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Analyzing the Major DepressionsResearch Paper

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¶ … Depression

Diagnosis and Treatment -- Research Findings and Information

Diagnosis

Major depression is diagnosed via clinical means. It is based on interviews and examination of the mental status of the patient. Evidence points to the fact that interviews compare well with other diagnostic procedures used in medical practice including radiologic examination and lab tests. The method of diagnosis applied in DSM-IV (Table 1) is the commonly accepted approach. Major depression is observed through syndromes. The final diagnosis is based on the patient's physical condition and medical history. In the process of diagnosis, it is critical to consider other possible problems including psychiatric problems such as obsessive compulsive disorder, bulimia nervosa, dementia and panic disorder. There should also be an observation of the general medical conditions, abuse of substances disorder so as to follow relevant investigations in the diagnostic processes (Goldman, Nielsen, & Champion, 1999).

There are tools available to physicians. These tools can assist the practitioners to foretell people likely to experience major depression. Like other screening tools, these tools seem general and do not focus on depression specifically. Scholars and specialists propose that screening be applied when the practitioner has good reason to suspect the occurrence of the same. Such suspicion is usually triggered by some specific symptom that points to the possibility of depression. These symptoms include subjective distress that is beyond the norm, some impaired functioning or another psychiatric problem. There is need for physicians to appreciate screening results with a keen eye and recognize the need for further tests to eliminate any doubt. There is no preventive guide that encourages screening in patients that do not show any symptoms of the depressive disorder (U.S. Preventive Services Task Force, 1996). The primary version for care of depression patients DSM-IV gives abbreviated guidance of the DSM-IV criteria for diagnosis of mental disorders in patients commonly witnessed in primary care centers. It comes with dynamics influenced by the patients to enable the practitioner to move from the complaint of the patient to a precise diagnosis of the problem. There is now a pediatric version of DSM-IV that has been developed by the American Academy of Pediatrics. WHO has also developed a version for the primary care based on the international classification of diseases that deal with mental problems (ICD-10). This resource contains information cards on the common complaints raised by patients, the diagnoses and the management of 24 common disorders of psychiatric nature (B, D, & J, 1995). Some aspects of DSM may cause problems in a conventional medical setting. Some symptoms are somatic on nature. Even though the criteria for diagnosis gives equal consideration to all the nine syndromes many clinicians fail to recognize depression as forming part of the pivotal diagnosis of the main complaint that the patient comes with; unless the patient clearly shows signs of sadness or that the complaint is of diasphoric nature. It is also worth noting that it is normal for patients to tend to emphasize physical symptoms because these tend to be more disturbing to the patient. Patients are usually less enthusiastic about providing information on their mental status or emotional distress because they mistakenly think that the practitioner will be interested in the symptoms that they provide. It is often hard to determine whether a given symptom is caused by depression or by a different medical problem.

Treatment scientific advances including the evolutions in the practice environment shape the treatment of depression in recent times. The United States has seen the introduction of several new antidepressants including (fluoxetine (Prozac), nefazodone (Serzone), paroxitene (Paxil), venlafaxine (Effexor), fluvoxamine (Lu-vox), and citalopram (Celexa) sertraline (Zoloft), bupropion (Wellbutrin), mirtazapine (Remeron). The drugs are different in terms of structure and pharmacological nature as compared to tricyclic and monoamine oxidase inhibiting agents. These medications inhibit a benign side effect, a simple dosing strategy, better adherence to prescription and a much lower death risk in situations of overdose as compared to older medications. Given the advantages, these medications have been widely applied in the field. These new drugs have been noted to exhibit a delay in the full therapeutic recourse. It normally takes several weeks for them to show their effect. When looked at against the background of older drugs, they manifest a shadowy relation between drug levels in serum and the response to the treatment. Some of them hold potential risk of presenting drug interaction (Masand, Chengappa, & Edwards, 1998). There have been several attempts in the testing of the available psychotherapies and their effectiveness. Behavioral, cognitive and interpersonal psychotherapy that are structured and limited in terms of time have been demonstrated to be equal in the levels of efficacy to anti-depressant medications for moderate and mild psychotic and non-bipolar major depression; this is the type that has been commonly seen in most medical environments. These medications are generally a welcome alternative to the patients that are averse or intolerant to antidepressants. They are also attractive to the patients that prefer to use psychotherapy, pregnant women and nursing mothers. It is not clear whether the effect of combining psychotherapy and pharmacotherapy is more successful than when the options are applied independently. The role of other psychotherapeutic options is also largely unknown (Goldman, Nielsen, & Champion, 1999).

Depression is increasingly appreciated as a chronic illness. At least half of those that experience major depression episodes without another medical condition occurring at the same time will proceed to experience another one. After a number of episodes, the risk of reoccurrence increases to 90%. Although a lot of patients make a complete recovery from specific episodes with the use of treatment or without it, approximately a fifth to a third of them have their symptoms persist residually or functioning impairment or both issues. There is an increased interest in the use of medications in prophylactic fashion, especially after the patient has undergone a number of episodes, i.e. after stopping psychotherapy or when it is offered at random or far between. Most of the information regarding the prevalence of infection, the cause and the treatment efficacy levels was reexamined, synthesized and published as a set of guidelines for treatment on depression focused on primary care centers by the Agency for Health Care Policy and Research (AHCPR) (Agency for Health Care Policy and Research, 1993)

Missing or Unstated Information and Assumptions in The Literature in Use

Contrary to the idiographic analysis of depressive disorder, the model applied in medical disease systems claims that depression is fundamentally a syndrome or a multiplicity of syndromes and that people inherit the risk for the syndrome-based response. Such a model draws information from research that shows some level of inheritance tendencies for people with the condition (Wallace, Schneider, & McGuffin, 2002). Yet, looking at the mode and details of the research, it is apparent that environmental factors play a much greater role in the symptomatic manifestations by the twins than genetic influences except for the extremely severe cases. There has also been widespread criticism of the research that highlights methodical flaws and assumptions in the research process. Therefore, inheritance as a major factor in the occurrence of depression has been greatly criticized. However, to be fair, it is apparent that there is some aspect of inheritance in some depression cases. There are theories that postulate such claims as depression facilitates conservation of resources and disengaging, in failed goal-directed activity by decreasing one's appetite, motivation, and the level of energy. For example, people try to avoid situations that avert negative reinforcement as they learn the rules of a new environment such as are the case when travelling to a new country. If such a person were to pursue a goal-directed activity such as looking for gainful employment, chances of failure would be significantly high.

According to Goldman, Nielson and Champion (1999), depression is neither adaptive nor a syndrome. They say that for any depression theory to hold true as adaptive, it has to overcome two basic hurdles that have been found to be inherent in the phenomenon. Since symptom profiles in depression vary greatly, there has to be a clear selection of the set of symptoms of depression that comprise the syndrome. It may even be a multiplicity of symptoms with different sets of symptoms (Keller & Nesse, 2006). A good example to cite is whether atypical depression and melancholy symptoms are adaptive syndromes. These are pertinent questions since many symptoms that are linked to melancholic depression are the exact opposite of the ones linked to atypical depression. It is practically untenable for the two theories to account for the two presentations. The very chronic nature of depressive symptoms appears to be maladaptive. For instance, a transient sad mood that is responding to loss clearly seems adaptive because it manifests empathy and triggers behavior for assistance in other people. If this holds true, then it means that such an effective response reaction may have been generated because of inherent survival instincts. It would thus, be expected that it has some losses as antecedents and… [END OF PREVIEW]

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