Depression Health Article

Major depressive episode

Individuals experiencing a major depressive episode have a depressed mood and/or a diminished interest or pleasure in activities. Children experiencing a major depressive episode may appear or feel irritable, rather than depressed. In addition, five or more of the following symptoms will occur on an almost daily basis for a period of at least two weeks:

• Significant change in weight
• insomnia or hypersomnia (excessive sleep)
• psychomotor agitation or retardation
• fatigue or loss of energy
• feelings of worthlessness or inappropriate guilt
• diminished ability to think or to concentrate, or indecisiveness
• recurrent thoughts of death, or suicidal and/or suicide attempts

Dysthymic disorder

Dysthymia commonly occurs in tandem with other psychiatric and physical conditions. Up to 70% of dysthymic patients have both dysthymic disorder and major depressive disorder, known as double depression. Substance abuse, panic disorders, personality disorders, social phobias, and other psychiatric conditions also are found in many dysthymic patients. Dysthymia is prevalent in patients with certain medical conditions, including multiple sclerosis, AIDS, hypothyroidism, chronic fatigue syndrome, Parkinson's disease, diabetes, and postcardiac transplantation. The connection between dysthymic disorder and these medical conditions is unclear, but it may be related to the way the medical condition and/or its pharmacological treatment affects neurotransmitters. Dysthymic disorder can lengthen or complicate the recovery of patients also suffering from medical conditions.

Along with an underlying feeling of depression, people with dysthymic disorder experience two or more of the following symptoms on an almost daily basis for a period for two or more years (most suffer for five years), or one year or more for children:

• under or overeating
• insomnia or hypersomnia
• low energy or fatigue
• low self-esteem
• poor concentration or trouble making decisions
• altered libido
• altered appetite
• altered motivation
• feelings of hopelessness

Diagnosis

The guidelines for diagnosis of major depressive disorder and dysthymic disorder are found in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV). In addition to an interview, several clinical inventories or scales may be used to assess a patient's mental status and determine the presence of depressive symptoms. Among these tests are: the Hamilton Depression Scale (HAM-D), Child Depression Inventory (CDI), Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), and the Zung Self-Rating Scale for Depression. These tests may be administered in an outpatient or hospital setting by a general practitioner, social worker, psychiatrist, or psychologist.

Treatment

A variety of alternative medicines have proven to be helpful in treating depression. A recent report from Great Britain emphasized that more physicians should encourage alternative treatments such as behavioral and self-help programs, supervised exercise programs, and watchful waiting before subscribing antidepressant medications for mild depression. Chocolate, coffee, sugar, and alcohol can negatively affect mood and should be avoided. Essential fatty acids may reduce depression and boost mood. Expressing thoughts and feelings in a journal is therapeutic. Aromatherapy, particularly citrus fragrance, has had a positive effect on depression. Psychotherapy or counseling is an integral component of treatment because it can find and treat the cause of the depression.

Psychosocial therapy

Psychotherapy explores a person's life to bring forth possible contributing causes of depression. During treatment, the therapist helps the patient to become aware of his or her thinking patterns and how they originated. There are several different subtypes of psychotherapy, but all have the common goal of helping the patient develop healthy problem solving and coping skills.

Cognitive-behavioral therapy assumes that the patient's faulty thinking is causing the current depression and focuses on changing thought patterns and perceptions. The therapist helps the patient identify negative or distorted thought patterns and the emotions and behavior that accompany them, and then retrains the patient to recognize the thinking and react differently to it.