Depression, in psychology, is a mood or emotional state that is marked by sadness, inactivity, and a reduced ability to enjoy life.

The symptoms of depression can include:

  • feelings of sadness, hopelessness, or pessimism
  • loss of interest and/or pleasure in once enjoyed activities (hobbies, sex, etc.)
  • changes in appetite or weight
  • changes in sleeping patterns or insomnia
  • restlessness or decreased activity that is noticeable to others
  • feelings of fatigue or having little energy
  • difficulty in concentrating or making decisions
  • slowness of thought or action
  • feelings of worthlessness or inappropriate guilt
  • recurrent thoughts of death or suicide
  • lowered self-esteem and heightened self-depreciation
  • a decrease or loss of ability to enjoy daily life
  • reduced energy and vitality

    Depression differs from simple grief, bereavement, or mourning, which are appropriate emotional responses to the loss of loved persons or objects.

    Where there are clear grounds for a person's unhappiness, depression is considered to be present if the depressed mood is disproportionately long or severe vis-a-vis the precipitating event.

    When a person experiences alternating states of depression and mania (extreme elation of mood), he is said to suffer from a manic-depressive psychosis.

    Depression is probably the most common psychiatric complaint and has been described by physicians from at least the time of Hippocrates, who called it melancholia.

    The course of the disorder is extremely variable from person to person; it may be fleeting or permanent, mild or severe, acute or chronic.

    Depression is more common in women than in men. The rates of incidence of the disorder increase with age in men, while the peak for women is between the ages of 35 and 45.

    Depression can have many causes.

    The loss of one's parents or other childhood traumas and privations can increase a person's vulnerability to depression later in life.

    Stressful life events in general are potent precipitating causes of the illness, but it seems that both psychosocial and biochemical mechanisms can be important causes.

    The chief biochemical cause seems to be the defective regulation of the release of one or more naturally occurring monoamines in the brain, particularly norepinephrine and serotonin. Reduced quantities or reduced activity of these chemicals in the brain is thought to cause the depressed mood in some sufferers.

    There are three main treatments for depression. The two most important are psychotherapy and drug therapy.

    Psychotherapy aims to resolve any underlying psychic conflicts that may be causing the depressed state, while also giving emotional support to the patient.

    Antidepressant drugs, by contrast, directly affect the chemistry of the brain, and presumably achieve their therapeutic effects by correcting the chemical imbalance that is causing the depression.

    The tricyclic antidepressant drugs are thought to work by inhibiting the body's physiological inactivation of the monoamine neurotransmitters. This results in the buildup or accumulation of these neurotransmitters in the brain and allows them to remain in contact with nerve cell receptors there longer, thus helping to elevate the patient's mood.

    By contrast, the antidepressant drugs known as monoamine oxidase inhibitors interfere with the activity of monoamine oxidase, an enzyme that is known to be involved in the breakdown of norepinephrine and serotonin.

    In cases of severe depression in which therapeutic results are needed quickly, electroconvulsive therapy has proven helpful.

    In this procedure, a convulsion is produced by passing an electric current through the person's brain. In many cases of treatment, the best therapeutic results are obtained by using a combination of psychotherapy with drug therapy or with electroshock treatment.

    Depression is characterized by a sad or hopeless mood, pessimistic thinking, a loss of enjoyment and interest in one's usual activities and pastimes, reduced energy and vitality, increased fatigue, slowness of thought and action, loss of appetite, and disturbed sleep or insomnia.

    Depression must be distinguished from the grief and low spirits felt in reaction to the death of a loved one or some other unfortunate circumstance. The most dangerous consequence of severe depression is suicide.

    Mania is characterized by an elated or euphoric mood, quickened thought and accelerated, loud or voluble speech, overoptimism and heightened enthusiasm and confidence, inflated self-esteem, heightened motor activity, irritability, excitement, and a decreased need for sleep.

    The manic individual may become injured, commit illegal acts, or suffer financial losses due to the poor judgment and risk-taking behavior he displays when in the manic state.

    There are enormous problems in the classification of affective disorders, particularly of depression, and the various clinical distinctions made by different authorities are difficult to correlate with particular sets of symptoms or particular causes.

    An important distinction, however, is made between depressions that are endogenous (i.e., arising independently of environmental influences and presumably caused by a biochemical imbalance) and those that are reactive (i.e., arising in response to external stresses or trauma).

    A person with bipolar disorder, which has traditionally been called manic-depressive psychosis, typically experiences discrete episodes of depression and then of mania lasting for a few weeks or months, with intervening periods of complete normality.

    The sequence of depression and mania can vary extremely from patient to patient and within one individual, with either mood abnormality predominating in duration and intensity.

    Depressive mood swings typically occur more often and last longer than manic ones, though there are patients who have episodes only of mania.

    Patients with bipolar disorder frequently also show such psychotic symptoms as delusions, hallucinations, paranoia, or grossly bizarre behavior.

    The lifetime risk for developing bipolar disorder is about 0.7 percent and is about the same for men and women.

    The onset of the illness often occurs around the age of 30, and the illness persists over the long term.

    The predisposition to develop bipolar disorder is partly genetically inherited.

    Antipsychotic drugs such as chlorpromazine or haloperidol are used for the treatment of acute mania. Lithium carbonate has proved effective in both treating and preventing recurrent attacks of mania.

    Severe and long-lasting depression without the presence of mania is classified by the DSM-III as major depression.

    Depression is a much more common illness than mania, and there are indeed many sufferers from depression who have never experienced mania.

    Major depression may occur as a single episode or it may be recurrent. It may also exist with or without melancholia and with or without psychotic features.

    Melancholia implies the so-called biological symptoms of depression: early-morning waking; daily variations of mood with depression most severe in the morning; loss of appetite and weight; constipation; and loss of interest in love and sex.

    Melancholia is a particular depressive syndrome that is relatively more responsive to physical methods of treatment, such as drugs and electroconvulsive therapy.

    It is estimated that the annual incidence of major depression is about 140 for men and 4,000 for women per 100,000 population. While the rates for major depression in men increase with age, the peak for women is between the ages of 35 and 45.

    There is a serious risk of suicide with the illness; of those who have a severe depressive disorder, about one-sixth eventually kill themselves.

    The loss of one's parents or other childhood traumas or deprivations can increase a person's vulnerability to depression later in life, and stressful life events, especially where some type of loss is involved, are in general potent precipitating causes of the illness.

    It seems that both psychosocial and biochemical mechanisms are important in causing depression.

    Of the latter factor, the best-supported hypotheses suggest that the faulty regulation of the release of one or more naturally occurring amines at sites in the brain where the transmission of nerve impulses takes place is the basic cause, with a deficiency of the amines resulting in depression and an excess causing mania.

    The most likely candidates for the suspect amines are the biological monoamines (norepinephrine, dopamine, and 5-hydroxytryptamine).

    The treatment of major depressive episodes usually requires antidepressant drugs; electroconvulsive therapy may also be helpful, as may cognitive psychotherapy.

    A less severe manifestation of the manic-depressive syndrome, in which the mood swings are present but not as extreme, is termed cyclothymic disorder. This illness is better considered a personality disorder of affective type; the prevailing mood swings are established in adolescence and continue throughout adult life.

    Dysthmic disorder, or depressive neurosis, may occur on its own, but it more commonly appears along with other neurotic symptoms such as anxiety, phobia, and hypochondriasis.

    Where there are clear external grounds for a person's unhappiness, a dysthymic disorder is considered to be present when the depressed mood is disproportionately severe or prolonged in regard to the distressing experience, when there is a preoccupation with the precipitating situation, when the depression continues even after removal of the provocation, and when it impairs the individual's ability to cope with the specific stress.

    At any time, depressive symptoms may be found in one-sixth of the population, more commonly in women than men.

    Social factors are important etiologically, as evidenced in the high rates of depression found in urban women living without a male cohabitant, having three or more children, and lacking employment outside the home.

    Loss of self-esteem, feelings of helplessness and hopelessness, and losses of various types of "loved objects" are also seen as important causes of minor depression.

    The course and severity of dysthymic disorder is extremely variable - from a few weeks or months to several decades and from the mild impairment of social functioning to almost total incapacitation.

    Psychotherapy is the treatment of choice, although antidepressant medication may prove beneficial.

    - Encyclopedia Britannica


    Unsafe sex among gay men linked to depression

    Oct. 12, 2000 - AP

    Homosexual men with long-term, low-grade depression are almost twice as likely to have had unsafe casual sex in the last six months, according to the findings of researchers at Adelaide University, Australia.

    A research team led by Dr Gary Rogers from the University's Department of General Practice surveyed more than 400 gay and other homosexually active men who enrolled into an integrated health care program in the city of Adelaide since 1998.

    The men underwent comprehensive health evaluations, which included questionnaires about their recent sexual behaviour and a diagnostic interview to identify depression and other psychological problems.

    Men who were severely depressed reported less sex overall because serious depression is associated with a lower sex drive. When these men were excluded, however, a clear relationship emerged between unprotected sex and long-term lower grade depression, known as dysthymia.

    "Forty percent of the men with dysthymia reported having had unprotected sex in the six months before they joined the Care & Prevention Program, compared with 22% of the men who weren't dysthymic," Dr Rogers says. "This is a statistically significant difference."

    But why?

    "It may be that the low self-esteem that is part of long-term depression leads to men not caring enough about themselves to stay safe," Dr Rogers says.

    The team will announce their findings at the Australasian Society for HIV Medicine conference at the Sofitel Hotel in Melbourne this week. They will also report on outcomes in the more than 270 men who have so far participated in the Care & Prevention Program for more than a year.

    "Gay men appear to suffer serious health disadvantage, and at the time they enrolled, 27% of the men met the criteria for dysthymia. This had fallen to 16% of the same men at follow-up, and we also saw significant improvement in a range of other health measures," Dr Rogers says.

    "It's our hope that by promoting the mental health of gay men we may be able to improve their ability to sustain safer sexual practices. It is pleasing that we have seen a very dramatic fall in the prevalence of depressive problems in the men who have taken part in the Program."

    Culture, health care system affect physical symptoms of depression

    October 30, 1999 - New York - The New England Journal of Medicine 1999

    The relationship between patient and doctor may have an important effect on whether a depressed person focuses on physical rather than mental symptoms, according to an international team of researchers.

    Cultural difference also appear to play a role in how frequently patients with depression go to their doctors complaining only of physical symptoms, according to a report in the October 28th issue of The New England Journal of Medicine.

    People who are depressed often go to the doctor because of physical symptoms, such as headache and back pain, rather than psychological complaints, such as feeling down or an inability to cope with daily life. Some research suggests that this is more likely to happen in non-Western and developing countries, perhaps because people living in these countries are less willing to talk about emotional problems.

    But a new study suggests that whether depressed people focus on physical symptoms may have less to do with cultural differences and more to do with the setting where they receive medical care.

    In the study, Dr. Gregory E. Simon, of the Center for Health Studies at the Group Health Cooperative in Seattle, and an international team of researchers screened 25,916 patients in clinics in 14 countries. The researchers classified 1,146 of these patients as having major depression.

    From their study of this group of people, the researchers conclude that complaints about physical symptoms often go hand-in-hand with depression. The proportion of people who had depression and physical symptoms varied greatly, however, ranging from 45% to 95%.

    ``People who are depressed tend to have more physical symptoms world-wide without clear differences across cultures,'' one of the researchers, Dr. Michael VonKorff, told Reuters Health.

    But whether a clinic was in a non-Western or a less developed country did not have an effect on the rates of the physical symptoms, according to the researchers.

    However, having a regular doctor did have an effect on symptoms. Compared to people who went to clinics where they usually saw the same doctor, people who did not have a personal physician were nearly twice as likely to have physical symptoms, according to the study.

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