Un 5,2 % de la población española sufre depresión

Depression is a mood disorder that can affect anyone regardless of sex, race or age. As the Dra tells us. Susana Álvarez Avello, specialist in Psychiatry with more than 20 years of experience.

It's more than feeling low in spirit from time to time. Depression is a serious disease that needs diagnosis and treatment. According to the latest data from the report of the World Health Organization (WHO), in Spain five percent of the population suffers from depression.

Despite the fact that more and more research is being done and their mechanisms are known, their ultimate cause is unknown. Every time we know better the neurotransmitters that regulate the state of mind, the thought, the sleep-wake cycle, the appetite and the behavior. The most studied neurotransmitters are serotonin, noradrenaline and dopamine, but the role of melatonin and glutamate is also studied. All research has shown that in the brain of people with depression there is an imbalance of these substances.

But there are also biological, psychosocial and social factors that can make people more vulnerable to a depressive episode, such as genes, hormonal changes, physical illnesses, traumatic events, the environment and stress.

The severity of the episode is defined by the amount of symptoms present and their severity. All these symptoms must cause alterations in social, work, family and personal functioning

What are the symptoms of depression?

The symptoms by which the diagnosis is made are:

• Pathological sadness most of the day.
• Apathy.
• Anhedonia, that is, loss of ability to enjoy activities that were previously pleasurable.
• Ideas of pessimism and uncertainty about the future.
• Ideas of low self-esteem and undervaluation.
• Tendency to get irritated.
• Subjective feeling of anxiety and anguish.
• Difficulties to maintain concentration.
• Alterations of sleep and appetite.
• Somatic complaints
• If the symptom picture progresses, ideas of death and autolytic ideation appear.

The most serious symptom of depression is the autolytic ideation that can lead to suicidal acts. It is essential to explore this symptom in order to avoid suicidal behaviors that may be irreparable. There are suicide risk factors such as:

• History of previous suicide attempts.
• Antecedents of suicide in the family.
• Comorbidity with personality disorders.
• Impulsiveness.
• Despair
• Traumatic early life events.
• Vital stress
• Low social support-couple.
• Male sex
• Abuse-dependence on alcohol or other drugs.

In many cases, depression is associated with other disorders such as anxiety, alcohol and other substance abuse, and with some organic brain and systemic diseases.. It is also frequent its association with eating disorders and some personality disorders. In addition, it is more common among people with chronic physical illness and the relationship between them is reciprocal, since physical problems can exacerbate depression and in turn depression can adversely affect the course of physical pathology. Depression is also a risk factor for some physical pathologies, as is the case of cardiovascular diseases.

Depression can start at any age, although its highest prevalence occurs between 15 and 45 years , young people show mainly behavioral symptoms, while older adults more often have somatic symptoms.

Depression treatment

Once the depression is diagnosed by specialists in Psychiatry it is fundamental to treat it. Fortunately nowadays it is a treatable disorder , since there is a wide arsenal of very effective antidepressant medication.

The treatment should be personalized for each patient , depending on the choice of a drug of the patient's personal characteristics, the present symptoms, other associated diseases or comorbidities, prior responses to medications.

Once the treatment is established, the efficacy should be evaluated between the first 15 days and a period of 6 weeks, since in this period the response to the antidepressant is given. If the response to treatment is partial or does not occur adequately, there are other strategies of combination, change and potentiation of the different medications available, always seeking the total remission of symptoms.

In addition to pharmacological treatment, psychotherapy is useful especially in episodes considered mild.

The risk of recurrence in major depression is high and thus, half of patients have a new episode after suffering the first, 70% after two and up to 90% after three. For this reason, an important issue in the treatment of major depression is the time that pharmacological treatment should be maintained after recovery to prevent recurrence.

Once the remission of symptoms has been achieved, treatment should be maintained for at least six months, extending this period depending on whether there have been previous episodes or if any residual symptoms are maintained.. In patients with a previous episode or presence of residual symptoms, treatment must be maintained at least 12 months after remission. In patients with more than 2 previous episodes, treatment must be maintained for at least 24 months after remission.

The dose of the drug used during the maintenance phase should be similar to that with which the remission was achieved. There are other forms of treatment for severe, chronic or resistant depressive episodes such as Electroconvulsive Therapy , a treatment of proven efficacy; or the Transcranial Magnetic Stimulation , with less evidence of efficacy in the literature.

Recommendations for patients with depression

A patient with depression, in addition to properly taking the prescribed treatment, can follow a series of recommendations that can help him recover:

• To eat a balanced diet.
• Enjoy an active life
• Exercise.
• Sleep as necessary and on a regular basis.
• Spend time with family and friends.
• Set yourself realistic goals.
• Decrease the level of stress.
• Assume that you may not be able to control your feelings or thoughts but your attitude and actions.