An Evaluation of Depression, its Impacts, and Care

An Introduction to Depression

Depression is an illness involving feelings of severe despondency and dejection. The
psychopathological state includes symptoms such as loss of interest in activities that were once
interesting or enjoyable, suicidal tendencies, loss of emotional expression, a persistently anxious
mood, feelings of hopelessness, pessimism, guilt, worthlessness and social withdrawal (Kessler,
2003). This disorder is life threatening and can occur at any age from childhood to late life.
Depression is a complex phenomenon that includes predisposition of episodic and often
continuous mood swings, distinction in symptomatology varying from faint to severe symptoms
with or without psychotic features, and interactions with other psychiatric and somatic disorders.
Depression increases the risk of developing cardiovascular diseases such as coronary
artery disease and worsens the prognosis after myocardial infarction. The disorder has a high rate
of comorbidity with other psychiatric disturbances. Corticotropin-releasing hormone (CRH) is a
neurotransmitter released by the hypothalamus in response to the notion of psychological tension
by cortical brain areas (Chang et al, 2006). The hormone induces the secretion of pituitary
corticotropin, which stimulates the adrenal gland to release cortisol into the plasma. Impaired
corticosteroid receptor signaling is a key mechanism in the pathogenesis of depression (Chang et
al, 2006).

Pathopharmacology of Depression

The pharmacological treatment of depression should be made based on the patient’s
symptoms, anticipated side effects, and safety. The treatment of depression is primarily
dependent on selective serotonin reuptake inhibitor as first-line acute treatment (Trivedi et al,
2004). Antidepressants are used for the treatment, but they do not entirely relief symptoms in

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some patients. For instance, the risk of suicidal ideation is not reduced by use of antidepressants.
Residual depressive symptoms persist in most patients while others partially respond to the
treatment. During treatment, antidepressants exert their effects upon the brain’s serotonin,
norepinephrine and neurotransmitter receptors.
According to the Texas Medication Algorithm Project, the frequency of clinical visits
should be adequate to implement treatment tactics including monitoring for system changes and
adverse effects, adjusting doses necessarily to achieve ideal therapeutic trial, and changing
regimens when suboptimal clinic response is observed after regimen optimization (Crismon et al
1999). The project also recommends for the use of a cross-tapering strategy when switching
between antidepressants medication. Changes in medication are made after evaluating tolerance
levels, patient safety, and efficacy across multiple symptom domains. The end goals of
depression treatment are to achieve and sustain remission, return to ideal levels of psychosocial
functioning and avert relapse and recurrence of the disorder.
In Texas, all patients with major depression disorder who achieve symptom remission
without psychotic features continue treatment at the same dose for at least 6 to 9 months (Trivedi
et al, 2004). It provides the caregivers with the necessary time to monitor changes in the patient’s
state of mind. In essence, this significantly improves the management of the disorder among
patients. Maintenance phase therapy is considered as appropriate based on the risk of recurrence
of depression after recovery. This step provides adequate insights of monitoring risk of
recurrence and means of averting the risks.

Standard of Practice for Depression

According to the Diagnostic and Statistical Manual (DSM-IV), the clinical guidelines for
the diagnosis of major depression disorder requires that five of the nine significant symptoms of

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depression be identified in a patient for a successful diagnosis (Kessler, 2003). The nine
symptoms are sad mood, loss of interest or pleasure, massive weight or appetite alteration,
insomnia or hyposomnia, psychomotor agitation or retardation, fatigue or loss of energy;
feelings of worthlessness, diminished ability to concentrate or indecisiveness; and suicidal
tendencies (Kessler, 2003). The clinical treatment of major depression disorder involves the
acute and maintenance phases (Gilson, 1999). The acute phase treatment eliminates depression
symptoms and restores psychosocial functioning. The treatment at the maintenance phase
ensures a return to baseline function, quality life and prevents recurrence of symptoms. The
clinical guidelines for treatment are systematic monitoring of patient outcomes, treatment
decisions that are evidence-based and responsive to therapeutic goals (Kessler, 2003). The
standard practice for managing major depression disorder in my community varies from that of
the state. The practice in my community lacks persistent monitoring of patient outcomes and
prevention of recurrence risks. The patients in the community also lack necessary amenities they
require to manage the disorder effectively.
Characteristics of and Resources for a Patient Who Manages Depression
Patients who manage the major depression disorder are characterized by positive
outcomes such as an increase in levels of concentration, reduced fatigue and suicidal ideation,
positive change in appetite and psychomotor relaxation. These patients have adequate access to
care, treatment and their life expectancy levels are quite high. The management of the disorder is
more efficient on an international scale compared to the national level. Patients have adequate
access to management resources internationally as opposed to nationally. There is an availability
of more information about the treatment and management of the disorder globally. There are also
international associations and centers that specialize in providing services solely to major

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depression disorder patients. In essence, this shows that patients who have access to resources
internationally have a greater chance to a quicker recovery process and management practices.
These patients take a shorter period to remission due to their exposure to better care facilities.
Factors that Contribute To a Patient Being Able To Manage Depression
The efficient management of major depression disorder depends on the availability of and
access to financial resources, Medicaid, and insurance. The treatment of depression requires
huge finances depending on a patient’s reaction to various mode of medication. Patients who can
meet the financial burden of the treatment often have a better chance of recovery compared to
those that cannot finance the treatment process. Availability of funding acts as a guarantee to the
access of the best medical facilities. Depression patients who have medical policy covers or
health insurance also have the undeniable access to the best treatment for the disorder. An
insured patient needs not to worry of how to finance the treatment. On the other hand, an
uninsured patient would have additional stress as to how they should fund the treatment. An
increase in the stress levels of a major depression disorder patient may be fatal. A patient’s
ability to access Medicaid also influences the capacity to manage the illness effectively.
Medicaid personnel provide medical services at no or subsidized costs thus enabling patients to
easily access treatment. Therefore, the availability of Medicaid has a significant impact on the
treatment and management of the disorder. The lack of Medicaid for depression patients would
hinder their ability to access treatment, medical care and ultimately affect the efficient
administration of the illness. It may not affect the patients who have the financial resources to
cater for the treatment but other patients who lack the resources would be affected by the lack of
Medicaid.

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Depression patients with an unmanaged disease process depict violent behavior due to
their limited perception of life. They are often aggressive towards people who do not concur with
their ideas and propositions. Patients with unmanaged depression have persistent mood swings,
which causes their aggressive nature. Individuals with unmanaged depression are often untidy
and weak due to their tendencies to neglect their personal hygiene and nutrition responsibilities.
Such patients are hopeless and feel unworthy hence lack the interest of tidying up. Due to the
feeling of unworthiness, patients with unmanaged depression also isolate themselves and avoid
social interaction.
The Impact of Depression on the Patients, their Families, and the Society
The effects of depression manifest physically, mentally and socially on the patient and
the people around them. The patient’s levels of production decline due to loss of energy that
causes fatigue thus affecting the individual’s ability to carry out duties and ultimately affecting
their financial viability. The mental effect of depression affects the patient’s ability to think and
concentration levels. The lack of focus affects one’s performance in intellectual activities and
capacity to make sound decisions.
The families of depression patients are affected by the social impact on the patients.
Individuals that suffer from depression often isolate themselves due to feelings of guilt and
unworthiness. These patients lack the interest to be socially active and cut communication ties
with others. The family members are the most affected because they are in a dilemma of how to
communicate with the patient without causing aggressiveness. A decline in the productivity
levels of depression patients adversely affects the population due to an increase in the
dependency ratio resulting from a growing number of depression patients.

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Depression poses weighty economic constraints on the patient, families and the
population. The productivity levels of the patients and their capacity to work declines due to loss
of energy, concentration and psychomotor agitation. Employers often have to retrench staff due
to issues related to depression. Studies indicate that 10% of depression victims consider direct
costs incurred as extreme while 27% also consider indirect costs like losing a job to be severe
(Maj & Sartorius, 2002). The loss of a job for patients results in a decline in the family’s income
levels. The responsibility for the family’s expenses rests solely on one partner in such instances.
This situation worsens if the partner has to abstain from work to offer care to the patient.
Research shows that 17% of family members refrain from work to provide care to depression
patients (Maj & Sartorius, 2002). The population is also affected by the increase in financial
costs arising from a decline in productivity levels of depression patients.
Best Practices for Managing Depression

I would promote best practices for managing depression by creating a follow-up platform
that enables healthcare providers to monitor the recovery progress. It would be done by setting
up a special relationship between the patients and the health providers. I would also urge
patients who have recovered from depression in the past to create a support group that
incorporates existing patients. The support group would help to implement a group therapy
strategy for encouraging and motivating patients. An additional strategy for implementing the
best practices would be establishing an outreach program to enable healthcare providers to attend
to patients in the comfort of their homes.
An evaluation of the implementation of the strategies would be done by maintaining a
statistical analysis of the patient follow-up. Addition in the number of sick people requesting for

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monitoring would indicate success in the policy. Analysis of the data of the patient’s healing
process would also be a good indicator of the policy’s performance.

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References

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Sackeim, H. A. (1999). The Texas Medication Algorithm Project: report of the Texas
consensus conference panel on medication treatment of major depressive disorder. The
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Gilson, M., & Freeman, A. (1999). Overcoming depression : a cognitive therapy approach for
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(2003). The epidemiology of major depressive disorder: results from the National
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Suppes, T. (2004). Clinical Results for Patients With Major Depressive Disorder in the
Texas Medication Algorithm Project. Archives of General Psychiatry, 61(7), 669-680.