Depression (mood)

Depression
Lithograph of a man diagnosed as suffering from melancholia with strong suicidal tendency (1892)
Classification and external resources
Specialty Psychiatry, psychology

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings, and sense of well-being.[1][2]

People with a depressed mood may be notably sad, anxious, or empty; they may also feel notably hopeless, helpless, dejected, or worthless. Other symptoms expressed may include senses of guilt, irritability, or anger.[3][4] Further feelings expressed by these individuals may include feeling ashamed or an expressed restlessness. These individuals may notably lose interest in activities that they once considered pleasurable to family and friends or otherwise experience either a loss of appetite or overeating. Experiencing problems concentrating, remembering general facts or details, otherwise making decisions or experiencing relationship difficulties may also be notable factors in these individuals' depression and may also lead to their attempting or actually committing suicide.

In addition to all the aforementioned factors, actions committed by siblings of these individuals may also contribute to the decision-making in individuals experiencing depression or attempting to take their own lives.[5]

Expressed insomnia, excessive sleeping, fatigue, and vocalizing general aches, pains, and digestive problems and a reduced energy may also be present in individuals experiencing depression.[6]

A depressed mood is a feature of some psychiatric syndromes such as major depressive disorder[2] and dysthymia, but it may also be a normal temporary reaction to life events such as bereavement, a symptom of some bodily ailments or a side effect of some drugs and medical treatments. A DSM diagnosis distinguishes an episode (or 'state') of depression from the habitual (or 'trait') depressive symptoms someone can experience as part of their personality.[7]

Causes

Life events

Adversity in childhood, such as bereavement, neglect, mental abuse, physical abuse, sexual abuse, and unequal parental treatment of siblings can contribute to depression in adulthood.[8][9] Childhood physical or sexual abuse in particular significantly correlates with the likelihood of experiencing depression over the life course.[10]

Life events and changes that may precipitate depressed mood include childbirth, menopause, financial difficulties, unemployment, work stress, a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation, and catastrophic injury.[11][12][13] Adolescents may be especially prone to experiencing depressed mood following social rejection, peer pressure and bullying.[14]

Personality

High scores on the personality domain neuroticism make the development of depressive symptoms as well as all kinds of depression diagnoses more likely,[15] and depression is associated with low extraversion.[16]

Medical treatments

Depression may also be iatrogenic (the result of healthcare), such as drug induced depression. Therapies associated with depression include interferon therapy, beta-blockers, Isotretinoin, contraceptives,[17] cardiac agents, anticonvulsants, antimigraine drugs, antipsychotics, and hormonal agents such as gonadotropin-releasing hormone agonist.[18]

Substance-induced

Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from chronic use. These include alcohol, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs such as heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants.[19]

Non-psychiatric illnesses

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions[20] and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, hypothyroidism, Lyme disease, multiple sclerosis, Parkinson's disease, chronic pain, stroke,[21] diabetes,[22] and cancer.[23]

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 mood, cognition and energy levels, but may also involve one or more episodes of depression.[24] When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as a seasonal affective disorder. Outside the mood disorders: borderline personality disorder often features an extremely intense depressive mood; 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;[25]:355 and posttraumatic stress disorder, an anxiety disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[26] Depression is sometimes associated with substance use disorder. Both legal and illegal drugs can cause substance use disorder.[27]

Historical legacy

Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may create depressive conditions.[28][29]

Assessment

Questionnaires and checklists such as the Beck Depression Inventory or the Children's Depression Inventory can be used by a mental health provider to help detect, and assess the severity of depression.[30] The Seasonal Pattern Assessment Questionnaire can be used to screen for seasonal affective disorder. Semi structured interviews such as the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) and the Structured Clinical Interview for DSM-IV (SCID) are used for diagnostic confirmation of depression.

Treatment

Depressed mood may not require professional treatment, and may be a normal temporary reaction to life events, a symptom of some medical condition, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition which may benefit from treatment.[31] Different sub-divisions of depression have different treatment approaches.[32] In the United States, it has been estimated that two thirds of people with depression do not actively seek treatment.[33] The World Health Organisation (WHO) has predicted that by 2030, depression will account for the highest level of disability accorded any physical or mental disorder in the world (WHO, 2008).[34]

The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, because the risk-benefit ratio is poor.[35] A recent meta-analysis also indicated that most antidepressants, besides fluoxetine, do not seem to offer a clear advantage for children and adolescents in the acute treatment of major depressive disorder.[36]

Epidemiology

About a quarter of medical students have depressive symptoms.[37]

Racial issue

There is a racial difference when considering people facing depression in the USA. For example, adult African Americans are 20 percent more likely to report serious psychological distress than adult whites.[38] Also, African-American men suffer from serious chronic illnesses such as diabetes and cancer at much higher rates than white men, and these diseases and disorders are known to be significant risk factors for depression.[39] By 2016 there is a huge lack of psychological specialists among black people. Whites dominate the psychological and psychiatric professions, as only 2 percent of licensed mental health professionals are African-American, and about three-fourths of these are women. Many African-American men feel uncomfortable revealing their feelings to people who do not share their cultural background, and a shortage of African-American male therapists also means a lack of role models for future scholars who might be searching for a way to give back to their communities.[40] A research conducted by Sirry Alang, a Pennsylvania Lehigh University assistant professor of sociology and anthropology, shows that many African-Americans see depression as a sign of weakness and not a health issue.[41]

Sex differences

Women experience a higher rate of major depression than men.[42] While women are much more likely to express somatic symptoms of both distress and depression than men, such as loss of or an increase in appetite, sleep disturbances and fatigue accompanied by pain and anxiety, the gender difference expressed is much smaller in other aspects of depression.[43] Instances of suicide in men is much greater than in women. In a report by Lund University in Sweden and Stanford University, it was shown that men commit suicide at a rate almost three times that of women in Sweden, and the Centers for Disease Control and Prevention and National Center for Injury Prevention and Control report that the rate in the US is almost four times as many males as females.[44] However, women have higher rates of suicide ideation and attempts.[45][46] The difference is attributed to men choosing more effective methods resulting in the higher rate of success.[47][48] This research would suggest that women are more likely to discuss their depression issues, whereas men are more likely to try and hide them.[49] The culture of women being more free to express psychological and emotional feelings than men could also be a contributing factor to this phenomenon.[50][51][52]

See also

References

  1. ↑ Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need. People's Medical Society. ISBN 978-1-882606-14-6.
  2. 1 2 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association. 2013.
  3. ↑ "Irritability, Anger Indicators of Complex, Severe Depression".
  4. ↑ "Depression (major depressive disorder)". Angry outbursts, irritability or frustration, even over small matters
  5. ↑ "The Relationship of Suicide Risk to Family History of Suicide and Psychiatric Disorders". psychiatrictimes.com. Retrieved 7 May 2017.
  6. ↑ "NIMH · Depression". nimh.nih.gov. National Institute of Mental Health. Retrieved 15 October 2012.
  7. ↑ Riese, H., Ormel, J., Aleman, A., Servaas, M.N., Jeronimus, B.F. (2016). "Don't throw the baby out with the bathwater: Depressive traits are part and parcel of neuroticism". NeuroImage. 125: 1103. PMID 26551260. doi:10.1016/j.neuroimage.2015.11.012.
  8. ↑ Christine Heim; D. Jeffrey Newport; Tanja Mletzko; Andrew H. Miller; Charles B. Nemeroff (July 2008). "The link between childhood trauma and depression: Insights from HPA axis studies in humans". Psychoneuroendocrinology. 33 (6): 693–710. PMID 18602762. doi:10.1016/j.psyneuen.2008.03.008. Retrieved 20 April 2014.
  9. ↑ Pillemer, Karl; Suitor, J. Jill; Pardo, Seth; Henderson Jr, Charles (2010). "Mothers' Differentiation and Depressive Symptoms Among Adult Children". Journal of Marriage and Family. 72 (2): 333–345. PMC 2894713 Freely accessible. PMID 20607119. doi:10.1111/j.1741-3737.2010.00703.x.
  10. ↑ Lindert J, von Ehrenstein OS, Grashow R, Gal G, Braehler E, Weisskopf MG (April 2014). "Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis". Int J Public Health. 59 (2): 359–72. PMID 24122075. doi:10.1007/s00038-013-0519-5.
  11. ↑ Schmidt, Peter (2005). "Mood, Depression, and Reproductive Hormones in the Menopausal Transition". The American Journal of Medicine. 118 Suppl 12B (12): 54–8. PMID 16414327. doi:10.1016/j.amjmed.2005.09.033.
  12. ↑ Rashid, T.; Heider, I. (2008). "Life Events and Depression" (PDF). Annals of Punjab Medical College. 2 (1). Retrieved 15 October 2012.
  13. ↑ Mata, D. A.; Ramos, M. A.; Bansal, N; Khan, R; Guille, C; Di Angelantonio, E; Sen, S (2015). "Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis". JAMA. 314 (22): 2373–2383. PMC 4866499 Freely accessible. PMID 26647259. doi:10.1001/jama.2015.15845.
  14. ↑ Davey, C. G.; Yücel, M; Allen, N. B. (2008). "The emergence of depression in adolescence: Development of the prefrontal cortex and the representation of reward". Neuroscience & Biobehavioral Reviews. 32 (1): 1–19. PMID 17570526. doi:10.1016/j.neubiorev.2007.04.016.
  15. ↑ Jeronimus; et al. (2016). "Neuroticism's prospective association with mental disorders: A meta-analysis on 59 longitudinal/prospective studies with 443 313 participants". Psychological Medicine. 46 (14): 2883–2906. PMID 27523506. doi:10.1017/S0033291716001653.
  16. ↑ Kotov; et al. (2010). "Linking "big" personality traits to anxiety, depressive, and substance use disorders: a meta-analysis". Psychological Bulletin. 136 (5): 768–821. PMID 20804236. doi:10.1037/a0020327.
  17. ↑ Rogers, Donald; Pies, Ronald (9 January 2017). "General Medical Drugs Associated with Depression". Psychiatry (Edgmont). 5 (12): 28–41. ISSN 1550-5952. PMC 2729620 Freely accessible. PMID 19724774.
  18. ↑ Botts, S; Ryan, M. Drug-Induced Diseases Section IV: Drug-Induced Psychiatric Diseases Chapter 18: Depression. pp. 1–23.
  19. ↑ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  20. ↑ Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. 12 April 2012. ISBN 978-1437704341
  21. ↑ Saravane, D; Feve, B; Frances, Y; Corruble, E; Lancon, C; Chanson, P; Maison, P; Terra, JL; et al. (2009). "Drawing up guidelines for the attendance of physical health of patients with severe mental illness". L'Encéphale. 35 (4): 330–9. PMID 19748369. doi:10.1016/j.encep.2008.10.014.
  22. ↑ Rustad, JK; Musselman, DL; Nemeroff, CB (2011). "The relationship of depression and diabetes: Pathophysiological and treatment implications". Psychoneuroendocrinology. 36 (9): 1276–86. PMID 21474250. doi:10.1016/j.psyneuen.2011.03.005.
  23. ↑ Li, M; Fitzgerald, P; Rodin, G (2012). "Evidence-based treatment of depression in patients with cancer". Journal of Clinical Oncology. 30 (11): 1187–96. PMID 22412144. doi:10.1200/JCO.2011.39.7372.
  24. ↑ Gabbard, Glen O. Treatment of Psychiatric Disorders. 2 (3rd ed.). Washington, DC: American Psychiatric Publishing. p. 1296.
  25. ↑ American Psychiatric Association (2000a). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc. ISBN 0-89042-025-4.
  26. ↑ Vieweg, W. V.; Fernandez, D. A.; Beatty-Brooks, M; Hettema, J. M.; Pandurangi, A. K.; Pandurangi, Anand K. (May 2006). "Posttraumatic Stress Disorder: Clinical Features, Pathophysiology, and Treatment". Am. J. Med. 119 (5): 383–90. PMID 16651048. doi:10.1016/j.amjmed.2005.09.027.
  27. ↑ Zwolinski, Richard and Zwolinski, C.R. Depression and Substance Abuse: The Chicken or the Egg? psychcentral.com
  28. ↑ Cvetkovich, Ann (2012). Depression: A Public Feeling. Durham, NC: Duke University Press Books. ISBN 0822352389.
  29. ↑ Cox, William T.L.; Abramson, Lyn Y.; Devine, Patricia G.; Hollon, Steven D. (2012). "Stereotypes, Prejudice, and Depression: The Integrated Perspective". Perspectives on Psychological Science. 7 (5): 427–49. PMID 26168502. doi:10.1177/1745691612455204.
  30. ↑ Kovacs, M. (1992). Children's Depression Inventory. North Tonawanda, NY: Multi-Health Systems, Inc.
  31. ↑ Cheog J et al. (Last reviewed 26 August 2010). Frequently Asked Questions About Depression. PsychCentral.com. Retrieved 11 May 2013
  32. ↑ Depression. UK National Institute for Health and Clinical Excellence (NICE) October 2009.
  33. ↑ Depression Facts. Psychiatry.wustl.edu. Retrieved on 2015-11-24.
  34. ↑ Manicavasagar, Vijaya (February 2012). "A review of depression diagnosis and management". Australian Psychological Society.
  35. ↑ NICE guidelines, published October 2009. Nice.org.uk. Retrieved on 2015-11-24.
  36. ↑ Cipriani, Andrew (8 June 2016). "Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis". The Lancet. 388 (10047): 881–90. PMID 27289172. doi:10.1016/S0140-6736(16)30385-3. Retrieved 10 June 2016.
  37. ↑ Rotenstein, Lisa S.; Ramos, Marco A.; Torre, Matthew; Segal, J. Bradley; Peluso, Michael J.; Guille, Constance; Sen, Srijan; Mata, Douglas A. (6 December 2016). "Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students". JAMA. 316 (21): 2214. PMID 27923088. doi:10.1001/jama.2016.17324.
  38. ↑ "African American Communities and Mental Health". [Mental Health America]. 1 June 2016.
  39. ↑ "Breaking the Taboo of Depression Among African American Men". [Lucida Treatment]. 12 May 2014.
  40. ↑ "Breaking the Taboo of Depression Among African American Men". [Lucida Treatment]. 12 May 2014.
  41. ↑ "Unseen Depression Plaguing Black Communities". [Blackmattersus]. 25 June 2016.
  42. ↑ "The 7 Reasons Why Depression is More Common in Women". psychologytoday.com. 2012-05-17. Retrieved 2017-05-06.
  43. ↑ Silverstein, Brett (2002). "Gender Differences in the Prevalence of Somatic Versus Pure Depression: A Replication". American Journal of Psychiatry. 159 (6): 1051–2. PMID 12042198. doi:10.1176/appi.ajp.159.6.1051.
  44. ↑ Nauert, Rick. "Men's Suicide Rate is 3 times that of Women". Psychcentral.com.
  45. ↑ Mościcki, E. K.; O'Carroll, P.; Rae, D. S.; Locke, B. Z.; Roy, A.; Regier, D. A. (1 January 1988). "Suicide attempts in the Epidemiologic Catchment Area Study.". Yale J Biol Med. 61 (3): 259–268. PMC 2590450 Freely accessible. PMID 3262956.
  46. ↑ Spicer, R S; Miller, T R (15 February 2017). "Suicide acts in 8 states: incidence and case fatality rates by demographics and method.". Am J Public Health. 90 (12): 1885–1891. PMC 1446422 Freely accessible. PMID 11111261.
  47. ↑ Langhinrichsen-Rohling, Jennifer. A Gendered Analysis of Sex Differences in Suicide-Related Behaviors:. University of South Alabama.
  48. ↑ AFSP. "Facts and Figures". AFSP. Retrieved 16 April 2015.
  49. ↑ rtiprojects.org
  50. ↑ spectrumhealth.ie
  51. ↑ "Depression in Men: Why It's Different". Dayton Daily News. March 7, 2017. Retrieved May 8, 2017.
  52. ↑ "What Stops Men From Seeking Help Eearly?". The Spectator. November 22, 2014. Retrieved May 8, 2017.
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