Depression

Definition

Depression, sometimes called major depression or depressive disorder, is

a mood disorder that has been called the

“common cold of mental illness”

because it is so common in the general population. Unlike the

common cold, however, depression can have serious long-term effects

on a person

  Dysthymia. Also called dysthymic disorder, dysthymia is a condition

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hallucinations, delusions, and other signs that they have lost contact

with reality.

Psychotic depression. Patients with this type of depression have

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some women following the birth of a baby.

Postpartum depression. This is a type of depression that affects

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related to changes in the seasons. Most people with SAD feel

depressed in the winter and better in summer, but there is also a

reverse form of SAD in which the person is depressed in summer

and feels better in winter.

Description

Depression is a mood disorder that does not affect everyone in the same

way. There is some evidence, for example, that women and men experience

depression differently; women are more likely to feel sad, worthless,

or guilty, while men are more likely to feel tired, irritable, and uninterested

in activities that they used to enjoy. Men appear more likely than

women to get angry and act abusively toward others, or to drive recklessly.

Depression in the elderly may take the form of memory problems or

slowed-down movement rather than crying or feeling sad. Depression in

children may have such symptoms as refusing to go to school, getting in

trouble, or sulking and being generally moody and hard to get along with.

Depression also has different patterns of recurrence in different

people. Some persons have one episode of depression, recover, and are

never troubled by recurrences. Others have a series of episodes at irregular

intervals. And as the definition of dysthymia indicates, some people

have a low-grade depression that may persist for years without turning

into an episode of major depression.

Depression often coexists with other mental and physical disorders,

which often makes it difficult to diagnose. Depression can occur before the

person gets sick; can occur as a result of the sickness; or exist alongside

other illness. Mental disorders that often coexist with depression include

alcoholism and substance abuse disorders, eating disorders, anxiety disorders,

posttraumatic stress disorder, and obsessive-compulsive disorder.

Physical disorders that commonly affect depressed patients include heart

disease, stroke, cancer, AIDS, diabetes, and Parkinson disease. Depression

can make the symptoms of these diseases worse and harder to treat.

Demographics

Depression is one of the more common mood disorders in the United

States. According to the National Institutes of Health, one in every five

women and one in every eight men will have an episode of major depression

at some point in their lifetime. Depression is a major cause of time

lost from work, lost opportunities for education, and vulnerability to substance

abuse. It is a factor in 55 percent of all suicide attempts, or about

110,000 attempts annually. Depression adds to the cost of treating such

physical illnesses as diabetes, heart disease, high blood pressure, and cancer.

People can suffer from depression at any age; however, adults between

the ages of thirty and forty are most likely to be diagnosed withmajor depression.

There is a second but smaller peak in adults between fifty and sixty.

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in children, boys are diagnosed with depression as often as girls.

Major depression is diagnosed twice as often in women as inmen; however,

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in the United States than among members of other racial groups.

Risk factors for depression in adult life include:

Depression appears to be less common among African Americans

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Death of a parent during one’s childhood

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A family history of depression

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A history of suicide in the family

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pills, drugs given to treat high blood pressure, and sleeping pills

Long-term use of certain medications, particularly birth control

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Long-term alcohol or drug abuse

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Poverty and unemployment

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Recent bereavement or traumatic incident

Causes and Symptoms

The causes of depression have been debated for decades, with researchers

disagreeing as to whether biology, psychology, or a combination of the

two offers the best explanation. Most researchers now think that depression

is the end result of biological vulnerability to a mood disorder combined

with personal history and certain personality traits.

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the disorder is known to run in families.

Genetic factors. No specific genes have been identified, although

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with depression have abnormal levels of certain brain chemicals

called neurotransmitters. Neurotransmitters relay impulses from

one nerve cell to the next.

Biochemical. Researchers have found that the brains of people

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experiences too close together, or high stress levels over a long

period of time can all make people more likely to become depressed.

Life history. Difficult circumstances early in life, too many traumatic

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or inclined to worry a lot are vulnerable to depression.

An occasional blue mood or temporary feeling of discouragement is not

a depression. For a diagnosis of depression a personmust have five symptoms

from the following list for at least two weeks. The symptomsmust be severe

enough to interfere with the person

’s daily activities and relationships:

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Depressed mood

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enjoy

Loss of interest or pleasure in activities that the person used to

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Weight gain or loss

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Difficulty sleeping or sleeping much more than usual

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Slowed movement or extreme restlessness

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Lack of energy; difficulty getting things done

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Feeling worthless or hopeless

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Problems with concentrating or decision making

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Thoughts of death or suicide

Diagnosis

The diagnosis of depression is complicated and often missed, particularly

in the elderly. Diagnosis begins with a complete physical examination,

partly to see whether the patient has medical problems that may increase

his or her risk of depression, and partly to rule out physical reasons for

changes in mood. These include thyroid disorders, infectious diseases like

syphilis or Lyme disease, and prescription medications that are known to

affect mood. The doctor may order blood or urine tests as part of the

physical examination.

Another important part of the diagnosis is taking the patient

and family history. This part of the patient interview often includes

giving the patient the Beck Depression Inventory or another questionnaire

that can be completed in the doctor

are special questionnaires of this sort for children and adolescents.

The doctor will also listen to the way the patient talks as well as the

content of what they are saying, because depressed people often talk

slowly and may sound sad. The patient

they are dressed may also provide clues; a patient who is usually neat and

tidy may come to the office looking poorly groomed.

Primary care doctors will usually refer their patients to psychiatrists

(mental health specialists) in order to distinguish major depression from

other mental illnesses, and to prescribe treatments for the depression.

Treatment

Treatment for depression may consist of antidepressant medications, psychotherapy,

electroconvulsive therapy (ECT), or a combination of these

approaches.

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affecting the levels of neurotransmitters in the brain. There are several

different families of antidepressant medications, and the

doctor may have to try several different drugs before finding the

one that works best for the patient. The choice of antidepressant

also depends on whether the patient is taking prescription drugs

for other health conditions. It takes anywhere from two to eight

weeks for the patient to know whether the antidepressant is

working for them. Between a half and two-thirds of people with

depression are helped by medications.

Antidepressant medications: These are drugs that work by

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to treat depressed people. The most common ones are interpersonal

therapy and cognitive therapy. In interpersonal therapy, the

person learns about the causes of depression and the social triggers

in his or her life that set off depressive thoughts, together with strategies

for coping with their social situation. Cognitive therapy

works by teaching the patient to change his or her ways of

thinking. Many people have underlying negative assumptions that

affect the way they see their life, and these expectations can be

challenged and changed.

Psychotherapy. There are several different approaches that are used

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ECT is a treatment in which seizures are induced in an anesthetized

patient to relieve the depression. It is thought to work by

changing the levels of neurotransmitters in the brain. ECT is generally

used only for depressed patients who have not been helped

by medications or psychotherapy.

Alternative and complementary treatments that are sometimes used

for depression include various herbal remedies, such as St. John

Those interested in herbal preparations should discuss these with their

doctor, however, as these preparations can interact with standard prescription

drugs and have side effects just like standard drugs. Other complementary

therapies include acupuncture, massage therapy, music therapy,

meditation, and stress reduction techniques. These are safe, and are

helpful to some patients with depression. Studies also indicate that regular

exercise can be helpful in controlling symptoms of depression and anxiety.

Prognosis

The prognosis of depression varies considerably. People who are not

treated for depression often feel better within six to twenty-four months;

however, episodes of depression can be shortened considerably with

treatment. About two-thirds of patients treated for depression feel well

enough to return to their normal activities within a few weeks. About a

quarter of patients will continue to have symptoms of depression for

months to years after the first episode. About 50 percent of patients

treated for depression will have a second episode at some point in time;

these recurrences usually respond well to treatment, however.

People who are depressed are at increased risk of suicide. About 3.4

percent of patients diagnosed with major depression eventually succeed

in committing suicide.

Prevention

People cannot change some risk factors for depression, such as their

family history or their sex, but they can lower their risk by taking good

care of their physical health, keeping up a strong family and friendship

network, learning to cope with normal life stressors, and talking to their

doctor if they are concerned about their moods.

The Future

Depression is one of the oldest known mental disorders, having been

described by physicians in ancient Egypt and China, and is likely to continue

to be a common problem around the world. Present research

includes trials of newer antidepressants, comparisons of standard treatments

with various alternative therapies, and studies of the ways in which

culture or ethnic background influences depression. Another important

area of research is looking for ways to predict how patients will respond

to specific antidepressant medications, so that the trial-and-error approach

to finding the best drug for each patient could be eliminated.

SEE ALSO

Postpartum depression; Posttraumatic stress disorder; Seasonal affective

disorder

For more information

BOOKS

Lam, Raymond W., and Hiram Mok.

Press, 2008.

Levin, Judy.

Company, 2009.

Miller. Debra A.

2008.

Willis, Laurie, ed.

Depression. New York: Oxford UniversityDepression and Mood Disorders. New York: Rosen PublishingPostpartum Depression. Detroit, MI: Lucent Books,Depression. Detroit, MI: Greenhaven Press, 2008.

PERIODICALS

Carey, Benedict.

March 3, 2008. Available online at http://health.nytimes.com/ref/

health/healthguide/esn-depression-ess.html (accessed on September 8,

2008).

“Lifting the Curtain on Depression.” New York Times,

WEB SITES

Depression and Bipolar Support Alliance.

www.dbsalliance.org/site/PageServer?pagename=about_depression_overview

(updated March 12, 2007; accessed on September 8, 2008).

KidsHealth.

feeling/thought/sadness.html (updated November 2007; accessed on

September 8, 2008).

Mental Health America (MHA).

www.mentalhealthamerica.net/go/depression (updated October 31, 2007;

accessed on September 8, 2008). The page contains a link to

Up Show,

National Alliance on Mental Illness (NAMI).

at http://www.nami.org/Template.cfm?Section=By_Illness&Template=/

TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=26414

(accessed on September 7, 2008).

National Institute of Mental Health (NIMH).

Depression. Available online at http://Why Am I So Sad? Available online at http://kidshealth.org/kid/Factsheet: Depression. Available online at http://“The Down &” a series of podcasts about depression.Major Depression. Available onlineWhat Is Depression?

Available online at http://www.nimh.nih.gov/health/publications/

depression/introduction.shtml (updated June 26, 2008; accessed on

September 7, 2008).

Public Broadcasting Service (PBS).

online in video format at http://www.pbs.org/wgbh/takeonestep/

depression/video-ch_01.html (accessed on September 8, 2008). This is a

twelve-part series of videos based on a television program that aired on

May 21, 2008. The segments range from about four minutes to nine

minutes in length.

WORDS TO KNOW

Delusion:

person holds to despite evidence or proof that

it is false.

In medicine, a false belief that a

Dysthymia:

long-term low-key depression.

A mood disorder characterized by a

Neurotransmitters:

brain that relay nerve impulses from one nerve

cell to another.

Chemicals produced by the

Postpartum depression:

some women experience after the birth of a baby.A type of depression thatDepression: Out of the Shadows. AvailableBipolar disorder; Child abuse; Obsessive-compulsive disorder;Electroconvulsive therapy (ECT). Sometimes called shock therapy,’s wort.’s personal’s office in a few minutes. There’s facial expressions and the wayPersonality factors. People who are pessimistic, easily discouraged,Seasonal affective disorder (SAD). SAD is a form of depression

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in which the person has milder symptoms of depression that

are less disabling than those of major depression over a period of

two years or longer.

Some types of depression are recognized as separate disorders:

’s quality of life.

Depression