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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 a diagnosis listed in the DSM 5 as a mood disorder describing people who feel sad and pessimistic. Most people feel sad, discouraged, or "down" sometimes, but that is not depression. In clinical depression, these feelings last for a long time and are combined with other symptoms. Someone with depression might have these symptoms: strong sad feelings or no strong feelings at all, feeling guilty, feeling helpless or hopeless, anxiety, fear, low self-esteem or a loss of interest in life. These are symptoms of depression when they last for a long time (usually for more than two weeks). 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.
How common depression is
Many people have depression. It is the most common form of disability in the world. Depression happens most often in people between the ages of 13 and 60 years. Although more women than men are diagnosed with depression, it is the most common mental illness for both men and women.
Signs and symptoms
There are many signs that a person may be suffering from depression. One of the most common is a depressed mood, which includes feeling sad, and having less interest or pleasure in things that are normally enjoyable. Other core causes include low self-esteem, guilt, tiredness, anxiety or pessimism, and sometimes thinking about suicide. Some changes are more physical, such as changes in how much and when a person eats and sleeps, misusing drugs or alcohol, or complaining of mental or physical fatigue.
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.
Depression is a syndrome of many symptoms that relate to each other, and is not just feeling sad. Medical measurements have shown that there are big changes in the chemicals in the brain, and that the whole brain slows down during depression. Depression that is not treated may get worse.
Types of depression
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
Depression comes from the brain, but scientists are still trying to find out exactly why it happens.
These things can cause depression, or make it worse:
- 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 medication works to balance 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 the duration and harshness of depression.
- Pesticides: Several scientific studies  have found statistics links between depression and some pesticides.
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.
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 Nortriptiline (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.
In psychotherapy, someone with depression is helped 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 (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).
- Dysthymia, a long-lasting mild depression
- Bipolar disorder, a mood disorder which involves both mania and depression
- Cyclothymia, a mild form of bipolar disorder
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
- "Depression: MedlinePlus Medical Encyclopedia". nlm.nih.gov. 2011 [last update]. http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm. Retrieved July 18, 2011.
- Hasselbring, Bobbie (2011 [last update]). "Discovery Health 'How Common Is Depression?'". health.howstuffworks.com. http://health.howstuffworks.com/mental-health/depression/questions/how-common-is-depression.htm. Retrieved July 18, 2011.
- Koppelman, Robin (August 2007). "Women Are Diagnosed with Depression Twice as Often as Men: UI Health Care". University of Iowa Health Care Today. Archived from the original on July 3, 2010. http://web.archive.org/web/20100703025238/http://www.uihealthcare.com/kxic/2007/august/womensmentalhealth.html. Retrieved July 18, 2011.
- ‘depression’ 2006, in Churchill Livingstone's Dictionary of Nursing, Elsevier Health Sciences, Philadelphia, PA, USA
- ‘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.
- 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 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.
- Lewinsohn, P. M., Munoz, R. F, Youngren, M. A., Zeiss, A. M. (1992). Control your depression. New York: Fireside/Simon&Schuster.