DEPOT INJECTION
D
depot injection
An intramuscular injection of a drug
that gives a slow, steady release of its
active chemicals into the bloodstream.
Release of the drug is slowed by the
inclusion of substances such as oil or
wax, and can be made to last for hours,
days, or weeks.
A depot injection can be useful for
patients who may not take their m edi-
cation correctly. It also prevents the
necessity of giving a series of injections
over a short period. Drugs that may be
given by depot injection include hor-
monal contraceptives (see
contraception,
hormonal methods of
) ,
corticosteroid drugs
,
and
antipsychotic drugs
.
Side effects may
arise due to the uneven release of the
drug into the bloodstream.
depressed skull fracture
A fracture in w hich a part of a skull
bone is pushed inwards towards the
brain
(see
skull, fracture of
) .
A depressed
skull fracture usually results from a
high-energy blow to a small surface
area of the skull.
depression
Feelings of sadness, hopelessness, and a
loss of interest in life, combined with
a sense
of reduced emotional w ell-
being. Most people experience these
feelings occasionally, usually as a nor-
mal response to an upsetting event; for
example, it is natural to feel depressed
when a close relative dies. W hen a per-
son’s behaviour and physical state are
also affected, however, this is an indica-
tion that the symptom is part of a
depressive illness.
Depression that occurs without any
apparent cause, deepens, and persists
may occur as part of a variety of psy-
chiatric illnesses.
Some
people who
suffer from depression are eventually
diagnosed as having
manic-depressive
illness
(also known as bipolar affective
disorder) a condition characterized by
episodes of depression alternating with
mania
(periods
of
overly
excitable
mood and uncontrolled behaviour).
SYMPTOMS
Symptoms vary with the severity of the
condition. In a person suffering from
m ild depression, the main symptoms
are anxiety and a variable mood; the
person may also have fits of crying that
occur for no apparent reason. More
severe depression may cause loss of
appetite, difficulty in sleeping, tired-
ness, loss of interest in social activities,
and impaired concentration. Movement
and thinking become slower; alterna-
tively,
the opposite
occurs,
and the
person may become extremely anxious.
Severely
depressed people may have
thoughts
of committing
suicide
and
feelings of worthlessness.
Hallucinations
or
delusions
may occur in extreme cases.
CAUSES
Often, there is no single obvious cause,
and a combination of factors may be
involved. Depression may be triggered
by physical illnesses (such as a viral
infection), by hormonal disorders (such
as
hypothyroidism
), or by the hormonal
changes that occur following childbirth
(see
postnatal depression
) .
Certain drugs,
such as
oral contraceptives
,
may
con-
tribute
to
the
condition. Inheritance
may play a part in manic-depressive ill-
ness. Some people become depressed in
the winter (see
seasonal affective disorder
syndrome
) ,
probably in response to the
long hours of darkness.
Aside from these causes, there are
social and psychological factors that
may play a role. Depression may also
be related to the number of disturbing
changes or events in a person’s life.
INCIDENCE
Depression is the most common serious
psychiatric illness. The World Health
Organization ranks it fourth in the ten
leading causes of disease worldwide.
One person in six is estimated to suffer
some degree of depression in their life-
time, and one person in
20
develops
clinical depressive illness.
Depression is particularly common in
people over 50, and appears to be more
common in women; twice as many
women as men seek help for the condi-
tion. This difference may result from
the fact that women are more prepared
to seek help for their symptoms, w hile
men may be more likely to express their
discontent in the form of problems
such as alcohol abuse and violence.
TREATMENT
There are three main forms of treat-
ment for depression, depending on the
type and severity of the illness.
Treatment usually includes a form of
psychotherapy
,
given either individually
or in a group. This form of treatment is
most useful for people whose personal-
ity and life experiences are the main
causes of their illness. Types of therapy
range from
counselling
to help deal with
practical problems to more structured
approaches such as
cognitive-behavioural
therapy
or
psychoanalysis
.
Antidepressant drugs
may be very effec-
tive, with up to seven in ten affected
people responding w ell to
the first
drug that is offered. Antidepressants are
not addictive. Many drugs, however, do
not start to take effect until about two
weeks into treatment,
and all types
need to be continued after the symp-
toms of depression have cleared.
ECT
(electroconvulsive
therapy)
is
infrequently used in the UK, but it
is still considered to be an effective
treatment for people suffering from
life-threatening depression. ECT may
be life-saving, but it can cause mild,
temporary memory impairment.
OUTLOOK
Depression is often a recurrent disor-
der; up to three-quarters of people who
have
needed
hospital
treatment
for
depression w ill have another episode
w ithin 10 years. However, long-term
antidepressant medication and psycho-
logical therapies can greatly reduce the
risk of recurrence.
Despite
the
effectiveness
of drug
treatment,
suicide remains a serious
risk; nearly half of all deaths in people
with recurrent depression are due to
suicide. This
risk
can,
however,
be
substantially reduced by maintenance
treatment with antidepressive drugs.
De Quervain’s disease
An inflammatory condition that affects
one of the
tendons
of the muscles that
are used to move the
thumb
.
In de
Quervain’s disease, the sheath (cover-
ing)
of this tendon becomes so in -
flamed and thickened that the tendon
can no longer move through the sheath
smoothly, and thumb movements are
painful.
The
inflammation
is
often
caused by overuse of the thumb.
Treatment is with rest,
nonsteroidal
anti-inflammatory drugs
(NSAIDs),
and
corticosteroid drug
injections into the
affected tendon sheath, w hich may be
helpful in relieving the inflammation,
but in severe cases surgery is needed to
loosen the sheath.
De Quervain’s thyroiditis
A form of
thyroiditis
(inflammation of
the thyroid gland) that is uncommon
and is caused by a viral infection; the
condition often follows a viral infec-
tion of the nose and throat.
The thyroid gland, w hich is situated
in the front of the neck, may become
painful and swollen; this swelling is
sometimes accompanied by fever. There
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