Depression (mood)

"Despair" redirects here. For other uses of despair, see Despair (disambiguation). For the mood disorder, see Major depressive disorder. For the album by Anohni, see Hopelessness (album).
Depression

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, 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, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present.[3] Depressed mood is a feature of some psychiatric syndromes such as major depressive disorder,[2] 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.

Causes

Historical legacy

Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may create depressive conditions.[4][5]

Life events

Adversity in childhood, such as bereavement, neglect, mental abuse, and unequal parental treatment of siblings can contribute to depression in adulthood.[6][7] Childhood physical or sexual abuse in particular significantly increases the likelihood of experiencing depression over the life course.[8]

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.[9][10][11] Adolescents may be especially prone to experiencing depressed mood following social rejection.[12]

Medical treatments

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).[13][14][15][16]

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, and inhalants.[13] 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").[16]

Non-psychiatric illnesses

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions[17] and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, hypothyroidism, Lyme disease, multiple sclerosis, Parkinson's Disease, chronic pain, stroke,[18] diabetes,[19] and cancer.[20]

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.[21] 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;[22]:355 and posttraumatic stress disorder, an anxiety disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[23] Depression is sometimes associated with substance use disorder. Both legal and illegal drugs can cause substance use disorder.[24]

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.[25]

Treatment

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.[26] Different sub-divisions of depression have different treatment approaches.[27] In the United States, it has been estimated that two thirds of people with depression do not actively try to receive treatment.[28]

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.[29]

Sex differences

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.[30] 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.[31] However, women have higher rates of suicide ideation and attempts. The difference is attributed to men choosing more effective methods resulting in the higher rate of success.[32][33]

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. ↑ "NIMH · Depression". nimh.nih.gov. Retrieved 15 October 2012.
  4. ↑ Cvetkovich, Ann (2012). Depression: A Public Feeling. Durham, NC: Duke University Press Books. ISBN 0822352389.
  5. ↑ 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. doi:10.1177/1745691612455204.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ Rashid, T.; Heider, I. (2008). "Life Events and Depression" (PDF). Annals of Punjab Medical College 2 (1). Retrieved 15 October 2012.
  11. ↑ Douglas A. Mata, Marco A. Ramos, Narinder Bansal, Rida Khan, Constance Guille, Emanuele Di Angelantonio & Srijan Sen (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. PMID 26647259.
  12. ↑ 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.
  13. 1 2 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  14. ↑ 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.
  15. ↑ Cory. "Medical Treatment of Mood Disorder".
  16. 1 2 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.
  17. ↑ 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
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ Gabbard, Glen O. Treatment of Psychiatric Disorders 2 (3rd ed.). Washington, DC: American Psychiatric Publishing. p. 1296.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ Zwolinski, Richard and Zwolinski, C.R. Depression and Substance Abuse: The Chicken or the Egg? psychcentral.com
  25. ↑ Kovacs, M. (1992). Children's Depression Inventory. North Tonawanda, NY: Multi-Health Systems, Inc.
  26. ↑ Cheog J et al. (Last reviewed 26 August 2010). Frequently Asked Questions About Depression. PsychCentral.com. Retrieved 11 May 2013
  27. ↑ Depression. UK National Institute for Health and Clinical Excellence (NICE) October 2009.
  28. ↑ Depression Facts. Psychiatry.wustl.edu. Retrieved on 2015-11-24.
  29. ↑ NICE guidelines, published October 2009. Nice.org.uk. Retrieved on 2015-11-24.
  30. ↑ 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.
  31. ↑ Nauert, Rick. "Men's Suicide Rate is 3 times that of Women". Psychcentral.com.
  32. ↑ Langhinrichsen-Rohling, Jennifer. A Gendered Analysis of Sex Differences in Suicide-Related Behaviors:. University of South Alabama.
  33. ↑ AFSP. "Facts and Figures". AFSP. Retrieved 16 April 2015.

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