Depression (mood)

Albrecht Dürer's engraving Melencolia I, ca. 1514

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless. They may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, or problems concentrating, remembering details or making decisions; and may contemplate or attempt suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains or digestive problems that are resistant to treatment may be present.

Depressed mood is a normal reaction to certain life events, a symptom of some medical conditions, and a side-effect of some medical treatments. Depressed mood is also a main or common feature of certain psychiatric syndromes.

Illnesses featuring depression

Psychiatric syndromes

A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (MDD), commonly called major depression or clinical depression, where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic depressed mood, the symptoms of which do not meet the severity of a major depressive episode. Another mood disorder, bipolar disorder, features one or more episodes of abnormally elevated energy levels, cognition and mood, but may also involve one or more depressive episodes.

Outside the mood disorders, borderline personality disorder commonly features depressed mood, and adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode.

Non-psychiatric illnesses

Depressed mood can be the result of a number of infectious diseases and physiological problems including Addison's disease, Lyme disease, multiple sclerosis, sleep apnea and disturbed circadian rhythm. It is often one of the early symptoms of hypothyroidism (reduced activity of the thyroid gland). For a discussion of non-psychiatric conditions that can cause depressed mood, see Depression (differential diagnoses). Some medical treatments, such as hepatitis C drug therapy, can produce depressed mood.

Adolescent Depression

Depression is common among adolescents due to a few different factors. Adolescents are susceptible to depression due to the stress which accompanies development. They are also influenced by sex hormones involved in maturation. In addition, adolescents may be at risk for depression due to independence conflicts they may face with parents. While these normal developmental processes can cause an adolescent to suffer from depression, the depression may also occur as a reaction to a traumatic event. Adolescents may suffer from depression after experiencing the death of a loved one, the end of a relationship, or problems in school. Adolescents who have low self-esteem, are self-critical, or who feel they have little control over their lives are more likely to become depressed after these traumatic events. In general, adolescent girls are two times more likely to experience depression as compared to boys. Adolescence is a crucial time in development, and it can be harmfully affected by depression or other psychological struggles. Children and adolescents with depression may benefit from different treatments including care from medical professionals, talk therapy, and possibly antidepressant medications. Individuals with depression and their families must be treated in a highly individualized manner. Only certain antidepressant medications are approved for treating adolescent depression because some medications may increase the risk of adolescent suicide. Those who take such medications must be closely monitored by a doctor and family members. Talk therapy can be very effective in helping treat adolescents with depression. This involves the adolescent discussing their feelings, as well as the adolescent and the professional coming up with strategies to safely deal with the depression. It may also be effective to make families a part of this process, as well as having the adolescent become a part of a support group. However, it is important to note each adolescent with depression is different. Therefore, each person should be treated in an individualized manner.

Adults with Depression

In the United States culture, depression is often associated with weakness and excessive emotion. Men who are depressed may choose to withhold acknowledging these feelings as a way to protect themselves. Men with depression may complain about other things such as fatigue, sleep difficulties, or loss of interest in activities. Some of the common signs of men with depression are anger, violence, or substance abuse. Twice as many woman as men suffer from depression. Women are more susceptible due to hormonal factors involved in premenstrual syndrome, premenstrual dsyphoric disorder, postpartum depression, and premenopausal depression. Women may have different symptoms related to their depression, including guilt, excessive sleep, and weight gain.

Research studies show that children who experience emotional neglect, domestic violence, or emotional, physical, or sexual abuse are at a greater risk for self reported adult depression. People who live with someone who is depressed or mentally ill during the childhood years are also more likely to self report adult depression. These adults, who were once children, would have benefited from early intervention to help decrease these harmful effects.

Elderly Individuals with Depression

Many elderly individuals suffer from depression; however, depression is not as commonly recognized among the elderly population as it it among younger generations. Many life changes occur in the lives of elderly individuals that can increase the risk for depression. Elderly individuals may experience feelings of loneliness as their children move away or as their close friends begin to pass away. As elderly people move from independent living to more dependent living, they may experience depression. In addition, chronic pain and illness can cause depression in elderly individuals. Depression in the elderly population may be hard to detect because many elderly individuals don't like to admit that they are struggling. Often times, a physical illness may cause depression in elderly individuals. Thyroid disorders, Parkinson’s disease, heart disease, cancer, stroke, and dementia are all illnesses or disorders that may lead to depression. Some of the clues that may help to determine if an elderly individual is depressed are increased confusion, poor appetite, poor hygiene, and social withdrawal. Elderly individuals have several options for dealing with their depression. They must first take care of any physical conditions or medications that may be making the depression worse. After this step, it may be helpful for individuals to take antidepressant medications and participate in psychotherapy with a mental health professional. It is important for elderly individuals with depression to remain socially, mentally, and physically active. This involves participating in regular exercise, getting enough sleep, and partaking in enjoyable activities. It is important for people to have a good social network of caring individuals to whom they can speak to and trust.

In older people with major depressive disorder, psychomotor disturbances are typical difficulties. Elderly individuals who suffer from major depressive disorder participate in less physical activity than those who do not suffer from depression. This is a problem because it is recommended that elderly individuals with depression remain physically active to help combat their mental illness.

Postpartum Depression

After a woman gives birth, she may suffer from postpartum depression. Postpartum depression can range from moderate to severe, and it occurs anywhere from soon after giving birth to up to a year later. This type of depression may be caused by both hormonal and non-hormonal factors. Certain non-hormonal factors that may lead to postpartum depression are changes in relationships, lifestyle, independence, body, or sleep patterns. Some women lack confidence in their abilities to be good mothers. Certain woman may experience the “baby blues”, which are feelings of restlessness, anxiety or tearfulness in the first two weeks after giving birth. If these feelings don’t go away after two weeks or if the depression begins months after giving birth, then the depression is postpartum. Women who suffer from postpartum depression experience the same symptoms that are caused by depression during other times in life. However, these mothers may be unable to care for themselves or their babies, or they may worry intensely about their babies. Some woman may think about harming their babies, or they may just have little interest in them.

Prevalence

A 2010 US Centers for Disease Control and Prevention analysis of Behavioral Risk Factor Surveillance System survey data from 2006 and 2008 found nine percent of 235,067 adults surveyed in 45 states, District of Columbia, Puerto Rico, and US Virgin Islands met the criteria for current depression (defined as meeting criteria for either major depression or "other depression" during the 2 weeks preceding the survey); 3.4% met the criteria for major depression. By state, age-standardized estimates for current depression ranged from 4.8% in North Dakota to 14.8% in Mississippi..

Assessment

Main article: Rating scales for depression

A full patient medical history, physical assessment, and thorough evaluation of symptoms helps determine the cause of the depression. Standardized questionnaires can be helpful such as the Hamilton Rating Scale for Depression, and the Beck Depression Inventory.

A doctor generally performs a medical examination and selected investigations to rule out other causes of symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism; basic electrolytes and serum calcium to rule out a metabolic disturbance; and a full blood count including ESR to rule out a systemic infection or chronic disease. Adverse affective reactions to medications or alcohol misuse are often ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism, a cause of depression in men. Subjective cognitive complaints appear in older depressed people, but they can also be indicative of the onset of a dementing disorder, such as Alzheimer's disease. Cognitive testing and brain imaging can help distinguish depression from dementia. A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. Investigations are not generally repeated for a subsequent episode unless there is a medical indication.

Risk for Suicide

In individuals who suffer from depression, suicide is a huge risk factor. Some people with depression may feel like suicide is the only path that will make things better. If an individual with depression threatens to commit suicide, this should be seen as a cry for help. There are many clues that help detect if a person is considering suicide. Some of these warning signs are talking about killing one’s self, a preoccupation with death, acting recklessly, calling people to say final goodbyes, or a sudden switch from extreme depression to acting happy.

Treatments

Many forms of treatment are available for depression associated with a mental disorder. Treatments may include psychotherapy such as cognitive-behavioral therapy, medicines such as antidepressants, Electroconvulsive therapy, music therapy, art therapy, group therapy, animal-assisted therapy (also known as pet therapy), physical exercise, light therapy and keeping a gratitude journal.

References

Selected cited works

• American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc.; 2000a. ISBN 0890420254.