Clinical Depression

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1.
a. List and explain three medical conditions that result in increased mortality with clinical depression.

Clinical depression is another term for endogenous depression. In clinical depression the affected individual displays enough signs and symptoms to meet the DSM-IV (the Diagnostic Statistical Manual of Mental Disorders) for depression. Clinical or endogenous depression has a fairly high mortality rate. Anywhere from 10-15% of affected individuals will commit suicide. Indi viduals who have been admitted to nursing homes have a much higher risk for suicidal tendencies within the first year.

Individuals who have been diagnosed with a major medical illness are more likely to experience clinical depression, such as:

I) myocardial infarction (heart attack),
II) diabetes,
III) Cancer or stroke

This now begs the question: While some individuals diagnosed with a major medical illness experience clinical depression, others do not. What is the difference in these individuals? (http://www.peaceandhealing.com/depression/clinical.asp).

Clinical Depression
Symptoms: Anywhere from 5-20% of individuals will experience some type or level of depression during their lives, Depression fluctuates in severity and range. Following is a list of commonly found symptoms of clinical depression. Only a few are listed, and in no way encompass all symptoms one may see. Please see the article on Depression on Peace and Healing.com, for more specific criteria to reach a DSM IV diagnosis in this area:
1. Depressed mood;
2. Anhedonia, which is a loss of interest in activities;
3. Fatigue;
4. Psychomotor agitation;
5. Restlessness;
6. Irritability;
7. Withdrawal;
8. Poor self image;
9. Excessive guilt;
10. Difficulty concentrating;
11. Poor memory;
12. Difficulty making decisions;
13. Suicidal ideation;
14. Past suicide attempts;
15. Accompanying anxiety;
16. Multiple complaints of physiological pain, chronic pain.
Causes: From the obvious environment stressors that cause depression, other areas that may elicit a depressive episode may include:
1. Impaired synthesis of neurotransmitters;
2. Strong family history of alcoholism or substance abuse;
3. Chronic disease, especially multiple diseases;
4. Migraine headaches;
5. Other physiological diseases including endocrine;
6. Peptic ulcer disease;
7. Insomnia;
8. Advancing age;
9. Recent myocardial infarction;
10. Serious illness such as cancer;
11. Retirement;
12. Children with behavior disorders, especially hyperactivity;
13. Menopause;
14. Loss in one's life;
15. Transitions in one's life (moving from one place to another);
16. Loss of peers and social networks. (http://www.peaceandhealing.com/depression/clinical_causes.asp).
Co-Morbidity of Depression and the following three conditions cause increased mortality:
1. Myocardial infarction (heart attack) - Heart Attack Warning Signs
Some heart attacks are sudden and intense -- the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:
• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath. May occur with or without chest discomfort.
• Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness (http://www.americanheart.org/presenter.jhtml?identifier=3053#Heart_Attack).
Cardiac arrest strikes immediately and without warning. Here are the signs:
• Sudden loss of responsiveness. No response to gentle shaking.
• No normal breathing. The victim does not take a normal breath when you check for several seconds.
• No signs of circulation. No movement or coughing (http://www.americanheart.org/presenter.jhtml?identifier=3053#Heart_Attack).

2. Stroke - Stroke Warning Signs
The American Stroke Association says these are the warning signs of stroke:
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause (http://www.americanheart.org/presenter.jhtml?identifier=3053#Stroke).
See article http://www.americanheart.org/presenter.jhtml?identifier=3026931

3. Diabetes and depression (see fuller explanation in response to question 2 below)

Symptoms of Depression
• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for depression. (http://www.nimh.nih.gov/publicat/depdiabetes.cfm).

Depression can strike anyone, but people with diabetes, a serious disorder that afflicts an estimated 16 million Americans,1 may be at greater risk. In addition, individuals with depression may be at greater risk for developing diabetes. Treatment for depression helps people manage symptoms of both diseases, thus improving the quality of their lives.
Several studies suggest that diabetes doubles the risk of depression compared to those without the disorder.2 The chances of becoming depressed increase as diabetes complications worsen. Research shows that depression leads to poorer physical and mental functioning, so a person is less likely to follow a required diet or medication plan. Treating depression with psychotherapy, medication, or a combination of these treatments can improve a patient's well-being and ability to ...