Depression is a common, serious and
costly illness that affects 1 in 10 adults in the U.S. each year,
costs the Nation between $30-$44 billion annually, and causes
impairment, suffering and disruption of personal, family, and work
life. Though a majority of depressed people can be effectively
treated, two out of three of those suffering from this illness do not
seek or receive appropriate treatment.
Of particular significance, depression
often co-occurs with medical, psychiatric, and substance abuse
disorders. When this happens, the presence of both illnesses is
frequently unrecognized and may lead to serious and unnecessary
consequences for patients and families.
When depressive illness is a
co-occurring condition, it should be treated. With treatment, up to
80% of those with depression can show improvement, usually in a matter
of weeks. Common interventions include a range of antidepressant
medications, focused short-term psychotherapy, or a combination of the
two.
The rate of major depression among
those with medical illnesses is significant. In primary care,
estimates range from 5 to 10 percent; among medical inpatients, the
rate is 10 to 14 percent.
Depressed feelings can be a common
reaction to many medical illnesses. However, depression severe enough
to receive a psychiatric diagnosis is not the expected reaction to
medical illness. For those reasons, when present, specific treatment
should be considered for clinical depression even in the presence of
another disorder.
Facts on Depression and Cancer:
Each year, more than 1.3 million Americans are diagnosed with
cancer. Receiving such a diagnosis is often traumatic, causing
emotional upset, sadness, anxiety, poor concentration, and withdrawal.
Often, this turmoil begins to abate within two weeks, with a return to
usual functioning in about a month. When that doesn't happen, the
patient must be evaluated for clinical depression, which occurs in
about 10% of the general population and in about 25% of persons with
cancer. Early diagnosis and treatment are important because depression
adds to a patient's suffering and interferes with his or her
motivation to engage in cancer treatment.
Facts on Depression and Heart
Disease:
Depression affects nearly 10% of adults in the U.S. each year.
Studies show that depression strikes cardiac patients at a
significantly higher rate and often with devastating consequences.
Among patients with coronary heart
disease, depression occurs in 18-20 percent of those who have not had
a heart attack (myocardial infarction) and in 40 and 65 percent of
those with a history of heart attack.
Major depression appears to increase
disability in heart patients, perhaps because it can contribute to a
worsening of symptoms as well as to poor adherence to cardiac
treatment regiments.
In addition, heart attack survivors
with major depression have a 3-4 times greater risk of dying within
six months than those who do not suffer from depression.
The good news is that treating
depression when it occurs in heart patients can minimize or avoid some
of these serious health consequences.
Facts on Depression After a Stroke:
There are currently about 3,000,000 stroke survivors in the U.S.,
and each year an additional 400,000-550,000 people will suffer a
stroke. Clinical depression occurs in 10-27 percent of stroke
survivors.
The average duration of major
depression in stroke patients is just under a year. An additional 15
to 40 percent of stroke survivors will have some of the symptoms of
depression within two months following the stroke.
Early diagnosis and treatment of
co-occurring depression are important because this second illness adds
to a patient's suffering, interferes with rehabilitation and family
relationships, and reduces quality of life.
Depression Co-occurs with
Psychiatric Disorders:
A higher than average co-occurrence of depression with other
psychiatric disorders, such as anxiety and eating disorders has been
documented.
Concurrent depression is present in 13
percent of patients with panic disorder. In about 25 percent of these
patients, the panic disorder preceded the depressive disorder.
Between 50 and 75 percent of eating disorder patients (anorexia
nervosa and bulimia) have a lifetime history of major depressive
disorder.
In such cases, detection of depression
can help clarify the initial diagnosis and may result in more
effective treatment and better outcome for the patient.
Depression Co-occurs with Substance
Abuse Disorders:
Substance abuse disorders (both alcohol and other substances)
frequently co-exist with depression.
Substance abuse disorders are present
in 32 percent of individuals with depressive disorders. They co-occur
in 27 percent of those with major depression and 56 percent of those
with bipolar disorder.
Substance use must be discontinued in
order to clarify the diagnoses and maximize the effectiveness of
psychiatric interventions. Treatment for depression as a separate
condition is necessary if the depression remains after the substance
use problem is ended.
Treatments
Antidepressant Medications: Several types of antidepressant
medication are effective, none of them are habit-forming. Most side
effects can be eliminated or minimized by adjustment in dosage or type
of medication, so it is important for patients to discuss all effects
with the doctor. Because responses differ, several trials of medicine
may be needed before an effective treatment is found. In severe
depression, medication is usually required and is often enhanced by
psychotherapy.
Psychotherapy:
Interpersonal Therapy and Cognitive Behavioral Therapy have also been
shown to be effective in treating depression. These short-term (10-20
weeks) treatments involve talking with a therapist to recognize and
change behaviors, thoughts, or relationships that cause or maintain
depression and to develop more healthful and rewarding habits.
Electroconvulsive Therapy:
Electroconvulsive therapy (ECT) is a safe and often effective
treatment for severe depression
Source: National Mental Health
Association
