Depression Symptoms and Information:
Depression is a mood disorder that most people have some awareness of, but may not know the various symptoms and what actually defines it as a disorder. Clinical depression is a serious disorder that presents in many ways resulting in various different levels of intensity and consequences. When people refer to the term “depression” they are frequently referring to a sad mood or experience of grief. Clinical depression however is actually a syndrome of at least five symptoms that have lasted for at least two weeks. When evaluating the symptoms of depression, a mental health clinician will analyze whether there has been a change from previous functioning, and must include at least one of the first two symptoms listed below:
1. Depressed or irritated mood
2. Diminished interest or pleasure in all or almost all activities
3. Significant weight loss or weight gain, or decrease or increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death, suicidal impulses or actions
The depression symptoms described above may actually form a syndrome which is referred to as Major Depressive Episode when it occurs for the first time. If it then reoccurs it is referred to as a Major Depressive Disorder. An individual may have only five of the above symptoms for a relatively short period of time while other individuals may experience many or most of the above symptoms for many years. Obviously, when someone is diagnosed as having Major Depression it is very important. Also, part of the analysis needs to include an assessment of its severity and duration.
Comorbidity of Depression:
The comorbidity of depression refers to when depression presents itself in conjunction with other psychiatric and medical disorders. Older individuals may have significant comorbidity with medical concerns such as heart disease, diabetes, stroke and various other medical concerns. They may also have significant comorbidity with anxiety disorders and other psychiatric diagnoses. Some of the most common comorbid psychological conditions include dysthymia, cyclothymia, anxiety disorders, personality disorders, eating disorders and substance abuse disorders.
Major depression is easily one of the most common of all mental disorders. It is believed to annually affect about 12.9% of American women on the average and is about 1.7 times higher than the rate for males in the United States. Also, it is believed that at least 20% of adults in the United States population will experience clinical depression during their lives. Many researchers and mental health clinicians believe that the incidence of depression has increased in recent years and that could be as much as 50% higher by the year 2050 than it is presently.
Age of Onset:
The most typical pattern of the initial presentation of major depression is for it to occur for the first time in individuals in their mid to late adolescence. However, a first or recurrent episode can occur at any point in an individual’s life. It was previously believed that young children could not experience clinical depression, but this viewpoint has changed and it is now believed that it is indeed possible. In most cases however, the symptom patterns among children are somewhat different than for adults.
Major Depressive Disorder usually lasts between four months and one year if you do not seek treatment according to statistics by the American Psychiatric Association. Antidepressant medications and psychotherapy have been found to be helpful and effective in treating Major Depression, although it is commonly recognized to be chronic, recurrent and have high relapse rates. Obviously, recurrent and severe patterns of Major Depression are much more difficult to treat than an episodic and less intense depression.
As previously mentioned, American females have an incidence of depression at a rate of 1.7 times that of males. That pattern seems to begin in early to middle adolescence and continue throughout adulthood and even into the senior years. Many explanations have been proposed to account for these differences between the sexes including hormonal differences, gender roles, and various other issues related to socialization and differences in coping styles.
Impairment and Other Concerns:
Individuals actually diagnosed with clinical depression may experience significant levels of emotional, physiological, behavioral and cognitive impairment that may affect many aspects of their daily functioning. For instance, many individuals with depression experience a negative impact upon their ability to work, function well in school or cause difficulties in interpersonal relationships with friends, spouses and children.
Making a diagnosis of depression:
In order to make a formal diagnosis of depression, a mental health clinician will first assess whether an individual has a specific constellation of depressive symptoms. Then they will determine whether they are of a high enough level of severity to impair their functioning and are not attributable to the effects of substance abuse or a medical disorder. The diagnosis should not be made unless the symptoms last longer than two months following an incidence of bereavement or grief. As stated previously, some other psychological disorders also include some of the features of clinical depression such as bipolar disorder and schizoaffective disorder. These other mental health syndromes need to be ruled out and the symptoms need to be differentiated from these other disorders in order to have a diagnosis of depression.
Major Depressive Disorder in the Older Adult:
Depression and Major Depressive Disorder frequently occur among the elderly as well as among younger individuals. However, there are unique concerns related to the elderly in that older individuals with depression frequently experience impairment in their thinking or cognitive skills as part of the clinical syndrome. Depression among seniors may actually simulate dementia as individuals experience concentration difficulties, memory loss and distractibility. It is very common for dementia and Major Depressive Disorder to co-occur. Comorbidity is common. It is not very often however that findings of dementia are fully explained on the basis of depression or what is referred to as a pseudodementia.
Some studies have found that the prevalence of Major Depressive Disorder among older individuals in nursing homes may be as high as 30%. It has a tendency to frequently occur in the presence of medical conditions such as heart disease and stroke which also then complicates the treatment for both the depression and the primary medical conditions. Careful evaluation of medications is imperative which may also help explain some of these associated symptoms. When older adults have their first occurrence of depression, they must be carefully evaluated for the comorbid medical conditions such as undiagnosed cancer, cerebral ischemic events, or complications of metabolic conditions such as adult onset diabetes mellitus and thyroid dysfunction.
By Paul Susic Ph.D. Licensed Psychologist
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