Missionary
Medical
Moment
A brief summary of a current topic of medical interest to missionaries.
Topics are updated frequently; if you have a topic or question, let us know!
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MISSIONARY MEDICAL MOMENT
Depression - Part Two
(Depression - Part One)
In the first portion of this discussion on Depression, we
looked at the types and causes of the illness of depression, and
the likelihood of a person's suffering from this type of disorder.
In this portion, we will look at the symptoms of different
types of depression, and the natural course of the illness. In
a subsequent segment we will examine the different types of
treatment available.
Symptoms of the illness of depression have been
grouped into those which must be present to make the
diagnosis and those which may be present. The two
symptoms which must be present are
- having a depressed mood most of the day, nearly
every day, and
- diminished interests or pleasure in activities.
The pervasive aspect of the depressed mood is what distinguishes
the illness of depression from the less severe "blues"
of normal life, which, while causing intense discomfort, are
usually transient and short lived; a person with the normal
"blues" can often distract from discomfort with
hobbies and other interests, while the person with clinical
depression feels bad persistently, and loses interest in those
things which used to give pleasure.
Other symptoms may include decreased appetite with significant
weight loss (usually defined as more than 5% of body weight
in one month), difficulty sleeping, increased restlessness,
fatigue or loss of energy, feelings of worthlessness or
inappropriate guilt, indecisiveness and difficulty
concentrating, and recurrent thoughts of death, with
thoughts of suicide (thoughts of suicide without intent are
known as "suicidal ideation", and can occur
spontaneously).
It should be noted that all of these symptoms can occur
normally in circumstances of bereavement, where
someone suffers a close personal loss. In that situation, the
symptoms usually subside gradually over several months.
While these are the most common types of symptoms seen in
depression, a significant number of people have what are called
Atypical Depressive Symptoms. People with atypical
depression may have mood reactivity (the capacity to be
temporarily cheered up), overeating with weight gain,
excessive sleepiness rather than the more common
insomnia, heavy limb sensation, and extreme sensitivity
to feeling interpersonal rejection. Atypical depression often
happens with a seasonal pattern (see a prior
Missionary Medical Moment topic:
Seasonal Affective Disorder).
While the symptoms may be "atypical", the depressed
mood and loss of interests and pleasure are every bit as
intense and pervasive.
Depression can manifest itself in other ways than just causing
emotional distress and changes in behavior. The effects
of depressive illness, in addition to effects on mood
and thinking, can be significant: depressed patients have a
higher incidence of chronic fatigue syndrome, irritable
bowel syndrome, chronic back, chest, and pelvic pain,
and migraine headaches. The death rate for depressed
people more than 55 years of age is increased four-fold, and
the risk of death from suicide is 15%.
The natural course of depression shows that
depression can last for months or even years. If depression is
not treated, after one year 40% of patients have recovered,
20% have partially recovered, while 40% remain depressed. The
likelihood of recurrence is significant; after
one episode of depression, 50% will have another episode. Of
those that have a second episode, 70% will have a third, and
for those unfortunate enough to have three episodes, 90% will
have even more episodes. This tendency for increasing risk
of recurrence with more episodes is what makes proper treatment
of initial episodes very important.
Discussion of treatment will be covered in
Part Three.
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