Depression

Complications /Information to beware of/General tips:

Do not wait, phone for an ambulance if one have symptoms and/or develop:

• Suicidal thought
• Harm oneself
• Hallucinations

Please beware (as this could be of initial symptoms) of symptoms of:

• Anorexia/Bulimia
• Alzheimer’s/Dementia disease
• Dementia
• Niemann-Pick disease type C

This condition can lead to:

• Temporomandibular joint (TMJ) disorders
• Tinnitus

Driving Authority

• One should notify their driving authority if one has this condition/disease.

This condition may be associated and/or similar and/or confused with:

• Autism
• Asperger’s syndrome
• Borderline personality disorder
• Bipolar disease
• Attention deficit hyperactivity disorder (ADHD) and Attention deficit disorder (ADD)
• Hypothyroidism
• Dyspraxia
• Narcissistic Personality Disorder
• Seasonal affective disorder (SAD)
  • Type of depression that’s related to changes in seasons — SAD begins and ends at about the same times every year.
  • Persons with mood changes are sensitive to light changes (due to hypothalamus function in the brain):
    • Less light- lenghthens the sleep -wake cycle leading to depression.
    • More light- shortens the sleep- wake cycle leading to mania.
  • Symptoms of depression are more intense symptoms during the winter (peak symptoms usually  occur during spring  and fall months)  and less intense symptoms during the summer sapping your energy and making you feel moody.
  •  The main age of onset for SAD is 18-30 years; SAD is less likely to occur in older adults.
  • Most individuals who experience SAD are women.
  • To be diagnosed with SAD, an individual must demonstrate at least two episodes of depressive disturbance in the previous 2 years and seasonal episodes should substantially outnumber nonseasonal episodes.
  • Symptoms, including hypersomnia (excessive daytime sleepiness), increased appetite, and craving for carbohydrates( sugar). Spring/summer SAD is more frequently associated with insomnia and loss of appetite.
  • treatment is to increase light exposure in the winter and decrease light exposure in the summer:
    •  Leave bedroom curtain/shutter open (increase morning sun exposure),  use sunglasses less, seek the sun , walk during noon in the winter/spring and fall months.
    • Consider light therapy in winter months only (not spring and falls).
    • Leave bedroom curtain/shutter  closed (reduce morning sun exposure), wear sun glasses and/or wear an eye mask at night in the summer.
• Dysthymia
  • long (≥1 year) low-level depression that is marked by pessimism and withdrawal from life. While the patient is depressed or irritable, at least two of the following must be present:
    • Decreased or increased appetite
    • Insomnia or hypersomnia
    • Low energy or fatigue
    • Low self-esteem
    • Poor concentration and/or difficulty making decisions
    • Feelings of hopelessness

Subtypes of MDD: Anxious Distress, Mixed Features

• Depressive disorder with anxious distress is noted when at least two of the following symptoms are present during most days of a major depressive episode or persistent depressive disorder (dysthymia):
  • Feeling keyed up or tense
  • Feeling unusually restless
  • Difficulty concentrating because of worry
  • Fear that something awful may happen
  • Feeling that the individual might lose control of himself or herself
• In addition, depressive disorder with anxious distress can be subcategorized by severity on the basis of how many of the above symptoms are present. Current severity is as follows:
  • Mild: Two symptoms
  • Moderate: Three symptoms
  • Moderate to severe: Four or five symptoms
  • Severe: Four or five symptoms, with motor agitation
• Anxious distress has been noted as a prominent feature of both bipolar disorder and MDD in primary care and specialty mental health settings. High levels of anxiety have been associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse. As a result, accurately specifying the presence and severity of anxious distress is important, for treatment planning and monitoring response to treatment.
• Depressive disorder with mixed features is diagnosed when the following manic/hypomanic symptoms are present nearly every day during most days of a major depressive episode:
  • Elevated expansive mood
  • Inflated self-esteem or grandiosity; more talkative than usual or pressure to keep talking
  • Flight of ideas or the subjective experience that thoughts are racing
• “Other specified depressive disorders” involve presentations in which symptoms are characteristic of a depressive disorder and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any of the depressive disorders in that diagnostic class.
• Examples of presentations that can be specified using the “other specified” designation include the following:
  • Recurrent brief depression: This requires concurrent presence of depressed mood and at least four other symptoms of depression for 2-13 days at least once per month (not associated with the menstrual cycle) for at least 12 consecutive months in an individual whose presentation has never met the criteria for any other depressive or bipolar disorder and does not currently meet active or residual criteria for any psychotic disorder.
  • Short-duration depressive episode (4-13 days): This involves depressed affect and at least four of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persists for more than 4 days but less than 14 days. The individual’s presentation has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for recurrent brief depression.
  • Depressive episode with insufficient symptoms: This requires depressed affect and at least one of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persist for at least 2 weeks.
  • The individual’s presentation has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for mixed anxiety and depressive disorder symptoms.
• “Unspecified depressive disorder” is a category that applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class. The unspecified depressive disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific depressive disorder and includes presentations for which information is insufficient to make a more specific diagnosis (i.e. in emergency department settings)

Medscape

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice