Clinical Depression --various Types
Q: Detection and Diagnosis systematically reviews the diagnosis of
depressive and other mood disorders, according to the current U.S.
standard system in Diagnostic and Statistical Manual of Mental
Disorders, Third Edition, Revised (DSM-III-R) (American Psychiatric
Association, 1987). The disorders reviewed include both unipolar forms
of primary mood disorders (e.g., major depressive disorder, dysthymic
disorder), depression not otherwise specified (DNOS), and bipolar forms
of primary mood disorders (e.g., bipolar I disorder, bipolar disorder
not otherwise specified, cyclothymic disorder). The co-occurrence of
depression with other nonmood psychiatric disorders and with other
nonpsychiatric medical conditions is also considered, as is depression
caused by medications. Finally, the guidelines offer a strategy for
making a differential diagnosis of depression, including risk factors
and clinical clues, use of laboratory and psychological tests, and
ongoing clinical reassessment.
A:A clinical depression or a mood disorder is a syndrome (a constellation
of signs and symptoms) that is not a normal reaction to life's
difficulties. Mood disorders involve disturbances in emotional,
cognitive, behavioral, and somatic regulation. A sad or depressed mood
is only one of many signs and symptoms of clinical depression. In fact,
the mood disturbance may include apathy, anxiety, or irritability in
addition to or instead of sadness; also, the patient's interest or
capacity for pleasure or enjoyment may be markedly reduced. Up to one in
eight individuals may require treatment for depression during their
lifetimes; up to 70 percent of psychiatric hospitalizations are
associated with mood disorders. According to data based on a 1980
population base, the total number of cases of major depressive disorder
among those 18 or older in a 6-month period is 4.8 million; in addition,
over 60 percent of suicides can be attributed to major depressive
disorder.
Based on 1980 data, mood disorders account for more than 565,000
hospital admissions, 7.4 million hospital days, and 13 million
physicians' visits annually. The total cost of mood disorders to
society, including indirect costs that result from lost productivity, is
estimated to be $16 billion annually. In addition to economic costs,
depression can carry great personal costs because of the social stigma
associated with diagnosis and treatment of a mental illness. This stigma
likely plays a large role in patients' reluctance to seek, accept, and
adhere to treatment. Yet, when identified, depression can almost always
be treated successfully, either with medication, psychotherapy, or a
combination of the two. The potential savings to be derived from the
appropriate treatment of persons suffering from depression are socially
and economically significant.
The high prevalence of depression and the success of available
treatments prompted the need to develop a guideline to assist primary
care providers (general practitioners, family practitioners, internists,
nurse practitioners, registered nurses, mental health nurse specialists,
physician assistants, and others) in the diagnosis of depression. The
Depression Guideline Panel that prepared these guidelines is composed of
experts from various mental health and primary care disciplines and a
consumer representative, selected for their range and diversity of
expertise. The guidelines are based on systematic literature reviews
commissioned by the panel and conducted by experts in numerous areas
relevant to depression, with special attention to clinical issues most
pertinent to diagnosis and treatment of depression in primary care.
Guideline development also included input from a broad range of
professional and consumer organizations and individuals. The guidelines
have undergone peer review and field review with intended users in
clinical sites to evaluate the document both conceptually and
operationally.
The panel did not review the material