What do we know about depression

Given that more than 20 percent of the population will experience depression at some point in life, you would think that we should know just about everything there is to know about this disorder.

The human brain is still uncharted territory in many ways and we continue to learn new things all the time about its biology and the conditions that affect it including depression.

Obviously, we know the symptoms of depression include more than simply feelings of sadness. Symptoms can include emotional ones such as sadness, but can also involve feelings of anxiety and irritability, but can also involve a range of physical effects including headaches, back ache, gastrointestinal trouble, disrupted sleep and appetite changes to name only a few.

Truly, depression is a systemic disorder that stems from our brain and affects virtually all aspects of our health.

Aside from what depression looks like, we also know it is a chronic condition that can often be lifelong and we have discovered a variety of treatment methods that seem to be effective in dealing with it.

A recent seven year study in the United States examined a clinical sample of depressed patients from both primary care and psychiatric settings to evaluate treatment outcomes. The study compared various treatment scenarios including strategies that are used when a first treatment is not sufficiently effective.

This study confirmed that depression is often chronic, severe and associated with substantial co-existing general medical and psychiatric health concerns.

Two thirds of patients surveyed for this study had at least one other general medical condition and two thirds also had at least one other psychiatric disorder. Almost 40 percent of individuals in this study experienced their first episode of depression before the age of 18 and more than half met criteria for a coexisting anxiety disorder.

A genetic aspect to depression was also confirmed as more than half of patients reported a mood disorder in at least one first degree relative.

Patients from a primary care setting only had slight clinical differences from those taken out of a psychiatric setting. There were slightly higher rates of prior suicide attempts among those from a psychiatric setting and slightly higher rates of general medical conditions among those in primary care.

One distressing discovery in this study was that there is a very large discrepancy between what we know to be true about treating depression and what is actually done in practice.

As a medical community we insist that complete remission of symptoms is the goal in treatment, but in practice symptoms are not often measured to ensure remission does occur. This is in spite of knowledge that simply improving symptoms without completely getting rid of them consistently leads to a worse long term prognosis than full remission.

Finally, this study showed that treatment usually takes longer than expected to reach response or remission. One third of those who ultimately did respond to treatment or reach remission did so after six weeks of treatment rather than the three weeks that is generally expected.

Itemized symptom measures that are always used in clinical research, but seldom in clinical practice might well detect a benefit that many patients may not report or be aware of if asked for their impression of treatment response. If such a benefit is recognized in spite of the patient’s lack of awareness, it is important to continue the treatment for a longer period rather than prematurely switching or discontinuing.

It is important not to give up on finding effective treatment for your depression. Give your treatment time to work and continue to seek alternatives if the first one is not effective for you. Leaving symptoms untreated can lead to more disability and worse symptoms that become harder to treat over time.

Okanagan Clinical Trials currently has an ongoing study in depression. If you would like more information or to schedule a free, no obligation medical assessment, please contact our office for more information.

 

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