Depression

Depression is a term used to describe a chronic state of lowering of mood. Some patients have a predilection for depression, but depression is a common state, occurring in more than 20% of all patients with major illnesses, particularly cancer.

Depression is a psychological reaction to the loss of health, a loved one, or one's own self-esteem. Certain degrees of depression probably accompany every chronic illness. There are many types of depression;reactive, neurotic, manic, melancholic, and agitated are only a few types. In general, patients with depression have pessimistic tones in speech and a downcast facial expression. They may express feelings of futility and self-accusation. They respond to questions with brief answers. Their speech is slow; their volume is low; their pitch is monotonous. Depressed patients feel inadequate, worthless, and defeated. They also suffer profound feelings of guilt. A remark such as ''You look sad'' invites these patients to talk about their depression. Crying can relieve severe depressive feelings, even if only momentarily, and thus enables patients to continue their story. Although crying may be brought on by patients' concern for their own illness, crying usually occurs when patients think of an illness or death of a loved one or of a potential loss. They often have much hostility and resentment and suffer from rejection and loneliness. Self-accusative and self-deprecating delusions can occur in severely depressed patients. When these delusions are present, the feelings of worth-lessness are so overwhelming that patients may believe that suicide is the only way out.

For example, a 23-year-old law student is engulfed by anxiety when he learns that he has acquired immunodeficiency syndrome (AIDS). When his friends and family learn of the illness, he is immediately excluded from all relationships. He has extreme feelings of guilt. His depression is worsened when he learns that his university has asked him to discontinue his studies. He is found later hanged in his parents' attic. His only way of coping with his illness has been through suicide.

Depression may be the most common reaction to illness, as well as the most frequently overlooked. The most important diagnostic symptoms of depression are the following:

• Markedly diminished interest or pleasure in almost all activities Insomnia

Change in appetite or weight Fatigue or loss of energy Agitation

Feelings of guilt or worthlessness # Decreased ability to think or concentrate Thoughts of death or suicide

Interviewers must not ignore any talk of suicide. If patients bring up suicidal thoughts, interviewers must get the assistance of someone experienced in the field.

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