Depression; Assessment and Treatment


In the course of life, a person experiences incidents of stress, sorrow, or grief. This may be brought about by such occurrences as loss of the loved one, going through a divorce, losing a job among other incidents. Most of the people are able to put up with this situations and able to revert to the life’s normal activities. But in the case where these feelings persist and makes one’s life difficult and they go on for over some weeks, the person acquires what is called “clinical depression”. This condition is not just a feeling of sadness but an illness that can bring about inability to carry out even the day to day activities. This condition can extend to a point that one affected starts considering committing suicide.

This paper is going to look at depression in detail. It consists of nine pages. In the first four pages, assessment of depression is going to be dealt with and the next four pages there will be a discussion on the treatment of depression. These two main areas will be sub-divided into even narrower areas. Under assessment, the areas covered include; types, causes and symptoms, prevalence and diagnosis of depression. Under the treatment section, the two major ways of treating depression are covered which include psychotherapy and use of antidepressants.


Types of depression

There are various types of depression or mental disorders that have depressive symptoms. Dryden-Edwards (2009). They include:

Major depression: This is a change in the state of the mind that goes on for weeks or even for months. It normally entails a low mood and loss of interest in the usual activities. This condition brings about interference in the affected person’s normal functioning and has physical symptoms. A person may incur one incidence of this condition, but often there is recurrence of these incidents in a person’s life.

Dysthymia: This is a less serious condition than major depression but extends for a longer time period, going for even several years. There are seasons where one feels relatively normal between the periods of sadness. The symptoms of this condition do not entirely interfere with a person’s usual activities.

Bipolar disorder: this is a condition where there is alternating of incidents of severe depression and extreme elevation. This condition is sometimes referred to as manic depression.

Seasonal depression: This condition is sometimes referred to as Seasonal Affective Disorder (SAD). This is a kind of depression that comes about only at specific seasons in the course of the year, especially during winter at which the number of daylight hours is lesser.

Psychotic depression: This is a condition whereby one goes through depression at the same time having hallucinations. This may come about as an effect of depression turning to be so severe that it brings about loss of touch with reality by the affected person.

Adjustment disorder: This is a condition that comes about as a result of the occurrence of an event in one’s life that is stressful. This is normally a separate reaction that fades away at the time the stress is over.


The major depression affects about 14 million people every year in the United States of America. Lisanby (2007). It is estimated by the World health Organization that at the present rates, depression will become the second biggest cause of disability by the year 2020 in the whole world. Major depression can bring about impairment of a person’s life and may result in committing suicide. The risk of suicide among those people affected by depression is estimated to be about between six and 15 percent.

Among the elderly people, depression is becoming a big health problem. There is an estimated prevalence of 1 to 2 percent in the overall total number of the old people, one to three percent among those living in the community and between ten and twelve percent among those people in outpatient primary care and inpatient scenario.

Causes and Symptoms of Depression

The causes of this condition are very much complicated and are not very much completely understood. However, these causes seem to have roots in the imbalances in neurotransmitters in the brain. More so, there is a possibility that heredity may also have influence in bringing depression in a person. However, even if depression may result from the inheritable traits that are susceptible to depression, it may come about as result of inheritable factors that do not depend on ones personality. Belmaker & Agan (2008). Heredity plays a minor role in major depression but a major role in the bipolar disorder. Yapko (2003).

Changes in life can bring about adjustment disorder. These changes in life can be brought about by death of a loved one, medical problems, one losing a job, divorce among others. This condition can fade away with time and the individuals affected may adjust to their normal life. However, in some cases, this kind of disorder may further develop major depression. The common symptoms of depression include a depressed mood, losing interest in almost everything, loss of weight, sleeping excessively or too little, too much restlessness, fatigue, feelings of being useless, loss of concentration and reduced ability to reason and thoughts regarding death such as contemplating suicide. Saisan, Smith, & Segel (2009).

The above mentioned symptoms are not necessarily exhibited in total in an individual having the condition of depression. More so, not all the people affected show these symptoms. The first signs observed in an individual who is developing depression are the complaints of physical problems like inadequate energy, tiredness, headache or stomachache. People like the adolescents portray such signs as becoming short-tempered when affected by depression.

In children, there can be poor performance in school and they can portray withdrawal signs. Brent & Birmaher (2002). Depression is very common among people who are having medical disorders that are chronic like multiple sclerosis, Parkinson disease, and chronic pain among others and among those people having other psychiatric disorders that may include bulimia, anorexia nervosa among others. Major depression is mostly traced among those people who abuse such substances as alcohol, heroine, and cocaine among other substances in their struggle to deal with their depression.


The diagnosis of the major depression is on the basis of standard clinical criteria like the ones whose publication has been done by the American Psychiatric Association. Mann (2005) Such criteria involve an incident of the a minimum of two weeks of a mood of depression, lack of interest, faded sense of enjoyment together with four of seven other features that are adequate to bring about clinically significant mental or physical suffering. These features are a five percent or more change in weight within one month, sleeplessness or oversleeping, fatigue, feelings of guilt and uselessness, lack of concentration, changes in psychomotor state, and contemplation or attempt of suicide.

 There is no major single test for clinical depression. Depression diagnosis depends on the evidence collected through observed personal symptoms, history, through questionnaires of mental health and physical examination. Any symptoms exhibited should be reported to the doctor who is carrying out the diagnosis. This is quite essential especially in determining whether the depression diagnosis is justified or if these symptoms are coming up from another condition which is not depression. An accurate list of the symptoms of depression also assists in determining whether the affected person is suffering from a major depression or any other form of depression.

It is estimated that more than half of those people who are depressed in the United States of America are not aware that they are undergoing depression. A large fraction of those people who are undergoing depression may just appear to be normal and make no complaints of feeling sad. Instead, this people put their focus on other signs such as feeling tired or having a headache. The expert in the medical field from whom they first seek assistance is the family practice physician. This physician may carry out a first screening interrogation for depression and may arrange various medical tests in order to cancel out other conditions. At the point where there is suspicion of the person having major depression, the person is sent to a psychiatrist or other mental health specialist for extra examination.     


The treatment of the major depression is done by psychotherapy and antidepressant medication.


The objective of using antidepressant medication is to give out symptoms relief within duration of about between two weeks and six weeks. The focus of psychotherapy is on the interpersonal as well as personal problems that underlies depression. When these two are used in a combination they become a very strong treatment to the person experiencing depression. However, not all antidepressants can be effective in treating a patient who is having depression. Therefore, it is quite vital for the medical attendant to try several of them in order to find the one that is effective that can bring about desirable results with the minimal side effects possible. The examples of the antidepressants are the selective serotonin reuptake inhibitors (SSRIs) like paroxetine, citalopram, fluvoxamine among others. These antidepressants bring about a decrease in depression by raising the level of serotonin in the brain. The side effects associated with these include headache, anxiety, sweating and poor sexual functioning. Similar to this type of antidepressants is the Selective serotonin/norepinephrine reuptake inhibitors (SNRIs) and these include venlafaxine and duloxetine. Mann (2005). Thy are often taken by those people with depression and are feeing intense tiredness or are having chronic pain and they have not effectively derived healing from the use of the SSRIs.

Another example of antidepressants is the Monoamine oxidase inhibitors (MAOIs) and these include phenelzine and tranylcypromine. The work of these antidepressants is to block the action of an enzyme found in the nervous system called monoamine oxidase. People using this drug should reduce foods that are rich in tyramine from their diet to evade probable side effects that are seriously hypertensive. Mann (2005). These kinds of antidepressants have various associations with other forms of drugs. Before one starts using these drugs, he or she must try to consider the current and previous medications together with a physician.

The other example is Tricyclic antidepressant (TCAs). These are less expensive as compared to SSRIs and have milder side effects. They have been used in treating depression for a long period of time. (2008). The side effects associated with these drugs include dizziness, dry mouth, and sedation. These side effects bring in the issue of taking care when prescribing for the older people these drugs. Examples of these drugs include doxepin, protriptyline, amitriptyline, imipramine, and trimipramine. This type of depressants can be quite risky when taken in overdose. Taking what is supposed to be taken, for instance, ten days at once can turn out to be lethal. Therefore, this implies that these drugs can not be quite appropriate for a person who is contemplating suicide.


In the course of treating the person, the therapist assists the person being treated to be conscious of the thinking patterns that he or she is having and how such patterns came about. Various psychotherapies exist but all of them are aimed at clearing depression in the affected person. All of them seem to work more effectively if they are used along with the antidepressant medications.

One of the psychotherapy is the cognitive-behavioral therapy. Under this, there is an assumption that the depression in the affected person is a product of the individual’s wrong pattern of thinking and that is the main cause of the individual’s present depression. Therefore here the focus is on the effort to alter the affected person’s thinking pattern and the way this person perceives things. The patient is assisted by the therapist to see his or her wrong thinking pattern and the emotions and conduct that come along with these negative thoughts. The therapist goes ahead and controls the patient to identify the thinking and take a new course in reacting to this wrong pattern.

Electroconvulsant Therapy (ECT)

These treatments are usually given to the patients three times every week for about between six and twelve treatments. Lisanby (2007). This depends on the severity of the condition and the rate of response to treatment.         This kind of therapy is quite effective as compared to drug therapy and produces results more quickly. Occasionally, this therapy is employed initially in treatment at the time severe depression is there, or when the patient does not want oral medication, or still, at the time when the affected person is psychotic. Other times, it is used in the case where the drug therapy has failed to work.

Under this therapy, treatment comprise of a sequence of electrical pulses that find their way in the brain via electrodes on the head of the person being treated. It is administered under anesthesia and the convulsions are prevented through administering the muscle relaxant. Even if the actual mechanisms that lead to the success of this kind of therapy are not well known, there is a belief that the electrical current brings about modification of the electrical processes of the brain and as a result there is the relief of the depression. The probable side effects of this therapy include nausea, confusion, headaches, muscle soreness and at other times, there can also be loss of memory.

Light Therapy

By the person affected by the Seasonal Affective Depression (SAD) exposing him or herself to the artificial light having equal wavelengths as that of the sunlight for about 60 minutes, there will be a reduction or complete prevention of the symptoms.

Alternative treatment

All over Europe the depressive symptoms are treated using St. John’s wort. This is a herbal antidepressant with very minimal side effects. Even if this antidepressant tends to be a more safe option, the improvement in the symptoms can take up to six months.


Prognosis of depression normally refers to the possible outcome of depression. This may include the period the depression takes, the possibilities of the complications associated with the depression, the possible outcomes, the potential of recovery, the duration for recovery, the rate of survival, the rates of death among other outcome likelihoods in the general prognosis of depression. As may be expected, such issues are by their nature not predictable.

Effective treatment of depression brings about improvements or completely clears the symptoms in about 75 percent of the people affected with major depression. But on the other hand, if depression is not treated, at the end of one year, 40 percent of the people affected will still be having the symptoms of depression. Whenever major depression occurs in an individual, there is a likelihood that the condition may occur again. The chances are that if the condition occurs once the possibility of happening again is 50 percent. If twice, the chances are 70 percent and if three times, the chances are 90 percent. Therefore’ it is of great importance for the affected people to be on the watch out on the symptoms occurring again and therefore these people may need protection treatment of antidepressants and/or Psychotherapy.

It is reported that 50 percent of the suicide cases that occur every year in the United States of America are caused by the major depression. Other problems caused by depression include heart disease problems among others.


People who are depressed are incapacitated emotionally by this condition and therefore they should be given encouragement to look for the assistance of the family members and those close to them. People should be educated about this condition of depression. The education along with therapy and existence of self-help groups can greatly assist in being aware of the depression symptoms. However, no sure way for the prevention of depression exists. But taking an initiative to control stress and to boost one’s self-esteem would go a long way in bringing about prevention of depression. In a time of crisis, friendship and social assistance is quite vital in enabling one to go over this rough spells. More so, taking a step to treat depression in the earliest stages, the moment the signs are exhibited will prevent the situation from getting worse. In addition, long-term maintenance treatment will also assist in the prevention of a relapse of depression symptoms.

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