Depression - Part II
Barney M. Davis Jr., MD, Godspeed Missionary Care

In the first portion of this discussion on Depression, we looked at the types and causes of the illness of depression, and the likelihood of a person's suffering from this type of disorder. In this portion, we will look at the symptoms of different types of depression, and the natural course of the illness. In a subsequent segment we will examine the different types of treatment available.

Symptoms of the illness of depression have been grouped into those which must be present to make the diagnosis and those which may be present. The two symptoms which must be present are

  1. having a depressed mood most of the day, nearly every day, and
  2. diminished interests or pleasure in activities.

The pervasive aspect of the depressed mood is what distinguishes the illness of depression from the less severe "blues" of normal life, which, while causing intense discomfort, are usually transient and short lived; a person with the normal "blues" can often distract from discomfort with hobbies and other interests, while the person with clinical depression feels bad persistently, and loses interest in those things which used to give pleasure.

Other symptoms may include decreased appetite with significant weight loss (usually defined as more than 5% of body weight in one month), difficulty sleeping, increased restlessness, fatigue or loss of energy, feelings of worthlessness or inappropriate guilt, indecisiveness and difficulty concentrating, and recurrent thoughts of death, with thoughts of suicide (thoughts of suicide without intent are known as "suicidal ideation", and can occur spontaneously).

It should be noted that all of these symptoms can occur normally in circumstances of bereavement, where someone suffers a close personal loss. In that situation, the symptoms usually subside gradually over several months.

While these are the most common types of symptoms seen in depression, a significant number of people have what are called Atypical Depressive Symptoms. People with atypical depression may have mood reactivity (the capacity to be temporarily cheered up), overeating with weight gain, excessive sleepiness rather than the more common insomnia, heavy limb sensation, and extreme sensitivity to feeling interpersonal rejection. Atypical depression often happens with a seasonal pattern. While the symptoms may be "atypical", the depressed mood and loss of interests and pleasure are every bit as intense and pervasive.

Depression can manifest itself in other ways than just causing emotional distress and changes in behavior. The effects of depressive illness, in addition to effects on mood and thinking, can be significant: depressed patients have a higher incidence of chronic fatigue syndrome, irritable bowel syndrome, chronic back, chest, and pelvic pain, and migraine headaches. The death rate for depressed people more than 55 years of age is increased four-fold, and the risk of death from suicide is 15%.

The natural course of depression shows that depression can last for months or even years. If depression is not treated, after one year 40% of patients have recovered, 20% have partially recovered, while 40% remain depressed. The likelihood of recurrence is significant; after one episode of depression, 50% will have another episode. Of those that have a second episode, 70% will have a third, and for those unfortunate enough to have three episodes, 90% will have even more episodes. This tendency for increasing risk of recurrence with more episodes is what makes proper treatment of initial episodes very important.

Depression, Part III

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