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Depression is closely associated with a lack of confidence and self-esteem and with an inability to express strong feelings. Repressed anger is thought to be a powerful contributor to depression. The person feels inadequate to cope with the situations that arise in everyday life and so feels insecure.
Treatment of profound and chronic depression is often very difficult, requiring in most cases intensive psychotherapy to help the patient understand the underlying cause of the depression. antidepressant drugs such as imipramine hydrochloride (Tofranil) and amitriptyline (Elavil) are often used in the treatment of profound depression. They are not true stimulants of the central nervous system, but they do block the reuptake of neurotransmitter substances, which may potentiate the action of norepinephrine and serotonin. monoamine oxidase (MAO) inhibitors are also used. When antidepressants fail, a different technique such as electroconvulsive therapy may be used in conjunction with the psychotherapy.
When patients are depressed, they are likely to isolate themselves and avoid social contact even with those who are trying to help them. Since loss of contact with others contributes to depression, members of the health care team should persist in attempts to talk with these patients, by asking them questions, and actively listening when they attempt to express their feelings. One should be especially careful to avoid being judgmental when the patient does express despair, anger, hostility, or some negative feeling. Above all, it is important not to be condescending or to respond to statements with a meaningless cliché such as “Don't worry,” or “I'm sure everything will turn out okay.” These responses convey a lack of empathy with the patient's suffering and are an unrealistic approach to a problem that is very real.
Physical contact and touching may be misunderstood by depressed patients. Sometimes, it is better just to sit with them and calmly observe them without making them feel uncomfortable. Honest dialogue and expressions of support and concern can often improve their mood and sense of self worth.
Severely depressed patients usually express three basic feelings associated with their mental state. These are a lack of desire for socializing or physical activity, feelings of worthlessness and loss of self esteem, and thoughts of self-injury or destruction. In planning the care of the depressed patient, one must always consider these feelings and strive for some understanding of the reasons for the patient's behavior. Only by gradually gaining their attention and pointing out encouraging signs of progress can they be helped in their early attempts to return to reality and socialize with others.
Physical inactivity will require attention to adequate nutrition, a normal balance of fluid intake and output, proper elimination, and good skin care. Patients will need help in maintaining good personal hygiene. Severely depressed patients may be totally out of touch with reality and completely unresponsive to anyone else's presence. In such instances the health care provider may be able to do little more than demonstrate caring and empathy by remaining with the patient.
Consistency of care is helpful to depressed patients. They know what to expect, and thus are not repeatedly disappointed when their expectations are not met. An example is consistency in scheduling and carrying out treatments and routine care at the same time each day. A supportive family and interested friends should be involved in choosing and planning activities that are helpful.
Constant vigilance must be maintained to prevent the profoundly depressed patient from injuring himself or committing suicide. Self-destructive behavior is a manifestation of the patient's feeling of worthlessness and loss of self esteem. An awareness of the potential dangers in such a situation should help the provider plan and provide a safe and congenial atmosphere, remaining alert to the early signs of a patient's intention to harm or destroy himself. In most cases suicide is most likely to occur when the patient is recovering from severe depression.
endogenous depressionMelancholia Psychiatry A form of depression that occurs either de novo or without external events severe enough to warrant the degree of depression Clinical Pervasive sadness, hopelessness, loss of interest in daily activities; physical Sx–weight loss, insomnia, reduced libido; in ED, there may be an ↑ 'threshold' to stressful life events that requires little external input to initiate recurrence. See Depression. Cf Reactive depression.
en·dog·e·nous de·pres·sion(en-doj'ĕ-nŭs dĕ-presh'ŭn)
Patient discussion about endogenous depression
Q. I want to know what causes clinical depression? My friend is diagnosed with clinical depression. He is showing signs for the past six months. We found this when he lost interest in music which was his soul before. He lost interest in all other activities including hang out with us. We were wondering what could be the reason for the drastic change in his behavior. Very recently he stopped attending school also. We have tried to contact him but in vain. Then we got to know from his brother that he feels very low and depressed and is diagnosed with clinical depression? I want to know what causes clinical depression?
Q. What's the difference between clinical depression that needs treating, and just regularly being depressed? I'm often depressed, and i just wondered what the difference is between just being depressed, and clinical? At what point does depression become depression?
Q. What's the difference between the depressions of the bipolar disorder and clinical depression? How can I differentiate between the two? Thanks