The major depressive episode can manifest itself as a single, recurrent or persistent episode, with significant implications for treatment, with the need for constant monitoring of the clinical picture, both for the management of the disorder in the current situation, and for planning prevention interventions with respect to the recurrence or persistence of the depressive picture.
Clinical specifiers can be associated with depressive symptoms:
For the general practitioner it is important to know how to identify them, as their presence – think of psychotic symptoms (delusions and hallucinations)
– necessarily implies a specialist intervention.
Another important specifier is that of anxiety,
Since where it assumes the characteristics of a clinically significant dimensionality, it provides useful elements, both from a diagnostic and therapeutic point of view, for example by conditioning the use or not of an anxiolytic in association with the antidepressant.
In fact, high levels of anxiety, so specified and contextualized, indicate that we are dealing with a patient of greater complexity, more difficult to manage from a therapeutic point of view.
As for the severity level of depression,
It can result in mild, characterized by the presence of distressing but manageable symptoms, with a limited number of symptoms and with low impairment of social and occupational functioning severe, where the symptoms are particularly worrying and difficult to manage, in the presence of a marked impairment of global functioning moderate, when a clinical picture of intermediate severity, between mild and severe, is believed to be present
Clinical evaluation must consider all aspects of life;
In this the family doctor has an advantage: he knows the history of the patient and his family, his relationships, his work. He can therefore assess the functional impairment deriving from the depressive picture with greater agility.
Ultimately, depressive disorders, and in particular major depressive disorder, represent an important challenge for the clinician, both for the extent of the clinical variability with which they occur, and for the implications they have on the overall functioning of the subject, not least also due to the higher incidence of suicide.
If in most cases the depressive episode resolves with a clinical remission, in many others the remission appears incomplete, with symptomatic residues, symptoms which, despite adequate treatment, tend to persist for a long time causing considerable discomfort to the patient.
In still other cases, depression tends to become chronic, to become persistent and difficult to manage; even in these situations, where a first treatment has not had the desired effects, it is necessary to request a psychiatric consultation. The evaluation of persistent depressive disorder (dysthymia) appears in fact more complex since it tends to identify a more strictly dysthymic symptomatological nucleus – probably with a prevalently neurotic structure and characterized by a dysfunctional personality profile and a symptomatology closer to major