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Introduction to Depression: Clinical Manifestation, Diagnosis, and Treatment
Depression is a condition that is associated with lowering or elevation of the mood of patients like bipolar disorder or depression. There are different types of depression-like bipolar disorder, clinical depression, persistent depressive disorder, and many others (Ogbo et al., 2018). There are many causes of depression and some of the factors are alcohol, drugs, severe life stressors, genetic vulnerability, and many others. It is found that every one individual out of 16 in Australia is suffering from depression and 1 out of every 7 is facing anxiety issues. Majorly, the people age 16 to 24 who are having families face depression issues, whereas the general practitioners of age more than 65 years also face depression issues a lot (Bailey et al., 2018). The following sections will discuss in brief about the clinical manifestations of depression, psychopharmacology for diagnosis, treatment options, and one standard that is critical in maintaining optimal experiences in consumers and its impact.
Clinical Manifestation and Criteria of Diagnosis
The clinical manifestation is very helpful as they help in getting insights about the disease which can be used in the diagnosis or treatment plans of the patients. The affected individual feels lonely, sad, and depressed many times but that is a normal reaction if he loses something or fails to achieve something. If that negative feeling continues for a long time then it can lead to depression in the person but medical help can make him/her feel normal and recover from this mental illness (Badcock et al., 2017). The clinical manifestations include symptoms like suicidal thoughts or attempts, persistent feelings of emptiness and sadness, headaches and pains that do not go away, appetite loss, overeating, restlessness, irritability, changes/disturbances in sleeping patterns, and many others.
A person may have an irregular heartbeat, affected heart rate, atrial fibrillation, reduced respiratory rates to 8 – 10 breaths per minute, respiratory acidosis, decreased or lowered blood pressure, and many others (Nankoo et al., 2019). The criteria of diagnosis include – the affected individual should experience at least one of the symptoms should be either first, loss of interest or pleasure second, depressed mood, and experience more than 5 symptoms during the same 2-week period (Gardiner et al., 2019). The level of self-harm, suicidal ideation, stress level, anxiety, failing performance in academics or workplaces, deteriorating family relationships, and many others. These are some of the criteria that are used for diagnosis of depression and few others are as follows: suicidality – thoughts of suicide plans or feelings, concentration – decreased or poor concentration in work with decision-making gets poor with time, loss of energy, sleeping patterns, change in activity - retardation or psychomotor agitation, and depressed mood or irritable (Ogbo et al., 2018).
It is found that older patients with depression face many problems with depression-like memory loss, reduced or very slow reaction time in daily activities in comparison to adults who have depression issues. People with depression face difficulty in establishing a healthy and sound social relationship with friends or families and they also find it difficult to manage in social gatherings or functions (Almeida et al., 2016). Depression also affects the digestive system because it is associated with eating problems like cramps, malnutrition, or constipation that arise due to depression. Therefore, depression is not just mental illness but it has a major impact on the rest of the functions of the body. Moreover, many factors act as a risk factor in depression and some of them are – drug abuse or alcohol abuse, severe anxiety or stress, physical illness, older age, living alone, and many others.
Psychopharmacology for Depression Diagnosis
The term psychopharmacology is the study about the effects of the drugs on the behavior, sensation, thinking, and mood of the consumer (Bailey et al., 2018). The glutamate modulating agentsare antidepressants that are taken intravenously is the most innovative drugs used for this diagnosis of depression. They are used often in healthcare services by health professionals because of its rapid onset (hours rather than days to weeks). It has the power to reduce suicidal thoughts, plans, and feelings if the affected depressed person (Badcock et al., 2017). The other reasons for using glutamate modulating agents are they show anti-depression effects on the patients, significant improvement in depressive symptoms, and many others. The opiate system is used for the treatment of mood disorders because of its putative antidepressant mechanism.
Opiate drugs or medication are often used in depression because they ensure increased energy, less fatigue, less depression, increased concentration, better pain reliefs, and improved mental and physical health (Strawn et al., 2017). The other classes that are used are anti-inflammatories and immunomodulators. Depression makes the immune system weak resulting in an increased risk of developing the illness, infections, and other diseases. Therefore, the use of such pharmacological approaches can help in having anti-depressant effects with strong immune systems. For example, infliximab – it helps with its anti-depressant efficacy and minocycline – it reduces oxidative stress with a reduction in depression symptoms (Strawn et al., 2017).
Another class is neurosteroids – it modulates GABA-A receptors positively and exerts antidepressant/anxiolytic, pro-cognitive and neuroprotective properties. These drugs have various multiple effects like positive effects on memory processes, stress, anxiety, behavior, and learning (Nankoo et al., 2019). They also help in maintain emotional homeostasis and thereby, help in depression treatment. For example, brexanoione helps in treating post-partum depression and pre-menstrual depression. The PPARϒ agonists like pioglitazone help with its antidepressant efficacy improve the metabolic status and increase the weight gain in patients. A class of anticholinergics like scopolamine helps in greater improvement of depression with reduced anti-muscarinic effects (Wang & Osser, 2019). Moreover, the patient should be educated about his/her medication that he/she should not miss/skip any of the medication doses and report to the nurses or doctors if he/she feels discomfort or unexpected results after the drug administration. A patient should be encouraged that he/she should provide proper feedback about his/her feelings and comfort after the medication administration. The patient should be explained about his/her medication, treatment, and other health care plans so that he/she is actively taking part in his/her medical processes (Harrington et al., 2017). He should be asked to have complete after his medication or drug administration so that the body gets complete and sufficient time to recover as soon as possible.
Other Treatment Methods
There are many non-pharmacological treatment options for depression patients. One of the very popular options is psychotherapy and it is also known as talk therapy. The reason that it is widely used is, it involves talking or speaking up and in depression, the patient gets less active and often does not talk much (Byun et al., 2019). So, this therapy is acting at the major aspects of the disorder. Other options are interpersonal therapy – it focuses on relationship related problems of depressed individuals because such individuals cannot maintain a sound and healthy relationship with friends or family. So, this therapy or counseling helps them in dealing with the issues in their relationships (Ceskova & Silhan, 2018). In psychodynamic therapy, the patients are counseled about their behavior patterns that get affected due to depression and this ultimately improves their mood and reduces their depression (Serretti, 2018). The group participation also helps in treating depression. In this, the depressed people are asked to get involved in various activities like physical activities or discussions or sharing of daily life routines so that they do not feel alone and express their stress and depression symptoms get reduced.
In cognitive-behavioral therapy (CBT), the patients learn to deal with their suicidal thoughts, negative feelings, and unexpected mood swings that make them feel depressed for a long duration. In art therapy, the patients or participants are asked to draw pictures and express their feelings. This is an activity of fun that encourages the participants to feel pleasure and excitement and increases the energy and concentration in them (MacQueem & Memedovich, 2017). These therapies also help in developing positive feelings in patients or depressed individuals and help them to recover from their depression at a faster rate. These non-pharmacological treatments have a great impact positively on the depressed person and they have no adverse or negative effect on the health of the person. Electro convulsion therapy (ECT) is another therapy that helps in the treatment of depression. Deep brain stimulation (DBS) helps in reducing depression symptoms and it has many advantages as well. The advantages are – it improves daily life activities, it is adjustable, it improves the quality of life, it treats tumors, and it is not permanent, it is reversible (MacQueem & Memedovich, 2017).
Two Standards and Their Impacts
According to the Department of Health of Australia (2020), out of the 13 standards of National practice standards for the mental health workforce 2013, the two standards are - standard 1: Rights, responsibilities, safety and privacy and other is standard 2: working with people, families, and carers in recovery-focused ways. These standards play a major role in impacting the experiences of the consumers and their carers as well and also impact a person’s recovery during diagnosis. During the therapies and counseling sessions, the patients speak about his/her things, feelings, or other private information. So, it is the responsibility of the care provider to maintain the privacy and confidentiality of the information related to the patients and work as per the boundaries of the law. The patient and care provider should try to maintain such an environment that encourages positive energy and positive feelings. A safe environment can help in minimizing the risks of harm and the patients’ rights should be maintained during treatments and he/she should not be judged for his/her mental state of illness.
The care providers should exhibit professionalism and work within the boundaries of standards and ethical principles. The care providers should ensure that the patent’s agitation and aggressive behavior are not handled with a negative approach. If such approaches are used then the recovery will be fast and create a positive impact with a sense of motivation and a positive attitude to live life happily. The National practice standards for the mental health workforce standards 2013 states that if the medical care services are provided with ethical, legal, and as per the proper standards then it will the patient to get complete, continuous, comprehensive, and quality care. The care providers should ensure that the patent’s needs and demands are fulfilled (Department of Health of Australia, 2020). Moreover, it is also important that the care should be patient-centered to ensure that the recovery is fast and effective.
The carer should ensure that he/she encourages the involvement of family members in the patient’s decision-making and treatment plans. As per the National practice standards for the mental health workforce standards 2013, the respect of the carer, family members, and patients should be maintained concerning their beliefs and values. The needs of the mental health of the patent should be identified to ensure that the interventions provided by the family or care providers are proper because if proper care is provided then the recovery rate will increase (Department of Health of Australia, 2020). The patient and the care providers should ensure that the use of language is proper so that both the ends understand each others’ feelings and respect them too.
Conclusion on Depression: Clinical Manifestation, Diagnosis, and Treatment
Depression is increasing in Australia at a high rate and is affecting people of various age groups. The clinical manifestations include symptoms like suicidal thoughts or attempts, persistent feelings of emptiness and sadness, patterns, and many others. The affected individual feels lonely, sad, and depressed many times. Many drugs are available for depression-like glutamate modulating agents, opiate drugs, neurosteroids, anti-inflammatories and immunomodulators, and many others. However, to prevent the side effects, the non-pharmacological therapies and approaches are used like cognitive behavioral therapy, talk therapy, art therapy, deep brain stimulation, and many others. The standards play a major role in impacting the experiences of the consumers and their carers as well and also impact a person’s recovery during diagnosis. The care providers should ensure that the patent’s needs and demands are fulfilled. The duty and responsibility should be within the boundaries of professionalism and law. Moreover, a safe environment helps in minimizing the risks of harm and the patients’ rights should be maintained during treatments.
References for Depression: Clinical Manifestation, Diagnosis, and Treatment
Almeida, O. P., Hankey, G. J., Yeap, B. B., Golledge, J., & Flicker, L. (2016). Depression as a risk factor for cognitive impairment in later life: The health in men cohort study. International Journal of Geriatric Psychiatry, 31(4), 412-420.
Badcock, P. B., Davey, C. G., Whittle, S., Allen, N. B., & Friston, K. J. (2017). The depressed brain: An evolutionary systems theory. Trends in Cognitive Sciences, 21(3), 182-194.
Bailey, E., Robinson, J., & McGorry, P. (2018). Depression and suicide among medical practitioners in Australia. Internal Medicine Journal, 48(3), 254-258.
Byun, T. H., Chaliki, S. S., & Poole Jr, K. G. (2019). New treatment options for depression: A primer for internists. The American Journal of Medicine, 132(6), 678-684.
Ceskova, E., & Silhan, P. (2018). Novel treatment options in depression and psychosis. Neuropsychiatric Disease and Treatment, 14, 741.
Department of Health of Australia. (2020). National practice standards for the mental health workforce 2013.
Gardiner, F. W., Coleman, M., Teoh, N., Harwood, A., Coffee, N. T., Gale, L., & Laverty, M. (2019). Aeromedical retrievals of people for mental health care and the low level of clinical support in rural and remote Australia. Medical Journal of Australia, 211(8), 351-356.
Harrington, K. D., Gould, E., Lim, Y. Y., Ames, D., Pietrzak, R. H., Rembach, A., & Rowe, C. C. (2017). Amyloid burden and incident depressive symptoms in cognitively normal older adults. International Journal of Geriatric Psychiatry, 32(4), 455-463.
Heifets, B. D., & Malenka, R. C. (2019). Disruptive psychopharmacology. JAMA Psychiatry, 76(8), 775-776.
MacQueen, G. M., & Memedovich, K. A. (2017). Cognitive dysfunction in major depression and bipolar disorder: Assessment and treatment options. Psychiatry and Clinical Neurosciences, 71(1), 18-27.
Nankoo, M. M., Palermo, R., Bell, J. A., & Pestell, C. M. (2019). Examining the rate of self-reported ADHD-related traits and endorsement of depression, anxiety, stress, and autistic-like traits in Australian University students. Journal of Attention Disorders, 23(8), 869-886.
Ogbo, F. A., Eastwood, J., Hendry, A., Jalaludin, B., Agho, K. E., Barnett, B., & Page, A. (2018). Determinants of antenatal depression and postnatal depression in Australia. BMC Psychiatry, 18(1), 49.
Serretti, A. (2018). The present and future of precision medicine in psychiatry: Focus on clinical psychopharmacology of antidepressants. Clinical Psychopharmacology and Neuroscience, 16(1), 1.
Strawn, J. R., Dobson, E. T., & Giles, L. L. (2017). Primary pediatric care psychopharmacology: Focus on medications for ADHD, depression, and anxiety. Current Problems in Pediatric and Adolescent Health Care, 47(1), 3-14.
Wang, D., & Osser, D. N. (2019). The psychopharmacology algorithm project at the Harvard South Shore program: An update on bipolar depression. Bipolar Disorders.
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