Life Comfort vs Depression | Mental Health Insights
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Life Comfort versus Depression
Historically, mood disorders have occupied a prominent part in medicine and numerous scholars have written about depression over the years. It is not surprising that people are very much aware of depression as a phenomenon. Quite a few people have asked me about specifics of depression with respect to age, gender and suicide potential. Those inquiries triggered interest in writing this article and summarizing some important aspects of clinical depression.
Let me focus first on the causes of depression, which indeed can be very different and complex. The most common life situations that account for depression are loss of a spouse, multiple physical illnesses, social isolation, and low socio-economic status. It is interesting that 50% of my patients deny depressive feelings and are referred for treatment due to social withdrawal and decreased activity. Depressed people tend to have a good understanding of their problems. At times, they overemphasize symptoms, their disorder, and their life problems. On one hand, it makes some facilitation for treatment because of good compliance with medications and therapy. On the other hand, it is difficult at times to convince such patients that improvement is possible. Patience and compliance with therapy usually give positive results in over 90% of cases. Nevertheless, we are aware that the risk for depression is 15% in a lifetime. Up to 65% of depressed individuals contemplate suicide, and 10%-15% commit suicide. Therapists are encouraged to ask depressed patients about suicidal thinking. This practice does not increase the risk for suicide.
Depressed mood and loss of interest in hobbies or pleasurable activities would be the key symptoms for depression. Other symptoms such as decreased appetite, insomnia, poor concentration and indecisiveness may also be part of the picture. Anxiety is present in 90% of all cases. Cognitive decline in depression has a sudden onset as opposed to dementing processes. In dementia, deterioration of cognitive functioning is more gradual.
Dynamically, it is common to see pain of “loss” directed toward oneself among depressed patients. Many of them live for somebody else and in those situations tend to experience multiple setbacks in relationships by not receiving empathy and compassion. Disappointments in life generate desperate sadness, and depressive feelings.
Biological predispositions have also been described in literature. Lately, in clinical practice, we have noticed a tendency of stopping estrogen / progesterone replacement medications among female patients. Discontinuation of this therapy exacerbates depressive symptoms. Although we are aware of increased incidence of mood disorders in post-partum and perimenopausal periods, future evaluation of sex steroids with respect to mood stabilization is warranted.
Many therapies and medications are currently available to improve our life and target depression. Yet, some people are still suffering from depressive symptoms and delay treatment. We believe that life comfort should be considered in every individual of either gender and in all age groups regardless of cultural backgrounds and socioeconomic status.
Alex Michelson, M.D.
Clinical and Medical-Legal Psychiatry
Offices in Laguna Hills, California
Phone: (949) 462-9114