Depression
Depression, in psychology, is a mood or emotional state that is marked by sadness, inactivity, and a reduced ability to enjoy life.
The symptoms of depression can include:
Depression differs from simple grief, bereavement, or mourning, which are appropriate emotional responses to the loss of loved persons or objects.
Where there are clear grounds for a person's unhappiness, depression is considered to be present if the depressed mood is disproportionately long or severe vis-a-vis the precipitating event.
When a person experiences alternating states of depression and mania (extreme elation of mood), he is said to suffer from a manic-depressive psychosis.
Depression is probably the most common psychiatric complaint and has been described by physicians from at least the time of Hippocrates, who called it melancholia.
The course of the disorder is extremely variable from person to person; it may be fleeting or permanent, mild or severe, acute or chronic.
Depression is more common in women than in men. The rates of incidence of the disorder increase with age in men, while the peak for women is between the ages of 35 and 45.
Depression can have many causes.
The loss of one's parents or other childhood traumas and privations can increase a person's vulnerability to depression later in life.
Stressful life events in general are potent precipitating causes of the illness, but it seems that both psychosocial and biochemical mechanisms can be important causes.
The chief biochemical cause seems to be the defective regulation of the release of one or more naturally occurring monoamines in the brain, particularly norepinephrine and serotonin. Reduced quantities or reduced activity of these chemicals in the brain is thought to cause the depressed mood in some sufferers.
There are three main treatments for depression. The two most important are psychotherapy and drug therapy.
Psychotherapy aims to resolve any underlying psychic conflicts that may be causing the depressed state, while also giving emotional support to the patient.
Antidepressant drugs, by contrast, directly affect the chemistry of the brain, and presumably achieve their therapeutic effects by correcting the chemical imbalance that is causing the depression.
The tricyclic antidepressant drugs are thought to work by inhibiting the body's physiological inactivation of the monoamine neurotransmitters. This results in the buildup or accumulation of these neurotransmitters in the brain and allows them to remain in contact with nerve cell receptors there longer, thus helping to elevate the patient's mood.
By contrast, the antidepressant drugs known as monoamine oxidase inhibitors interfere with the activity of monoamine oxidase, an enzyme that is known to be involved in the breakdown of norepinephrine and serotonin.
In cases of severe depression in which therapeutic results are needed quickly, electroconvulsive therapy has proven helpful.
In this procedure, a convulsion is produced by passing an electric current through the person's brain. In many cases of treatment, the best therapeutic results are obtained by using a combination of psychotherapy with drug therapy or with electroshock treatment.
Depression is characterized by a sad or hopeless mood, pessimistic thinking, a loss of enjoyment and interest in one's usual activities and pastimes, reduced energy and vitality, increased fatigue, slowness of thought and action, loss of appetite, and disturbed sleep or insomnia.
Depression must be distinguished from the grief and low spirits felt in reaction to the death of a loved one or some other unfortunate circumstance. The most dangerous consequence of severe depression is suicide.
Mania is characterized by an elated or euphoric mood, quickened thought and accelerated, loud or voluble speech, overoptimism and heightened enthusiasm and confidence, inflated self-esteem, heightened motor activity, irritability, excitement, and a decreased need for sleep.
The manic individual may become injured, commit illegal acts, or suffer financial losses due to the poor judgment and risk-taking behavior he displays when in the manic state.
There are enormous problems in the classification of affective disorders, particularly of depression, and the various clinical distinctions made by different authorities are difficult to correlate with particular sets of symptoms or particular causes.
An important distinction, however, is made between depressions that are endogenous (i.e., arising independently of environmental influences and presumably caused by a biochemical imbalance) and those that are reactive (i.e., arising in response to external stresses or trauma).
A person with bipolar disorder, which has traditionally been called manic-depressive psychosis, typically experiences discrete episodes of depression and then of mania lasting for a few weeks or months, with intervening periods of complete normality.
The sequence of depression and mania can vary extremely from patient to patient and within one individual, with either mood abnormality predominating in duration and intensity.
Depressive mood swings typically occur more often and last longer than manic ones, though there are patients who have episodes only of mania.
Patients with bipolar disorder frequently also show such psychotic symptoms as delusions, hallucinations, paranoia, or grossly bizarre behavior.
The lifetime risk for developing bipolar disorder is about 0.7 percent and is about the same for men and women.
The onset of the illness often occurs around the age of 30, and the illness persists over the long term.
The predisposition to develop bipolar disorder is partly genetically inherited.
Antipsychotic drugs such as chlorpromazine or haloperidol are used for the treatment of acute mania. Lithium carbonate has proved effective in both treating and preventing recurrent attacks of mania.
Severe and long-lasting depression without the presence of mania is classified by the DSM-III as major depression.
Depression is a much more common illness than mania, and there are indeed many sufferers from depression who have never experienced mania.
Major depression may occur as a single episode or it may be recurrent. It may also exist with or without melancholia and with or without psychotic features.
Melancholia implies the so-called biological symptoms of depression: early-morning waking; daily variations of mood with depression most severe in the morning; loss of appetite and weight; constipation; and loss of interest in love and sex.
Melancholia is a particular depressive syndrome that is relatively more responsive to physical methods of treatment, such as drugs and electroconvulsive therapy.
It is estimated that the annual incidence of major depression is about 140 for men and 4,000 for women per 100,000 population. While the rates for major depression in men increase with age, the peak for women is between the ages of 35 and 45.
There is a serious risk of suicide with the illness; of those who have a severe depressive disorder, about one-sixth eventually kill themselves.
The loss of one's parents or other childhood traumas or deprivations can increase a person's vulnerability to depression later in life, and stressful life events, especially where some type of loss is involved, are in general potent precipitating causes of the illness.
It seems that both psychosocial and biochemical mechanisms are important in causing depression.
Of the latter factor, the best-supported hypotheses suggest that the faulty regulation of the release of one or more naturally occurring amines at sites in the brain where the transmission of nerve impulses takes place is the basic cause, with a deficiency of the amines resulting in depression and an excess causing mania.
The most likely candidates for the suspect amines are the biological monoamines (norepinephrine, dopamine, and 5-hydroxytryptamine).
The treatment of major depressive episodes usually requires antidepressant drugs; electroconvulsive therapy may also be helpful, as may cognitive psychotherapy.
A less severe manifestation of the manic-depressive syndrome, in which the mood swings are present but not as extreme, is termed cyclothymic disorder. This illness is better considered a personality disorder of affective type; the prevailing mood swings are established in adolescence and continue throughout adult life.
Dysthmic disorder, or depressive neurosis, may occur on its own, but it more commonly appears along with other neurotic symptoms such as anxiety, phobia, and hypochondriasis.
Where there are clear external grounds for a person's unhappiness, a dysthymic disorder is considered to be present when the depressed mood is disproportionately severe or prolonged in regard to the distressing experience, when there is a preoccupation with the precipitating situation, when the depression continues even after removal of the provocation, and when it impairs the individual's ability to cope with the specific stress.
At any time, depressive symptoms may be found in one-sixth of the population, more commonly in women than men.
Social factors are important etiologically, as evidenced in the high rates of depression found in urban women living without a male cohabitant, having three or more children, and lacking employment outside the home.
Loss of self-esteem, feelings of helplessness and hopelessness, and losses of various types of "loved objects" are also seen as important causes of minor depression.
The course and severity of dysthymic disorder is extremely variable - from a few weeks or months to several decades and from the mild impairment of social functioning to almost total incapacitation.
Psychotherapy is the treatment of choice, although antidepressant medication may prove beneficial.
Genes 'play key happiness role' BBC - March 2008
[From Ellie: Depression and others form of mental illness are mostly genetic]
Depression May Be World's Most Disabling Disease Live Science - September 8, 2007
Depression more harmful than angina, says study Guardian - September 7, 2007
Scientists Discover Gene Therapy for Depression Live Science - December 28, 2006
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