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Arkansas Catholic
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November 18, 1990     Arkansas Catholic
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November 18, 1990

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f . ARKANSAS CATHOLIC NOVEMBER |8, 1990 PAGE II By Max Alden Baker, MD Transient periods of depressed aOods are part of everyday life -- one of the normal re- sPnses to the Varieties of stress, losses and rever- ii- f Sals which we all I l experience as m rs [ Part of the hu- 0r'[ r an condiuon. of Yet Some indi- Viduals have syraptoms of de- Pression or sad- naltal" n/ bess as only part . L.,, fa larger whole; that is, the depression drome. This syndrome, also called Pr~aary affective disorder, is a medical adition and is among the most dis- .essful and most common of condi- ti0as, affecting an estimated ten percent f?e population at some times during lr lives. About three million Ameri- Cans will actually seek help for this edical condition; however, up to three this number will suffer from this rious disorder, often unrecognized, in Painful silence. The past 10 to 15 years have wit- eSSed an explosion of medical research l!0 this disorder, leading to an im- understanding with more ef- rive treatments. The accumulated supports the hypothesis that mood states are biochemically r a class of substances called biogenic amine neurotransmitters. believed that the depressive syn- occurs when there is an alter- in the delicate balance of these within the nervous system. these changes can only be indirectly in a research cen- the information derived from these has advanced treatment through Use of antidepressant medications. Studies have also led to an in- recision in diagnosis and n of patients with depres- allowing for the "selection of cer- Patient groups which are likely to to a given medication. identification of patients suf- from depression is important--- Only to alleviate their suffering, but lives. Suicidal behaviors are in this disorder. Studies have that 75 percent of persons who themselves suffered from depres- In addition, the social conse- of untreated depression are leading to personal problems, of families and disturbances kd other activities. Although the disorder is subtle and to identify, usually the symp- are easily recognized. The de- iii!iiiii!iii!ii!iiii!iii!U i i pressed person may need help in get- ting treatment, however, as in the de- spondent state their thinking may be altered to the extent that they feel nothing can be done for them, that they are not worthy of treatment, or that to admit their need for assistance would be yet another weakness and an em- barrassment to their family. The depressive syndrome, in addition to the symptom of depressed mood, includes a variety of physiological and psychological changes. There may be drastic shifts in the levels of appetite, weight, energy, bowel function and sexual drive. The quantity and quality of sleep are often disrupted severely with both difficulty falling and staying asleep, and the individual may awaken totally exhausted. Symptoms may be Depressed persons feel as if everything is out of con- trol and worry they are los- ing their minds. worse in the morning. Concentration and thinking may become so impaired that the person feels their memory is failing. Other strictly physical aspects of depression include a heightened heart and respiratory rate, causing palpita- tions and shortness of breath. There may be an increase in muscle tension, headaches, chest pains, and other muscular pains. The body movements may become disturbed, with either marked slowing or restless agitation and overactivity. The psychological components of a depressive syndrome include low mood, anxiety, irritability, worrying, low self- esteem, loss of interest, guilt and de- spair. The individual feels unable to comprehend and cope with responsi- bilities and demands. Work becomes an increasing effort; things are put off, and this procrastination is accompanied by indecisiveness and lack of self-confi- dence. Depressed persons feel as if everything is out of control and worry they are losing their minds. They may blame themselves and think everybody would be better off without them. A deep sense of gloom and blackness seems all-pervasive and unstoppable. Although there is a tendency for these disorders to run in families, it is not known whether they are inherited. Their cause is unknown. Are they a simple reaction to stress? Everyone, of course, has to cope almost daily with failures, frustrations and losses. It has been proposed that those who develop a depressive syndrome have an internal vulnerability based on biological fac- tors m and not weaknesses in their character, upbringing, or personality -- which allows them to react to stress with a depressive syndrome. However, these disorders may also arise spontaneously, without recogniz- able precipitants. Their onset may be abrupt or insidious at any age. Women are affected more frequently than men. The average length of an episode is four to six months, although this is quite variable. Depressions are usually cyclical but may be chronic. There is about a 50-50 chance of recurrence. Since the depressive syndrome has a wide variety of physical symptoms, it is obviously important to rule out the possibility that there is an underlying medical condition, as a wide range of medical disorders can have accompa- nying depression. Depressive disorders are treated most commonly by family practitioners and internists, with only the more severe or nonresponsive patients requiring re- ferral to a psychiatrist. The treatment of these conditions includes various types of antidepressant medications (which through various mechanisms are thought to restore the chemical im- balance), counseling therapy and, in severe or refractory cases, electrocon- vulsive treatments. With adequate therapy, the vast majority of patients with these painful conditions can be alleviated from their suffering and re- stored to a productive, happy life. (Dr. Max Alden Baiter is a psychiatrist at Harbor Irsew Mercy Hospital in Fort Smith. Reprinted with permission by St. Edward Development Corporation.) g! By Vince Capozzi Latrobe, PA (CNS) - The U.S. health care system "is the most expensive in the world and way out of control," Catholic ethicist Daniel Callahan said in a talk on "The Limits of Medical Progress" at St. Vincent College. He said that with the exception of South Africa, "the United States is the only developed country that does not have a national health care program." Despite the Fact that $65 billion, about 12 percent of the U.S. gross national product, is devoted to medical care, "there are approximately 35 million people who have no health care cov- erage at all," he said. Callahan is co-founder and director of the Hastings Center in Briarcliff Manor, NY, a research and education institute specializing in issues of medi- cal and biological ethics. He called for a reordering of U.S. priorities in health care, especially in the emphasis on "curing" over "caring." "We are mortal human beings," he said. "No matter how much medical "No matter how much medical progress we get, we are going to get sick, we are going to age, we are going to die." progress we get, we are going to get sick, we are going to age, we are going to die. There is nothing medicine can ultimately do about thaL" "I would give the highest priority to 'care' because 'cure' always runs out," he said. will all at some point die." He described an American desire for the best medical technology possible, regardless of cost, as one of the factors driving up costs without comparable benefit. He called for "deep changes" to make medical care affordable as the U.S. heads toward the 21st century. %Ve can't keep expanding," he said. "We go after everything, try to cure every disease. We need to recognize our limits." As you come to know the seriousness of our situation - the war, the mdsm, the poverty in the world - you come to realize it is not going to be changed just by words or demonstrations. It's a question of living your life in dm/tically different ways. Dorothy Day