysthymia.

People with Depression may experience:

  • A loss or increase in appetite.

  • Lack of interest in previously- pleasurable activities.

  • Problems concentrating.

  • Excessive tiredness/sleeping.

  • Aches and pains.

  • Suicidal ideation.


Major (Clinical) Depression can be recognised by the DSM-IV criteria for a Major Depressive Episode:

  1. At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning:
    (at least one of the symptoms is either depressed mood or loss of interest or pleasure.)

    1. Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)

    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation made by others)

    3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day

    4. Insomnia or hypersomnia nearly every day

    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

    6. Fatigue or loss of energy nearly every day

    7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

    8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

    9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

  2. The symptoms do not meet criteria for a mixed episode.

  3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  4. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

  5. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.


Criteria for Depression in ICD-10:

At least one of these, most days, most of the time for at least 2 weeks:

  1. Persistent sadness or low mood; and/or

  2. Loss of interests or pleasure

  3. Fatigue or low energy

    If any of above present, ask about associated symptoms:


  4. Disturbed sleep

  5. Poor concentration or indecisiveness

  6. Low self-confidence

  7. Poor or increased appetite

  8. Suicidal thoughts or acts

  9. Agitation or slowing of movements

  10. Guilt or self-blame


The 10 symptoms then define the degree of depression and management is based on the particular degree:

  • Not depressed (fewer than four symptoms)

  • Mild depression (four symptoms)

  • Moderate depression (five to six symptoms)

  • Severe depression (seven or more symptoms, with or without psychotic symptoms)


Symptoms should be present for a month or more and every symptom should be present for most of every day

Cause of Depression

Although depression can appear without cause or obvious reason, or as a result of chemical changes in the brain, in many cases it can be due to external factors such as triggering life events (divorce, money problems, loss, moving, change in jobs), trauma in childhood, unexpressed anger, diet, physical conditions (sleep problems, low blood sugar, hormonal problems), drug and alcohol abuse, or side effects of medication. Genetic predisposition can also be a factor.

Diagnosing Depression

If you think you or a family member may have depression you should make an appointment with your GP. They may perform tests first to rule out any physical illness that may be causing the symptoms. You may receive a diagnosis of Depression if your your functioning is impaired by your mood, it is persistently low for over 2 weeks, or you meet at least 5 of 9 criteria for a Major Depressive Episode (singular or recurrent) as stated by the DSM-IV, or at least 4 criteria described by the ICD-10.

Treatment

Antidepressant medication is often used in the treatment of Depression. People with moderate to severe depression may be offered forms of Psychotherapy such as Cognitive Behavioural Therapy (CBT) and Interpersonal therapy (IPT). Electroconvulsive Therapy may be used in very severe cases where other treatment has failed to work. Your doctor may also advise dietary changes or an increase in exercise.

By Megan Sennett

References:
http://www.patient.co.uk/health/depression
http://en.wikipedia.org/wiki/Depression_(mood)
http://alerecares.com/pl/MultiSiteInclu ... 003-11.pdf
http://www.gpnotebook.co.uk/simplepage. ... 2205182440



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