Treatment And Diagnosis Of Depression

Diagnosis Of Depression Although depression causes physical symptoms, such as changes in sleep and appetite, there is no test or laboratory test that detects specific changes (called biomarkers) that can be used as a diagnostic method. Laboratory tests are generally required for the differential diagnosis, ie, to exclude diseases that can cause depression. The method for diagnosis of depression is the diagnostic interview with the patient, wherein the investigating physician: Symptoms of the patient history Family history Differential diagnosisrnWhenever possible, the doctor seeks to complement the information with the family report. Depression can be difficult to distinguish from normal sadness, particularly in the case of bereavement or physical illness. In addition, a person may be depressed, without presenting any symptoms of depression. Some people have few symptoms, others have many. Symptom severity varies from person to person and also over time. Diagnosis depends on finding a pattern of clinical abnormalities accompanied by depressed mood and the degree and duration of the impairment associated. The differential diagnosis must be made with other mental disorders in which depressive symptoms occur, such as anxiety disorders, schizophrenia, eating disorders, personality disorders and abuse or dependence on alcohol and drugs. Furthermore, various clinical conditions and drugs can cause depression (see below). In these cases, treatment and control of the appropriate key is associated condition, the treatment of depression. Diagnostic Criteria for Depressive Episode For the diagnosis of a depressive episode ICD-10 or DSM-IV is required the realization of at least 5 to 9 symptoms (listed below), with a compulsorily depressed mood or anhedonia, present in most of the time lasting minimum of 2 weeks and significant impairment of social activity, occupational and other: * Depressed mood most of the time, almost every day; * Loss of interest or pleasure (anhedonia) on all or nearly all activities (including sexual activity) in most of the time, almost every day; * Change in appetite and / or loss or weight gain when not dieting (+ / - 5% of body weight in one month); * Insomnia or hypersomnia nearly every day; * Psychomotor agitation or retardation nearly every day; * Fatigue and loss of energy nearly every day; * Feelings of worthlessness or excessive or inappropriate guilt; * Diminished ability to think or concentrate, or indecisiveness, nearly every day; * Recurrent thoughts of death (not just fear of dying), ideas or attempted suicide. rnFurthermore, the symptoms should not be direct physiological effect of substance (drug or drugs) or attributable to the clinical condition (such as alcoholism or hypothyroidism) or be attributable to grief. Treatment Of Depression The main goals of treatment of depression are:rn1. Eliminate the symptoms and restore psychosocial and occupational activity to the pre-symptomatic.rn2. Reduce the probability of relapse and reoccurrence. rnThe treatment must Eliminate the symptoms improve occupational functioning, interpersonal and marital Reduce the potential for suicide rationalize resources (reduce use of health services) to improve long-term evolution Potential adverse effects which should be avoided include Side Effects of Medical Complications Worsening initial condition Excessive time for the purpose terapeuticao ExpensivernThe optimal treatment should be acceptable for most patients, expected to be effective and produce minimal side effects. rnAntidepressant Treatment Modalities The formal treatments for depression are pharmacologic treatment with antidepressants Psychotherapy Combination of drugs and psychotherapy Electroconvulsive therapy (ECT). Each treatment modality has benefits and risks should be carefully evaluated in choosing the best option for each patient. Second treatments. and 3a. line are considered in certain cases, if the first-line treatments are contraindicated, ineffective or inappropriate. Antidepressants are a heterogeneous group of drugs with therapeutic effects in common, the most important of which are in depression. However, most of these drugs are also effective in the treatment of panic and other anxiety disorders, some are also effective in OCD (obsessive-compulsive disorder) and other condicoes.Nao not know the exact mechanism of action of antidepressant drugs. It is known that they interact with monoaminergic cerebral neurotransmitter systems, particularly serotonin and norepinephrine. rnAntidepressants are conventionally subdivided into Tricyclic antidepressants (TCAs) Antidepressants Selective Serotonin Reuptake Inhibitors Serotonin (SSRI) Non-selective MAOI antidepressants Selective Others. The tricyclic and nonselective MAOIs are older antidepressants. Interact with both serotonin and norepinephrine with, are more potent and more effective in severe forms of depression. However, they have more side effects and overdose are cardiotoxic (potential risk in patients with suicidal tendencies). Furthermore, they are highly variable dose (one dose is tapered individually) and to be gradually and slowly introduced. Particularly MAOIs because of its toxicity and risk, are reserved for refractory patients. The newer antidepressants such as SSRIs and others (bupropion, mirtazapine, reboxetine, and venlafaxine) have a more favorable profile of side effects, ease of administration (doses less variable). For this reason, are preferable to tricyclics as the first option, particularly in patients more sensitive or high risk, such as the elderly or patients with physical illnesses. On the other hand, are generally more expensive.