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Depression is a common disorder. In severe
cases, depression may be fatal and is highly amenable to treatment by physicians.
Symptoms
Symptoms include: loss of ability to experience pleasure or feeling depressed. In
addition, at least four minor symptoms are usually present. They include:
Sleep Disorder (early awakening or excessive sleep)
Motivation to take an action
Hopeless, helpless, worthless feelings
Fatigue in morning, may improve in evening
Concentration difficulties (includes short-term memory problems)
Overeating or undereating
Irritability, anxiety, slowed speech and movement, or depressed affect
Suicidal ideation or plans
Diagnosis
Diagnosis is made based on the symptoms specified above. Ina ddition many patients also
present with physical complaints. For example, persistent pain, such as headache or
backache, is common. Frequently, periods of depression alternate with periods of mania
(feeling "high"). The elderly tend to have more physical complaints and may have
paranoia or agitation when depressed. In children and adolescents, school avoidance,
separation anxiety, irritability or aggressiveness, promiscuity, drug abuse, or school
problems are signals for possible depression. The presence of substance abuse, alcoholism,
coexisting anxiety (especially panic disorder), a history of mania, and being single
increases the possibility of suicide. Suicide attempts, threats, frank suicidal plans,
psychosis, mania, and treatment failure require an immediate consultation with or referral
to a psychiatrist.
Treatment
A. Medication: Antidepressants. Successful treatment of depression depends on the issues
of medication selection, side effects, cost, dosing regimens, and proper follow-up.
Popular medications include the tricyclic antidepressants, the heterocyclic
antidepressants, and serotonin reuptake inhibitors (SRIs). Side effects are common. Most
are pesky and go away with continued use or with dosage adjustments. An appropriate
medication trial is 4–6 weeks. In patients over age 65, half the usual dose and
slower dose adjustments is the rule.
B. Counseling: Psychotherapy sessions with a licensed psychiatrist.
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