What should a GP know?

Depression affects approximately one in four women and one in eight men during their lifetime. About 10% of patients in primary care practices suffer from depression.

Depression involves changes in behaviour (e.g. withdrawal, slowing of speech) and feelings (e.g. feeling exhausted or guilty). These symptoms always result from underlying changes in brain function: depression is associated with disturbances in the serotoninergic and noradrenergic systems and the stress hormone system. However, to date, there is no biological marker available that can be used clinically for diagnosis.

Regarding the causes of depression, it is important to separate a genetically determined or acquired vulnerability for depression from triggering life events or life circumstances. Sometimes, even positive life events (such as start of holidays or a promotion) can trigger depressive episodes, or depressive episodes can begin without an identifiable trigger. There is a tendency to overemphasise such external triggers while downplaying biological factors, with the resultant risk that depression is not carefully diagnosed as a clinical disorder and treated according to guidelines.

Depression affects quality of life profoundly. This is clearly supported by the fact that there are no other disorders so closely linked to suicidality resulting from unbearable suffering and despair. A patient┤s quality of life and prognosis will be more severely affected when a depression is comorbid with other diseases.