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[L. depressio, a pressing down]
1. A hollow or lowered region.
2. The lowering of a part, such as the mandible.
3. The decrease of a vital function such as respiration.
4. Any of several mood disorders marked by loss of interest or pleasure in living. Disorders linked to depression include dysthymia, major depressive disorder, schizoaffective disorders, bipolar disorders, seasonal affective disorders, postpartum depressive disorders, and mood disorders caused by substance abuse or other medical conditions. Medical and psychiatric conditions that can trigger or exacerbate depression include anxiety disorders, autoimmune diseases, chronic pain, eating disorders, endocrine disorders, heart attack, infectious diseases, neurologic disorders (stroke), sleep disorders, substance abuse, and drugs, e.g., some beta blockers, calcium channel blockers, steroids, hormones, chemotherapeutic agents, appetite suppressants, and sedatives. The U.S. Preventive Services Task Force recommends screening for depression in primary care settings. Formal screening tools may be used, e.g., the Beck Depression Inventory, Hamilton Rating Scale for Depression, and Geriatric Depression Scale. A simple means of screening for depression is to ask patients: (1) Over the past 2 weeks have you felt down, depressed, or hopeless? (2) Over the past 2 weeks have you felt little interest or pleasure in doing things?
Depressive disorders are common: about 20% of women and about 10% of men may suffer from major depression at some point during their lives. Worldwide, depression is considered to be the fourth most serious illness as far as the overall burden it imposes on people's health. Depressed patients have more medical illnesses and a higher risk of self-injury and suicide than patients without mood disorders.
SYMPTOMS AND SIGNS
Characteristic symptoms of the depressive disorders include persistent sadness, hopelessness, or tearfulness; loss of energy or persistent fatigue; persistent feelings of guilt or self-criticism; a sense of worthlessness; irritability; inability to concentrate; decreased interest in daily activities; changes in appetite or body weight; insomnia or excessive sleep; and recurrent thoughts of death or suicide. These symptoms cause pervasive deficits in social functioning.
Psychotherapies, behavioral therapies, electroconvulsive therapy (ECT, shock therapy), noninvasive neuromodulation, and psychoactive drugs are effective in the treatment of depressive disorders.
Depressed people who express suicidal thoughts should not be left alone, esp. if hospitalized.
The patient is assessed for feelings of worthlessness or self-reproach, inappropriate guilt, concern with death, and attempts at self-injury. Level of activity and socialization are evaluated. Adequate nutrition and fluids are provided. Dietary interventions and increased physical activity are recommended to manage drug-induced constipation; assistance with grooming and other activities of daily living may be required. A structured routine, including noncompetitive activities, is provided to build the patient's self-confidence and to encourage interaction. Health care professionals should express warmth and interest in the patient and be optimistic while guarding against excessive cheerfulness. Support is gradually reduced as the patient demonstrates an increasing ability to resume self-care. Drug therapies are administered and evaluated: these may include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine and serotonin reuptake inhibitors, dopamine-norepinephrine reuptake inhibitors, and norepinephrine-serotonin modulators. Monamine oxidase inhibitors also may be used, but these have a high risk for toxicity unless necessary dietary restrictions are strictly followed. These drugs may be used alone or in combination with specific psychotherapeutic approaches such as cognitive behavioral therapy (CBT) or brief psychosocial counseling. CBT helps patients understand how their thoughts can become distorted and contribute to depression and anxiety and helps them learn coping behaviors that reduce feelings of anxiety, distress, and helplessness caused by distorted thinking.
If ECT is required (usually for patients who have not responded well to drug therapy or for whom drugs pose a risk), the patient is informed that a series of treatments may be needed. Before each ECT session, the prescribed sedative is administered, and a nasal or oral airway inserted. Vital signs are monitored, and support is offered by talking calmly or by gentle touch. After ECT, mental status and response to therapy are evaluated. The patient may be drowsy and experience transient amnesia but should become alert and oriented within 30 min. The period of disorientation lengthens after subsequent treatments.
SYN: SEE: unipolar depression