by Ron Parks, MD
ealth care money spent for depression in the United States, plus the cost of lost work, is enormous. In addition, this depression also effects general physical healing. Studies have shown that effective intervention for depression, when it exists with substance abuse or medical problems, also promotes health recovery.
New research shows that if depression exists alongside other illnesses, whose recovery is much more severe and difficult to treat. Effective identification and treatment of depression often produces marked benefit in the form of medical improvement, enhanced quality of life, reduction in the degree of disability in such illnesses as diabetes, chronic pain, substance abuse, arthritis, hypertension and heart disease.
Depression can clearly predate a medical or addiction problem, or it may be a reactive response to the illness or to the stress of it. It can also relate to the physiology of the illness or its treatment. In neurological conditions such as Parkinson's disease, multiple sclerosis, Alzheimer's disease and strokes, the lifetime prevalence of depression is 30 to 60 percent, compared to 16 to 17 percent in the general population.
In diabetes, the lifetime prevalence of depression is double to triple that of the general population. It can cause increased insulin requirement and increase the risk of diabetic complications. People with coronary artery disease and depression are estimated to have a 40 percent higher risk of having a cardiac event. Depression increases the risk of death from heart attack fivefold and is a significant predictor of disability one month after a heart attack or one year after coronary bypass surgery. Estimates of depression and cocaine dependence range from 33 to 53 percent. Estimates of depression in alcoholics seeking treatment range from 15 to 67 percent. Those who are dependent on opiates have rates of depression estimated as high as 75 percent.
Early diagnosis and treatment of depression is critical in preventing and alleviating sickness, suffering and possible death. Some studies suggest that in primary care settings, 30 to 50 percent of depressed patients go unrecognized and only about 20 percent of those recognized receive adequate treatment. Health care providers, friends, family and employers all need to make a greater effort. Community education about key signs of depression is important.
Symptoms include loss of interest or pleasure in doing things; often feeling down, hopeless or sad; trouble sleeping or sleeping too much; feeling tired or having little energy; poor appetite or overeating; frequently feeling bad about yourself; trouble concentrating; slowing down of speech or movements, or being fidgety or restless more than usual; thoughts of dying or of hurting yourself; difficulty functioning at home, work or getting along with people.
An integrative approach to treatment gives the best chances for improvement or recovery. Identification and treatment of contributing factors can be as important as taking an antidepressant medication or other remedies. Specialized testing may uncover hormone deficiencies such as hypothyroidism; deficiencies in B12, folic acid, minerals, amino acids or essential fatty acids; toxic metals such as mercury; environmental illness such as allergies to mold; food sensitivities to wheat or diary; or any of the medical or addiction problems listed above.
People with depression, beyond simply taking an antidepressant or a natural remedy, can benefit greatly from social support, psychotherapy and other complementary approaches. Seek out help from appropriate health professionals, especially integrative health-care practitioners, and learn as much as possible about depression by seeking information, attending educational programs and reading.
Ronald R. Parks, M.D.
practices integrative medicine and psychiatry in Asheville.
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