Depressive disorders

In view of the growing number of depressive disorders, pharmacists and PTA are increasingly faced with the problem of obtaining information on the ­severity of a depression by asking specific questions. The division in neurotic, reactive and endogenous depressions has long been outlived. 

According to the National Disease Management Guidelines »unipolar ­depression«, depressive disorders of varying degrees of severity – mostly passing episodically – must be distinguished from dysthymia being a continuing depressive state of low intensity lasting at least two years. Depressive periods have by definition a duration of at least two weeks.

The unipolar depression, being the most frequent form of depressive disorders, is characterised by a depressed mood, loss of interest, joylessness as well as reduced drive with increased fatigue and limited activity. The underlying mood of sadness is something completely different from true grief or sorrow, which depressive persons are not capable of. In the case of bipolar disorders, hyper-­euphoric, hyperactive phases alternate with phases where a grey haze is covering everything. What’s more, the affected persons often have great difficulty in naming the true problem. It is possible that they do not predomi­nantly perceive the deterioration in sentiment but rather complain about ­somatic syndromes and general ­discomfort.

Against the background of a depression, fatigue, faintness, difficulties falling asleep and sleeping through the night, gastrointestinal problems such as gastric discomfort, constipation and diarrhoea, neuralgic pains and sexual disorder frequently appear.

Neglected personal hygiene and clothing can also be an indication of a depression as experiencing regular daily tasks as excessively demanding is one of the possible symptoms. The speaking pattern too – sound, speed, modulation – can raise suspicion. In a suspicious case, the guideline recommends the »two-question-test« as a time-effective method with high significance: Did you frequently feel low, sad or desperate during last month? Did you feel considerably less enjoyment and pleasure last month in doing things that you normally much enjoy?

If both questions are answered with »yes«, further clarification will be required by a doctor. Questions as to the duration of a depressive mood or earlier episodes as well as the occurrence of depressions in the family will also help to confirm the suspicion of a serious illness. Having the »blues« in the mornings is also a typical sign. The mood of many sufferers, even though not all, is especially low in the morning but brightens up towards the evening.

In the case of tangible depressions – this too is an indication – the acute mood can as a rule not be justified or explained by the current living conditions. Traumata may, however, have played a role in the development of the affective disorder, but this has then become autonomous. However, if those concerned are presently in a stressful situation, it is more likely that self­-medication will be considered acceptable. Also in the case of winter-blues, treatment on one’s own account is ­justifiable. True winter depression on the other hand, which needs to be treated with light therapy, must receive medical attention.

Consultation

In the case of slight depressive illness, St. John’s wort (hypericum perforatum), which is obtainable over the counter, has been approved for treatment. With moderately severe depressions on the other hand, the phytopharmaceutical is available only on prescription. The S3 guideline on unipolar depression re­commends St. John’s wort explicitly as being suitable for a first therapeutic attempt. If using hypericum there is no improvement within four weeks, a visit to a doctor is called for.

The risk of photosensitization primarily affects light-skinned people who should avoid exposure to strong sunrays and apply a highly potent sunscreen when undergoing a hypericum therapy. Drug interactions are another subject of the consultation as St. John’s wort induces some cytochrom-P450-enzyme and P-glycoprotein. The combination with anticoagulants is considered as contraindicative. Due to interaction with oral contraceptives, unwanted pregnancies could be observed. Therefore switching to other methods of contraception is ­re­commended.

Against insomnia St. John’s wort is only effective if there is definitely an underlying depression. St. John’s wort is, how­ever, not effective against insomnia without a depression. This is important as in this respect customers often go to a pharmacy with wrong information. If depressions are associated with fears, which is often the case, lavender oil (Silexan^®), offered in soft gelatine capsules (Lasea^®), can be helpful. This phytopharmaceutical too is being credited with an antidepressant effect, but the anxiolytic effect is paramount. The highly concentrated ingredients linalool and linalyl ­acetate reduce the calcium influx in nerve terminals, this way unfolding psychotropic effects. Not least because there is ­evidently no dependence potential, the lavender oil is assessed as an interesting alternative to synthetic ­anxiolytics.