• The World Health Organization (WHO) estimates that over 19,000,000 people each year experience depression.
  • Depression occurs in people of all ages, socio-economic strata, tribes and educational levels.
  • One in four women and one in 10 men may develop depression during their lifetime.
  • 69% of depressed patients show signs of physical or somatised symptoms (chest pain, fatigue, gastrointestinal upset).
  • Patients with severe organic disease (cancer, diabetes, stroke, myocardial infarction) may suffer a high rate of depression.
  • 90% of depressed patients show signs of anxiety.
  • Depression in the elderly is the most common mental disorder, as 10-34.5% of the elderly may experience depressive symptoms, particularly with atypical symptoms (masked depression). Fatigue, diffuse pain in various parts of the body, gastrointestinal disturbances, giving up daily habits or actions, sleep disorders (special attention to pharmacotherapy due to existing pathologies or other diseases).
  • In elderly men, according to statistics, the risk of suicide is particularly high.

Psychotraumatic life events

Often, just before the onset of the depressive episode, psychotrauma (stresogenic) events take place, such as:

  • Loss of a loved one (due to death or separation)
  • Violent Attack (Sex Attack, Robbery, Abduction, Hostage)
  • Serious road accidents
  • Diagnosis of a life-threatening disease
  • Physical or human-induced disaster
  • War-terrorist attack
  • Torture

Clinical Forms of Depression

  • The main forms of depression are the following:
  • Major depression
  • Mild or minor depression
  • Distraction/Dysthymia
  • Postpartum Depression
  • Manic-depressive disease spectrum.

Diagnostic Criteria

To determine the diagnosis, there must be one of the first two main symptoms and at least four of the remaining seven of the list below:

  1. Depressed emotion (disproportionate to current life events and frequent daily fluctuations),
  2. Reduced interest and pleasure (anonecnia)
  3. Changes in appetite, which lead to weight loss or weight gain not related to diet,
  4. Insomnia or hypersomnia (typically younger people usually have difficulty sleeping while the elderly wake up too early)
  5. Psychokinetic anxiety (nervousness, anxiety, hypertension) or psychokinetic deceleration
  6. Feeling fatigue (especially in the absence of a real physical reason) and / or loss of energy
  7. A feeling of deprecation (unrealistic depiction of the self and the environment) and / or unjustified-excessive guilt,
  8. Reduced ability to concentrate and think (memory problems), indecision
  9. Self-destructive idea (suicidal ideas, attempts).

Any symptom must be present for at least two consecutive weeks for most of the day, almost every day.

Intense strenuous psychosomatic disorders such as headache, back pain, cardiovascular and gastrointestinal symptoms, supplement the clinical picture of depression.
The probability of subsequent episodes of major depressive disorder is 50-60% after the first episode, 70% after the second episode, and 90% after the third episode.

Mild or minor depression

Its symptoms are milder than those of the major. These differences are described as following:

  • The depressed feeling is softer.
  • There are often “neurosis” symptoms (anxiety, irritability, excessive physical symptoms).
  • The risk of self-destruction is much smaller or totally absent.
  • Low self-esteem and the patient opposes to others (hemorrhaging).
  • There is usually no weight loss.
  • There are usually no disturbances in sexual desire.
  • Appearance and behavior do not resemble a depressed patient (for example, it does not have slowness in movements, sad expression, neglected dressing).

Dysthymic Disorder

Chronic, low-intensity, depressed mood that lasts for at least two years, most days and most of the day.

  • They are murmuring, pessimists with “absolute and dogmatic” way of thinking, indecisive and introspective personalities.
  • One third of patients may develop into major depression.
  • 3 times more common in women than in men.
  •  It’s hard to diagnose.
  • It damages the quality of life significantly.

Postpartum Depression

Women with postpartum depression love their babies just like the other ones, but they are overwhelmed by excessive anxiety and ideas of self-confession and worthlessness (responding to the role of “right”, “worthy”, and “responsible” mothers).

It is related to the change in neuro-hormonal factors, often seen in women with premenstrual dysphoric disorder and, depending on the intensity of the symptoms, the treatment is necessary (when the condition is too severe, the patient should be hospitalized in a clinic to get treatment, especially if There is a risk of “harming” her or her own baby).

How to diagnose?

The symptoms of the patient are often not so severe or obvious enough that they can easily be attributed to a depressive disorder.

First of all, the physician should consider the possibility of an organic basis of the reported symptoms (pathological conditions such as stroke, multiple sclerosis, hypothyroidism and drugs such as opioids, cardiological medication, diazepam, cimetidine, contraceptives and corticosteroids).

Similar Clinical Situations with Depression

Chronic fatigue, chronic pain, headaches, gastrointestinal disorders and sleep disturbances.

Disturbances that coexist

Anxiety disorders, abuse of psychoactive substances, personality disorders, mourning, somatic-pathological disease, eating disorders, sexual dysfunction.

Modern Therapeutic Approache

Depressive episodes often recur, especially when treatment is impaired or prematurely interrupted, and may reappear throughout life.

Cognitive-Behavioral Psychotherapy on an individual basis and / or in a group therapy is a treatment in mild, moderate and / or severe depression, since it is well combined and complementary to medication.

Interpersonal Psychotherapy (IPT) focuses primarily on dealing with a loved one’s death (mourning process) and within a short time it has great results.

Of course, the classic therapeutic approach is also in the field of medication, since technology offers new substances of direct efficacy, high safety and a particularly favorable adverse reaction profile. The challenge is to persuade the patient to take the treatment for 9-12 months in principle in order to feel better and prevent recurrences and minimize the risk of recurrence of the disease with continuous reassessment by the therapist.

It is the second generation of newer antidepressants (SSRiS, SNRiS, NaSSA),  which now holds a dominant position, having the same efficacy as the older tricyclics (TCAS), but without their side effects such as e.g. Constipation, urinary disorders (in prostate hypertrophy), dry mouth, increase in intraocular pressure, confusion, and memory disorders, tachycardia, supression, weight gain etc.

It is worth noting the results of the study of the Professor of Clinical Psychology and Psychiatry at University of Verona, A. Cipriani and his collaborators recently published in the Lancet Review (issue 373, pp. 746-758, March 2009).

117 randomized trials of a total of 25,928 patients, from 1991 to November 30, 2007, were reviewed in order to draw specific conclusions on the efficacy of second generation antidepressants for urgent treatment of unilateral major depressive disorder in adults.

We compared 12 newer second-generation antidepressants and the researchers concluded that HCL sertraline may be the best option for initiating the treatment of adult patients with moderate to severe major depressive disorder as it has the best balance between (therapeutic) effect, acceptance on behalf of patients, relatives and therapists) and costs (from the insurance funds).

In conclusion, patients and relatives gradually relieved from the stamp of social stigma should seek scientifically proven treatment approaches by experts for depressive illness, which is treated in the majority of cases.