Sunday, January 26, 2020

Are you depressed?

Image result for depression

The focus this week is on mental health.    
Have you ever wondered if you are depressed? Major depression is one of the most common mental health disorders in the United States.  It’s estimated that approx. 17.3  million adults in the United States will experience a depressive episode in their lifetime. That is approximately 7.3% of the US adult population.  Because depression is so common, in this post I’ll share the criteria for major depression as well as look at some other secondary causes of depression  that you might not have considered.

A major depressive episode is diagnosed when a person experiences five or more of the following symptoms nearly every day over a two-week period:
Emotional Symptoms:
              *Depressed mood most of the day, nearly daily
              *Diminished interest or pleasure
              Feelings of worthlessness
Cognitive Symptoms:
              Thoughts about death, or suicidal thoughts or behaviors
Neurovegetative symptoms:
              Significant weight loss (5% of body weight in one month)
              Insomnia (difficulty sleeping) or hypersomnia (sleeping too much)
              Psychomotor agitation (movements that serve no purpose such as pacing)  or psychomotor retardation (visible slowing of physical and emotional actions, including speech)
              Difficulty concentrating
One of the five symptoms must include one of the two symptoms marked with a star (*).

There are many other depressive disorders as well, including persistent depressive disorder (> 2 years of depressed symptoms), premenstrual dysphoric disorder (depression that occurs in the week prior to the onset of menses), and disruptive mood dysregulation disorder (diagnosed in children ages 6-18 and marked by severe recurrent temper tantrums). There is also a type of depression that is part of bipolar disorder. Each type of depression has its own criteria as well as effective treatments.

In my studies this week I’ve been learning about what’s called “secondary causes of depression.” This is when depression is caused by another factor. This is the type of depression that no physician wants to miss. There are generally three categories of secondary causes.

The first category is when a medical condition causes the depression. It’s important to note that this is not stress about a medical diagnosis leading to depression, but rather the actual medical condition itself causing depression. There are several different medical conditions that can lead to depression. Some of the most common are cancers (especially pancreatic cancer), cardiac causes (such as stroke and heart attacks), endocrine disorders (such as thyroid disorders), and neurological disorders (such as MS, epilepsy and TBI). Even obstructive sleep apnea can cause to depression.

The second category is depression caused by  substance use. Alcohol use can cause depression, as can opioids, sedatives, cocaine, and amphetamines. My board review book also lists benzodiazepines and sleeping pills as well.

The third category of secondary causes includes commonly prescribed medications that can cause depression. This list is very long, but common offenders include steroids, ACE inhibitors, beta blockers, and interferon. The antibiotics ciprofloxacin and metronidazole are also on the list, as are baclofen and estrogen.

Because the types and causes of depression are so varied, it is absolutely critical that you see a physician if you are experiencing the symptoms of depression listed above. Your primary care provider is a good starting place. You should have a full physical exam, lab work, honest discussion about substance use and review all of your current medications. There may well be a secondary cause for your depression which can be addressed. And if it is major depression, there are many treatment options available. 

No one needs to suffer alone and hopeless in the darkness. There is help readily available.


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