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Depression

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Introduction

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. Depressed mood is a feature of some psychiatric syndromes such as major depressive disorder, but it may also be a normal reaction to life events such as bereavement, a symptom of some bodily ailments or a side effect of some drugs and medical treatments. 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. Instances of suicide in men is much greater than in women.

Signs & Symptoms

 People with a depressed mood can feel:

  • sad, anxious & empty
  • hopeless, helpless & worthless
  • guilty, irritable, ashamed or restless.
  • lose interest in activities that were once pleasurable
  • experience loss of appetite or overeating
  • have problems concentrating, remembering details or making decisions
  • contemplate, or attempt to commit suicide.
  • Insomnia or excessive sleeping
  • fatigue, aches, pains, or reduced energy may also be present.
  • digestive problems

Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, 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. Different sub-divisions of depression have different treatment approaches.

Causes

Causes of Depression include Adversity in childhood, which contribute to depression in adulthood such as:

  • bereavement
  • neglect
  • mental abuse
  • unequal parental treatment of siblings
  • Childhood physical or sexual abuse in particular.

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
  • catastrophic injury.
  • Social rejections, especially among adolescents.

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).

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 like heroin)
  • stimulants (such as cocaine and amphetamines)
  • hallucinogens
  • inhalants.

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").

Non-psychiatric illnesses

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions and physiological problems, including hypoandrogenism (in men), Addison's disease, Lyme disease, multiple sclerosis, chronic pain, stroke, diabetes, and cancer.

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. 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; and posttraumatic stress disorder, an anxiety disorder that sometimes follows trauma, is commonly accompanied by depressed mood. Depression is sometimes associated with substance use disorder. Both legal and illegal drugs can cause substance use disorder.

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 detect and assess the severity of depression.

References

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