Depression (mood)

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Depression, or a depressed mood, may in everyday English refer to a state of melancholia, unhappiness or sadness, or to a relatively minor downturn in mood that may last only a few hours or days. This is quite distinct from the medical diagnosis of clinical depression. However, if depressed mood lasts at least two weeks, and is accompanied by other symptoms that interfere with daily living, it may be seen as a symptom of clinical depression, dysthymia or some other diagnosable mental illness, or alternatively as sub-syndromal depression.

In the field of psychiatry, the word depression can also have this meaning of low mood but more specifically refers to a mental illness when it has reached a severity and duration to warrant a diagnosis, whether there is an obvious situational cause or not; see Clinical depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that a depressed mood is often reported as being: "... depressed, sad, hopeless, discouraged, or 'down in the dumps'." In a clinical setting, a depressed mood can be something a patient reports (a symptom), or something a clinician observes (a sign), or both.

A depressed mood is generally situational and reactive, and associated with grief, loss, or a major social transition. A change of residence, marriage, divorce, the break-up of a significant relationship, the death of a loved one, graduation, or job loss are all examples of instances that might trigger a depressed mood.

1 Subjective experience of being depressed
2 Determinants of mood
3 Adaptive benefits of depression
4 Depressed mood in literature and culture
5 Music as a therapy
6 Notes
7 See also
8 External links

[edit] Subjective experience of being depressed

Depression is suffering, sometimes seen as mental echoes of physical pain. Other somatic expressions can be a sense of "dispirited", or "lagging" or being weighed down, and a heaviness in breathing, expressed as broken or despondent sighs. It may also be associated with apathy, boredom, hollowness and lack of any positive source of interest or joy.

External affective signs of depressed mood also include a physical hunching or stooping, or putting the head in the hands, and an appearance of being physically subdued, and flatness of speech.

See also: Dysphoria

[edit] Determinants of mood

Depression can be the result of many factors, individually and acting in concert.

[edit] Environment

Reactions to events, often a loss in some form, are perhaps the most obvious causes. This loss may be obvious, such as the death of a loved one, or having moved from one home to another, or less obvious, such as disillusionment about one's career prospects. A significant disappointment, such as when a trusted professional fails to provide expected helpful assistance may trigger a discouraged response. Monotonous environments or boring personal or vocational routines can be depressing. A lack of control over one's environment can lead to feelings of helplessness. Domestic disputes, financial difficulties, or a sense that the lives of others are more successful or enjoyable are common contibutors to a depressed mood. The inability to adequately express one's feelings or to not have them be accepted as valid by others can lead to a feeling of unexplainable sadness or grief.

[edit] Psychological Factors

Sometimes the depressed mood may relate more to internal processes or even be triggered by them. Pessimistic views of life or a lack of self-esteem can lead to depression. Illnesses and changes in cognition that occur in psychosis and dementias, to name but two, can lead to depression. Depression may also be comorbid with cardiovascular disorders. [3].

[edit] Physiological Considerations

A diathesis-stress model of depression (including clinical depression) is now widely accepted. This implies that underlying personality has some degree of influence over how the mood of individuals is affected by life events. The social, psychological and biological etiology of depression is still being actively investigated. The causal relationship with biological variables is unknown and so it is difficult to pinpoint the condition's roots. Some general physiological considerations include genetics (i.e. a hypothesised innate disposition to depression), neurochemistry (e.g. high levels of stress hormones such as cortisol, low dopamine activity), sleep patterns, female hormone imbalance (e.g. PMS in women), male hormone imbalance (testosterone) in men, use of medication (e.g. corticosteroids), chronic illness (e.g. diabetes or hypothyroidism), and seasonal factors (e.g. seasonal affective disorder related to hormones and sunlight). See Clinical depression.

[edit] Adaptive benefits of depression

While a depressed mood is usually seen as deleterious, it may have adaptive benefits. The loss of a loved spouse, child, friend or relation, a physical illness or loss of lifestyle, tends to lead to feelings of depression. Freud noted the similarities between mourning and depression (then called melancholia) in a now famous paper entitled, "Mourning and Melancholia". The depressed mood is adaptive in that it leads the person towards altering his thought patterns and behavior or way of living or else continues until such a time as he does so. It can be argued that depression and clinical depression is in fact the refusal of a person to heed the call to change from within his own mind. For example, in mourning it is essential that one must eventually let go of the dead person and return to the world and other relationships.

Depression appears to have the effect of stopping a person in his tracks and forcing him to turn inwards and engage in a period of self reflection; it is a deeply introspective state. During this period, which can last anything from days to years, the individual must find a new way to interpret his thoughts and feelings and reassess the extent to which his appraisal of his reality is realistic.

Seasonal affective disorder may point to an atavistic link with behaviour in hibernation.

[edit] Depressed mood in literature and culture

Unlike jealousy or anger, a mild depressed state is not intimately associated with a motive for action, and this is a likely reason for it being under-represented in drama. The journey of King Lear could be seen as a state of depression seeking forgiveness and redemption, although it is arguably pathological; Hamlet is often described as a consummate melancholic. Sylvia Plath's The Bell Jar is a semi-autobiographical chronicle of her descent into profound depression. Many of the works of Anton Chekhov, such as Uncle Vanya, involve either depressed mood or clinical depression. On the other hand, sorrow and regret perhaps occur much more commonly in literature, and tragedy, where the audience or readers may share the sadness or despair of the characters, is seen as one of the greatest of art forms and perhaps the most profound. One of the most famous examples of depression in literature is Johann Wolfgang Goethe's The Sorrows of Young Werther, and for this reason it is referred to in Frankenstein.

A similar example in music is Schubert's Winterreise, a setting of poems by Wilhelm Mueller.

The films and plays of Ingmar Bergman cover both bereavement (as in Virgin Spring) and depressed mood (Wild Strawberries).

A Pietà is an example of the representation of grief and sorrow in Christian art. Self-portraits of Frida Kahlo often show her depressed state. Many more examples could be added.

[edit] Music as a therapy

Robert Burton wrote in the 16th century in his classic work, The Anatomy of Melancholy, that music and dance were critical in treating mental illness, especially melancholia. ^[1] ^[2] ^[3]

In November 2006, Dr. Michael J. Crawford ^[4] and his colleagues again found that music therapy helped the outcomes of schizophrenic patients. ^[5]

[edit] Notes

^ cf. The Anatomy of Melancholy, Robert Burton, subsection 3, on and after line 3480, "Music a Remedy":

But to leave all declamatory speeches in praise [3481]of divine music, I will confine myself to my proper subject: besides that excellent power it hath to expel many other diseases, it is a sovereign remedy against [3482] despair and melancholy, and will drive away the devil himself. Canus, a Rhodian fiddler, in [3483]Philostratus, when Apollonius was inquisitive to know what he could do with his pipe, told him, "That he would make a melancholy man merry, and him that was merry much merrier than before, a lover more enamoured, a religious man more devout." Ismenias the Theban, [3484]Chiron the centaur, is said to have cured this and many other diseases by music alone: as now they do those, saith [3485]Bodine, that are troubled with St. Vitus's Bedlam dance. [1]
^ "Humanities are the Hormones: A Tarantella Comes to Newfoundland. What should we do about it?" by Dr. John Crellin, MUNMED, newsletter of the Faculty of Medicine, Memorial University of Newfoundland, 1996.
^ Aung, Steven K.H., Lee, Mathew H.M., "Music, Sounds, Medicine, and Meditation: An Integrative Approach to the Healing Arts", Alternative & Complementary Therapies, Oct 2004, Vol. 10, No. 5: 266-270. [2]
^ Dr. Michael J. Crawford page at Imperial College London, Faculty of Medicine, Department of Psychological Medicine.
^ Crawford, Mike J., Talwar, Nakul, et al. (November 2006). "Music therapy for in-patients with schizophrenia: Exploratory randomised controlled trial". The British Journal of Psychiatry (2006) 189: 405-409.