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    Depression or unipolar depression is one of the more commonly encountered psychiatric disorders. While many effective treatments are available, this disorder is often under diagnosed and under treated. Primary care providers should strongly consider the presence of depression in their patients; studies suggest a high prevalence of affective disorders among patients seeking medical attention in the office setting.

    Psychological and emotional perspective

    From psychological stand point we have found a very interesting description of depression (Tatro Bryce) applicable to some of us. Please see the following image and its explanations.

    We can help you to treat it but understanding the message of this image You can help You in changing the paradigm of your life and in preventing the recurrence of this disorder: DEPRESSION.

    "This image symbolizes the psychodynamics of depression. Briefly, the depressed individual's problem is that he (she) depends too much on parents or parent surrogates for emotional nurturance to feel secure and worthwhile. Like a young child, his significant others seem much larger than life and possessed of everything he needs to feel fulfilled and happy. When he is being loved by these all-important, omnipotent-seeming others, he feels good about himself and is self-confident (God is in His heaven and all is well with the world), but if he perceives that he is displeasing, being disapproved of, or, much worse, being rejected and abandoned by them, he feels helpless, lost, unbearably alone, and devoid of all worth. Because he derives self-esteem through dependent attachment to significant others, if they turn their backs on him or he loses the connection in some other way, his self-esteem deserts him.

    The basic depressive conflict is that because the individual depends so mightily on his all-important others, he empowers them with the capacity to exert tremendous influence on him, and when they do this in ways that he finds frustrating, he begins to resent and feel angry and hostile toward them. These are very threatening feelings. He cannot express them, or even allow himself the critical thoughts that they give rise to, since he dare not risk doing anything that might displease the objects of his dependency and make them go away. Thus, instead of directing his anger and hostility at his all-good others, he turns it back against himself. If they are all-good, and they are turning away from him, then he must be a worthless, all-bad person. He becomes extremely self-critical, full of guilt, and, if his anger and hostility are intense, he may subject himself to painful punishments. In worst case instances, when all seems lost and there is no relief from the pain of unremitting helplessness, he may end up committing suicide.

    Often, as a kind of life-saving mechanism, the depressed individual may find substitute sources of dependent gratification in the world around him. If he cannot get his needs for emotional nurturance met by some important person, he sometimes gets them met through dependent attachment to alcohol and/or drugs, which at least temporarily give him the feelings of security, self-worth, and self-confidence that he cannot find within himself. Because he uses such substances to lift himself out of depression, when their effects start wearing off, the depression returns, so he is driven to take more and more of the substances. As time goes on, due to the ruinous effects that alcohol and drugs have on all of his involvements, he has more reason than ever to be depressed, and a vicious-circle pattern is established.

    In the image, the basic dependency on sources of nurturance is symbolized by the infant yearning toward a giant breast in the sky. The depressed individual in the foreground is out in the cold, symbolized by his nakedness and the snow-covered ground. He is reaching out to a gigantic, larger-than-life, turning-away, disapproving parent figure, who is situated on a bright, warm, green island, meant to symbolize the paradise that she/he has to offer, but can also take away. The broken mirror containing reflections of both himself and the parent figure is meant to represent the depressive person's pattern of directing anger and hostility aroused by the all-important significant other toward himself instead."

    Either we like or dislike the image and the explanations they can be a good starting point of understanding and healing, reflection and forgiveness, of new thoughts and perspective.

    Western Medicine

    The underlying path of physiology of major depressive disorder (MDD) has not been clearly defined. Clinical and preclinical trials suggest a disturbance in CNS serotonin (i.e., 5-HT) activity as an important factor. Other neurotransmitters implicated include nor epinephrine (NE) and dopamine (DA).

    Diagnostic criteria for a major depressive episode are as follows:

    A. At least 5 of the following, during the same 2-week period, representing a change from previous functioning; must include either (a) or (b):
    (a) Depressed mood
    (b) Diminished interest or pleasure
    (c) Significant weight loss or gain
    (d) Insomnia or hypersomnia
    (e) Psychomotor agitation or retardation
    (f) Fatigue or loss of energy
    (g) Feelings of worthlessness
    (h) Diminished ability to think or concentrate; indecisiveness
    (i) Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan for suicide

    B. Symptoms do not meet criteria for a mixed episode (i.e., meets criteria for both manic and depressive episode).

    C. Symptoms cause clinically significant distress or impairment of functioning.

    D. Symptoms are not due to the direct physiologic effects of a substance or a general medical condition.

    E. Symptoms are not better accounted for by bereavement, i.e., the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

    Next Page - Depression treatment

    Revision 2.00 - January 6, 2007


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