Emergency Live | Psychiatric emergencies management

Depression, symptoms and treatment

By Cristiano Antonino On Nov 26, 2022

Depression is a clinical condition that involves a number of issues that are not always easy to manage and affects an increasing number of people

What is depression?

It is a mood disorder that generates a sense of deep sadness, psychophysical reactivity, emotional distress and reduced psychic energy.

People suffering from this condition experience a state of desolation, bewilderment, loss of interest, negative and pessimistic thoughts about themselves, others and their future.

This condition is long-lasting and differs from mood fluctuations that anyone may experience in response to unpleasant events.

Depression can also manifest itself with varying degrees of severity and early diagnosis is essential for effective treatment.

How widespread is depression?

Depressive states are among the most common conditions in the world.

According to some data, 20-30% of adults experience at least one episode of depression in their lifetime.

The World Health Organisation estimates that by 2030 depression will be the most common disease.

More than 300 million people worldwide suffer from depression and the female sex is most affected.

In the most severe cases, it can lead to suicide.

Approximately 800,000 people take their own lives each year and suicide is the biggest cause of death in the 15-29 age group.

Although there are effective treatments for depression, less than half of those affected receive adequate therapy (in many countries the figure is 10%).

The main problem is the lack of early diagnosis; it should also not be underestimated that for many people it is particularly difficult to recognise that they are in a state of distress and to be able to seek the necessary help.

Depression: manifestations and symptoms

Depression can be characterised by a range of symptoms that can vary from person to person and it is important to specify that we can all experience similar symptoms, but the more intense, frequent and persistent the condition is, the greater the likelihood of depression.

The depressive condition generates a very deep feeling of sadness, a feeling of unbridgeable inner emptiness, a state of helplessness, apathy, with total loss of the sense of pleasure.

The characteristic symptoms of depression are:

depressed mood;
loss of interest and pleasure in normal activities;
loss of appetite resulting in weight loss or increased desire to eat, especially sweet food;
sleep disorders such as insomnia (difficulty falling asleep, repeated waking at night or waking up early in the morning) or hypersomnia (intense desire or need to sleep for a long time)
psychomotor slowness or agitation (e.g. slowing down of movements, speech or inability to sit still, relaxed, continuous hand and/or body movements)
sense of tiredness or exhaustion, lack of energy;
negative self-concept, loss of self-esteem;
excessive or inappropriate feelings of self-evaluation or guilt;
reduced ability to concentrate and pay attention;
indecision or inability to make decisions;
recurrent thoughts of death, ideas of suicide that may result in actual attempts to take one’s own life.

These symptoms may be attributable to a genuine depressive pathology (Major Depressive Disorder) or to reactive or physiological depression, i.e. depressive episodes that arise as a consequence of painful life events such as bereavement, separation, illness, panic attacks, etc.

The role of a careful and scrupulous diagnosis is therefore essential, distinguishing the level of severity, which may be mild, moderate or severe.

The Diagnostic and Statistical Manual of Mental Disorders (DSM – V) differentiates on the basis of specific symptoms between:

Disruptive mood dysregulation disorder
Major depressive disorder
Persistent depressive disorder (dysthymia)
Premenstrual dysphoric disorder
Substance/drug-induced depressive disorder
Depressive disorder due to another medical condition
Specified or unspecified depressive disorder.

Given the complexity, a distinction can be made between Major Depressive Disorder and Persistent Depressive Disorder to better understand certain aspects of it.

Major Depressive Disorder

Major Depressive Disorder (often identified as major depression) is when five or more of the symptoms occur over a period of 2 weeks, causing a change from the person’s previous level of functioning.

Depressed mood for most of the day, almost every day, hopeless feeling of sadness, irritability and psychosomatic symptoms, social withdrawal and loss of interest in almost all activities.

Persistent Depressive Disorder (dysthymia)

Persistent Depressive Disorder differs from major depression in the presence of a depressive symptomatology of lesser but constant severity, in particular the deflected mood is present almost every day for at least 2 years.

In this case the lived experience of sadness is more integrated into the patient’s current events and life history and is persistent, with a sometimes intermittent and irregular course, but with relatively short intervals of normality.

The symptomatological picture is not as severe as in major depression and in particular differs from the latter in the following characteristics

the feeling of sadness and desolation is more similar to the reactive feeling of a loss than to the endogenous feeling that characterises the episode of major depression;
the symptomatology is more varied;
psychomotor functions do not reach marked alterations;
there is greater dependence and reactivity to external and environmental situations;
the duration is variable and the course is chronic.

Risk factors and prevention of depression

Depression is the result of a complex interaction of elements.

Research shows that the causes of depression can be traced back to two main risk factors

the biological factor, i.e. a genetic predisposition
the psychological factor, i.e. the experiences and behaviour learned during one’s life.

People who have gone through particularly adverse events in the course of their lives, such as bereavement, trauma, are at a higher risk of developing a depressive state.

In addition, depression is also linked to an individual’s general health condition; 25 out of 100 people who suffer from an organic disorder also suffer from depression.

Treatment: how depression is treated

The treatment of depression involves the integration of various interventions that aim to address the pathological condition in relation to the level of severity.

Outpatient medical treatment

An initial discussion to receive adequate information about the meaning of the disorder, its clinical features and the possible need for treatment can take place in an outpatient medical setting.

Psychotherapy

Psychotherapy is one of the fundamental tools for supporting patients suffering from depression.

There are different approaches that demonstrate great effectiveness, such as Strategic Therapy, Systemic-Relational Therapy and Cognitive-Behavioural Therapy.

In less severe cases, a good psychotherapeutic course is sufficient, whereas in cases of severe depression, psychotherapy must be accompanied by an appropriate pharmacological treatment, with constant monitoring of the progress of the two therapeutic processes.

Pharmacological therapy

The most commonly used classes of antidepressant drugs today are:

serotonin reuptake inhibitor antidepressants (also called SSRIs);
serotonin and noradrenaline reuptake inhibitor antidepressants (also called SNRIs);
antidepressants with specific noradrenergic and serotonergic action (also called NaSSAs)
tricyclic antidepressants (TCAs);
noradrenaline reuptake inhibitor antidepressants (also called NRIs);
others (trazodone, agomelatine, vortioxetine).

Psychopharmacological treatment with antidepressants should be commenced after careful medical assessment based on the clinical picture and subjective tolerance, keeping the possible occurrence of side effects under control.

Hospitalisation

Hospitalisation is required in the absence of family, social or environmental support, in cases where the symptomatological conditions are extremely severe and show a high suicide risk.

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