Depression can be defined as a "mental state characterized by feelings of sadness, despair and discouragement." It is a common illness that can affect individuals of all ages. In fact, it is estimated that at least 15% of the population will - at some time in their life - suffer from depression. This incidence tends to be twice as high in women as it is in men.

There is a common misconception that depression is a weakness of character when it is actually a medical illness linked to neurochemical alterations in the brain. Although depression is considered a mood disorder, it is important to realize that this debilitating disease can significantly impair social and occupational functioning in many people.

Diagnosing Depression

Unfortunately there is no laboratory test that can diagnose depression. Instead, it is diagnosed based on the presence of certain symptoms. The criteria for depressive episodes are outlined by the Diagnostic and Statistical Manual of Mental Disorders, which suggests that suffering from 5 or more of the following symptoms for at least 2 or more weeks is sign of depression:

• Depressed mood and/or diminished interest or pleasure
• Significant weight gain or weight loss
• Sleep disturbance
• Change in physical activity
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Difficulty with decisions or concentration
• Recurring thoughts of death or suicide

Risk Factors of Depression

Although anyone can become depressed, studies show that some people are at greater risk than others. These risks tend to be related to genetic, stress and chemical factors.

Genetic

People who have a family history of depression, suicide and other psychiatric illnesses are 1½ to 3 times more at risk of becoming depressed. This increased risk can also be attributed to the fact that learning coping skills from depressed parents can be very difficult and stressful; however, these difficulties may be partially overcome in the future as depression is less often considered to be "unacceptable" behaviour and remains under-treated.

Other risk factors include being female and suffering from verbal or physical abuse.

Stress

Stress factors that increase the risk of depression include:

• Early parental loss
• Financial stress
• Job loss
• Marital stress
• Illness and postpartum conditions

A vicious circle tends to develop for many depressed people: they are more likely to have higher rates job absenteeism, which may lead to job loss, which can cause financial problems that lead to marital problems and therefore increase their feelings of depression, and so on.

Patients with chronic illness are 3 to 4 times more likely to suffer from depression. This is most common in post-stroke, post-myocardial infarction, diabetic and cancer patients.

Approximately 10-15% of women will have a depressive episode in the first few months following childbirth.

Chemical

Depression is a side effect of some prescription medications, including:

• Oral steroids (e.g. prednisone)
• Birth control pills
• Anti-seizure medications

If you are taking any of these medications and are experiencing problems with depression, talk to your pharmacist or physician about possible alternatives.

Symptoms of Depression

Emotional

A common emotional side effect of depression is apathy - a feeling of indifference or "a lack of feeling". Depressed patients may be tearful, angry, frustrated and harbour a sense of hopelessness.

Low self-esteem frequently accompanies depression, which can have a definite negative impact on personal and professional relationships.

Anxiety is seen in approximately 30-50% of depressed patients.

Physical

Depression affects people physically as well as emotionally. In fact, two-thirds of depressed patients come to doctors with complaints of physical problems or pain. When these varying symptoms are linked to an undiagnosed depression, it becomes quite confusing to physicians, patients and family members.

Some of the physical aches and pains seen in depressed patients include: headaches, jaw pain, chest pain and abdominal pain.

Other physical symptoms include fatigue, insomnia, changes in appetite, and memory impairment. Social

The social implications of depression tend to go unrecognized. Statistics from studies suggest that, on average, a person suffering from a major depression will miss 11 days of work per year, compared to only 2 days missed by non-depressed people. Poor concentration and memory skills affect work performance, safety and learning. These types of symptoms may lead to unemployment and a further decrease in self-esteem.

Symptoms of depression can be extremely disturbing and severely limiting. If you are diagnosed with depression, it is important to know that most modern antidepressants are well tolerated and any side effects are generally preferable to the debilitating effects of depression itself.

If you or someone you care about is exhibiting possible signs or symptoms of depression, talk to your doctor or pharmacist for more information about what actions to take.

Compiled by Melanie Hanson
Columbia Pharmacy, Castlegar, B.C.
and adapted with permission from Dr. Teresa Hogarth's
"Depression in Pharmacy Care"
Edited by Megan Stiles
Last Reviewed: September 2001