Depression: Difference between revisions

 

The diagnosis of depression has traditionally been conducted by psychiatrists or doctors. However, to reduce 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 growing shift towards using algorithmic psychometric tests based on yes/no or rating-scale questionnaires. Emerging advancements in the field suggest that 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 technology<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> could play a significant role in enhancing diagnostic accuracy in the future.

[[Cognitive biases]] are believed to be both a root cause and a symptom of depression, with two primary biases playing a significant role. The first is [[Attention Bias|attention bias]], where the mind becomes unconsciously conditioned to focus on negative external stimuli. The second is [[Negativity Bias|negativity bias]], which involves a tendency to dwell on negative internal thoughts—such as past regrets or future anxieties—as well as unfavorable aspects of the surrounding environment.

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 prioritised, 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 and psychedelics|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.