Depression and anxiety are very common medical conditions in the community. Unfortunately fewer than 50% of cases present to their doctors for a wide variety of reasons. A lesser number agree to undertake medical management to full remission. Delayed diagnosis, implementation of care and follow-up result in many complications such as chronic courses in the anxiety and depressive states including self-harm, suicide. All this translates into much distress for the patient and their immediate kin.
Recognizing the Patient with Depression and Anxiety
The recognition of patients at risk for depression is an extraordinarily important responsibility. There is a genetic susceptibility to such conditions and then there are environmental predisposing factors which contribute in various shades in the individual case. Obtaining the patient’s family history is crucial. The patient’s personal history of depression is also important since a previous episode increases an individual’s risk for a subsequent episode.
Women are approximately twice as likely as men to develop depression. Although the reasons for the difference in gender susceptibility are unclear, there is evidence to suggest that the increased incidence is related to hormonal factors, stress, and lifestyle. Life stressors are important risk factors for the development of depression; individuals who have experienced adverse childhood experiences, including childhood trauma, neglect, sexual and/or physical abuses, and parental loss at an early age, are at increased risk for developing depression.
A number of other psychiatric and medical disorders increase the risk for depression, with anxiety disorders prominent among them. Alcoholism and other forms of substance abuse are associated with an increased risk of depression; many patients undoubtedly use alcohol and drugs as a means of self-medication for depressive symptoms. There are medical disorders with high rates of comorbid depression, including Parkinson’s disease, Alzheimer’s disease, cardiovascular disorders, pancreatic cancer, and a variety of other malignancies. One-quarter of women with breast cancer experience major depression.
Depression and Reproductive Issues
Postpartum depression, for example, has an overall prevalence of 10%. Certain subgroups are at even greater risk. Over 25% of adolescents who give birth, particularly single mothers, have a risk of developing postpartum depression. This condition is associated with an increased risk for suicide. Obstetricians, with whom new mothers are most likely to have contact after delivery, are likely to focus on issues such as episiotomy healing and breastfeeding at the first postpartum visit and therefore may not inquire about symptoms of depression. Besides being a risk factor for suicide, postpartum depression can impede mother-infant bonding. Deficits in this area can result in negative outcomes for the child, including an increased risk for anxiety and depression in adulthood. The depressive disorder also occurs in some women after spontaneous miscarriage.
Treatment for Depression and Anxiety…