Definition of depression
Depression is a disease affecting the operation of part of the brain. It is a mood disorder defined today by physicians according to specific criteria, which has not always been the case. In public, the term refers to many situations more or less transient sadness and depression (depression), not a depression as an illness installed and lasting (more than 15 days) requiring medical care.
Risks and consequences of depression
Six to 12% of the French population have symptoms of a depressive episode characterized (the variation in prevalence is partly explained by the different measurement methods). Approximately 20% of the population is affected by depression at some point during their lifetime moment episode: women twice as much as men (HAS - recommendations for the management of complications of a depressive episode in the Adult, 2007). This figure is higher in Anadep 2005 INPES survey: 45% of respondents have experienced an episode of great sadness for at least 15 days during their life, with twice the prevalence among women men. In 12% of them this episode lasted at least one year.
But the number of patients seen is lower and the number of patients treated properly even lower. With individual and social cost: family breakdown, stoppage, termination, loss of autonomy, accidents or work.
Adds the risk of suicide: nearly 70% of people who die by suicide suffer from depression, often undiagnosed or untreated (Depression in adults, INPE 2007) and worsening of other diseases . Depression increases mortality of cardiovascular disease (myocardial infarction and stroke).
However some depression cures without medical intervention over time, when the support of the environment and personal resources are sufficient.
Causes and origins of depression
Areas of the brain that manage mood, emotions and emotional malfunction (limbic system). As they relate to areas that support memory, learning, and process information and gives it meaning (cognition), depression also leads to impaired memory, learning and intellect.
There is disruption of the secretion of neural chemical messengers that modulate emotions serotonin in particular. Such neurochemical disturbances are possible (but not systematic) when taking certain medications, as adverse. The best known of these requirements are beta-blockers, anti-ulcer (H2), methyl-dopa (against Parkinson's disease), or corticosteroids and antipsychotics ...
Symptoms of depression
Depression is persistent beyond 15 days in a table said depression with at least four of the following criteria (International Classification of Diseases - WHO). That in the absence of drug use or physical illness with psychological implications. According to the cumulative number of signs, depression is called mild, moderate or severe.
1) Presence of at least two of the following three symptoms:
- Depressed mood abnormal, almost all day, almost every day, little or not affected by the circumstances, persisting at least 2 weeks;
- Fall of interest or pleasure in normally enjoyable activities to;
- Decreased energy or increased fatigue.
2) Presence of at least one of the following seven symptoms:
- Loss of self-confidence or self-esteem;
- Feelings of guilt unjustified (excessive or inappropriate);
- Thoughts of death or recurrent suicidal ideation or suicidal behavior (whatever it is);
- Difficulty thinking or concentrating, with, for example, an unusual indecision or hesitation to act.
- Modification of physical and mental activity, either in the form of agitation, either in the form of slowing down.
- Sleep disturbance (any type).
- Net change in appetite (increased or decreased) with weight change in the same direction.
The clinical examination must achieve a total of at least 4 of the above symptoms to bring the medical diagnosis of depressive disorder in adults.
Nervous Breakdown - Prevention
Suicidal ideation are they part of the depression?
No, depression is defined by the four minimum criteria described above. But the question of suicide is always asked as a fatal complication of the disease, common but not mandatory.
The doctor always research ideas or suicidal behavior, project developed a clear intention (professional recommendation HAS). For the "suicidal crisis" is an emergency requiring immediate treatment, usually in a hospital.
What is the error not to commit?
For the doctor, ignoring a bipolar mental disorder, illness alternating depression and excitement.
For the patient, discontinue antidepressant treatment before the deadline set by the doctor. The effect is not immediate (6-8 weeks), especially in the elderly. If the treatment is effective, it continues 6 months (minimum) a year: this includes the consolidation period to prevent relapse (frequent).
Nervous breakdown - Consultation
When to see a doctor?
Once marked sadness extends beyond 15 days.
Depression is a medical emergency because of the risk of suicide and fatal negligence in acts of everyday life: the road accident, accident, accident at home.
Marked disinterest in social life causes the patient in a disinsertion serious consequences: dismissal, homelessness ...
What is the doctor?
It verifies the absence of physical illness and / or medication that could explain the depressed mood.
It takes into account a simple sadness that the patient can overcome through personal and family resources.
If it finds an installed depression (called "characterized"), he treated with antidepressants, which often adds supportive psychotherapy. He also advises a healthier lifestyle. In some severe cases, other medications may be necessary (neuroleptics).
About two-thirds of patients respond well to antidepressants if treatment is followed (at least 6 months).
In some people, depression resumes after complete remission (recurrent depression). This may require treatment to prevent relapse extending therapy to 12 months or beyond. Medical supervision for at least six months is recommended to stop antidepressant treatment to ensure the absence of relapse.
Among antidepressants, serotonin (inhibitors of serotonin reuptake inhibition with or without associated reuptake of norepinephrine) are the best known and most prescribed. They are effective in 6-8 weeks time minimum before questioning prescription.
This is especially cognitive-behavioral therapy (CBT), combined to fight against the defeatism and retrain the brain. The patient learns to see life from its good sides, to be convinced of his own worth.
Based on the collective expertise of psychotherapy, psychoanalysis and analytical inspiration therapies have not proven their therapeutic efficacy in the treatment of depression during the scientific evaluation , largely due to insufficient studies.
It includes the withdrawal of alcohol and toxic substances (drugs), and regular physical activity, which has proven its antidepressant effect. Also useful: a balanced diet, reassuring rituals (prayer for the believers), appointments with yourself (meditation, tea break) during the day to avoid the mental exhaustion.
How to prepare your visit to the doctor?
Make a summary of what's wrong: causes we see in the state (personal or collective dramas), and fears for the future.
To the point of self-administration.
A survey among relatives identifies a family vulnerability and ensure that they find the same mood.
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