Depression Signs and Symptoms

Signs and Symptoms

Introduction

Depression can be defined as:
- Mood state indicating the absence of a positive affect or the feeling of sadness, despair, anxiety, discouragement or hopelessness
- Syndrome (eg major depression, minor depression or dysthymia)
- Mental disorder wherein depression is a manifestation (eg unipolar major depression, bipolar disorder, schizophrenia)

Epidemiology

According to the World Health Organization (WHO), depression is estimated to affect 5% of adults globally and is a leading cause of disability
- Approximately 5.7% among adults >60 years are affected
Depression is also a major contributor to the overall global burden of disease and can result in poor functioning of an individual in various areas such as work, school and family life
Approximately 75% of affected individuals in low- and middle-income countries receive no treatment due to lack of resources, lack of trained healthcare providers and social stigma associated with mental disorders

Signs and Symptoms

Patients may not present with depressive mood; somatic complaints may predominateDepression should be suspected in patients who present with physical symptoms (eg fatigue, gastrointestinal distress or back pain) which cannot be explained or in those who present with pain, anxiety or substance abusePresence of depressed mood or diminished interest or pleasure in activities (anhedonia), feeling of fatigue or lack of energy (anergia), significant loss of motivation (avolition) are essential in diagnosing depressionDiagnosis may be easier in patients who are more aware of their moods or functioning

Pathophysiology

Involves multiple factors including genetic, environmental, social, psychological, and neurobiological factors
It is believed to be related to changes in neurotransmitter levels in the brain, particularly the neurotransmitters glutamate, γ-aminobutyric acid (GABA), serotonin, dopamine, and norepinephrine
- These neurotransmitters play a crucial role in regulating mood, emotion, and behavior
Patients with depression have been observed to have problems involving the hypothalamic-pituitary-adrenal (HPA) axis (eg hypercortisolemia and decreased rhythmicity)
Volumetric reductions in the hippocampus and other forebrain regions in patients with depression support the contribution of decreasing neurotrophic factors that regulate neuronal plasticity in depression
Studies have also implicated the role of inflammation in depression
- Treatment with antidepressants significantly decreased the levels of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), IL-10 and C-C motif ligand 2 chemokine
Recent studies have also linked the microbiota-gut-brain axis to the regulation of mood, behavior and neuronal transmission, and its association with the development of depression
- Gut microbiota can influence the brain through the HPA axis, neuroendocrine, autonomic and neuroimmune systems

Long COVID: What we have learned so far

Prof. Ghassan Dbaibo, 27 Apr 2023

The WHO defines long COVID as a condition that occurs 3 months from COVID-19 onset, whose symptoms last ≥2 months and cannot be attributed to an alternative diagnosis. In an interview with MIMS Doctor, Professor Ghassan Dbaibo of the Center for Infectious Diseases, American University of Beirut, Beirut, Lebanon, describes the evolving attitudes towards long COVID among healthcare professionals (HCPs), some unexpected predisposing factors, potential biological mechanisms behind prolonged symptom duration and shares data on vaccination’s protective effects against long COVID.

NCDs in Focus Act Now! Summit 2022

16 Mar 2023

Viatris, a global healthcare company, collaborated with the Thai Hypertension Society and the Thai NCD Collaboration Group to organize the NCDs in Focus Act Now! Summit 2022 in Bangkok on October 29^th and 30^th. This summit brought together nearly 300 multidisciplinary experts from Southeast Asia and India to address the unmet needs in managing two critical noncommunicable diseases (NCDs): cardiovascular diseases (CVDs) and mental health disorders (MHDs) in the region.

The summit had several key objectives. Firstly, it highlighted the effectiveness of clinical data in addressing gaps and unmet needs in clinical practice. Secondly, it emphasized the importance of sharing expertise and best practices through a platform that can optimize patient care. Additionally, it discussed the challenges of cardiovascular disease and mental health disorder care in a post COVID-19 world, and the need to re-examine them.

The summit also offered valuable insights into policy and practice changes, as well as innovative digital solutions that can lead to better outcomes. Lastly, it emphasized the significance of gaining a deeper understanding of the gaps in the patient journey to enhance patient care further.

Overall, the NCDs in Focus Act Now! Summit 2022 was a highly informative and productive event, with experts collaborating to improve the management of CVDs and MHDs in Southeast Asia and India.