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Depression is occupying a greater part of our daily lives. The normal cycle of human existence is that we have happy days and sad days. It may not be a regular cycle, but for most people it tends to balance out. Some of us enter prolonged periods of the sad cycle where it seems that the negative thoughts and ideas will never end. Oftentimes things may suddenly change and the positives start to accumulate. But on occasion, hope becomes faint and things just seem to get more dismal.
The diagnosis of clinical depression is a difficult one and relies on a judgment call by a clinician. It is often based on the responses to a series of inquiries involving desires, appetite, sleep, relationships and concentration. At the same time, observation of associated mood, posture, facial expression and other cues are recorded. The diagnosis of depression is important in order to determine if a patient is being functionally impaired and at higher risk of harm. It implies that various modalities should be used to improve things.
Psychotherapy comes in many forms. Short interventional and monitoring sessions are the common forms employed in family practice. Intensive psychotherapy, analytical therapy and other forms are within the spectrum of psychiatrists and psychologists. Psychiatrists are medical doctors with specialized training who work in the OHIP system and employ various medications, intensive sessions, electro-therapy and other techniques to treat people. Psychologists are trained in psychotherapy, but generally do not prescribe medications. They are allowed to function outside of OHIP and can be easier to access. We have a dire shortage of psychiatrists, while the existing ones tend to be overworked and difficult to see.
Most patients diagnosed with mild clinical depression are functional. Stress is a symptom while depression is a diagnosis. Many jobs are stressful, but they don't necessarily cause depression. Depressed people are encouraged to continue to function and participate in all aspects of their lives, including work. In many cases, a clinician may prescribe medication. The two commonest types are sleeping pills and serotonin-based antidepressants. In most cases, the primary goal is to try and restore disturbed sleep and improve the ability to concentrate and process thoughts. In the last 20 years, the first drug of choice in mild clinical depression has been one of many serotonin-uptake inhibitor types of medication. I view these medications as tools to aid treatment and they should not be viewed as a treatment on their own. Their use requires monitoring and I try to see patients more frequently at the onset and then at a regular interval once they are using medications. The medications are fairly safe. It takes a lot of medicine to develop toxicity, and side effects are minor and easily tolerated. Long term use seems to be acceptable to many people and no serious long term side effects have been identified.
A rare side effect has been identified with the serotonin-uptake inhibitors. It is called Serotonin Syndrome. Serotonin is one of many brain molecules which brain cells use to communicate with each other. It seems that there is some depletion of this molecule in the depressed state. The medications work by slowing the uptake of molecules from their active sites. This results in less molecules being able to do more work. Clinical dictum suggests to only use medication until a somewhat normal state is re-established. In the rare case, elevated levels of serotonin may result. It is seen after increasing the dose, or adding another interfering medication such as amphetamines, herbs or pain killers. Common symptoms include: agitation, fever, restlessness, delirium, anxiety and increased muscle tone. This state needs to be recognized and treated in the hospital due to the chance of coma and death. It underlies the importance of maintaining monitoring with your doctor if you are using prescribed medication.
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