Virtual Medical Centre

Clinical depression

• What is Clinical depression?
• Who gets Clinical depression?
• Predisposing Factors
• Progression
• Probable Outcomes
• How Will Clinical depression Affect Me?
• Clinical Examination
• How is Clinical depression Diagnosed?
• How is Clinical depression treated?
• Clinical depression References
• Drugs/Products Associated with Clinical depression

What is Clinical depression?

Feelings of depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel depressed at some stage, but this is not clinical depression. True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere and impede upon one's everyday life for an extended period of time.

Who gets Clinical depression?

Feeling low or sad is something that everyone experiences. Depressive symptoms are common, affecting 10-40% of people who see their GP. Feeling temporarily down is different to clinical depression, however, and only half of these patients actually meet the specific criteria used to diagnose a patient with a major depressive disorder. Still, depression remains the most common psychological disorder that a GP sees, and the rates of depression appear to be increasing even further. It is thought that depression will become the second most important disease in terms of disability and premature death, second only to cardiovascular disease.

Women

Female gender is considered a risk factor for depression. Studies suggest that 20-25% of women will be affected by major depression at some time in their life. The reason for this is not completely understood but several factors may contribute, including the high incidence of post-natal depression,  social factors (e.g. history of childhood abuse, low self-esteem), and gender differences in the metabolism of chemical signalling molecules in the brain.

Men

 

True depression, characterised by low mood and reduced pleasure, is becoming relatively common in men, affecting 7-12% of men during their lifetime. It is estimated that one in six Australian men suffer depression at any given time. Teenagers and elderly men have higher rates. Depression in men is associated with destructive behaviour, alcohol and drug abuse, and numerous medical disorders such as cardiovascular disease and diabetes.

The true rates of male depression may be underestimated because many males are reluctant to seek medical advice. Depression has commonly been thought of as a disease of women, although the ratio is increasing in favour of men. The increased rates of depression in men may be attributed to changing social roles. Fewer men are becoming the sole financial provider in a family, leading to a loss of social status, and to isolation. In addition, increased rates may reflect changes in diagnosis and admission criteria, or greater health seeking behaviours by men.

High rates of depression are reflected by the tripling of suicide rates for males aged 15-24 over the last three decades, making suicide the second most common cause of death in this age group. This is an alarming statistic. Furthermore, elderly men have the highest suicide rates in the country. Depression in these patients may stem from loss of spouse, isolation, financial difficulties and physical illness.

Children and Adolescents

Depression in children is actually far more common than many people realise. It is estimated that one in 10 children and adolescents are suffering depressive symptoms at any one time. This equates to over 95,000 Australian children and adolescents who are affected by depression. Studies have shown that the most common time to be affected by depression is in mid to late adolescence, though it can occur at any time.

Similarly to depression in adults, depression amongst adolescents is greater in females than in males. Some studies show that up to 25% of female teenagers report depressive symptoms. In prepubertal children, the incidence of depression is thought to be about 2.5%. The actual rate might be even higher - it is hard to diagnose children, since they do not display the same symptoms. Many children find it difficult to speak about their feelings very clearly, and may often present with behavioural changes that can be difficult to identify as depression.

Predisposing Factors

• Genetic cause of depression:

  The risk of developing depression is increased three-fold when an immediate relative is affected by depression. If you have had depression in the past, you are also more likely to develop it again.

• Physical causes of depression:

  Virtually all chronic diseases (including diabetes and obesity) and chronic pain syndromes are associated with depression. This is partly due to low moods over having a disease, and partly due to the disease disrupting the normal balance of chemistry within the body. Depression associated with chronic diseases can be problematic, as it can remove your desire and motivation to pursue treatment and take medications as prescribed.

• Hormonal causes of depression:

  There is a greater incidence of depression in patients with hormonal disorders (e.g. Cushing's syndrome).

• Poor sleep as a cause of depression:

  Patients with poor sleep quality are more likely to develop depression.

• Psychological causes of depression:

  Physical or sexual abuse in childhood predispose adults to depressive illness. Certain personality traits are also risks for depressive illness. If you have any other psychological problems such as anxiety, you are also at higher risk.

• Social causes of depression:

  Traumatic life events are closely linked with the development of depression. Separation, divorce, bereavement and redundancy are all associated with depressive illness. If you are from a lower social class or are unemployed, you may also be more likely to develop depression.

• Drugs that cause depression:

  Chronic alcohol consumption and other substance abuse has been linked with depression.

Children and Adolescents

• Genetic:

  20-50% of children with depression have a family history of the illness, and children of depressed parents are up to three times more likely to experience depression.

• Environmental:

  The home and school environment in which a child is brought up can influence the chance of experiencing depression. Factors such as high levels of conflict within the home, or an early death of a family member, increase the chances of a child experiencing depression. Sexual, physical and emotional abuse can also contribute.

• Negative life events:

  Events such as parental divorce, poor social relationships, death of a family member or friend, and other negative experiences are reported more commonly in adolescents suffering from depression.

• Personality characteristics:

  Some personality types are particularly prone to adolescent depression. Those with attributes such as high levels of anxiety, low self-esteem, high self-criticism and poor school performance are more likely to have depression.

Progression

 

Unlike feeling gloomy or having a bad day, as happens to all of us from time to time, the symptoms of a severe clinical depression usually occur in episodes that last for ten months. During this time, the symptoms of depression will be more pronounced, with the sufferer becoming socially withdrawn and subjectively depressed. At these times, patients are more vulnerable to acts of self-harm and suicide attempts. Sometimes patients suffering depression will need to be observed more closely to prevent these events from occurring.

Children and Adolescents

There are a few long-term consequences associated with major depression, especially in children. There is some evidence, though not conclusive, that depression during early and late adolescence is associated with later obesity, especially in females, and that the more episodes of depression there are, the higher the level of obesity. Depressed adolescents are more likely to be involved in unsafe sexual practices and other risky behaviours. It can lead to some negative outcomes such as:

• School failure
• Substance abuse
• Early pregnancy
• Social isolation
• Poor physical health

This does not mean that all depressed children will experience these things; it just reinforces that depressed children need to be treated and monitored very closely to prevent these kinds of problem from occurring.