ANN ARBOR, Mich.--The initial stage of a major depression, which recurs in 50 percent to 85 percent of all patients who experience a first episode, is like a stealth bomber. It seems to fly under a patient's radar in the guise of vaguely negative, uncomfortable emotions that patients don't at first identify as warning signs of depression.
Instead--even though they have experienced major depression before--patients deny what they glimpse on their psychic screens, attribute their fatigue and stress to external demands, and put on a front to conceal their distress, according to a study from the University of Michigan School of Nursing.
"It is important for patients and their families to learn how to recognize the early warning signs of an oncoming depression because early intervention can prevent or minimize relapse or recurrence," said Bonnie M. Hagerty , assistant professor of nursing . "There is some evidence that the 'prodromes' or early symptoms of depression, while they vary from patient to patient, are fairly consistent within each patient.
"Also, research suggests that patients generally experience at least one psychiatric symptom prior to the onset of depressed mood--generalized anxiety, perhaps, or sadness, irritability, impaired work, decreased initiative, loss of interest, fatigue or insomnia."
Hagerty's study of the early warning signs and subsequent course of major depression is reported in the April issue of the Journal of Orthopsychiatry. Hagerty and her colleagues conducted a series of focus group sessions over the course of a year with 16 people who had experienced more than one episode of depression.
The U-M researchers identified four consistent themes in the onset stages of depression:
"The 'something's not right' feelings the participants described tended to be different--much vaguer and more diffuse than those used as standard criteria for diagnosing depression," Hagerty said. "Also the symptoms sometimes disappeared for a while, then recurred.
"Patients should try to monitor themselves when they feel that something is not right, and acknowledge the possibility that depression may be setting in so they can catch it in time before they spiral down."
"The participants described feeling desynchronized, out of harmony or out of tune with their surroundings. They had different daily schedules, different sleep-wake cycles, reduced ability to think clearly and efficiently.
"Participants who took action at this point--who sought therapy or were able to provide some sort of self-help--felt more control over their emerging depressions and were often able to relieve and shorten the episodes."
Hagerty's colleagues on the study were Reg A. Williams , associate professor of nursing, and Michelle Liken, U-M doctoral candidate in nursing.