Depression in the Patient with Rheumatologic Disease

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Depression in the Patient with Rheumatologic Disease

Major Depressive Disorder is a common illness that is under-diagnosed and

under-treated. About 15% of the population will have a major depressive

episode at some time during their lifetime. For women, the chance is twice

as high as it is for men. Medical illness and therapy play a major role in

the cause of depressive illness.

Although it is normal for everyone to feel depressed at some time,

clinicians must know when to respond and intervene. The onset of depression

may come on suddenly or gradually over time. In order for a diagnosis to be

made, five of the following must be present:

Depressed mood for most of the day

Decreased interest or pleasure in all or nearly all activities

Significant appetite or weight changes

Sleep disturbances

Loss of energy and fatigue

Psychomotor agitation or retardation

Sense of worthlessness and guilt

Impaired concentration or indecisiveness

Recurrent thoughts of death or suicide

Although medical illness may be present along with depression, emphasis

should be placed on treating the underlying disorder. A complete patient

history along with a complete family history is important to obtain. It is

also helpful to have the patient describe his or her social support system,

which helps to identify contacts and reinforces this network to the patient.

Because depression is common in patients with chronic disease,

rheumatologists are able to recognize depressive disorders because of close

and frequent contact with their patients. This enables the physician to

tailor a treatment plan to fit the needs of the patient. Early recognition

and intervention will guarantee the patient with a major depressive disorder

the best chance of recovery.