Dr. Miguel Perez-Camacho Duque ICAPSI
Director of
Depression is one of the most common diseases to which mankind is subject. Paradoxically, it is probably the symptom that most often goes unnoticed, and when recognized, is probably the single worst symptom treated in clinical practice. Not only are multiple and complex signs and symptoms of depression at any stage of the disorder, but there are many stages and different problems in age groups distintos.Por example, your symptoms, onset, differ considerably from those that develop below and displayed in second lowest in the depressed patient who commits suicide. There is also an age factor. The demonstrations in adolescents differ significantly from those observed at later ages.
From a purely descriptive, often the phenomena that accompany depression are indistinguishable from those seen in grief over the loss of someone or something, ie, the normal reaction of grief and mourning .
addition depressogenic factors and social psychological in origin, they should not ignore biological factors. Certain medications may lead to depression grave.La reserpine, high-dose corticosteroids, and phenothiazines, and as the abuse of sedatives.
As we shall see, some depressive symptoms may be better understood as a cry for help.
anaclitic depression refers to the syndrome exhibited by children in the first year of life if they are deprived of the care of a mother figure right.
The clinical picture comprises a set of depressive symptoms (subjective features) and signs (objective features: eg Veraguht fold) and varied somewhat heterogeneous, variable from one patient to another.
Veraguht The fold described by the Swiss neuropsychiatrist Otto Veraguht as a peculiar fold in a triangle in the angle nasal upper eyelid. The fold is often associated with depression.
What we understand today is equivalent to clinical depression called melancholy and for at least twenty-five centuries. Since they can find descriptions of what we now know as mood disorder in ancient texts. The story of King Saul in the Old Testament describes a depressive syndrome, as does also the suicide of Ajax in the Iliad of Homer. In 400 BC, Hippocrates used the terms "mania" and "melancholy" to describe mental disorders. The Jewish physician Moses Maimonides in the twelfth century saw the blues as a particular disease.
Depression is an illness that accompanies man from birth to grave. And in the infant and early childhood, as noted earlier, depression may occur (anaclitic) in the form of persistent crying, a weak reactivity to stimuli, lack of emotional expressiveness or a sleep disorder. The highest rate
depression occurs after age 70.
demographic most popular feature of depression is that the number of women is twice that of men. This ratio of two women by a man depressed its validity extends between 15 and 70 years. Below age 15 there is a balance here between the masculine and feminine, and so is more than 70 years.
The relationship between marital status and presence of depression has high with useful data separated and divorced people are most affected by depression, and married women, the least. The frequency distribution of depression is consistent with this scale, from least to most: married, single, widowed and divorced. In all states marital male frequency is lower than the female with the exception of widowhood.
low socioeconomic status in the incidence of depression was somewhat higher than in the rest of the population. Call
fortunately depression does not respond vigorously to this designation, and therefore not a product of fortune. Rated depression and is usually due to increased demands and responsibilities involved in improving the economic or employment status or simply a lack of accommodation to the new lifestyle.
The innovative adaptation to any situation requires a double effort: to move away from old habits or preferences and adjust to new circumstances. On this high-risk traffic gravitates to influence the situation described by German authors Entwurzelungsdepression ( uprooting depression), whose greatest threat is when the subject is deprived of the ties that bound him to the old situation without being still anchored in the new. It comes in migrants and immigrants. Until the new house, if only to improve women can have on the table identified in the literature as Umzugsdepression Germanic ( moving depression).
The symptoms of depressed mood.
The depressive patients show some symptoms very different from each other.
In depression there are four dimensions (symptoms). All the traits of any depressive illness are covered by one of these four items: depressed mood, anergy (weak pulses), and ritmopatía discomunicación.
In practice, the depressive may be complete, comprising features of the four dimensions (symptoms), or partial, limited to the features of one, two or three dimensions. The
depressed mood is a mood permeated pesimismo.Puede sound like, a.
Bitterness or despair, prone to crying, tears or without them. B.
Inability to experience pleasure and joy (anhedonia). C.
Impairment or underestimation own ideas as of worthlessness or inferiority feeling somatic or mental disability, or guilt. D.
Decreased attachment to life or thoughts of suicide. E.
Chest tightness. F.
Localized pain in the head, back or in another sector.
The depressive mood, as occurs in the other three dimensions, often accompanied by some unpleasant somatic symptoms. There depressive which imposes moral pain and other physical pain invaded. The painful experiences are the most common physical: the general feeling heavy or rigid body, the tightness or pain in the head, face, chest region, mouth stomach and back, tingling in the head, arms and hands or legs and feet itching in the genital or rectal mucosa. It should be pointed out that the head is one of the sectors most affected by somatic depressive suffering physical.
The depressive mood is expressed externally by the issuance of complaints, whining and crying spells, sometimes crying without tears.
sometimes mimic the depressive state does not match the interior. The best example is the smiling depressive mimicry .
The anergy is defined as the weakening of the impulses. It manifests as: a.
Apathy and boredom. B.
Musing on the same idea or presence of indecision. C.
Lack of concentration. D.
Decrease in normal activity at work and / or distractions. E.
Early general fatigue or tiredness. F.
Sexual dysfunction or digestive disorders.
Patients feel unable to cope with daily tasks seems exhausted minimal effort. Some experience this feeling of tiredness, exhaustion, somatic terms. Accused and seat-type headache, variable, and the subsequent headache with feeling of weight, and J. individualized TH.Alajouanine Nick under the name "Atlas syndrome."
This inhibition psychic also reflects the feeling of fatigue, which is ultimately a "taedium vitae, an increasing difficulty to conduct themselves in daily life. There are defects in memory, they forget the simplest things, attention is biased towards the patient experiences difficulties, it weakens the will, the patient appeared to be empty of all energy.
Fatigue adynamia depression can appear as (not wanting to move) or fatigue (fatigue early). The syndrome consisting of chronic fatigue and fibromyalgia (muscle pain myalgia means) is often a depressive state.
discomunicación The depression is a disorder that leads to depressive patient isolation by blocking the transmission and reception.
depressive block transmission and reception is extended to two levels and channels of direct interpersonal communication: the main language spoken and written, and the complementary, non-verbal language or body language.
sender and recipient impoverishment of bodily communication is reflected in these other data: the rigid facial expression, with a less expressive mime, the gesture very limited, the abandonment of the apparel or clothing, sometimes extended to the hygienic care , reduction of visual acuity. Furthermore, in some depressive discomunicados blocks the reception of olfactory cues and their release may take the form delusional to believe that deriving one's own body odors (autodisosmofobia). The loss of taste for food is also a common disorder in this series.
The discomunicación can occur in: a.
Outbreak in a bad mood or enervation. B.
Tendency to grieve for everything. C.
Social withdrawal. D.
Abandonment of the readings, radio and television. E.
Sense of isolation and distrust. F.
Neglect of the body under and in the locker room.
The ritmopatía or dysregulation of the rhythms includes not only disruption of rhythmic forms biopsychic more specific human characteristics, namely: activity / rest, food and sleep, but they express profoundly changing existential rhythm and timing.
cycles of activity / rest, food and sleep coniciden in psychobiological phenomena grouped among the so-called circadian rhythm.
appetite disorders and weight disorders account for between ritmopáticos second. Its most common is anorexia accompanied by weight loss. The majority of anorexia are in fact symptomatic behavior depressive state. Its basic disorder is not really the anorexia (lack of appetite), but a rejection of particular food by phobia of gaining weight. At the other extreme, the episodes of binge eating of sweets and pastries, known as bulimia and lived as an overwhelming sense of guilt, almost always owe their origin to a depressed state.
circadian cycle par excellence is composed of the sleep / wake or nictameral pace. The most frequent sleep disturbance in the early depression is insomnia, which refers to difficulty falling asleep. It is also very common middle insomnia, in which sleep is subject to the submission of nightmares or termination by awakenings. Late insomnia, which occurs early awakening represents the disorder sómnico more weight to the diagnosis of depression. The
ritmopatía may manifest as: a.
Large fluctuation of symptoms during the day or significant differences between morning and afternoon. B.
Loss of appetite and weight. C.
Ravenous hunger crisis. D.
Difficulty sleeping. E.
Nightmares, dark dreams or waking up early.
f. Sleepiness during the day.
The causes of depression.
Depression is a syndrome encompassing four classes of illness:
- The endogenous depression is largely caused by herencia.La symptoms are accentuated and complete. Its evolution can be multiphase (several stages), type unipolar (depression only) or bipolar (alternating between depressive episodes and hyperthymic).
- The neurotic depression is largely caused by neurotic anxiety or insecurity about himself. The mild or moderate symptoms associated with neurotic traits. Its evolution can become chronic.
- The reactive depression which is caused by the situation in life. The symptoms are variable. The evolution is variable, but always unipolar. Feelings of guilt and self-reproach not seen much in this form or are very mild, which is a classic difference of major depression (formerly known as melancholy.) Suicidal ideation are quite common, but death is deliberate much rarer than in depression mayor.Las suicidal behavior often made here correspond to a "call for help" or an attempt to pressure on the environment. Reactivity to external conditions is very large in these patients and this is also a difference with major depression. Environmental influences and circumstances play a large role in evolution. The trigger: "Sometimes it's a real affective treatment, an important and easily understood by the observer: loss of a loved one, failure of important interpersonal relationships, difficulties in family, professional, financial, collective failure of an ideal , state of longing or loneliness. "Sometimes, it is the injury which appears the least and have the impression that it was rather a neurotic decompensation.
- The depression somatogenic disease whose cause is medical or exogenous chemical. Its symptoms are masked by the fundamental somatic process. Evolution is single phase. The four types of depression include: depression symptomatic (general medical condition), organic depression (organic brain disorder, brain damage tumor, neural artrofias, meningitis, depression, Parkinson ,...), , pharmacological (drugs) and depression addictive (drugs).
depression in women.
Women are much more vulnerable to depression than men.
The categories of depressive illness for which the surcharge affects women with a resounding emphasis are neurotic depression and reactive depression.
is to consider the impact of depressive states in accordance with this order from most to least: separated or divorced, widowed, single and married. Widowhood means for a sector of disenchanted women liberation.
never ruled out the full potential depressogenic influence exerted by the second X chromosome
The premenstrual depression, now called "premenstrual dysphoric disorder" can take a progressive and get transformed into a depressive state maintained without interruption. His improvement with the active ingredients of the serotonergic system, helped by remedies for water retention (low-salt diet and a diuretic) causes rapid and sometimes spectacular.
The postnatal depression occurs within two months following childbirth or abortion. The sharp fall experienced by the female hormones (estrogen and progesterone) and high level of prolactin and the low plasma thyroid substances. Favor the incidence of depression, stressful or difficult childbirth, indifference the spouse or partner, negative or ambivalent maternal attitude toward the infant, isolation or lack of social support and financial means are insufficient. The antecedent of a sentence even more depressed and premenstrual or postpartum depression, most likely to predict the presentation of depression in the postpartum.
The clinical picture varies from mild and steep grades. In light boxes tend to dominate the symptoms of depressed mood, the anergy and / or ritmopatía. Accented tables can become more massive forms of depression, such as depression, stupor, delirium and hallucination. The trend towards repeat in successive births is very high.
The menopausal depression is actually a pre-menopausal depression, ie, a depression that is established during the two years preceding menopause. Prevention is suggested as the administration of estrogen (in patch form) and the same product is used frequently as an adjunct or supplement to the basic antidepressant treatment.
melancholy loveFor now known as depression indifference means the depressive illness caused by unrequited love or even a loving inner state defined unaddressed. Table trial was described many years ago by the famous Arab physician Avicenna (980-1037):
"The signs are sunken eyes and dry, no humidity but when they cry, continuous blinking, smiling as if they had seen something or heard something delicious nice ... All the body parts appear dry, sunken eyes but because of the many crying and insomnia "
geriatric depression.
is the depression that occurs in late or advanced age. Affects 15-20 percent of the population aged over 75 years. It also offers the peculiarity about equally affect men and women.
Drugs antidepressants. I want to finish
succinctly naming or antidepressant medications, including those chemicals that have proven to possess the ability to reduce all or part of the depressive state in a large group of depressive patients.
According to the chronology of the appearance of the drug are distinguished:
- the first generation antidepressants : most of them are tricyclic antidepressants such as imipramine, desipramine, clomipramine, amitriptyline and nortriptyline.
- second-generation antidepressants : a very heterogeneous group their chemical structure, which includes, among others maprotiline, mianserin and viloxacina.
- third generation antidepressants : This group includes inhibitors reuptake inhibitors (trazodone, nefazodone, fluoxetine, fluvoxamine, sertraline, paroxetine and citalopram), plus also added relatively recently as venlafaxine , reboxetine, mirtazapine and duloxetine.
- generation antidepressants: agomelatine.
Under sedative / stimulant antidepressant produced in all individuals whether or not depressive patients, we obtain the following scale:
- intense Sedatives: amitriptyline, trimipramine, doxepin, mianserin, mirtazapine.
- mild sedative, maprotiline, clomipramine, fluvoxamine, paroxetine, citalopram.
- Neutral: imipramine. Stimulants
- light: fluoxetine, sertraline. Stimulants
- intense, nortriptyline, desipramine, amineptine, bupropion, venlafaxine.
Bibliography.
* Francisco Alonso Fernández.-Key of depression. Second Edition.
* Francisco Alonso Fernández.-Fundamentals of psychiatry. Renewed and updated third edition.
* Hey Herry. P. Bernard. Brisset Ch. "Textbook of psychiatry. Eighth edition.
* Alfred M. Freedman. H. Kaplan. Sadock BJ .- Textbook of psychiatry.
* Harold Kaplan. B. Sadock.JAGrebb.-Synopsis of Psychiatry. Seventh Edition.
* Benjamin J. Sadock. Virginia A. Sadock .- Summary of Psiqquiatría. Ninth Edition.
* C. Koupernik. P. Nayrac. JJSchneider.-Psychiatry Psychology.
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