Studies indicate that 15-30% of adults in the general population experience depressive episodes often of moderate severity at some time in their lives. While many individuals will be seen by their family physicians and G.P`s, only only a minority of people with clinical depression seek professional health from psychologists, psychiatrists, and other mental health workers. Because of difficulties in gaining access to treatment, financial disadvantages, stigma and shame etc., most people suffering from depression do not receive professional help.
Symptoms of Depression
Clinically, people with depression almost always experience one or more of the following symptoms
1) Depressed mood characterized by reports of feeling sad, low, blue, despondent, gloomy, hopeless etc.
2) Inability to experience pleasure
This symptom is almost universal in that almost all people report that previous sources of gratification such as food sex, hobbies, sports social events or time spent with children family or friends no longer provide pleasure
3) Loss of energy, fatigue
This is also associated with reduced social, familial, occupational and sexual activity and feelings of being run down, of heaviness in the arms and legs and of energy being drained from the body. Often these feeling states are interpreted as nervous exhaustion, overwork, nervous breakdown, or vitamin or nutritional deficiency. In severe forms the person may believe, sometimes with delusional intensity, that she is suffering from a life threatening malady such as AIDS
4) Retardation of speech, thought and movement
Psychomotor retardation manifests as slow physical movements. Speech is slower and reduced in volume, answers to questions are delayed, and content of the verbal response is sparse (yes or no answers). Depressed patients often complain of diminished ability to think or concentrate with complaints and often experience mixed up thoughts
5) Changes in appetite, usually weight loss
Approximately 70% of patients experience loss of appetite and weight loss.
A minority, especially younger patients with milder forms of depression may experience an increase in eating often in the evening and at night
6) Sleep disturbances, usually insomnia
Depressed individuals may have difficulty in falling asleep with ruminations (thoughts about events and experiences that won’t stop and endless re-examination of details of life circumstances). Others may awaken early in the morning or be awakened in the middle of the night by frightening dreams or uncomfortable body sensations. Not surprisingly, they often feel tired throughout the day
7) Bodily complaints
This symptom involves complaints that include headaches, neck-ache, back pain, muscle cramps, nausea, vomiting, constipation, heartburn, indigestion, gas, blurred vision etc.. In fact, almost every organ may be involved often leading family physicians to prescribe expensive medical tests and work-ups
8) Agitation (increased motor activity experienced as restlessness)
With this symptom there is increased psychomotor activity experienced as ego-alien (i.e. why is this happening to me) and typically reported as restlessness or tension. The person may complain of being unable to relax or sit still, or being fidgety
Efforts to release this tensions are often seen in the wringing of the hands, nail biting, or increased smoking.
9) Decrease in sexual interest and activity
Impotence in men is a frequent distressing symptom that may aggravate marital tension and further diminish a persons self-esteem.
10) Loss of interest in work and other activities
Although loss of interest may occur the persons actual level of performance may not fall. In severe states the depressed person may be unable to assume his ordinary responsibilities or family role claiming nervous exhaustion or inability to cope.
Persistent feelings of inadequacy and inferiority are often present during an acute depressive state. This especially troubling when the patient feels that family members, friends and work associates also feel this way about them.
12)Feelings of helplessness
In more severe depressions patients complain they cannot cope even with simple tasks of dressing, self-care or grooming. Parental, household or occupational tasks are even more difficult to negotiate
Handicapped by feelings of low self-esteem and helplessness, depressives patients also report feeling pessimistic and hopeless. In addition to fears and worries about health, finances, family affairs and their careers, such patients tend to anticipate misfortune, experience gloom and forecast doom.
In its most severe form despair may be all encompassing and may be associated with suicidal thoughts and acts.
Among patients with recurrent depressions death by suicide occurs at the rate of about 1% per year. The highest period of suicidal mortality occurs 6 to 9 months after symptomatic improvement has occurred. In these instances the patient’s apparent symptomatic improvement reflects an inner decision to commit suicide and the outer calm covers the further development of plans for self-destruction.