A few words on depression

For over 2500 years, the affective disorders have been reported among the most frequent conditions affecting humans, but only recently have they captured the public health interest. It is estimated that depression, now on the 4th position in the general morbidity, will assume the second place (after cardiovascular diseases) before 2020. More so, WHO voices are raising concern that by 2030, depression will become the main public health problem, before cancer and heart disease. Various depressive conditions affect over 20% of women and more than 12% of men, at least once in their lifetime.

Hippocrates (460-357BC) has pictured depression as „melancholia” or the „black bile”; it was him to describe the relationship between depression and anxiety, so frequently observed nowadays. Detailed mentions appear in the writings of the ancient Greeks, who formulate the first neurobiochemical postulates of the condition.

Depression belongs to the wide spectrum of affective disorders. Today, there are many theories trying to explain the mechanisms behind the depression (neurobiochemical, neurophysiological, neuroendocrinological, behavioral, etc). The most likely is an integrative model with a complex mechanism, which includes heredity and genetics, predisposing, triggering and maintaining factors.

Recent theories try to shine a new light on the condition, presenting it as an adaptation attempt, a natural and useful response, a way to ensure survival as individual and species. Depression is widespread into the animal world. The depressed individuals (either humans, dogs or other animals) are showing a decreased interest in sexual activity and food, decreased level of energy and activity, altered sleeping patterns, decreased grooming and personal hygiene activities. As humans, we share a wide variety of depression-stimulating factors with other species (disease, famine, death of relative). The animal experiments are showing that the individuals that respond to stressful situations through hyperactivity, exploration and energy expenditure have a poorer prognosis than those who attempt to conserve energy in an environment that is hostile or is lacking the basic means for subsistence.

Some research is suggesting that the depressive mood helps saving the energy and facilitates the disconnect from impossible tasks and goals, helping the human capacity of identifying deception and unhappiness, of assessing the realistic control level we have over the environment in its all aspects.

Depression can be a needed response in particular conditions, but, most often, becomes an invalidating condition which affects profoundly the individual’s quality of life. The mechanism that helps us disconnect from dead-end situations may become a generalized status which inhibits the desire to follow any goal or interest, even those perfectly attainable.

Overall, the depression symptoms include: sad (depressed) mood, decreased pleasure and interest for persons and activities, decreased self-esteem, hopelessness, anxiety, irritability, sleep disturbances, changes of appetite and weight, health-related-worries, various somatic complains.

The evaluation and diagnosis are being handled either by the Family Practitioner or the Psychologist (through screening) or, better, by the Psychiatrist. The evaluation and diagnosis involve the use of various instruments (scales, questionnaires, interviews, observational studies). One frequently used questionnaire is the Beck Depression Inventory (BDI). Although it has its own limitations, like any self-administered test, BDI can offer fast information regarding the severity of depression; a score over 14 should be followed soon by a specialty consult.

The progression of the depressive episode is difficult to be foreseen. Some reactive episodes tend to be self-limited, after the disappearance of the triggering event. Some other forms linger towards chronicity. Generally speaking, the depression symptoms last way longer than the initial causes, and the improving of circumstances does not lead always towards symptoms resolution.

It is of major interest the presence of suicidal thoughts in the context of depression. Many patients think, plan and attempt suicide, and between 15 and 18% commit it. The rate is comparable with the suicide rate in schizophrenia. The various therapies aim towards the reduction of the suicide risk, improvement of the quality of life and prevention of recurrences.
The treatment for depression is multi-modal, and includes a plethora of pharmacological agents, psychotherapy, re-socializing and social reinsertion techniques.

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