Abstract

MARSIGLIA G, Italo. Depresión: Visión holística de la medicina interna*. Gac Méd Caracas. [online]. 2008, vol.116, n.1, pp.10-17. ISSN 0367-4762.

Depression, and adjoined anxiety, is the most frequent and intense psychological manifestation of human suffering, which in extreme cases could lead to suicide. Even though it could affect significantly the quality of life, interpersonal and social interactions and individual productivity, it astonishes that at primary care, only half of the cases are diagnosed, and only half of those diagnosed are actually treated. However, it is the responsibility of the Internist to recognize depression and treat it efficiently for the following reasons: 1. Internal medicine proposes the integral view of the patient as its fundamental conception; 2. Functioning of mind, both normal and pathological, is established in biological principles; 3. In medical practice, anxiety and depression are the most frequent emo- tional manifestations, either as primary disorders or as associated conditions to others psychiatric and medical diseases (including their treatments), or by the emotional impact of medical and surgical disorders. Psychiatric referral should be made in severe depression, unsatisfactory therapeutic response and evidence of psychosis or suicidal ideation. In managing depression, a solid medical-patient relationship is fundamental to guarantee patient liberty and integrity and to preserve professional secret, which acquires special relevance when dealing with human senses, emotions and behavior. Test and scales for depression, although useful, do not substitute the personal interview with patients that allow us to appreciate depressive mood and anhedonia, which result from the desolation and defenseless state that oppress the patient. In mania, opposite extreme of mood spectrum, the agitation, expansive and grandiloquent language as well as the irritability could be accompanied by psychotic irrationality. Abnormalities in norepinephrine and serotonin neurotransmitters play an important role in mood disorders, their levels and effects are less actives in depression and hyperactives in mania. Patients with mayor depression and the majority of those with chronic minor depression need antidepressant treatment and psychotherapy. Electroconvulsive therapy could be indicated in refractory depression, acute suicidal ideation, and associated psychosis no responsive to antipsychotic drugs. In mania, mood stabilizers as, lithium, carbamazepine andvalproate, alone or combined with antidepressant drugs, are used to prevent recurrences. Neuroleptic treatmentcould be required in acute mania.