Advertisement

Advertisement

depression

Expect One to Two Cases of Depression for Every Day of Office Practice

Expect One to Two Cases of Depression for Every Day of Office Practice

Teaser: 

Expect One to Two Cases of Depression for Every Day of Office Practice

D'Arcy L Little, MD
Chief Resident, Department of Family Medicine,
Sunnybrook Campus of Sunnybrook and
Women's College Health Sciences Centre,
North York, Ontario

Depression is one of the most common illnesses seen by primary care doctors. The lifetime prevalence of this disease lies between 15 and 30%. It is estimated that one in 20 Canadians are suffering from depression at any given point in time, therefore the average family physician should expect to see one to two cases of significant depression for every day of office practice. Besides being common, depression causes significant morbidity in terms of suffering, disability, and cost to society, as well as a 15% mortality rate from suicide.

There is evidence that the recognition of depression and its early treatment improves outcome by decreasing suffering and improving function, quality of life and somatic symptoms. It is estimated, however, that between 35 and 50% of cases go undiagnosed. There can be numerous barriers to the diagnosis of this illness, for instance, only half of depressed people seek help specifically for this problem. However, the Ontario Health Survey [1990&endash;91] estimated that approximately 80% of depressed people did visit their family physician one or more times during the period of their illness for other reasons.

Riding the Bipolar Roller Coaster

Riding the Bipolar Roller Coaster

Teaser: 

Thomas Tsirakis, BA

Bipolar disorder is a recurrent and potentially incapacitating illness affecting a person's mood and behaviour, which manifests itself in different ways throughout its course (Table 1). The first episode of bipolar disorder may be manic, hypomanic (milder form of mania with elevated mood), mixed (both mania and depression), or depressive. Due to the extremely variable nature of the illness, it may present itself differently from patient to patient in terms of the severity and duration of episodes. Often, the type of episode an individual experiences may also follow a seasonal pattern (e.g. hypomanic in the summer and depressed in the winter.) With proper intervention, some people recover completely between episodes and may experience years of symptom-free relief, while others may experience continuous low-grade depression and mild mood swings throughout the course of their lives.

Bipolar disorder is classified according to the symptoms that an individual experiences. In Bipolar I Disorder, an individual will have one or more manic episodes, or mixed episodes, lasting at least one week. Many also experience at least one major depressive episode. In Bipolar II Disorder, a person will have one or more major depressive episodes accompanied by at least one hypomanic episode but no manic episodes.

Distinguishing Depression from Dementia Difficult

Distinguishing Depression from Dementia Difficult

Teaser: 

Robin Dwarka, BSc, BAA

The incidence of depression among the elderly has been widely documented in recent studies. Approximately 2% of the population over 65 years of age who remain in the community have major depression, while up to 15% show significant depressive symptoms. In institutional settings, the figures jump to over 10% having major depression, and symptoms.

With the proportion of Canadians over 65 growing rapidly, recognition and treatment of depression in senior citizens is of growing concern.

Recognizing depression in the elderly poses a unique problem because of its symptomatic links to Alzheimer's Disease (AD), according to geriatric psychiatrist Dr. Richard Shulman of Sunnybrook Health Science Centre in Toronto.