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The diagnosis and treatment of depression

Depression is a common disorder, but to diagnose the condition, there are a number of symptoms that a doctor has to identify. This article discusses the symptoms associated with depression, how doctors make a diagnosis and how depression can be treated.


The difference between depression and sadness

The term “depression” is loosely bandied around to describe someone who is feeling low, but in reality, feeling this way doesn’t necessarily imply a depressive illness.

We all go through upsetting and potentially devastating situations during the course of our lives, be it losing a job, divorce, death of a loved-one or simply growing older. Feeling sadness as a consequence is perfectly normal but when does being sad stop and depression take over?

To be given a diagnosis of depression, an individual has to tick a number of symptoms on a list of diagnostic criteria AND just as important, these symptoms need to be present every day for at least two weeks.

Diagnosis

In general, the more symptoms a person has, the greater the severity of the illness. In the UK, doctors classify depression as either mild, moderate or severe. And if we look at depression as being on a sliding scale, we can add to this list a much lesser known form of depression called dysthymia, which falls into the very mild category. Dysthymia earned a label of its own because symptoms are less severe but tend to last longer.

The symptoms

Depression is a common disorder and current estimates suggest that as many as one in five of us suffer from depression at some point in our lives.

Depressed people may look down in the mouth, don’t want to do anything positive or proactive, and when you talk to them life may seem hopeless. On top of that, they may get irritable or anxious, become socially withdrawn, can’t make decisions, have a loss of libido or find it difficult to focus. You get the general picture.

But for a doctor to confirm a diagnosis of depression, the individual must have at least two of the following three overriding symptoms: persistent sadness, loss of interest or pleasure in the things that they used to enjoy, and a lack of energy.

Doctors then look for associated symptoms which include problems sleeping, poor concentration, low self-confidence, poor or increased appetite, suicidal tendencies, agitation or slowing of movements, guilt or self-blame.

The more of these associated symptoms the depressed person has, the more severe the depression. Four symptoms points to mild depression, six symptoms equates to moderate depression and eight or more is a sign of someone with severe depression. For someone to be diagnosed with depression, doctors will really be looking for these symptoms to have been present daily and for most of the day for at least one month.

Depression can affect people in different ways

It may also help to understand that depression is a very broad-spectrum disease and can affect people in different ways. For example, men tend to lose interest in work and become irritable and sleep poorly, whilst women typically feel sad, worthless and guilty. Older people may be less obviously depressed and not admit to negative feelings. And children may pretend to be ill and cling to a parent. 

Depression can affect anyone

We all know people who are more buoyant than others and who are likely to take a more positive spin given any situation. These people experts might describe as more “resilient”. Indeed, studies suggest that some people are more vulnerable to feeling depressed than others.

People most likely to get depressed don’t have an obvious physical blueprint. As Dr Ian Drever, Consultant Psychiatrist at Drever Associates explains: “Depression is a disease of the mind and is likely a complex mix of interactions between our genes, body chemistry, the wiring of our brains and life experiences. Depression certainly isn’t a weakness or something you can fight off at will.”

If we look at celebrities blighted with depression, it becomes clearer that depression appears to strike all sorts of people, even those who on the outside, seem to have it all: Alec Baldwin, Woody Allen, Jim Carrey, Courteney Cox, Gwyneth Paltrow, Robbie Williams and Churchill to name but a few.

Treatment

“Thankfully, everyone with depression is treatable. It may take perseverance and effort to find the right treatment or treatment combination that works for a particular individual, but there is no reason why anyone cannot be treated,” says Drever. “It’s also important to rule out other potential causes of depression, such as an under-active thyroid or various medications such as beta-blockers used to treat high blood pressure.”

Treatment options include medication, talking therapies, computer-based therapy and lifestyle changes. A first option for people with mild depression is a simple 10 – 12 week programme of cognitive-behavioural therapy which helps participants to change the way they think and eliminate negative thought patterns. It can be hard work and take practice but may provide lifelong change and help prevent further relapses.

Other simple and accessible treatment options include regular exercise and self-help books.

The first thing you should do if you suspect that you are depressed, is go and see your GP. You may then be referred for counselling or to see a specialist.

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The diagnosis and treatment of depression
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