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→‎Life events: we all can think of lots of life events that can cause depression, but what does science say?
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===Life events===
===Life events===
Life events that may precipitate or cause depression include personal conflicts or disputes with family members or friends, bereavement, moving, losing a job or income, losing a loved one, divorce, stress, loss of sleep, retirement, menopause,<ref>Schmidt, Peter (2005). "Mood, depression, and reproductive hormones in the menopausal transition". The American Journal of Medicine.</ref> falling in love with someone who can't or won't return one's affections, social isolation, and social rejection.
Life events that may precipitate or cause depression include personal conflicts or disputes with family members or friends, bereavement, moving, losing a job or income, losing a loved one, divorce, stress, loss of sleep, retirement, menopause,<ref>Schmidt, Peter (2005). "Mood, depression, and reproductive hormones in the menopausal transition". The American Journal of Medicine.</ref> falling in love with someone who can't or won't return one's affections, social isolation, and social rejection.{cn}


===Medical treatments===
===Medical treatments===

Revision as of 08:09, 30 August 2012

"Despair" redirects here. For other uses, see Despair (disambiguation).
Albrecht Dürer's engraving Melencolia I, ca. 1514

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and physical well-being.[1] Depressed people may feel sad, anxious, empty, hopeless, worried, helpless, worthless, guilty, irritable, hurt, or restless. They may lose interest in activities that once were pleasurable; experience loss of appetite or overeating; have problems concentrating, remembering details, or making decisions; and may contemplate, attempt, or even desire suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains or digestive problems that are resistant to treatment may be present.[2]

Depressed mood is not necessarily a psychiatric disorder. It is a normal reaction to certain life events, a symptom of some medical conditions, and a side effect of some medical treatments. Depressed mood is also a primary or associated feature of certain psychiatric syndromes such as clinical depression.

Causes

Life events

Life events that may precipitate or cause depression include personal conflicts or disputes with family members or friends, bereavement, moving, losing a job or income, losing a loved one, divorce, stress, loss of sleep, retirement, menopause,[3] falling in love with someone who can't or won't return one's affections, social isolation, and social rejection.{cn}

Medical treatments

Certain medications are known to cause depressed mood in a significant number of patients. These include Hepatitis C drug therapy and some drugs used to treat high blood pressure, such as beta-blockers or reserpine.

Non-psychiatric illnesses

Depressed mood can be the result of a number of infectious diseases and physiological problems including hypogonadism (in men), Addison's disease, Lyme disease, multiple sclerosis, sleep apnea and disturbed circadian rhythm. It is often one of the early symptoms of hypothyroidism (reduced activity of the thyroid gland). Chronic pain causes depression. For a discussion of non-psychiatric conditions that can cause depressed mood, see Depression (differential diagnoses).

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 energy levels, cognition and mood, but may also involve one or more depressive episodes. 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.[4]

Outside the mood disorders: borderline personality disorder commonly features depressed 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,[5] and posttraumatic stress disorder, an anxiety disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[6]

Assessment

Main article: Rating scales for depression

A full patient medical history, physical assessment, and thorough evaluation of symptoms helps determine the cause of the depression. Standardized questionnaires can be helpful such as the Hamilton Rating Scale for Depression,[7] and the Beck Depression Inventory.[8]

A doctor generally performs a medical examination and selected investigations to rule out other causes of symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism; basic electrolytes and serum calcium to rule out a metabolic disturbance; and a full blood count including ESR to rule out a systemic infection or chronic disease.[9] Adverse affective reactions to medications or alcohol misuse are often ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism, a cause of depression in men.[10] Subjective cognitive complaints appear in older depressed people, but they can also be indicative of the onset of a dementing disorder, such as Alzheimer's disease.[11][12] Cognitive testing and brain imaging can help distinguish depression from dementia.[13] A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms.[14] No biological tests confirm major depression.[15] Investigations are not generally repeated for a subsequent episode unless there is a medical indication.

Depression in Young Adults

Depression in young adults is a common health problem and a growing public concern. In 2006, 1 in 20 U.S. adults had experienced a major depressive episode with severe impairment.[16] The Center for Disease Control and Prevention (CDC) reported that among ages 18–24, 2.8% met the criteria for major depression, 8.1% met the criteria for other depression (DSM-IV category Depressive Disorder, Not Otherwise Specified - minor or subthreshold depression, or Dysthymia) and 10.9% met the criteria for current depression.[17] Forty-four percent of American college students report feeling symptoms of depression.[18] This data suggests that traditional college aged students may be at high risk for depression or depressed mood.

Each year 44 colleges and universities use random sampling to administer the American College Health Association’s (ACHA) National College Health Assessment (NCHA) survey to 28,000 students. This assessment surveys students’ health status and behavior, including depression and depressive symptoms, for their previous academic year. Based on the findings, the rates of students reporting having been diagnosed with depression have increased from 10% in 2000[19] to 21% in 2011.[20] In 2011, female students reported depressive symptoms, including 22% feeling that things were hopeless, 23% feeling lonely, and 26% feeling very sad within the preceding two weeks[19] to 21% in 2011.[20] Women are at higher risk than men to experience depression.[21]

References

  1. ^ Sandra Salmans (1997). Depression: questions you have - answers you need. People's Medical Society. ISBN 978-1-882606-14-6.
  2. ^ "Depression". National Institute of Mental Health. 2009-09-23. Retrieved 2010-05-22.
  3. ^ Schmidt, Peter (2005). "Mood, depression, and reproductive hormones in the menopausal transition". The American Journal of Medicine.
  4. ^ Gabbard, Glen O. Treatment of Psychiatric Disorders. Vol. 2 (3rd ed.). Washington, DC: American Psychiatric Publishing. p. 1296.
  5. ^ American Psychiatric Association 2000a, p. 355
  6. ^ Vieweg WV, Julius DA, Fernandez A, Beatty-Brooks M, Hettema JM, Pandurangi AK (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. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  7. ^ Zimmerman M, Chelminski I, Posternak M (2004 Sep). "A review of studies of the Hamilton depression rating scale in healthy controls: implications for the definition of remission in treatment studies of depression". J Nerv Ment Dis. 192 (9): 595–601. PMID 15348975. {{cite journal}}: Check date values in: |date= (help)CS1 maint: multiple names: authors list (link)
  8. ^ McPherson A, Martin CR (2010 Feb). "A narrative review of the Beck Depression Inventory (BDI) and implications for its use in an alcohol-dependent population". J Psychiatr Ment Health Nurs. 17 (1): 19–30. doi:10.1111/j.1365-2850.2009.01469.x. PMID 20100303. {{cite journal}}: Check date values in: |date= (help)
  9. ^ Dale J, Sorour E, Milner G. Do psychiatrists perform appropriate physical investigations for their patients? A review of current practices in a general psychiatric inpatient and outpatient setting. Journal of Mental Health. 2008;17(3):293–98. doi:10.1080/09638230701498325.
  10. ^ Orengo C, Fullerton G, Tan R. Male depression: A review of gender concerns and testosterone therapy. Geriatrics. 2004;59(10):24–30. PMID 15508552.
  11. ^ Reid LM, Maclullich AM. Subjective memory complaints and cognitive impairment in older people. Dementia and geriatric cognitive disorders. 2006;22(5–6):471–85. doi:10.1159/000096295. PMID 17047326.
  12. ^ Katz IR. Diagnosis and treatment of depression in patients with Alzheimer's disease and other dementias. The Journal of clinical psychiatry. 1998;59 Suppl 9:38–44. PMID 9720486.
  13. ^ Wright SL, Persad C. Distinguishing between depression and dementia in older persons: Neuropsychological and neuropathological correlates. Journal of geriatric psychiatry and neurology. 2007;20(4):189–98. doi:10.1177/0891988707308801. PMID 18004006.
  14. ^ Sadock 2002, p. 108
  15. ^ Sadock 2002, p. 260
  16. ^ "Results from the 2007 National Survey on Drug Use and Health: National Findings". Department of Health and Human Services Substance Abuse and Mental Health Services Administration Office of Applied Studies. Retrieved April 25, 2012.
  17. ^ e%0d%0a#tab1 "Current Depression Among Adults --- United States, 2006 and 2008". Center for Disease Control and Prevention. Retrieved March 12, 2012. {{cite web}}: Check |url= value (help)
  18. ^ "Ranking America's Mental Health: An Analysis of Depression Across the States". Mental Health America. Retrieved January 19, 2012.
  19. ^ a b "Reference Group Data Report 2000" (PDF). American College Health Association National College Health Assessment. Retrieved February 20, 2012.
  20. ^ a b "Reference Group Data Report Spring 2011" (PDF). American College Health Association National College Health Assessment. Retrieved February 20, 2012.
  21. ^ Nolen-Hoeksema, Susan (2001). "Gender Differences in Depression". Current Directions in Psychological Science. 10 (5): 173–176. {{cite journal}}: Unknown parameter |month= ignored (help)

Selected cited works

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc.; 2000a. ISBN 0-89042-025-4.
  • Sadock, Virginia A.; Sadock, Benjamin J.; Kaplan, Harold I.. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Philadelphia: Lippincott Williams & Wilkins; 2003. ISBN 0-7817-3183-6.
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