Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.
The first step to getting appropriate treatment is to visit a practitioner. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A practitioner can rule out these possibilities by conducting a physical examination, interview and lab tests. If the practitioner can eliminate a medical condition as a cause, he or she should conduct a psychological assessment or refer the patient to a behavioral health professional.
It is extremely important that the practitioner or behavioral health professional uses a multi-disorder behavioral health assessment tool and does not just ask you questions about depression alone. This is because depression often co–exists with other illnesses and such illnesses may precede the depression, cause it, and/or be a consequence of it. It is likely that the mechanics behind the intersection of depression and other illnesses differ for every person and situation. Regardless, these other co–occurring illnesses, in particular alcohol and other drug use, will need to be diagnosed and treated.
The multi-disorder assessment tool recommended by your practitioner should also ask questions about any family history of depression and get a complete history of symptoms, e.g., when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated. The assessment tool should also ask whether the patient is thinking about self harm or suicide.
Single-disorder assessment tools are ineffective in bringing to the attention of the practitioner other behavioral health conditions that may be present with the patient. In particular, many patients are diagnosed with depression (unipolar depression) when they should be diagnosed with bipolar disorder (also known as manic depression) simply because the practitioner did not ask questions about the patient experiencing manic symptoms (see below). The importance of multi-disorder assessment tools can’t be emphasized enough particularly as it relates to depression and comorbid conditions often present with depression.
Anxiety disorders, such as post–traumatic stress disorder (PTSD), obsessive–compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, often accompany depression.3,4 People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat.
People with PTSD often re–live the traumatic event in flashbacks, memories or nightmares. Other symptoms include irritability, anger outbursts, intense guilt, and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH)–funded study, researchers found that more than 40 percent of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.5
Alcohol and other substance abuse or dependence may also co–occur with depression. In fact, research has indicated that the co–existence of mood disorders and substance abuse is pervasive among the U.S. population. 6
Depression also often co–exists with other serious medical illnesses such as heart disease, stroke, cancer, hiv/aids, diabetes, and Parkinson's disease. Studies have shown that people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co–existing depression.7 Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the co–occurring illness.8
Depression in adolescence frequently co–occurs with other disorders such as anxiety, disruptive behavior, eating disorders or substance abuse. It can also lead to increased risk for suicide. 22, 24
Depression and Bipolar Disorder Comorbidity Nearly 40 percent of people with major depression may also have subthreshold hypomania, a form of mania that does not fully meet current diagnostic criteria for bipolar disorder, according to a new study entitled “Major depressive disorder with sub-threshold bipolarity in the National Comorbidity Survey Replication. American Journal of Psychiatry. August 15, 2010 by Angst J, Cui L, Swendsen J, Rothen S, Cravchik A, Kessler R, Merikangas K.
Mania is a symptom of bipolar. According to the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), it is generally defined as a diskrete period of increased energy, activity, euphoria or irritability that leads to marked impairment in one’s daily life. The DSM-IV states that a manic episode lasts for one week or more, and may sometimes require hospitalization. Hypomania is defined as a milder form of mania that lasts for four days at a time, but does not interfere with one’s daily activities. The majority of people diagnosed with bipolar disorder experience repeated episodes of hypomania rather than mania.
The aim of the above study was to characterize the full spectrum of mania by identifying hypomanic episodes that last less than four days among those diagnosed with major depression. They described this type of hypomania as subthreshold hypomania. The study used data from 5,692 respondents of the US National Comorbidity Survey Replication (NCS-R), a nationally representative survey of American adults ages 18 and older.
The researchers found that nearly 40 percent of those identified as having major depression also had symptoms of subthreshold hypomania. Compared to those with major depression alone, those with depression plus subthreshold hypomania tended to be younger at age of onset and to have had more coexisting health problems, more episodes of depression and more suicide attempts. They also found that among those with subthreshold hypomania, a family history of mania was just as common as it was among people with bipolar disorder.
According to the researchers, the findings indicate that many adults with major depression may in fact have mild but clinically significant symptoms of bipolar disorder. In addition, because many with subthreshold hypomania had a family history of mania, the researchers suggest that subthreshold hypomania may be predictive of future hypomania or mania. Previous research has indicated that young people with subthreshold hypomania symptoms are more likely to develop bipolar disorder over time, compared to those without subthreshold hypomania.
The researchers suggest that depression and mania may be defined as dimensions, rather than as diskrete diagnostic categories. Practitioners should be aware that patients who report repeated episodes of subthreshold hypomania may have a risk of developing mania.
This reasearch shows the importance of early assessment, diagnosis and intervention of depression and bipolar disorder.