Depressive disorders physical symptoms

Major depressive disorder causes the following physical symptoms ... 

Buspirone (Buspar). The first nonsedating, nonbenzodiazepine specifically introduced as an anxiolytic, buspirone is FDA approved for the treatment of GAD. This medication acts as a partial agonist at the postsynaptic serotonin (5HT)-1A receptor. Like the antidepressants, buspirone has a delayed onset of action and effectively relieves the intrapsychic symptoms of GAD. Devoid of the muscle-relaxing properties of benzodiazepines, buspirone does not as effectively relieve the physical symptoms of GAD. Buspirone is not effective in the treatment of depression. Furthermore, its utility for the treatment of anxiety disorders other than GAD appears to be limited. 

Depressive disorders can lead to death in other ways (Table 6-9). For example, depressed individuals are more prone to accidents that result from their impaired concentration and attention. They also often attempt to self-medicate, particularly with alcohol or other sedative agents, which may lead to death as a result of organ toxicity, as well as accidents. Psychotic depressive patients may act irrationally, putting themselves at greater physical risk. Although rare today, patients have died of severe malnutrition secondary to catatonic symptoms that precluded the ability to care for their basic needs. Depression can also contribute to a higher morbidity and mortality rate in patients with co-morbid medical disorders. For example, a large database indicates that depression may predispose to the development of ischemic heart disease and increase the risk of cardiac-related death ( 51). 

In clinical practice, depressive symptoms were common in patients with physical illness, including cardiovascular disease, diabetes mellitus, end-stage renal disease, and women in pregnancy, following delivery or menopause. However, data that specifically addressed serum lipid profiles in patients with depressive disorders and physical illnesses were still scarce. 

A 14-year-old boy with major depressive disorder responded to paroxetine 20 mg/day with full remission of depressive symptoms except insomnia (16). Diphenhydramine and trazodone did not improve his sleep and caused excessive daytime drowsiness. He then responded well to zaleplon 10 mg, but when he took two extra tablets 3 weeks later he developed complex behavior and sleepwalking. He had slurred speech, was slow in responding to questions, was moderately confused, and was uncoordinated and moved slowly. Physical examination, routine laboratory investigations, and an electrocardiogram were all normal. He remained in hospital for 8 hours and awakened without any memory of his activities. His mental state at 1 week and 1 month were both normal. 

The therapist continues to work collaboratively with Dr. D to address Ms. A s many health concerns her skin disorder, her symptoms of anxiety and depression, her weight gain, and her continued alcohol abuse. Physician, therapist, and patient make explicit that connection among the various problems she experiences her inability to identify the source of her stress and her reluctance to express that stress seem to cause her skin disorder to flare up. She seeks alcohol in order to soothe herself, and as the months pass with no improvements in her physical or emotional health, she continues to turn to drink as the only way to combat the anger and frustration she feels about many aspects of her life. 

Several medical, medication-induced, or substance-related causes of mania and depression have been identified (see Table 68-2 for causes of mania and Table 67-1 in Chap. 67 on depressive disorders for causes of depression). " A complete medical, psychiatric, and medication history physical examination and laboratory testing are necessary to rule out any organic causes of mania or depression. An accurate diagnosis is important because some psychiatric and neurologic disorders present with manic-like symptoms. For example, attention-deficit/hyperactivity disorder and a manic episode have similar characteristics thus individuals with bipolar disorder may be misdiagnosed and prescribed central nervous system stimulants. Use of any substance that affects the central nervous system (e.g., alcohol, antidepressants, caffeine, central nervous system stimulants, hallucinogens, or marijuana) can worsen symptoms and decrease the... 

Panic disorders, with or without agoraphobia, affect 1.6% of the adult population (>3,000,000 people) in the United States at some time in their lives. In panic disorder, brief episodes of fear are accompanied by multiple physical symptoms, such as terror, fear of dying, heart palpitations, difficulty in breathing, and dizziness. Panic attacks recur and the victim develops an intense fear of having another attack, which is termed anticipatory anxiety. In addition, the victim may develop irrational fears, called phobias, that relate to situations in which a panic attack has occurred. This condition may coexist with other phobias (agoraphobia, simple phobia, social phobia), depression, obsessive-compulsive disorder, alcohol and drug abuse, suicidal tendencies and irritable bowel syndrome. 

Depression Common mood disorder that involves severe and persistent sadness, lack of interest in pleasurable activities, suicidal thoughts, and physical symptoms, such as sleep disturbance, loss of appetite, and reduced sexual desire. 

Adjustment disorder is a state of emotional distress which typically interferes with an individual s normal level of functioning and arises in the adaptation period that follows after experiencing a traumatic event. It can be classified according to its predominant symptoms which include anxiety, worry, poor concentration, depression, irritability and physical symptoms such as tremor or palpitations. Symptoms usually develop within one month of a traumatic event and do not normally last more than six months, although depressive disorders can be more prolonged. 

Depression is one of the most common psychiatric disorders. It is characterized by feeling of intense sadness, helplessness, worthlessness, and impaired functioning. Those experiencing a major depressive episode exhibit physical and psychological symptoms, such as appetite disturbances, sleep disturbances, and loss of interest in job, family, and other activities usually enjoyed. A major depressive episode is a depressed or dysphoric (extreme or exaggerated sadness, anxiety, or unhappiness) mood that interferes with daily functioning and includes five or more of the symptoms listed in Display 31-1. 

Beach and Amir have demonstrated that with a given sample using the same procedures, some markers of depression may define a taxon, while others do not. In other words, both continuous and taxonic forms of depression exist. However, questions remain about the nature of the identified taxon. Is it really a depression taxon or has the exclusive focus on vegetative symptoms changed the nature of the construct Interestingly, certain somatic symptoms, such as sleep and appetite disturbance, are common in many disorders and can be considered the physical component of nonspecific distress (Clark Watson, 1991). Thus, perhaps the identified taxon is not a depression taxon at all and actually reflects general somatic complaints. Only construct validation can address these concerns. 

In contrast to panic disorder, the somewhat more subtle and persistent symptoms of GAD do not always command immediate attention. Although patients with GAD may present with a primary complaint of anxiety, they are more likely to complain of a physical ailment or another psychiatric condition or symptoms, for example, depression or insomnia. As such, many patients with GAD will seek treatment from a primary care physician long before recognizing the need for mental health care despite readily acknowledging that they have been anxious virtually all of their lives. 

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