February 2008
Life | MENTAL HEALTH
Beyond sadness

Understanding what makes depression distinctive. by Maria Perno Goldie, RDH, MS

Many times the words sadness and depression are used interchangeably. It is no wonder, as even the definitions overlap from time to time.1 But, whether it be a friend, a patient, or even yourself, there are times when you notice that something is off—there is an aura that goes beyond sadness. This article will attempt to explain the differences between depression and sadness, the signs to look for and—believe it or not!—the repercussions for oral treatment.

just a stage?

Symptoms of Depression ✽ Persistent sad, anxious or “empty” feelings ✽ Feelings of hopelessness and/or pessimism ✽ Feelings of guilt, worthlessness and/or helplessness ✽ Irritability, restlessness ✽ Loss of interest in activities or hobbies once pleasurable, including sex ✽ Fatigue and decreased energy ✽ Difficulty concentrating, remembering details and making decisions ✽ Insomnia, early-morning wakefulness, or excessive sleeping ✽ Overeating, or appetite loss ✽ Thoughts of suicide, suicide attempts ✽ Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

Sadness is a part of being human, a natural reaction to painful circumstances that all of us will experience at some point in our lives. It is a normal response to upsetting situations and plays an important role in helping us understand how much we really care about someone or something. While a loss of any kind or an unexpected change can cause unhappiness, unrest or mental suffering, there are a host of other, less obvious reasons that can trigger sadness. In any case, there are five basic stages people go through during this time: shock/denial; anger; asking, “What if...?” or making, “If only...” statements; sadness; and acceptance. Again, these feelings are normal, and we may go through some of them more than once, but the important thing is that at some point, we move on.

In contrast, when a person is depressed, it can last an inordinate amount of time, interfering with daily life and activities and normal functioning, causing actual pain for the person who is depressed as well as those around them. Depression is a common but serious illness, and most who experience depression will need to obtain diagnosis and treatment from a professional in order to become well—it is important to overcome the stigma of “getting help” because the untreated affects can be disabling. The cause of depression is thought to be a combination of genetic, biochemical, environmental, and psychological factors. Chemicals in the brain appear to be out of balance, and some types of depression appear in family members, signifying a possible genetic link.

who’s at risk?

Depression is less common among men, due to biological, life cycle, hormonal and psychosocial factors unique to women. Hormones have been shown to directly affect brain chemistry that controls emotions and mood. Elderly people often deny feeling sad while exhibiting other characteristics of depression; they often have unexplained somatic complaints and exhibit a sense of hopelessness. Anxiety and anhedonia (a general loss of ability to feel pleasure) may be present, as well as slowness of movement and lack of interest in personal care. A screening device, such as the Center for Epidemiologic Studies: Depression Scale, Revised (go to www.counsellingresource.com and click on ‘quizzes’), may identify depression in suspicious cases.

Oral effects?

Depression also may be associated with oral disease. It is vital to obtain a thorough medical/dental history, including current medication regimens and history of alcohol or other substance abuse. People taking antidepressants tend to have reduced salivary flow (and resultant dry mouth), increased rate of dental decay, and an increased rate of periodontal disease.2 Because there is a solid relationship among depression, pain, pain medication use, and wound healing, it is important to educate periodontists and other oral health care professionals about the role of anxiety and stress and the significance of depression on their patients’ responses to periodontal therapy.

Also, women with stress-related depression and exhaustion have been shown to have more plaque accumulation, GI, and increased levels of IL-6 and cortisol in GCF compared to normal controls, suggesting that depression might affect immune function, which could lead to impaired periodontal health.3

The prevalence of oral disease in patients with depressive disorders is generally extensive due to poor oral hygiene and medication-induced xerostomia. Preventive education, saliva substitutes and anticaries agents are indicated. To avoid adverse drug interactions with the usually prescribed psychiatric medications, special precautions should be taken when administering certain antibiotics, analgesics and sedatives. Dental hygienists and dentists should consult with physicians and other mental health professionals as needed.

Maria Perno Goldie, RDH, MS, is editor-in-chief of Modern Hygienist.

References:
1. www.answers.com/topic/sadnes
2. Kloostra PW, Eber RM, and Inglehart MR. Relationship of Clinical Depression to Periodontal Treatment Outcome. Journal of Periodontology Apr 2002, Vol. 73, No. 4: 441-449.
3. Johannsen A, Rylander G, Söder B, Åsberg M. Dental Plaque, Gingival Inflammation, and Elevated Levels of Interleukin-6 and Cortisol in Gingival Crevicular Fluid From Women With Stress-Related Depression and Exhaustion. J Periodontol 2006;77:1403-1409.

Additional Information
www.mayoclinic.com/health/depression/DS00175/DSECTION=8
www.depression.com/
www.nimh.nih.gov/health/publications/depression/complete-publication.shtml
www.nlm.nih.gov/medlineplus/depression.html