Phenomenology Of Depression
The most prominent characteristic that all mood disorders share is a disturbance in mood (APA, 2000). For the mental health professionals these clients might be perceived frustrating to deal with because about 70% of the clients who have had mood disorder can expect its reoccurrence (Dziegielewski, 2002).
Depression is a mood state that is characterised by significantly lowered mood and a loss of interest or pleasure in activities that are normally enjoyable. Depression is often difficult to diagnose because it can manifest in so many different ways. This disorder encompasses body, feelings, thoughts and behaviour to varying degrees. Symptoms can cause a significant personality change; ability to love and work is grossly impaired by the depression and it makes difficult for others to empathise with the depressed person.
Depressed mood is a common and normal experience in the population. However, a MAJOR DEPRESSIVE EPISODE can be distinguished from this “normal” depression by its severity, persistence, duration and the presence of characteristic symptoms. The most common emotional, behavioural and physical symptoms of a major depressive episode are:
- Markedly depressed mood
- Loss of interest or enjoyment
- Reduced self-esteem and self-confidence
- Feelings of guilt and worthlessness
- Bleak and pessimistic views of the future
- Ideas or acts of self-harm and suicide
- Disturbed sleep
- Disturbed appetite
- Decreased libido
- Reduced energy leading to fatigue and diminished activity
- Reduced concentration and attention
Source: (WHO Collaborating Centre for Mental Health and Substance Abuse, 2000).
According to The International Classification of Diseases and Related Health Problems ICD-10 (WHO, 2007), major depression can be coded according to:
Severity – mild, moderate, severe
In mild depression, an individual have some symptoms and is usually associate with only minor impairment in work and social functioning. Moderate depression already involves impairment in occupational and social functioning and severe depression may include psychotic symptoms as well. Somatic features are present in most cases.
Psychotic Features – hallucination, delusions
Psychotic features are usually present in only severe form of depression and most prominent features are hallucinations and delusions. Hallucinations are distorted perception and sensation (i.e. seeing, hearing, smelling) and delusions are distorted thoughts (i.e. false beliefs that are firmly held despite objective and contradictory evidence). Usually they involve mood congruent themes of guilt, punishment, impending disaster and bodily illnesses.
Somatic Features
Most prominent somatic features include marked loss of interest or pleasure in activities that are normally pleasurable, lack of emotional reaction, waking in the morning 2 hours or more before the usual time, marked psychomotor retardation or agitation, marked loss of appetite, weight loss and marked loss of libido
The average duration of an untreated episode is 12 weeks (sometimes only 4-6 weeks). Approximately 10% of people never recover without treatment. With an appropriate treatment, the majority of individuals will experience a complete recovery from the current episode. However, some individuals will require more lengthy and intensive treatment.
The term ‘treatment resistant depression’ (WHO Collaborating Centre for Mental Health and Substance Abuse, 2000) has sometimes been used to define depression that does not respond well to medical treatment such as medication and ECT (Electro Convulsive Therapy).
This term has been criticised as being a pure labelling phenomenon. It does not take into account that individual’s depression and symptoms should be matched with the treatment and that psychosocial factors influence maintenance of depression. It does even not include whether or not the client has received an adequate course of psychotherapy or counselling.
Quick Reference to Depression
(Source: APA, 2000)Depression disorders: These disorders have the presence of one or more depressive episodes without history of manic or hypomanic episodes.
Major depressive disorder: This disorder is characterised by one or more major depressive episodes that must last at least two weeks.
Dysthymia: This disorder is characterised by a two-year history of depressed mood, and the individual must not be without symptoms for two months. This disorder is considered less severe than the symptoms noted in major depressive disorder.
Depressive disorder NOS (Not Otherwise Specified): This disorder is similar to the other NOS categories as individuals in this area do not meet the full criteria for one of the other mood disorders listed above.
In the next post we’ll look at the aetiology of depression.