Depression: Difference between revisions

'''Depression is a of mental illness which is characterised by persistent low mood,  diminshed interest in activities and 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>. Its causes are often multifaceted, involving a combination of external (exogenous) factors, such as environmental influences, and internal (endogenous) factors, including neural wiring and [[Neurochemistry|neurochemical]] imbalance (see '''Figure 1''').

Diagnosis of depression is traditionally performed by a psychiatrist or doctor. 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> there has been a shift toward patients self diagnosing via algorithmic psychometric tests. New developments in the field have indicated 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.

 

Two key [[cognitive biases]] contribute to depression. The first is [[Attention Bias|attention bias]], where the mind becomes inadvertently conditioned to focus on negative external factors. The second is [[Negativity Bias|negativity bias]], which involves a tendency to dwell not only on negative aspects of the environment but also on internal negative thoughts, such as past experiences or anxieties about the future.

Depression, first must be approached as a disorder influenced by environmental factors rather than treated pharmacologically. Jumping to medication to soon may obscure the distinction between external (exogenous) and internal (endogenous) causes. Addressing and eliminating external factors should be prioritized, followed by an evaluation of potential neurochemical (endogenous) imbalances if symptoms persist.The main points to initially address are:

 

 

The last step would be to consider taking drug such as a traditional [[Antidepressants|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.