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Depression: Difference between revisions
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[[File:Exogenous Depression.png|alt=Endogenous depression vs exogenous depression|thumb|'''Figure 1'''. Exogenous causes of depression are often missed | [[File:Exogenous Depression.png|alt=Endogenous depression vs exogenous depression|thumb|'''Figure 1'''. Exogenous causes of depression are often missed by psychometric analysis.]] | ||
'''Depression is a form of mental illness which is characterised by a negative [[Cognitive Biases|cognitive bias]] resulting in depressed mood, loss of interest in activities, or cognitive impairment'''<ref>'''The association between overweight/obesity and poor cognitive function is mediated by inflammation in patients with major depressive disorder.''' Xiaofeng Lan, Chengyu Wang, Weicheng Li, Ziyuan Chao, Guohui Lao, Kai Wu, Guixiang Li, Yuping Ning, Yanling Zhou, Journal of Affective Disorders, Volume 313, 2022, Pages 118-125,https://doi.org/10.1016/j.jad.2022.06.073.</ref>. The causative factor(s) of the disease may be external via the environment (exogenous) or internal via a [[Neurochemistry|neurochemical]] imbalance (endogenous) (see '''Figure 1'''). | '''Depression is a form of mental illness which is characterised by a negative [[Cognitive Biases|cognitive bias]] resulting in depressed mood, loss of interest in activities, or cognitive impairment'''<ref>'''The association between overweight/obesity and poor cognitive function is mediated by inflammation in patients with major depressive disorder.''' Xiaofeng Lan, Chengyu Wang, Weicheng Li, Ziyuan Chao, Guohui Lao, Kai Wu, Guixiang Li, Yuping Ning, Yanling Zhou, Journal of Affective Disorders, Volume 313, 2022, Pages 118-125,https://doi.org/10.1016/j.jad.2022.06.073.</ref>. The causative factor(s) of the disease may be external via the environment (exogenous) or internal via a [[Neurochemistry|neurochemical]] imbalance (endogenous) (see '''Figure 1'''). | ||
=== Diagnosis === | === Diagnosis === | ||
Diagnosis of depression was traditionally performed by a psychiatrist, however due to an undue amount of human error<ref>'''Rates of Detection of Mood and Anxiety Disorders in Primary Care''': A Descriptive, Cross-Sectional Study Monica Vermani, PsyD, Madalyn Marcus, MA. Prim Care Companion CNS Disord. 2011; 13(2): PCC.10m01013. doi: 10.4088/PCC.10m01013. Accessed on 30th November 2022 via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184591/</ref><ref>'''Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting'''. Shen H, Zhang L, Xu C, Zhu J, Chen M, Fang Y. Shanghai Arch Psychiatry. 2018 Apr 25;30(2):93-101. doi: 10.11919/j.issn.1002-0829.217080. PMID: 29736129; PMCID: PMC5936046. Accessed on 30 November 2022 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5936046/</ref><ref>'''Beyond Misdiagnosis, Misunderstanding and Mistrust: Relevance of the Historical Perspective in the Medical and Mental Health Treatment of People of Color'''. Derek H. Suite, MD, MS; Robert La Bril, MDiv; Annelle Primm, MD, MPH; and Phyllis Harrison-Ross, MD. Accessed on 30 November 2022 via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2574307/pdf/jnma00207-0025.pdf</ref>in the modern day this has shifted to algorithmic psychometric tests. New developments in the field have shown the efficacy of using voice<ref>'''Detecting subtle signs of depression with automated speech analysis in a non-clinical sample.''' König, A., Tröger, J., Mallick, E. ''et al.'' ''BMC Psychiatry'' 22, 830 (2022). https://doi.org/10.1186/s12888-022-04475-0.</ref> and facial recognition<ref>'''Diagnosis of Depressive Disorder Model on Facial Expression Based on Fast R-CNN. Diagnostics''' (Basel). Lee YS, Park WH. 2022 Jan 27;12(2):317. doi: 10.3390/diagnostics12020317. PMID: 35204407; PMCID: PMC8871079.</ref> technology to further aid diagnosis. | Diagnosis of depression was traditionally performed by a psychiatrist, however, due to an undue amount of human error<ref>'''Rates of Detection of Mood and Anxiety Disorders in Primary Care''': A Descriptive, Cross-Sectional Study Monica Vermani, PsyD, Madalyn Marcus, MA. Prim Care Companion CNS Disord. 2011; 13(2): PCC.10m01013. doi: 10.4088/PCC.10m01013. Accessed on 30th November 2022 via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184591/</ref><ref>'''Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting'''. Shen H, Zhang L, Xu C, Zhu J, Chen M, Fang Y. Shanghai Arch Psychiatry. 2018 Apr 25;30(2):93-101. doi: 10.11919/j.issn.1002-0829.217080. PMID: 29736129; PMCID: PMC5936046. Accessed on 30 November 2022 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5936046/</ref><ref>'''Beyond Misdiagnosis, Misunderstanding and Mistrust: Relevance of the Historical Perspective in the Medical and Mental Health Treatment of People of Color'''. Derek H. Suite, MD, MS; Robert La Bril, MDiv; Annelle Primm, MD, MPH; and Phyllis Harrison-Ross, MD. Accessed on 30 November 2022 via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2574307/pdf/jnma00207-0025.pdf</ref>in the modern day this has shifted to algorithmic psychometric tests. New developments in the field have shown the efficacy of using voice<ref>'''Detecting subtle signs of depression with automated speech analysis in a non-clinical sample.''' König, A., Tröger, J., Mallick, E. ''et al.'' ''BMC Psychiatry'' 22, 830 (2022). https://doi.org/10.1186/s12888-022-04475-0.</ref> and facial recognition<ref>'''Diagnosis of Depressive Disorder Model on Facial Expression Based on Fast R-CNN. Diagnostics''' (Basel). Lee YS, Park WH. 2022 Jan 27;12(2):317. doi: 10.3390/diagnostics12020317. PMID: 35204407; PMCID: PMC8871079.</ref> technology to further aid diagnosis. | ||
=== Treatment === | === Treatment === | ||
Depression may be a natural reaction to the environment. To treat the disease, external factors should be eliminated first, then endogenous issues should be explored. The main points to initially address are: | Depression may be a natural reaction to the environment. To treat the disease, external factors should be eliminated first, and then endogenous ([[Neurochemistry|neurochemical]]) issues should be explored. The main points to initially address are: | ||
# '''Healthy diet''' - supplementation of Vitamin D3, tryptophan<ref>'''The effects of dietary tryptophan on affective disorders.''' Arch Psychiatr Nurs. 2015 Apr;29(2):102-7. doi: 10.1016/j.apnu.2014.11.008. Lindseth G, Helland B, Caspers J. Epub 2014 Dec 9. PMID: 25858202; PMCID: PMC4393508. Accessed on 30 Jan 2023 via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393508</ref> and Omega 3, ↓ alcohol consumption. | # '''Healthy diet''' - supplementation of Vitamin D3, tryptophan<ref>'''The effects of dietary tryptophan on affective disorders.''' Arch Psychiatr Nurs. 2015 Apr;29(2):102-7. doi: 10.1016/j.apnu.2014.11.008. Lindseth G, Helland B, Caspers J. Epub 2014 Dec 9. PMID: 25858202; PMCID: PMC4393508. Accessed on 30 Jan 2023 via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393508</ref> and Omega 3, ↓ alcohol consumption. | ||
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# '''Exercise''' - 3+ times a week, the higher the intensity the better, best activity is to run in nature<ref>'''Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews'''. Ben Singh, Timothy Olds, Rachel Curtis, University of South Australia, Adelaide, Australia; Accessed on 31 March 2023 via the BMJ <nowiki>http://orcid.org/0000-0002-7227-2406</nowiki></ref><ref>'''The effects of walking in nature on negative and positive affect in adult psychiatric outpatients with major depressive disorder''': Kia Watkins-Martin, Despina Bolanis, Stéphane Richard-Devantoy, Marie-Hélène Pennestri, Catherine Malboeuf-Hurtubise, Frederick Philippe, Julie Guindon, Jean-Philippe Gouin, Isabelle Ouellet-Morin, Marie-Claude Geoffroy, A randomized-controlled study, Journal of Affective Disorders, Volume 318, 2022,Pages 291-298, ISSN 0165-0327, <nowiki>https://doi.org/10.1016/j.jad.2022.08.121</nowiki>.</ref>. | # '''Exercise''' - 3+ times a week, the higher the intensity the better, best activity is to run in nature<ref>'''Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews'''. Ben Singh, Timothy Olds, Rachel Curtis, University of South Australia, Adelaide, Australia; Accessed on 31 March 2023 via the BMJ <nowiki>http://orcid.org/0000-0002-7227-2406</nowiki></ref><ref>'''The effects of walking in nature on negative and positive affect in adult psychiatric outpatients with major depressive disorder''': Kia Watkins-Martin, Despina Bolanis, Stéphane Richard-Devantoy, Marie-Hélène Pennestri, Catherine Malboeuf-Hurtubise, Frederick Philippe, Julie Guindon, Jean-Philippe Gouin, Isabelle Ouellet-Morin, Marie-Claude Geoffroy, A randomized-controlled study, Journal of Affective Disorders, Volume 318, 2022,Pages 291-298, ISSN 0165-0327, <nowiki>https://doi.org/10.1016/j.jad.2022.08.121</nowiki>.</ref>. | ||
# '''Sleeping well''' - by exposing yourself to sunlight you can reset your Circadian Rhythm whilst exercising can also help you sleep. | # '''Sleeping well''' - by exposing yourself to sunlight you can reset your Circadian Rhythm whilst exercising can also help you sleep. | ||
# '''Reducing overstimulation''' - anti rumination, reduce caffeine intake | # '''Reducing overstimulation''' - anti rumination, reduce caffeine intake, increase mindfulness and meditation practices. | ||
# '''Talking''' - self therapy, counselling, increase social contact. | # '''Talking''' - self therapy, counselling, increase social contact. | ||
The next step would be to consider | The next step would be to consider an antidepressant. Doctors often prescribe the SSRI, fluoxetine as the first port of call however, statistically, they (and all other antidepressants) are only effective by a small margin. It has been found that 54% of adults experience a reduction in symptoms after taking an antidepressant, however 35–40% experience similar improvements after taking a [[placebo]]. This means antidepressants are only responsible for a decrease in symptoms of around 20%<ref>'''Treatment outcomes for depression: challenges and opportunities.''' Pim Cuijpers, Argyris Stringaris, Miranda Wolpert. Published in the Lancet Psychiatry: February 17, 2020. Accessed on 31 March 2023 via DOI:<nowiki>https://doi.org/10.1016/S2215-0366(20)30036-5</nowiki></ref>. To compound this, the 20% who see some effectiveness are plagued by the fact that about a third of these symptoms return at some point during therapy. | ||
=== Relapse === | === Relapse === | ||