There are several types of depression:
- Dysthymia is a chronic low grade depression which is present for at least two years.
- Major depression may be unipolar when present alone, or bipolar when associated with at least one episode of mania (a period of elevated, expansive, or irritable mood).
- Seasonal affective disorder (SAD) is a type of major depression which occurs at specific seasons of the year. Some people residing in the northern latitudes experience SAD during winter. This remits with the arrival of spring.
Unipolar depression usually responds to antidepressant medications. If medications fail, electroconvulsive therapy (ECT or "Shock Treatment") is usually required. SAD responds to intense white light. Treatment for a bipolar disorder is generally Lithium.
50% of people with major depression recover within the first 6 months. Thereafter, the rate of recovery declines markedly. Recurrences are common.
Depressed clients experience increased mortality from natural as well as accidental causes. Most of the excess mortality from natural causes is due to common conditions such as heart disease, lung infections and influenza. The higher incidence of accidental deaths is probably related to greater risk taking behavior. Persons with psychiatric illnesses are more likely to be either victims or perpetrators of violence. They are more prone to abuse alcohol and drugs. The risk of death from accidental causes is greatest for those aged 35- 44 and least for those over 75 years of age.
The most serious complication of major depression is suicide. It has been estimated that half of all patients who commit suicide suffer from major depression. A quarter of patients with a diagnosis of major depression attempt suicide in a life-time and 15% of patients with major depression ultimately die by suicide.
Features associated with a poor risk include: three or more episodes; prolonged disability; lack of full maintenance dose medication; multiple drug therapy; poor compliance; need for hospitalization and co-morbidity such as substance abuse (alcohol or drugs), psychotic episodes, personality disorder and suicidal attempt.
Underwriting considerations for Mood Disorders (Depression and Bipolar Disorder), absent other significant impairment:
|
Mild |
No disability; able to carry on normal
activities; no suicidal ideation or history of psychiatric hospitalization; medical treatment (1 drug) and/or psychotherapy
|
Non-Rated
|
|
Moderate |
Disability of not more than 3 months; no psychiatric hospitalization; medical treatment (more than 1 drug); suicidal ideation but no definite plan, gestures, or attempts
|
Present or within 1 year of recovery Table B*
After 1 year, non-rated
|
|
Severe |
Disability of more than 3 months with or
without history of psychiatric hospitalization, any history of delusions or hallucinations; treatment by electroconvulsive therapy (ECT); suicidal ideation or gesture but no
attempts
|
Within 1 year of recovery - Decline*
2nd-3rd years - Table D-F*
4th-5th years - Table C-D*
6th-9th years - Table A-C*
After 10 years - Non-rated to Table B* |
* If more than 1 episode, add 1 year to decline and use highest rating in table range for other durations.
