Physiotherapy versus depression

          Physiotherapy versus depression 



According to the World Health Organization (WHO), depression affects more than 300 million people in the world, being considered a frequent mental disorder. The emotional symptoms are usually the first to be treated with current existing treatments, but how can we intervene on the cognitive impairment that often affects the people that suffer from depression?
In a recent scientific study carried out in a population with Major Depressive Disorder (MDD) (Escolano, 2014) a new cognitive rehabilitation neurotechnology was proven effective, with 20% improvement in functions such as working memory, sustained attention and processing speed.

What is depression?

Depression is a very frequent mental disorder that can start at any age, and in more severe cases can even lead to suicide. Although the probability of suffering from this disorder increases with puberty, the average age at onset is around 35 years of age, with higher prevalence in women. 
Duration of the depressive episodes is highly variable and, although most people recover in one or two years, approximately 15% present a chronic course. This chronic course is related to other mental disorders such as personality disorders, anxiety disorders or substance use.
Six stages can be identified in the course of depressive disorders:
  • Response to treatment: severity of symptoms reduces in more than 50% in comparison with the initial levels of the disorder.
  • Partial remission: some symptoms continue to manifest but very mildly. The depression diagnosis criteria are not fulfilled and more than two months have passed since the last episode.
  • Total remission: symptoms have disappeared during at least the last two months.
  • Recovery:  remission is maintained during more than six months, and normal functionality is recovered. 
  • Relapse: depressive symptoms reappear during the remission period.
  • Recurrence: new episode of depressive symptoms.

What are the symptoms of depression?

Although the most representative symptom of depression is sadness, it could be accompanied by mood, motivational, behavioral, cognitive, physical or interpersonal symptoms. Therefore, the depressive symptomatology can be classified into:
  • Mood-related symptoms: sadness, irritation, numbness, emptiness, anxiety, etc.
  • Motivational and behavioral symptoms: anhedonia (reduced motivation or ability to experience pleasure), apathy, abulia (lack of will or energy to do something), psychomotor delay, behavior inhibition, etc.
  • Cognitive symptoms: important difficulties in executive functions and cognitive capabilities such as memory, attention, concentration, processing speed, cognitive distortions, thoughts of uselessness and guilt, etc.
  • Physical symptoms: alterations in sleep and appetite, inhibited sexual drive, headaches, nausea, vomits, gastrointestinal discomfort, etc.
  • Interpersonal symptoms: deteriorated interpersonal relationships produced, in many cases, by the rejection generated in others towards the people who suffer from depression, due to their multiple complaints and lack of motivation.
Focusing on the cognitive symptoms, the first cognitive capabilities and executive functions to deteriorate in people with depression are:
  • Attention: capacity of generating, selecting, directing and maintaining an adequate activation level to process relevant information.
  • Processing speed: capability that establishes a relationship between cognitive execution and invested time. Enables the processing of information in a fast and automatic manner.
  • Learning: relatively stable transformations in behavior, elicited by different experiences that originate new knowledge and abilities.
  • Memory: registers, stores and elicits different experiences, which could be ideas, images, events, etc.
  • Reasoning: capability to solve problems, extract conclusions and learn in a conscious manner from events, in such a way that we can establish causal and logical relations. 

Role of physiotherapists:

One of the biggest things a physical therapist can do for their patients is to be aware of the signs and symptoms of depression and some of the common disorders associated with depression. If the therapist is sensitive to the signs and symptoms of depression they can document it in the plan of care and then notify the physician so the patient can get the appropriate medical treatment, if necessary. Also, because patients with depression may be emotionally unstable, recognizing the signs and symptoms of depression can help you in approaching different situations and then redirecting the patient toward other activities, instructions or more positive topics of conversation.

Exercise has been shown to benefit patients with mild to moderate mood disorders, especially anxiety and depression. When performing aerobic exercise your body releases endorphins from the pituitary gland which are responsible for relieving pain and improving mood. These endorphins can also lower cortisol levels which have been shown to be elevated in patients with depression. Additionally, exercise increases the sensitivity of serotonin in the same way antidepressants work, allowing for more serotonin to remain in the nerve synapse. Exercise can be aerobic or resistive in nature, as both have been shown to be beneficial in a variety of patient types. Anyone with depression can participate in an exercise program no matter how old or young they are, as long as proper supervision is provided. Exercise is an excellent option for treatment when taking anti-depressants is not an option due to their side effects. Depression symptoms can be decreased significantly after just one session but the effects are temporary. An exercise program must be continued on a daily basis to see continued effects. As a person continues to exercise they may experiences changes in their body type which can help to improve self esteem and body image issues they may have been having. Some other benefits of regular physical exercise include:
  • reduces/prevents functional declines associated with aging
  • maintains/improves cardiovascular function
  • aids in weight loss and weight control
  • improves function of hormonal, metabolic, neurologic, respiratory, and hemodynamic systems
  • alteration of carbohydrate/lipid metabolism results in favorable increase in high-density lipoproteins
  • strength training helps to maintain muscle mass and strength
  • reduces age-related bone loss; reduction in risk for osteoporosis
  • improves flexibility, postural stability, and balance; reduction in risk of falling and associated injuries
  • psychological benefits (preserves cognitive function, alleviates symptoms/behaviors of depression, improves self awareness, promotes sense of well-being)
  • reduces disease risk factors
  • improves functional capacity
  • improves immune function
  • reduces age-related insulin resistance
  • reduces incidence of some cancers
  • contributes to social integration
  • improves sleep pattern

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