Seligman (1973) referred to depression as the ‘common cold’ of
psychiatry because of its frequency of diagnosis. According to BPS
figures a staggering 9 million people in Britain reported feelings of
depression to their GP in 1998! However to continue Seligman’s analogy,
although this ‘cold’ may have reached epidemic proportions in the West
it is certainly not pandemic since many cultures and areas of the World
report little or no depression
Characteristics of
depression
Depression is an affective disorder in that it is characterised by
disturbances of affect (or mood). During the course of any period of
time it is not unusual for a person’s mood to alter. However with
affective disorders this variation is more marked and is accompanied by
other symptoms.
These symptoms of depression do vary; the DSM-IV recognise three main
types of depression, only two of which will be mentioned here, and only
one of which will be covered in detail. A possible 6 mark question on
the paper could ask you to describe the symptoms or characteristics of
depression. Clearly ‘feeling sad’ is not going to earn you very much
credit!
Emotional symptoms
The symptoms we most associate with depression, those feelings of
sadness, loss of mood and loss of pleasure from what were previously
enjoyable activities. Mood may also alter during the course of the day,
typically being lowest in the morning and gradually showing improvement
as the day progresses. This may be associated with circadian rhythms
Physical symptoms
Disturbances of sleep: patients sometimes report insomnia, but sleeping
longer than before is also common, perhaps as patients attempt to escape
their problems.
Appetite can also decrease or it may increase in the form of comfort
eating. Part of this may be due to boredom since typically depressed
people tend to have lower activity levels.
Motivational symptoms
Apathy and loss of drive are common. Typically the depressed person
will sit around waiting for things to happen, making no attempt to
initiate activity or social contact. This could be because they don’t
want people to see them in a depressed state.
Cognitive symptoms
These can vary from negative self thoughts, loss of self esteem and self
confidence, feelings of despair and hopelessness, inability to
concentrate on tasks for any length of time to feelings of inadequacy
and blaming themselves for their situation and on occasions and suicidal
thoughts.
Demographics
Age of onset of depression appears to have fallen in the second half of
the twentieth century. Increasingly adolescents are beginning to
display symptoms of depression. If depression goes untreated then each
bout typically lasts about six months, although this can be reduced to a
more typical three months following treatment.
Women are up to four times more likely than men to be diagnosed with
depression and we’ll consider possible reasons for this later. Up to 9%
of women are diagnosed with depression compared to only 2 0r 3% of men.
About 10% of patients diagnosed with unipolar depression will commit
suicide.
|
 |
Famously Sir
Winston Churchill suffered from manic depression and referred to
his low moods as his ‘Black dog.’ |
Bit of trivia
for those of that persuasion: this particular photograph,
perhaps the most famous of Churchill was taken by the great
*Karsh of Ottawa. Legend
has it that having problems getting the picture he wanted he
leaned forward and pulled the cigar from Churchill’s mouth.
This was the result!
*Yousuf
Karsh, although always referred to as ‘Karsh of Ottawa’ was
actually born in Armenia!
Diagnosis
For a formal diagnosis of depression to be made the patient needs to be
suffering from low mood (most of the day, nearly every day for at least
two weeks) and or loss of interest and pleasure together with four of
the following:
|
Category |
Symptom |
|
Sleep |
Like some of
the other symptoms this can swing either way. Sometimes
patients report insomnia, other times a desire to sleep all the
time |
|
Eating |
As above,
sometimes patients lose their appetite resulting in weight loss,
others engage in comfort eating and show noticeable weight gain. |
|
Activity |
This usually
decreases (except during a manic phase of bipolar) and patients
can be lethargic. To be diagnosed this needs to be observable
rather than just the patient feeling there’s been a change.
|
|
Energy |
Usually
energy levels take a sharp decline with general lack of interest
|
|
Feelings |
A major
symptom is the negative feelings experienced by most patients.
These can be about self, World, future (see Beck) |
|
Cognition |
Usually
manifested by difficulties holding concentration |
|
Death! |
In the more
severe cases of depression, recurrent thoughts of death and/or
suicide. |
All of these in the absence of bereavement.
Also as with schizophrenia, symptoms and severity vary between
patients. Some unipolar patients experience delusions and
hallucinations (more common in bipolar). Many patients don’t respond to
SSRI or MAOI drug treatments whereas others do. Sometimes patients
diagnosed with depression will respond better to a combination of
antidepressants and anti-psychotics such as chlorpromazine. This all
tends to suggest that like schizophrenia, major depression should not be
seen as a unitary disorder but rather a collection of related disorders
with some overlapping symptoms, but with different causes and
prognoses.
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