Welcome to this week’s module on depression. Our patient this week is Maria Tarantino, a 32-year old mother of three, including a young baby. In the following short video, Maria describes how she’s feeling, and is recommended to see the doctor to discuss treatment. Depression can range from mild to severe, and treatment options vary depending on severity of symptoms. Treatments include psychological therapies and antidepressant medications. During this module you’ll learn more about this treatment options, with a focus on an antidepressant medicine called Fluoxetine.
And how about you? I’m good Really? You’re looking very pale. Yeah, I’m not coping too well. I feel tired all the time, and [INAUDIBLE] [INAUDIBLE] saps my energy. And just being around the house all day is–
Do you have some friends you could call, just to break up the day a bit?
I actually wanted to ask you about St. John’s Wart. I bought some to try, and they say it’s good for depression. Unfortunately, you won’t be able to use it. There’s no evidence that it’s safe while you’re breastfeeding. But make an appointment to see a GP about how you’re feeling. It’s really important. There are medications for the depression that are safe to use while you’re breastfeeding.
Depression is a serious and potentially life threatening disease that affects over 1 million Australians. It’s predicted to be the second most common medical condition, after heart disease, leading to death or disability over the next 20 years. Globally, suicide can be one of the tragic outcomes of depression– particularly in the 15 to 34-year-old age group, where it is one of the three leading causes of death. Depression can be a standalone problem, or a component or other mental health problems, including things like anxiety, bipolar disease, post traumatic stress disorder, amongst others. The symptoms may also mask an underlying problem, such as substance or alcohol abuse, or indicate a medical disease, such as underactive thyroid.
Before deciding on a management strategy, it’s important to differentiate stress, as well as the cause of mood change, from clinical depression. Diagnosis of depression requires at least one to two of the three key criteria to be present most at the time, on most days of the week. Having at least five out of the nine specific symptoms also helps differentiate the depression as either mild, moderate, or severe. Defining levels of depression helps us target treatment. Our patient this week, Maria Tarantino, also raises the possibility of another category of depression, that of postnatal depression. In women of childbearing age this is the most common disorder, affecting up to 16%, or 1 in 6 women, in this age group.
Depression is thought to be caused by many different factors. Choosing the most appropriate treatment for each patient thus requires an individual approach, with no single approach on medication always working in every situation. Self-help and support groups are also very important in managing depression, especially if it is chronic, persistent, or recurrent. Medical treatment goes into two main categories– psychological therapies, for example, counselling, and pharmacological therapies, or the use of medicines. The effectiveness of these approaches to treat depression is very dependent on the individual patient. Although there are some differences of opinion about the place of medication in the management of depression, generally it is still regarded as effective in treating moderate depression, and very effective in treating severe depression.
Newer anti-depressants have improved response to treatment, and reduced some of the side effects commonly experienced by patients treated with the older agents. Choosing the most appropriate medication for an individual depends on the range of factors, including the patient’s age, their other medical conditions, use of other medications, and the nature of their condition, and specific symptoms. For example, treatment may vary if a patient is agitated or anxious, suffering with a lack or too much sleep, and whether they are experiencing weight gain or weight loss.
We’ll check back with Maria at the end of the module, to see how she’s getting on.