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DEPRESSION

PREPARED BY :
DAYANGKU AMANINA BINTI AWANGKU OMARALI
MOHAMAD ISMADI BIN RAMLI


DEPRESSION


INTRODUCTION

What is depression?

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Sadness, feeling down, having a loss of interest or pleasure in daily activities - these are symptoms familiar to all of us. But, if they persist and affect our life substantially, it may be depression.

According to the Centers for Disease Control and Prevention (CDC), 7.6 percent of people over the age of 12 have depression in any 2-week period. This is substantial and shows the scale of the issue.

According to the World Health Organization (WHO), depression is the most common illness worldwide and the leading cause of disability. They estimate that 350 million people are affected by depression, globally.

Being depressed often feels like carrying a very heavy burden, but you are not alone in this struggle. Millions of Americans suffer from some form of depression every year, making it one of the most common mental disorders in the country.

Gaining a deeper understanding of depression can help begin the journey to recovery. Taking some time to learn more about the causes and symptoms of depression will assist you greatly when it comes time to consider methods of treatment.

Depression is more than just feeling sad. Everyone feels upset or unmotivated from time to time, but depression is more serious. It is a mood disorder characterized by prolonged feelings of sadness and loss of interest in daily activities. If these symptoms persist for a period of at least two weeks, it is considered a depressive episode. Depression is a common illness worldwide, with more than 300 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Close to 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.

Although there are known, effective treatments for depression, fewer than half of those affected in the world (in many countries, fewer than 10%) receive such treatments. Barriers to effective care include a lack of resources, lack of trained health-care providers, and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.

The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level.


MAIN CONTENTS

In 2017, depression was the leading cause of ill health and disability worldwide, according to the World Health Organization. Depression may be so widespread because it has no single cause.

Women are more likely to become depressed than men. Opinions vary on why this is the case. Puberty, pregnancy, and menstruation are all common times for symptoms to appear. More women than men have depression. However, depression can affect anyone, including men, children and seniors. And while depression symptoms most commonly appear between 15 and 45 years of age, the condition can strike anyone at any age.

No matter what your age or stage of life, if you experience the signs and symptoms of depression you should talk to your doctor about what you're experiencing. And if you recognize the symptoms of depression in someone you love or care for, share this information with them. Statistics vary from country to country, but depression is more prevalent in the following groups:

 •  people at an economic disadvantage

 •  people with chronic health conditions, such as coronary heart disease or cancer

 •  children of parents with depression

 •  people with other mental health conditions, such as anxiety

Also, many medications can trigger depression. If a person is unsure whether emotional changes are related to medication, they should consult a doctor.

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted—the more likely it is that you’re dealing with depression.


10 common symptoms of depression:

  1.  Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.

  2.  Loss of interest in daily activities. You don’t care anymore about former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.

  3.  Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.

  4.  Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping.

  5.  Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.

  6.  Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.

  7.  Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.

  8.  Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.

  9.  Concentration problems. Trouble focusing, making decisions, or remembering things.

  10.  Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

You may be depressed if, for more than two weeks, you've felt sad, down or miserable most of the time, or have lost interest or pleasure in usual activities. It’s important to remember that we all experience some of these symptoms from time to time, and it may not necessarily mean you're depressed. Equally, not everyone who is experiencing depression will have all of these symptoms.

Living with depression can be difficult, but treatment can help you cope. Talk to your doctor about possible options. You may successfully manage symptoms with one form of treatment. It is also common to combine conventional and lifestyle therapies, including the following.

  1.  Medications: Your doctor may prescribe antidepressants, antianxiety, or antipsychotic medications.

  2.  Psychotherapy: Speaking with a therapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions.

  3.  Light therapy: Exposure to doses of white light can help regulate mood and improve symptoms of depression. This therapy is commonly used in seasonal affective disorder (which is now called major depressive disorder with seasonal pattern).

  4.  Alternative therapies: Ask your doctor about acupuncture or meditation. Some herbal supplements are also used to treat depression, such as St. John’s Wort, SAMe, and fish oil.

Talk with your doctor before taking a supplement or combining a supplement with prescription medication. Doing this will help prevent complications and side effects. Some supplements may worsen depression or reduce the effectiveness of medication.

  5.  Exercise: Aim for 30 minutes of physical activity three to five days a week. Exercise can increase your body's production of endorphins, which are hormones that improve your mood.

  6.  Avoid alcohol and drugs: Drinking or using drugs may make you feel better for a little bit. But in the long run, these substances can worsen depression and anxiety symptoms.

  7.  Learn how to say no: Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your professional and personal life can help you feel better.

  8.  Take care of yourself: You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.

Sometimes depression doesn't respond to medication. Your doctor may recommend other treatment options if your symptoms don’t improve. These include electroconvulsive therapy to stimulate the brain and treat major depression, or transcranial magnetic stimulation to stimulate nerve cells and regulate your moods. Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa. Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention. There are effective treatments for moderate and severe depression. Health-care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Healthcare providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.

Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution.


CONCLUSION

In brief, depression is one of the most common conditions in primary care, but is often unrecognized, undiagnosed, and untreated. Depression has a high rate of morbidity and mortality when left untreated. Most patients suffering from depression do not complain of feeling depressed, but rather anhedonia or vague unexplained symptoms. All physicians should remain alert to effectively screen for depression in their patients. There are several screening tools for depression that are effective and feasible in primary care settings. An appropriate history, physical, initial basic lab evaluation, and mental status examination can assist the physician in diagnosing the patient with the correct depressive spectrum disorder (including bipolar disorder). Primary care physicians should carefully assess depressed patients for suicide. Depression in the elderly is not part of the normal aging process. Patients who are elderly when they have their first episode of depression have a relatively higher likelihood of developing chronic and recurring depression. The prognosis for recovery is equal in young and old patients, although remission may take longer to achieve in older patients. Elderly patients usually start antidepressants at lower doses than their younger counterparts. Patients, who live with depression, and their family and friends, have enormous challenges to overcome. Primary care physicians can provide compassionate care, important education, psychiatric monitoring, social support, reassurance, and advocacy for these patients and their loved ones.


REFERENCE

•   American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013. National Institute of Mental Health. (Data from 2013 National Survey on Drug Use and Health.)

•   Kessler, RC, et al. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593602

•   King’s College London, “Scientists find genetic link to depression”, 2011, https://www.kcl.ac.uk/newsevents/news/newsrecords/2011/05May/Scientistsfindgeneticlinktodepression.aspx

•   Scientific American, “Researchers Take a Closer Look at the Most Common and Powerful Triggers of Depression”, 2013, https://www.scientificamerican.com/article/triggersof-depression/

•   Scientific American, “Researchers Take a Closer Look at the Most Common and Powerful Triggers of Depression”, 2013, https://www.scientificamerican.com/article/triggersof-depression/

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