Central PA Medicine Fall 2017 - 18

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Community, Health & Wellness

BLUES
THE

NOT THE MUSIC, NOT THE INSURANCE COMPANIES . . .
THE OTHER KIND

P

hilosophers say that joy in life can
only be experienced if it is contrasted
with sorrow.  We all experience sad
moments, moments that can go on
for hours, days or months.  They often happen
due to life experiences that leave us unhappy,
but sometimes they can happen from events
that others handle more effectively.  Sometimes,
we can feel blue for seemingly no good reason at
all.  When sadness happens in a dysfunctional
way on a persistent basis, doctors give it the
label "Major Depressive Disorder." 
How does this problem differ from the plain
old "blues" from which we can resolve quickly
and easily, and what can we do about it?

Major Depressive Disorder is believed to affect
216 million people worldwide, which is 3% of
the population, and is defined by medical and
psychological experts by way of very specific
criteria. While several diagnostic scales exist,
these are often expressed and defined by the
popular Hamilton Scale, a nearly 60-year-old
listing that correlates with the presence of
Depression is at least 5 out of the following
9 items are present in a 2 week period.  They
should also represent a decline in mood and
difficulty with functioning.   

18 Fall 2017 Central PA Medicine

By ROBERT ETTLINGER, MD 

DEPRESSION IS AT LEAST
5 OUT OF THE FOLLOWING 9
ITEMS ARE PRESENT IN A
2 WEEK PERIOD.
1. Depressed mood
2. Diminished interest or
pleasure in life
3. Significant weight loss or
weight gain
4. Insomnia or excessive
sleeping
5. Psychomotor agitation or
retardation (feeling that your
body or your thoughts are too
rushed or too slow)
6. Fatigue or loss of energy
7. Feeling worthless, or
excessively guilty
8. Decreased ability to
concentrate  
9. Recurrent thoughts of death,
including by suicide (of note,
2-7% of adults with major
depression die by suicide)

Almost invariably, people with Depression
have one or more external issues that lead to a
feeling of stress. Otherwise, four other causes
are involved:
1. Brain chemistry - our brain is composed
of neurons, long rope-like cells that meet at
their ends with other neurons.  The space between these ends are called synapses, and they
spread signals to one another by chemicals
called neurotransmitters.  The signals facilitate
our brains to express cognitive behaviors, such
as enjoyment or sadness.  These chemicals
are incorrect in levels or otherwise work in a
dysfunctional manner, with an association to
clinical Depression.  They include dopamine,
norepinephrine, and serotonin, the latter
of which is corrected with a class of drugs
called SSRIs (including Prozac, Zoloft, Paxil
and Lexapro.)
2. Biologic differences - depressed patients
have exhibited physical changes in the brain,
found either by  radiologic studies, or by tissue
specimen analysis.
3. Hormones - blood stream chemicals are
often abnormal in depressed patients, causing
it to occur more commonly during or after
pregnancy, in thyroid disease, in menopause,
and in men with low testosterone levels.


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