Depression (mood)

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Depression
A man diagnosed as suffering from melancholia with strong su Wellcome L0026693.jpg
Facial features of a person who is depressed
Classification and external resources
Specialty Psychiatry, psychology
ICD-10 F32.8
DiseasesDB 3589
MeSH D003863

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 can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, angry,[3] ashamed or restless. They may lose interest in activities that were once pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details or making decisions, experience relationship difficulties and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present.[4]

Depressed mood is a feature of some psychiatric syndromes such as major depressive disorder,[2] but it may also be a normal reaction, as long as it does not persist long term, to life events such as bereavement, a symptom of some bodily ailments or a side effect of some drugs and medical treatments.

Causes[edit]

Melencolia I (ca. 1514), by Albrecht Dürer.

Life events[edit]

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.[5][6] Childhood physical or sexual abuse in particular, if not dealt with, significantly increases the likelihood of experiencing depression over the life course.[7]

Life events and changes that may precipitate depressed mood include childbirth, menopause, financial difficulties, job problems, a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved one, natural disasters, social isolation, relationship troubles, jealousy, separation, and catastrophic injury.[8][9][10] Adolescents may be especially prone to experiencing depressed mood following social rejection, peer pressure and bullying.[11]

Medical treatments[edit]

Certain medications are known to cause depressed mood in a significant number of patients. These include medications for hepatitis C (such as interferon), anxiety and sleep (such as benzodiazepines like alprazolam, clonazepam, lorazepam and diazepam), high blood pressure (such as beta-blockers, methyldopa, reserpine), and hormonal treatments (such as corticosteroids, contraceptives).[12][13][14][15] It is important for these factors to be considered when treatment of depression is considered.

Substance-induced[edit]

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 like heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants.[12] While many often report self-medicating depression with these substances, improvements in depression from drugs are usually short-lived (with worsening of depression in the long-term, sometimes as soon as the drug effects wear off) and tend to be exaggerated (e.g., "many people report euphoria after the fact with alcohol intoxication, even though at the time of intoxication they were tearful and agitated").[15]

Non-psychiatric illnesses[edit]

Main article: Depression (differential diagnoses)

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions[16] and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, hypothyroidism, Lyme disease, multiple sclerosis, Parkinson's Disease, chronic pain, stroke,[17] diabetes,[18] and cancer.[19]

Psychiatric syndromes[edit]

Main article: Depressive mood disorders

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.[20] 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;[21]:355 and posttraumatic stress disorder, an anxiety disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[22] Depression is sometimes associated with substance use disorder. Both legal and illegal drugs can cause substance use disorder.[23]

Historical legacy[edit]

Main article: Dispossession, oppression and depression

Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may create depressive conditions.[24][25]

Racial issue[edit]

There is a racial difference in a number of people, facing depression in the US. For example, adult blacks are 20 percent more likely to report serious psychological distress than adult whites. [26] 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. [27] 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 deepest secrets and 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. [28] A research conducted by Sirry Alang, a Pennsylvania Lehigh University assistant professor of sociology and anthropology, shows that many of blacks see depression as a sign of weakness and not a health issue. [29]

Assessment[edit]

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]

Treatment[edit]

Main article: Management of depression

Depressed mood may not require professional treatment, and may be a normal 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] The treatment of depression is best managed by lifestyle choices, which includes, diet, sleep and exercise. 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]

Sex differences[edit]

Main article: Sex differences in depression

Women have a higher rate of major depression than men. While women have a greater proportion of somatic symptoms, such as appetite, sleep disturbances and fatigue accompanied by pain and anxiety, than men, the gender difference is much smaller in other aspects of depression.[37] 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.[38] However, women have higher rates of suicide ideation and attempts.[citation needed] The difference is attributed to men choosing more effective methods resulting in the higher rate of success.[39][40] This research would suggest that women are more likely to discuss their depression, whereas men are more likely to try and hide it. The culture of women being more free to express than men, could be a contributing factor to this phenomenon[citation needed].

See also[edit]

References[edit]

  1. ^ Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need. People's Medical Society. ISBN 978-1-882606-14-6. 
  2. ^ a b Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association. 2013. 
  3. ^ "Irritability, Anger Indicators of Complex, Severe Depression". 
  4. ^ "NIMH · Depression". nimh.nih.gov. Retrieved 15 October 2012. 
  5. ^ 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. doi:10.1016/j.psyneuen.2008.03.008. PMID 18602762. Retrieved 20 April 2014. 
  6. ^ 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. doi:10.1111/j.1741-3737.2010.00703.x. PMC 2894713. PMID 20607119. 
  7. ^ 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. doi:10.1007/s00038-013-0519-5. PMID 24122075. 
  8. ^ Schmidt, Peter (2005). "Mood, Depression, and Reproductive Hormones in the Menopausal Transition". The American Journal of Medicine. 118 Suppl 12B (12): 54–8. doi:10.1016/j.amjmed.2005.09.033. PMID 16414327. 
  9. ^ Rashid, T.; Heider, I. (2008). "Life Events and Depression" (PDF). Annals of Punjab Medical College 2 (1). Retrieved 15 October 2012. 
  10. ^ 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. doi:10.1001/jama.2015.15845. PMC 4866499. PMID 26647259. 
  11. ^ 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. doi:10.1016/j.neubiorev.2007.04.016. PMID 17570526. 
  12. ^ a b American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 
  13. ^ Ehret M, Sobieraj DM (February 2014). "Prevention of interferon-alpha-associated depression with antidepressant medications in patients with hepatitis C virus: a systematic review and meta-analysis". Int. J. Clin. Pract. 68 (2): 255–61. doi:10.1111/ijcp.12268. PMID 24372654. 
  14. ^ Cory. "Medical Treatment of Mood Disorder". 
  15. ^ a b Guina, Jeffrey; Rossetter, Sarah R.; DeRHODES, Bethany J.; Nahhas, Ramzi W.; Welton, Randon S. (2015-07-01). "Benzodiazepines for PTSD: A Systematic Review and Meta-Analysis". Journal of Psychiatric Practice 21 (4): 281–303. doi:10.1097/PRA.0000000000000091. ISSN 1538-1145. PMID 26164054. 
  16. ^ 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
  17. ^ 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'Encephale 35 (4): 330–9. doi:10.1016/j.encep.2008.10.014. PMID 19748369. 
  18. ^ Rustad, JK; Musselman, DL; Nemeroff, CB (2011). "The relationship of depression and diabetes: Pathophysiological and treatment implications". Psychoneuroendocrinology 36 (9): 1276–86. doi:10.1016/j.psyneuen.2011.03.005. PMID 21474250. 
  19. ^ Li, M; Fitzgerald, P; Rodin, G (2012). "Evidence-based treatment of depression in patients with cancer". Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30 (11): 1187–96. doi:10.1200/JCO.2011.39.7372. PMID 22412144. 
  20. ^ Gabbard, Glen O. Treatment of Psychiatric Disorders 2 (3rd ed.). Washington, DC: American Psychiatric Publishing. p. 1296. 
  21. ^ 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. 
  22. ^ 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. doi:10.1016/j.amjmed.2005.09.027. PMID 16651048. 
  23. ^ Zwolinski, Richard and Zwolinski, C.R. Depression and Substance Abuse: The Chicken or the Egg? psychcentral.com
  24. ^ Cvetkovich, Ann (2012). Depression: A Public Feeling. Durham, NC: Duke University Press Books. ISBN 0822352389. 
  25. ^ 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. doi:10.1177/1745691612455204. PMID 26168502. 
  26. ^ "African American Communities and Mental Health". [Mental Health America]. 1 June 2016. 
  27. ^ "Breaking the Taboo of Depression Among African American Men". [Lucida Treatment]. 12 May 2014. 
  28. ^ "Breaking the Taboo of Depression Among African American Men". [Lucida Treatment]. 12 May 2014. 
  29. ^ "Unseen Depression Plaguing Black Communities". [Blackmattersus]. 25 June 2016. 
  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. doi:10.1016/S0140-6736(16)30385-3. Retrieved 10 June 2016. 
  37. ^ Silverstein, Brett (2002). "Gender Differences in the Prevalence of Somatic Versus Pure Depression: A Replication". American Journal of Psychiatry 159 (6): 1051–2. doi:10.1176/appi.ajp.159.6.1051. PMID 12042198. 
  38. ^ Nauert, Rick. "Men's Suicide Rate is 3 times that of Women". Psychcentral.com. 
  39. ^ Langhinrichsen-Rohling, Jennifer. A Gendered Analysis of Sex Differences in Suicide-Related Behaviors:. University of South Alabama. 
  40. ^ AFSP. "Facts and Figures". AFSP. Retrieved 16 April 2015. 

External links[edit]

  • APA treatment page for Depression
  • Bennet J. K. (2014). "Psychiatric Services". Cost utility analysis in depression: the mcsad utility measure for depression health states 51 (9): 1171–1176. doi:10.1176/appi.ps.51.9.1171. 
  • Stuber J.P; Rocha A.; Stuber J.P.; Rocha A.; Christian A.; Link B.G. (2014). "Psychiatric Services". Concepts of mental illness:attitudesof mental health professional and the general public 65 (4): 490–497. doi:10.1176/appi.ps.201300136. 
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