21 April 2020 Author : Ana Margarida Baptista Depression is a very common mental disorder. However, it can be undetected and not diagnosed, which is due to two main reasons: The lack of recognition of depression as a disease; Symptoms are mistakenly attributed to other causes, for example physical illnesses, stress, among others. Currently, there are several treatments for depression, which allow, in most patients: To compensate symptoms during crises; Help prevent relapse in most patients. What is depression? Depression is a persistent mental disorder that negatively affects the way someone feels, thinks and acts. It causes sadness and / or loss of interest and pleasure in the usual recreational activities and significantly decreases the person functional capacity, both professionally and socially. Depression thus induces intense suffering and can ultimately lead to suicide. Depression different from mood fluctuations reactive to everyday events and challenges. These fluctuations usually occur in a short period of time and do not affect the person functional capacity. What are the causes of depression? This mental disorder has usually several causes, which means that it results from a complex interaction between biological, social or environmental and psychological factors. First-degree relatives of individuals with severe depression are 2 to 4 times more likely to develop this disorder than the general population. Adverse life events, for example divorce, unemployment or loss of a loved one, are a known precipitating factor of severe depression. Some personality characteristics, such as low self-esteem, pessimism or high levels of self-criticism, also increase the risk of developing depression. What are the main symptoms? The following are among symptoms of depression : Persistent sadness; Loss of interest or pleasure in the usual recreational activities; Changes in appetite, with an increase or decrease in appetite; Changes in sleep, with insomnia, or on the contrary increased need for sleep; Loss of energy or of initiative capacity or persistent feeling of tiredness; Motor or speech slowing; Feelings of guilt or incapacity / devaluation; Difficulty concentrating and making decisions; Thoughts about death or suicidal ideation; Persistent physical symptoms such as headaches, gastrointestinal problems that do not respond to conventional treatment. Is the severity of depression variable? The number of symptoms of depression and its intensity vary from person to person. Therefore, depressive episodes are not always the same and can be classified as: Mild; Moderate; Severe. In order to formulate a diagnosis of depression, symptoms must be present for a minimum of 2 weeks. For example, it is likely that someone with a mild depressive episode has some difficulty maintaining their usual professional and social activity but will not be completely unable to exercise them. A person with a severe depressive episode, on the other hand, will most likely be unable to continue to pursue their professional activity or other usual social activities. This global disability is due not only to cognitive disability, but also to the lack of interest and pleasure in doing it. In severe cases, life does not make sense, does not have purpose, simple existence becomes painful and the patient seriously contemplates the possibility of suicide. It is important to recognize that these clinical conditions are not a “weakness” of that particular person, but that it is a mental disorder and as such, appropriate medical and therapeutic help should be provided. What is the difference between depression and mourn? In depression, all thoughts are negative and clearly dominate the patient mental space. In mourn, self-esteem is usually preserved, while in depression, inadequate feelings of devaluation and guilt are very frequent. In mourn, people often experience sadness and / or decreased interest in the usual recreational activities. However, these feelings are limited in time and positive feelings about the memories they have of that loved one are also described. On the contrary, in depression, sadness and / or decreased interest in playful activities are persistent. The grieving process can lead to depression, but in this case the clinical picture has the characteristics of depression that are different from a simple grieving process: Cognition strongly dominated by negative thoughts; Absence of pleasure in the usual recreational activities; Overrated ideas of guilt or devaluation. The distinction between mourn and depression is crucial to identify the problem and to establish the appropriate treatment. Early diagnosis facilitates and determines the effective functional recovery and rehabilitation. How is depression treated? Most depressed people improve substantially with appropriate treatment. The choice of treatment depends on: Severity of the clinical picture; Patient preference; Presence or not of other diseases. In general, depressive conditions of moderate to severe intensity require the association of: Cognitive behavioral psychotherapy Briefly, cognitive-behavioral therapy is a form of psychotherapy that in these situations is focused on the current moment of the patient and the resolution of current problems. As such, it helps the patient to recognize distorted thought patterns and to change it, as well as the corresponding patterns of behavior associated with it. Drug treatment There are currently many drugs, antidepressants and others, which make it possible to adapt pharmacological therapy to the characteristics of depression in a particular person and to their biological characteristics, for example personal and family history, current and pre-existing diseases. After remission of symptoms, it is necessary to maintain this association of cognitive behavioral psychotherapy and drug treatment for some months, in some cases even definitively, to prevent recurrence of the disease. Other treatment options In more severe cases, which do not respond to the referred therapeutic modalities and which are a minority of cases, electrostimulation techniques may be an option, which allow to recover a significant part of these patients with depression. Electrostimulation techniques include, for example: Vagus nerve stimulation; Transcranial electrical stimulation; Electroconvulsivotherapy. How important is depression in the world population? According to data from the World Health Organization more than 264 million people of all ages suffer from depression. The prevalence of depression in the general population is 5% and depression 2 times more frequent in women than in men. Meet the psychiatry team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
