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The national average rate of depression is 6.7 % in a given year. In home care, 1 in 7 patients meet full diagnostic criteria for depression and 1 in 3 suffer from significant clinical depression. Because depression can affect treatment outcomes, it is imperative to address any symptoms of depression. Depression doesn’t just affect our mood but also gives physical and behavioral symptoms.

There are three “classes” of symptoms to look for:

Emotional or Cognitive: depressed mood, lack of interest or motivation in things you enjoy, having problems making decisions, difficulties focusing, memory problems, excessive guilt, and flat mood.

Behavioral: crying uncontrollably, angry outbursts, withdrawing from others, becoming a workaholic, abusing alcohol or drugs, cutting, attempting suicide.

Physical: sleep difficulties (too much/too little, problems staying asleep), weight loss/weight gain, aches and pains, heart palpitations, burning or tingling.

Some people experience only behavioral symptoms or a mix between the different classes of symptoms. Clinically, symptoms have to be present for at least 2 weeks. Symptoms can vary depending on the person and the severity of their illness and are not the same for everyone. There is a stigma that people who have depression should just ‘get over it’ or are just ‘being lazy’. Nothing could be further from the truth – there are very real physiological changes that happen in the brain that can create these symptoms.

Depression modifies our brain structure by releasing excessive amounts of cortisol, the stress hormone. Cortisol changes our brain structure, leading to some of the symptoms we’re familiar with in depression. Excessive cortisol ‘shrinks’ our prefrontal cortex (the structure that allows us to critically think and focus). It also causes our memory center (the hippocampus) to shrink. People who are diagnosed with depression also have a larger amygdala (the part of the brain that controls our emotions such as fear or pleasure). That results in disturbances in sleep and emotion.

Depression in the elderly looks a little different than it does for younger people. Elderly patients often experience tiredness, trouble sleeping, and irritability when they suffer through depression. It also is more dangerous. There is a very real link between our physical health and our mental health. Depression is associated with an increased risk of cardiac disease and increased risk of death from illness. Studies show that some people become depressed after experiencing a heart attack or developing heart failure. And those with depression develop heart disease at a higher rate than the general population. Furthermore, people with depression often have a harder time rehabilitating and therefore have a higher risk of dying.

If you suffer from any of the symptoms above, please talk to your primary care physician – they can refer you to get the help you need. What are your thoughts? Let us know in the comments below.

Written by Andreea Socoloschi, MSW LCSW

Philadelphia Home Care Agency

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