Depression

A mood disorder which affects how a person feels, thinks, and handles daily activities.⁴⁴ Clinical signs and symptoms are summarized in Figure 8. These signs and symptoms must be present most of the day, nearly every day, for at least 2 weeks to signal the presence of depression (also called major depressive disorder or clinical depression). People who are depressed may experience a wide-ranging number of symptoms. A key consideration is that the symptoms interfere with daily functions and cause significant distress for the person experiencing them.

Epidemiology and Etiology

Depression is one of the most common mood disorders in the United States.^44,45Major depression affects 21 million adults and 5 million adolescents ages 12-17.⁴⁵ For both ages groups it’s prevalence is higher in females and those reporting two or more races.⁴⁵ It is thought to be caused by a combination of genetic, biological, environmental, and psychological factors.⁴⁴ It may present itself at any age, but often it begins in adulthood. Risk factors include high levels of anxiety as a child, a personal or family history of depression, being diagnosed with a serious medical condition or medications, and major life changes, trauma, or stress.⁴⁴ In children, depression often presents as irritability.⁴⁴ Serious mental illness decreases life expectancy by 25 years.⁴⁵ Depression can co-occur with other chronic diseases such as diabetes, cancer, heart disease, chronic pain, and Parkinson’s disease. When people have depression and a chronic disease, the symptoms tend to be more severe for both illnesses.⁴⁴

Patient Management and Oral Health Considerations for Depression

If you have a patient experiencing depression who is suicidal or in emotional distress, consider using the 988 Suicide and Crisis Lifeline.

Click to access the 988 Suicide and Crisis Lifeline

Click to access the 988 Suicide and Crisis Lifeline

Patients experiencing depression may not recognize their oral hygiene needs or they may not care about their oral health. This can lead to poor oral self-care, fewer dental appointments, and ultimately oral health problems.⁴⁶ Medications used to treat depression can also contribute to oral health problems (Figure 9).^20,47 Antidepressants have been associated with bruxism and TMD.⁴⁶

Antidepressants, antihistamines, anticholinergics, antihypertensives, and antipsychotics are known to alter salivary gland function resulting in xerostomia.^20,47 A high percentage of patients taking these medications experience dry mouth. This leads to many of the other problems listed in Figure 9 such as dental caries, taste distortion, chewing, swallowing, and oral infection.