Depression (mental illness)
|Major depressive disorder|
|Classification and external resources|
Depression is common, can affect anyone, and can be treated.
Depression (also called major depressive disorder, unipolar depression or clinical depression) is commonly misconstrued as a mood disorder classifying individuals who feel sad and pessimistic; however, symptoms listed in most diagnostic manuals cover a more wider range. Depression is generally diagnosed when symptoms persist for a period of two weeks (or more) significant enough to represent a change in functioning. Generally five or more of the following symptoms have to be present for an individual to be diagnosed with major depressive disorder: depressed mood most of the day (feelings of sadness, emptiness, hopelessness; or in adolescents, exhibiting an irritable mood), markedly diminished interest or pleasure in all, or almost all, activities, significant weight loss (when not dieting) or weight gain (generally a change of 5% or more in body weight), insomnia/hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy nearly every day, feelings of worthlessness or guilt, diminished ability to think/concentrate or indecisiveness, and/or recurrent thoughts of death (not just fear of dying).
Most people who have not had depression do not completely understand its effects. Instead, they see it as simply being sad. Since it is not understood, many people with depression are criticized by others for not helping themselves. Some people with depression commit suicide; today, it is thought that over half the people who committed suicide had suffered from depression at least once.
Prevalence[change | change source]
It is impossible to get an exact statistic of individuals suffering from depression due to many reasons (a possible stigma attached to admitting to having a mood disorder could cause hesitancy in people admitting depression to themselves or others; inaccuracies/discrepancies in diagnosis; and also prevalence varies cross-culturally and throughout gender). Recent estimations place depression in around 40% of Americans; however, results vary cross-culturally. Prince (1968) found virtually no trace of depression in most Asian/African countries. Similarly, psychologists such as Zhang and Kleinman have found disorders with different names and similar symptoms. Zhang (1980s) found that in China there was little mention of depression and that instead, a disorder called Neurasthenia was far more prevalent. When interviewing Neurasthenia patients, Zhang found a correlation rate of over 80% of symptoms that matched Western cultures' symptoms of depression. While the term "depression" was practically unheard of in China, Neurasthenia could well have been a similar – if not, the same – disorder. It is also important to take in different cultures' methods of classification. Going back to the example on China, many believe doctors solve physical and not somatic symptoms so perhaps reports of depression were less frequent for those reasons.
As for gender prevalence, it has typically been recorded that more women suffer than men (with a ratio of 2:1 in most Western cultures). Estimations as to causes generally orbit around social status, income, family, and romantic relationships. Despite the higher rate of depression in women, often suicide rates prevail in men. 
Signs and symptoms[change | change source]
There are many signs that a person may be suffering from depression. As aforementioned, five or more of the following symptoms have to be present for an individual to be diagnosed with major depressive disorder: depressed mood most of the day (feelings of sadness, emptiness, hopelessness; or in adolescents, exhibiting an irritable mood), markedly diminished interest or pleasure in all, or almost all, activities, significant weight loss (when not dieting) or weight gain (generally a change of 5% or more in body weight), insomnia/hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy nearly every day, feelings of worthlessness or guilt, diminished ability to think/concentrate or indecisiveness, and/or recurrent thoughts of death (not just fear of dying).
Depression in children is harder to see. Children who are depressed may have a loss of appetite, meaning that they do not want to eat. They may also be clearly having more trouble in everyday life than before. This can include sleep problems such as nightmares, new problems with behaviour or grades at school, or being more agitated or easily irritable than usual.
Types of depression[change | change source]
Major depressive disorder is also referred to as major, biochemical, clinical, endogenous, or biological depression. It may also be called unipolar affective disorder.
There are many subtypes of depression:
- Melancholia, or melancholic depression, is very severe (bad). It can cause many physical changes, like sleep and appetite changes, weight gain, and withdrawal from other people.
- Psychotic depression is much like melancholia, but with hallucinations or delusions.
- Atypical depression causes anxiety and panic attacks.
- Chronic dysthymic disorder is a long-term, mild depression that lasts for at least two years. It often begins in adolescence and lasts for many years.
- Seasonal affective disorder (SAD) is when the depression seems to be tied to the winter season. It usually starts in the autumn and goes away in the spring every year. It is common in Alaska, Canada, and Scandinavia (Sweden, Norway, Denmark, Finland), but not in Iceland.
Causes of depression[change | change source]
Speculations about whether depression is caused by biological, cognitive, or sociocultural factors vary greatly. Arguments about biological causes generally border along the lines of fluctuations in brain chemicals or neurotransmitters. There are also many theories about how the way we think (cognition) affects our mood and that negative thinking can lead to negative thoughts about oneself and the world around them. Finally, sociocultural factors can also be to blame (ex: divorce, losing one's job, and in adolescents, bullying and/or changing school).
Depression comes from the brain, but scientists are still trying to find out exactly why it happens.
Some common biological, cognitive, and sociocultural speculations about causes of depression:
- Heredity (someone's genes): Depression is known to often be inherited (meaning that someone whose parent or parents or a grandparent are depressed is much more likely to get it). However, people can get depression even if they are not related to anyone else who has it.
- Physiology: The amounts of some chemicals in the brain. Serotonin is the main chemical in the brain that has to do with happiness. Many antidepressant medications work by balancing the amount of serotonin in the brain.
- Psychological factors: Low self-esteem and harmful thinking
- Early experiences: Events such as the death of a parent or guardian, abandonment or rejection, neglect, chronic illness, and severe physical, psychological, or sexual abuse.
- Life experiences: Losing a job, homelessness, problems with money, death of a loved one, relationship problems, separation from a partner, being a victim of crime, or other life problems can cause depression.
- Medical conditions: Some illnesses, such as hypothyroidism, hepatitis, mononucleosis, or head injuries, may contribute to depression.
- Alcohol and other drugs: Alcohol can make people depressed. The abuse of alcohol, benzodiazepine-based tranquillizers, sleeping medications, or narcotics can influence how long depression lasts and how bad it is. Some medicines like birth control pills and steroids may also contribute to depression.
- Pesticides: Several scientific studies  have found statistical links between depression and some pesticides.
Treatment[change | change source]
Depression is usually treated with a combination of medication and other therapy. Good exercise helps deal with depression, since exercise releases chemicals that put a person in a better mood. Having a supportive group of friends and doing outside activities can also help prevent or ease depression.
Medication[change | change source]
There are many medications that can help with depression. Many of these are called antidepressants.
- Tricyclic antidepressants are the oldest kind of medicine for depression. They are not used often today because they have many bad side effects and do not work very well. An example is nortriptyline (Allegron).
- Selective serotonin reuptake inhibitors (SSRIs) are now the most commonly used type of antidepressant medicine. These drugs work by allowing the brain to have more serotonin. There are fewer side effects with this kind of drug. An example is fluoxetine (Prozac).
- Monoamine oxidase inhibitors (MAOIs) may be used if other antidepressant medications do not work well. This kind of medicine can cause problems with many kinds of food and drugs. An example is Tranylcypramine.
Sometimes, antidepressant medicine works better when it is used together with another drug that is not an antidepressant. These "augmentor" drugs are:
- Tranquillizers and sedatives can make sleep easier and help with anxiety.
- Antipsychotics can help keep stop mood swings and reduce or get rid of hallucinations.
- Lithium is a mood stabilizer often used for bipolar disorder, but also can help people with depression.
If people with depression do not take their medicine the right way, the depression can get worse. A doctor must help when they want to change to another medication, or to take a different amount of a medication than before.
Psychotherapy[change | change source]
In psychotherapy, a therapist helps the person with depression to understand and solve problems which cause depression.
Psychotherapy can help a person make changes in the way they think, in order to help with relationship problems and understand what makes depression worse. The most effective psychotherapy for depression is Cognitive behavioral therapy (CBT). This teaches a person to think in a more rational, positive, realistic manner.
Electroconvulsive therapy[change | change source]
Electroconvulsive therapy (ECT), also called electroshock therapy or shock therapy, is used to treat a small percentage of severely depressed people. ECT uses a small amount of electricity to cause an epileptic seizure while the patient is under anesthesia. This may cause some memory loss (amnesia).
Another, much more inhumane method, is lobotomy: a surgical incision into the frontal lobe of the brain to sever one or more nerve tracts, a technique formerlyused to treat certain mental disorders but now rarely performed.
Related pages[change | change source]
- Dysthymia, a long-lasting mild depression
- Bipolar disorder, a mood disorder which involves both mania and depression
- Cyclothymia, a mild form of bipolar disorder
Further reading[change | change source]
In a study published in early 2013, genetic links were shown between five major psychiatric disorders: autism, ADHD, bipolar disorder, depression, and schizophrenia per recent study.doi:10.1016/S0140-6736(08)61345-8
- 5 Disorders Share Genetic Risk Factors, Study Finds February 28, 2013 The New York Times
- Psychiatric Disorders Linked Genetically February 27, 2013 WSJ
References[change | change source]
- "Diagnostic and Statistical manual of Mental Disorders". http://www.dsm5.org/Pages/Default.aspx.
- "Suicide Statistics Report 2015". http://www.samaritans.org/sites/default/files/kcfinder/branches/branch-96/files/Suicide_statistics_report_2015.pdf.
- ‘Child depression’ 2005, in Cambridge Encyclopedia of Child Development, Cambridge University Press, Cambridge, United Kingdom
- "NIMH · Causes of Depression". nimh.nih.gov. 2011 [last update]. http://www.nimh.nih.gov/health/publications/men-and-depression/causes-of-depression.shtml. Retrieved July 18, 2011.
- Psychiatric disorders among Egyptian pesticide applicators and formulators.By Amr MM, Halim ZS, Moussa SS. In Environ Res. 1997;73(1-2):193-9. PMID 9311547
- Depression and pesticide exposures among private pesticide applicators enrolled in the Agricultural Health Study. By Beseler CL, Stallones L, Hoppin JA, Alavanja MC, Blair A, Keefe T, Kamel F. In: Environ Health Perspect. 2008 Dec; 116(12):1713-9.PMID 19079725
- A cohort study of pesticide poisoning and depression in Colorado farm residents. By Beseler CL, Stallones L. In Ann Epidemiol. 2008 Oct; 18(10):768-74.PMID 18693039
- Mood disorders hospitalizations, suicide attempts, and suicide mortality among agricultural workers and residents in an area with intensive use of pesticides in Brazil. By Meyer A, Koifman S, Koifman RJ, Moreira JC, de Rezende Chrisman J, Abreu-Villaca Y. In J Toxicol Environ Health A. 2010; 73(13-14):866-77. PMID 20563920
- Suicide and potential occupational exposure to pesticides, Colorado 1990-1999 , By Stallones L. In J Agromedicine. 2006; 11(3-4):107-12. PMID 19274902
- Increased risk of suicide with exposure to pesticides in an intensive agricultural area. A 12-year retrospective study. Di Parrón T, Hernández AF, Villanueva E. In Forensic Sci Int. 1996 May 17; 79(1):53-63.PMID 8635774
- Dunn, A., Exercise for Depression Rivals Drugs, Therapy. American Journal of Preventive Medicine, January 2005; vol 28: pp 1-8. National Institutes for Mental Health, "Depression." News release, University of Texas Southwestern Medical Center at Dallas.
- "Lobotomy". http://www.thefreedictionary.com/lobotomy.
Other websites[change | change source]
- Internet Mental Health: Major Depressive Disorder
- Depression Alliance website (UK charity) [useful information]
- Depression Fact Sheets [Facts about the causes, symptoms, and treatment of depressive disorders.]
- Detailed information [concerning Emil Kraepelin, who identified Manic Depression]
Books[change | change source]
- Books by psychologists/psychiatrists:
- Beck, A. T., Rush, A. J., Shaw, B. F., Emery, G. (1987). Cognitive therapy of depression. New York: Guilford.
- Klein, D. F., & Wender, P. H. (1993). Understanding depression: A complete guide to its diagnosis and treatment. New York: Oxford University Press.
- Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books.
- Books by persons suffering or having suffered from depression:
- Smith, Jeffery (2001). Where the roots reach for water: A personal and natural history of melancholia. New York: North Point Press.
- Solomon, Andrew (2001). The noonday demon: An atlas of depression. New York: Sribner.
- Styron, William (1992). Darkness visible: A memoir of madness. New York: Vintage Books/Random House.
- Wolpert, Lewis (2001). Malignant sadness: The anatomy of depression. London: Faber and Faber.
- Self-help (bibliotherapeutic) books:
- Lewinsohn, P. M., Munoz, R. F, Youngren, M. A., Zeiss, A. M. (1992). Control your depression. New York: Fireside/Simon&Schuster.