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Common Symptoms of Depression?

Q.According to the World Health Organization, depression will be the most debilitating disease in the developing world by the year 2020. Already, about 5.7% of Canadians aged 18 and over, or 1.1 million people, suffer a clinical depression during a 1 2-month period, representing $3.5 billion to $4 billion annually in health care costs and lost income. Still, less than half of those suffering depression seek help. Royal Ottawa Hospital psychiatrist-in-chief Dr. Yvon Lapierre, who is director general of the Institute of Mental Health Research, and professor and chairman of the department of psychiatry at the University of Ottawa, tackles some of the most asked questions surrounding depression. Dr. John McDonald, who has a full spectrum family practice in Paris, Ont., and who sits on the Ontario Medical Association commit tee on mental health, offers the family practitioner's point of view.

A.The presentation of depression in family practice is somewhat different than that presenting in a psychiatric practice, mainly because the symptoms leading a patient to consult a primary care physician are of a physical nature. The symptoms may actually be a physical facade to rationalize the need to seek out and talk to a physician. In contrast, the patient consulting a psychiatrist de novo or as a referral has usually progressed further in the illness and may have developed an acceptance of the emotional component of depression. Typically, the symptoms presented as the main complaint to the primary care physician are fatigue and sleep disturbances. The fatigue is seldom related to exertion and can usually be recognized as being of a psychological nature. The sleep disturbances can be quite variable but the classical presentation is late-night or middle-of-the-night insomnia. A patient who awakens for no reason after a few hours of sleep should raise the physician's level of suspicion that a mood disorder such as depression may be involved. Once the initial presenting symptoms have been explored, it is essential to go on to a more detailed history and examination for other symptoms of mood disorder. The hallmark symptom of depression is anhedonia, or the inability to seek and enjoy pleasurable experiences. These experiences usually involve most aspects of daily living such as our basic appetites for food, sexual satisfaction, personal interaction, and the pleasure of accomplishing things such as with work. A second group of symptoms evolve from cognitive difficulties which lead to problems with concentration, and with appreciating and solving problems in a realistic manner. The appreciation of objective reality becomes distorted by a negative tone to all perceptions of the world, leading to a pessimistic and hopeless outlook for the future. A third group of symptoms evolves around a disturbance of regulatory hypothalamic mechanisms. These are identified through a diurnal variation in mood and activity level. The disturbances in the regulatory mechanisms affect the menstrual cycle and produce shifts in sleep patterns. In addition, a number of biological functions deteriorate, such as appetite, with its consequent weight loss. The DSM-IV lists the cardinal symptoms of depression and has by convention established the necessity of at least five of the cardinal symptoms being present for a duration of at least two weeks. It is important to maintain the proper perspective on these "checklists" for diagnosis; they are a guide to a confirmation of a clinical diagnosis and are not a diagnostic tool per se. They are really not meant to supersede a good clinical evaluation, but rather to assist in its confirmation DSM-IV DIAGNOSTIC CRITERIA FOR MAJOR DEPRESSION Five of nine symptoms present during the same two-week period: * Depressed mood most of the day, nearly every day * Diminished interest or pleasure in almost all activities * Significant weight gain or loss * Insomnia or hypersomnia nearly every day * Psychomotor agitation or retardation nearly every day * Fatigue or loss of energy nearly every day * Feelings of worthlessness or guilt * Diminished ability to think or concentrate, indecisiveness * Recurrent thoughts of death or suicide

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