Serious medical conditions like any chronic illness or physical disability can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions.
While depression can affect anyone, its effect may vary depending on one's age and gender.
- Women are almost twice as likely to become depressed as men. The higher risk may be due partly to hormonal changes brought on by puberty, menstruation, menopause, and pregnancy.
- Men. Although their risk for depression is lower, men are more likely to go undiagnosed and less likely to seek help. They may show the typical symptoms of depression, but are more likely to be angry and hostile or to mask their condition with alcohol or drug abuse. Suicide is an especially serious risk for men with depression. Statistics reveal that men are four times more likely than women to kill themselves.
- Elderly. Older people may lose loved ones and have to adjust to living alone. They may become physically ill and unable to be as active as they once were. These changes can all contribute to depression. Loved ones may attribute the signs of depression to the normal results of aging, and many older people are reluctant to talk about their symptoms. As a result, older people may not receive treatment for their depression.
About 15 percent of the general public will suffer from major depressive disorder sometime in their life. A person with major depressive disorder suffers intense mental, emotional, and physical anguish, and substantial disability. The depression disrupts family, job, and social functioning. Depression worsens the prognosis for other general medical illnesses.
Depression is viewed by many as evidence of a character defect or lack of will power. Thus, those with major depressive disorder must endure the additional burden of having an illness that society views as the reflection of an inherent personal weakness or fault. We, as practitioners should be sensitive to these issues, provide support, and become a client's advocate. In many cases, primary care practitioners can successfully accomplish the diagnosis and treatment of major depressive disorder. When psychotherapy is called for, it may be conducted in either a primary care or specialized setting, depending on the availability of a trained, competent therapist. The primary care practitioner should emphasize to the client, who is already suffering inappropriate guilt, that major depression is a medical condition that can be successfully treated.
Surveys consistently show that 6 to 8 percent of all outpatients in primary care settings have major depressive disorder; as stated above, women are at particular risk for depression. Although sadness is frequently a presenting sign of depression, not all people complain of sadness, and many sad individuals do not have major depression. Common complaints of patients in primary care settings with major depressive disorder include:
Pain-including headaches, abdominal pain, and other body aches, change in appetite and sleep pattern.
Low energy-excessive tiredness, lack of energy or a reduced capacity for pleasure or enjoyment.
A mood of apathy, irritability, or even anxiety rather than, or in addition to, any overt sadness may be present.
Problems with sexual functioning or desire.
Additional clinical clues that raise the likelihood of a major depressive disorder include:
Prior episodes of depression.
A family history of major depressive or bipolar disorder.
A personal or family history of suicide attempt(s).
Concurrent general medical illnesses.
Concurrent substance abuse.
Symptoms of fatigue, irritability, or sadness.
Recent stressful life events and lack of social supports. (Stress should not be used to "explain away" depression; stress may precipitate a depression in some cases.)
General medical disorder can result in depression; for example, a patient with cancer may become clinically depressed as a reaction to the prognosis, pain, or incapacity, although most patients with cancer do not suffer a major depressive episode.
The effectiveness of any treatment rests on a cooperative effort by client and practitioner. The client should be told of the diagnosis, prognosis, and treatment options, including costs, duration, and potential side effects. It is useful to remember the following:
Depression is a medical illness, not a character defect or weakness.
Recovery is the rule, not the exception.
Treatments are effective, and there are many options for treatment. An effective treatment can be found for nearly all patients.
The aim of treatment is complete symptom remission, not just getting better, but getting and staying well.
The risk of recurrence is significant: 50 percent after one episode, 70 percent after two episodes, and 90 percent after three episodes.
Patient and family should be alert to early signs and symptoms of recurrence and seek treatment early if depression returns.
American Psychiatric Association.
Diagnostic and statistical manual of mental disorders. 4th rev. ed. Washington, DC: American Psychiatric Press; 1987.
Depression Guideline Panel.
Depression in Primary Care: Volume 1, Diagnosis and Detection. Clinical Practice Guideline, Number 5. Rockville, MD. U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0550. March 1993.
Lockley P (2005), Counselling for Depression, UK, FA Books
Anna Wroblewska M Psych Sc is a Regional Rehabilitation Psychologist with the National Learning Network, formerly known as the N.T.D.I.