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 for at least 2 weeks to signal the presence of depression (also called major depressive disorder or clinical depression).

Epidemiology and Etiology

Mood disorders are the 3^rd most common cause of hospitalization in the US for people age 18 to 44 years old.⁴⁵ Depression is one of the most common mood disorders in the United States.^44,45It 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

Patient Management and Oral Health Considerations for Depression

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.