CRITERIA FOR DIAGNOSIS OF DEPRESSION: The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), describes the following criteria for diagnosis of a major depressive disorder:
A depressed affect plus at least five of the following symptoms lasting for a minimum of 2 weeks:
1) Difficulty sleeping or sleeping too much.
2) Extremely tired; without energy.
3) Abnormal eating patterns (eating too much or not enough).
4) Vague physical symptoms (gastrointestinal [GI] pain, joint/muscle pain, or headaches).
5) Inability to concentrate or make decisions.
6) Feelings of despair, guilt, and misery; lack of self-worth.
7) Obsessed with death (expressing a wish to die or to commit suicide).
8) Avoiding psychosocial and interpersonal interactions.
9) Lack of interest in personal appearance or sex.
10) Delusions or hallucinations.
AGGREVIATING FACTORS TO DEPRESSION: The majority of depressed patients are not found in psychiatric hospitals but in mainstream society. For proper diagnosis and treatment to occur, recognition of depression is often a collaborative effort among health care providers. For example, it might be the pharmacist who recognizes that a customer is depressed when the customer buys natural or over-the-counter (OTC) remedies to control anxiety symptoms or to induce sleep.
Situational depression occurs when the depression is the result of a circumstance in a person’s life, for example, loss of a job or unfavorable event at home such as death, children leaving home, or divorce. Dysthymic disorder is characterized by less severe depressive symptoms that may prevent a person from feeling well or functioning normally. Because depressed patients may be found in multiple settings, health workers should be proficient in the assessment of patients afflicted with these conditions. Some women experience intense mood shifts associated with hormonal changes during the menstrual cycle, pregnancy, childbirth, and menopause.
WOMEN AND DEVELOPMENT DEPRESSIVE DISORDER: Up to 80% of women who give birth experience postpartum depression during the first several weeks after birth of their baby. About 10% of new mothers experience a major depressive episode within 6 months related to the dramatic hormonal shifts that occur during postdelivery. Along with the hormonal changes, additional situational stresses, such as responsibilities at home or work, single parenthood, and caring for children or for aging parents, may contribute to the onset of symptoms. If mood is severely depressed and persists long enough, many women will likely benefit from medical treatment, including women with premenstrual dysphoric disorder, depression during pregnancy, postpartum mood disorders, or menopausal distress. Because of the possible consequences of perinatal mood disorders, some state agencies mandate that all new mothers receive information about mood shifts prior to their discharge after giving birth. Health care providers in obstetrician’s offices, pediatric outpatient settings, and family medicine centers are encouraged to conduct routine screening for symptoms of perinatal mood disorders.
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