Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Contradiction

contradictionContradiction
“We read two of your consultation reports last month.  One said that the patient lost 20 pounds which was a symptom of depression.  The other said that a second patient was depressed because she gained 22 pounds in the past month.  We accept that the patient is depressed, but we do not see this as majorly depressed, and how can you lose weight and be depressed and gain weight and be depressed.  In that way, virtually everyone is depressed all the time. This seems a contradiction.
When we learn of a major disaster, hear of a major storm or prepare for major surgery, we equate “major” with “severity.”  Bad is bad, but major is much worse; a clarification, not a contradiction.
This is not true with depressive disorders.  Major depression, a term many of us would prefer be changed, need not be severe.  Indeed, patients can suffer from mild major depression.  There are those who have several and repeated mild major depressive episodes.  So we categorize major depressive disorder as mild, moderate or severe.
Mild, moderate or severe categorization of major depressive disorder refers to the number of symptoms with which the patient is coping.
Additionally, we further characterize major depressive episodes with such qualiers as “anxious distress” in which the patient appears agitated or with melancholic features in which the person lacks pleasure in activities that once brought joy.
Symptoms are often physical in nature and include problems with sleep, eating, attention, concentration and decision making.  However, some patients, for example those with anxious distress, have difficulty staying asleep and may lose weight due to decreased apetite.  Others may gain weight, sleep a great deal and rather than being agitated and restless, they cannot get going, feel listless and lacking in energy.
In summary, there is always this confusion, and it is presented to me in the referral as “Does this patient have major depression, or is his depression only mild in nature?”
“Major” complicates diagnosis for many who fear that the term refers to the complexity of treating the patient. Again, this is a clarification, not a contradiction.
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