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Depression is not only a very prevalent condition; it is increasingly recognized as a recurrent or

chronic illness. Among depressed primary care patients who received antidepressant treatment,
more than two-thirds reported a history of recurrent depression, and about 20% experienced a
chronic course. Over one-third of these patients suffered a recurrence in the year following
initiation of antidepressant treatment. Maintenance pharmacotherapy has demonstrated efficacy
in preventing recurrence of depression. However, adherence to antidepressant medicines is far
below treatment recommendations in the US and other parts of the world. Two years of
maintenance pharmacotherapy is recommended for persons at high risk of depression relapse
after they complete the initial nine months of acute and continuation phase treatment. Half to
almost three-quarters of primary care patients discontinue medicines in the first 6 months of
treatment. Unfortunately, the earlier an antidepressant treatment is discontinued, the more likely
a relapse is to occur.
Major depressive disorder, or major depression, is characterized by a combination of symptoms
that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable
activities.
The exact causes of depression still are not clear. What we do know is that both genetics and a
stressful environment, or life situation, contribute to its cause or sudden onset.
Some of the signs and symptoms according to the Diagnostic & Statistical Manual of Mental
Disorders 5, include the following:

Prolonged sadness or unexplained crying spells

Significant changes in appetite and sleep patterns

Irritability, anger, worry, agitation, anxiety

Pessimism, indifference

Loss of energy, persistent lethargy

Feelings of guilt, worthlessness

Inability to concentrate, indecisiveness

Inability to take pleasure in former interests, social withdrawal

Unexplained aches and pains

Recurring thoughts of death or suicide

There are many names for the different types of depression. Depression often co-exists with
other mental or physical illnesses. Substance abuse, anxiety disorders and eating disorders are
particularly common conditions that may be worsened by depression, and it is important that the
depression and each co-occurring illness be appropriately diagnosed and treated. Substance use
disorders (abuse or dependence) also frequently co-occur with depression.
Depression may have a slightly different set of symptoms when a child or teen has it. Children
and adolescents may be more likely to have symptoms like unexplained aches and pains,
irritability and social withdrawal. On the other hand, symptoms more likely to affect adults
include slowed speech and activity, sleeping too much and believing things that arent true
(delusions).

Depression is not a normal part of growing older. Older adults may be going through changes
such as children moving away, illness, moving to assisted living facilities or the death of loved
ones. All of these things can cause feelings of sadness or grief. But when feelings of sadness last
for a significant length of time and keep older adults from enjoying life the way they used to, it
may be a sign that they should seek treatment.
There are different ways to prevent depression which include: Primary prevention and secondary
prevention.
Primary prevention:
Interventions in parent-child relationships: The impact of poor parenting may not specifically
predispose a child to depression in adulthood. However, if parental care could be improved, or
self-esteem of the child at risk enhanced, it might have a long-term primary preventive effect.
Rutter (1985) highlights how problems experienced by one individual may adversely affect
another individual in the immediate environment, which may further worsen the interaction and
problems of both people. Strayhorn & Weidman (1991) attempted to intervene in this vicious
cycle by targeting distressed mothers who were having difficulty managing children who had
identified behavior problems. Support for the mothers was associated with reduced levels of
behavioral disturbance in the offspring.
School programs with 'at risk' children and adolescents: In the USA, Shure & Spivack (1982)
described improved problem-solving skills with a program targeted at over 200 young children
with behavior problems who came from disadvantaged backgrounds. Others describe small
projects which reduced neurotic traits in adolescents through the use of rational emotive therapy.
School programs that educate children and adolescents in how to cope with conflict and crises

and improve life skills may benefit women more than men. School-based suicide prevention
programs are not deemed effective.
Event centered interventions: Support and counselling reduces depression and other
psychiatric morbidity in those at high risk of abnormal grief reactions. Furthermore, research
showed that treated high-risk individuals were less symptomatic than non-treated controls up to
20 months post intervention. Morbidity rates in the counselled group were reduced to the same
levels as found in individuals at low risk of an abnormal grief reaction.
Secondary prevention:
Early detection: Early detection of affective disorders depends in part on the attitude of the
individual towards any symptoms which develop, and the behavior of the professional they
present to. The use of self-report or simple observer-rated questionnaires such as the General
Health Questionnaire, the Beck Depression Inventory, or the Hospital Anxiety and Depression
Scale offer a cost effective method of helping primary care staff detect depression.
Early intervention: Early intervention offers possibilities both of interrupting distress before it
reaches the level of clinical depression and of markedly shortening clinical depressive episodes.
Access to services: Increasing direct access to mental health services (e.g. offering self-referral
or providing liaison sessions in primary care) is another way of increasing detection and early
intervention
Tertiary Prevention:
Rehabilitation: Vocational rehabilitation of the patients focuses less on the role of work
performance and more on its potential for restoring confidence, improving self-esteem and

enhancing feelings of mastery. Re-employment may also reduce depression in socially isolated
men who have been made redundant, and women working outside of the home show less
impairment following depression than housewives.
Educational and support programs: Psycho-educational programs for hospital treated
depressives and their families may be associated with better resolution of the index depressive
episode and better global outcome. Also, individuals with chronic neurotic disorders and their
families benefit more from home-based support of a community psych iatric nurse rather than
intermittent symptom orientated out-patient appointments.