Depression (mood)
Depression | |
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Lithograph of a person diagnosed with melancholia and strong suicidal tendency in 1892 | |
Specialty | Psychiatry, psychology |
Symptoms | Low mood, aversion to activity, loss of interest, loss of feeling pleasure |
Causes | Brain chemistry, genetics, life events, medical conditions, personality[1] |
Risk factors | Stigma of mental health disorder[2] |
Diagnostic method | Patient Health Questionnaire, Beck Depression Inventory |
Differential diagnosis | Anxiety, bipolar disorder, borderline personality disorder |
Prevention | Social connections, physical activity |
Treatment | Psychotherapy, psychopharmacology |
Part of a series on |
Emotions |
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Depression is a mental state of low mood and aversion to activity.[3] It affects more than 280 million people of all ages (about 3.5% of the global population).[4] Depression affects a person's thoughts, behavior, feelings, and sense of well-being.[5] Depressed people often experience loss of motivation or interest in, or reduced pleasure or joy from, experiences that would normally bring them pleasure or joy.[6]
Depressed mood is a symptom of some
it is a normal temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical diseases and a side effect of some drugs and medical treatments. It may feature sadness, difficulty in thinking and concentration and a significant increase or decrease in appetite and time spent sleeping. People experiencing depression may have feelings of dejection or hopelessness and may experience suicidal thoughts. It can either be short term or long term.Contributing factors
Life events
Adversity in childhood, such as bereavement, neglect, mental abuse, physical abuse, sexual abuse, or unequal parental treatment of siblings can contribute to depression in adulthood.[8][9] Childhood physical or sexual abuse in particular significantly correlates with the likelihood of experiencing depression over the survivor's lifetime.[10] People who have experienced four or more adverse childhood experiences are 3.2 to 4.0 times more likely to suffer from depression.[11] Poor housing quality, non-functionality, lack of green spaces, and exposure to noise and air pollution are linked to depressive moods, emphasizing the need for consideration in planning to prevent such outcomes.[12]
Studies have consistently shown that physicians have had the highest depression and suicide rates compared to people in many other lines of work—for suicide, 40% higher for male physicians and 130% higher for female physicians.[13][14][15]
Life events and changes that may cause depressed mood include (but are not limited to): childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education, military service, family, living conditions, marriage, etc.), a medical diagnosis (cancer, HIV, diabetes, etc.), bullying, loss of a loved one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation, drug abuse, alcohol abuse, or catastrophic injury.[16][17][18][19][20] Adolescents may be especially prone to experiencing a depressed mood following social rejection, peer pressure, or bullying.[21]
Childhood and adolescence
Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral dyscontrol instead of the more common sad, empty, or hopeless feelings seen with adults.
Personality
Depression is associated with low
Side effect of medical treatment
It is possible that some early-generation
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 such as heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and
Non-psychiatric illnesses
Depressed mood can be the result of a number of infectious diseases,
Studies have found that anywhere from 30 to 85 percent of patients suffering from chronic pain are also clinically depressed.[34][35][36] A 2014 study by Hooley et al. concluded that chronic pain increased the chance of death by suicide by two to three times.[37] In 2017, the British Medical Association found that 49% of UK chronic pain patients also had depression.[38]
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 (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.[39] 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:
Inflammation
There is evidence for a link between inflammation and depression.[42] Inflammatory processes can be triggered by negative cognitions or their consequences, such as stress, violence, or deprivation. Thus, negative cognitions can cause inflammation that can, in turn, lead to depression.[43][44][dubious – discuss] In addition, there is increasing evidence that inflammation can cause depression because of the increase of cytokines, setting the brain into a "sickness mode".[45]
Classical symptoms of being physically sick, such as lethargy, show a large overlap in behaviors that characterize depression. Levels of cytokines tend to increase sharply during the depressive episodes of people with bipolar disorder and drop off during remission.[46] Furthermore, it has been shown in clinical trials that anti-inflammatory medicines taken in addition to antidepressants not only significantly improves symptoms but also increases the proportion of subjects positively responding to treatment.[47]
Inflammations that lead to serious depression could be caused by common infections such as those caused by a virus, bacteria or even parasites.[48]Historical legacy
Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may create depressive conditions.
Psychogeographical depression overlaps somewhat with the theory of "deprejudice", a portmanteau of depression and
Unlike the theory of "deprejudice", a psychogeographical theory of depression attempts to broaden study of the subject beyond an individual experience to one produced on a societal scale, seeing particular manifestations of depression as rooted in dispossession; historical legacies of genocide, slavery, and colonialism are productive of segregation, both material and psychic material deprivation,[52] and concomitant circumstances of violence, systemic exclusion, and lack of access to legal protections. The demands of navigating these circumstances compromise the resources available to a population to seek comfort, health, stability, and sense of security. The historical memory of this trauma conditions the psychological health of future generations, making psychogeographical depression an intergenerational experience as well.
This work is supported by recent studies in genetic science which has demonstrated an
Measures
Measures of depression include, but are not limited to: Beck Depression Inventory-11 and the 9-item depression scale in the Patient Health Questionnaire (PHQ-9).[55] Both of these measures are psychological tests that ask personal questions of the participant, and have mostly been used to measure the severity of depression. The Beck Depression Inventory is a self-report scale that helps a therapist identify the patterns of depression symptoms and monitor recovery. The responses on this scale can be discussed in therapy to devise interventions for the most distressing symptoms of depression.[6]
Theories
Schools of depression theories include:
- Cognitive theory of depression
- Tripartite Model of Anxiety and Depression
- Behavioral theories of depression
- Evolutionary approaches to depression
- Biology of depression
- Epigenetics of depression
Management
Depressed mood may not require professional treatment, and may be a normal temporary reaction to life events, a symptom of some medical condition, 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. Many have linked depression to a life falling short of expectations and have blamed influencers for setting unrealistic expectations.[56][57][58]
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.[59]
Physical activity has a protective effect against the emergence of depression in some people.[60]
There is limited evidence suggesting yoga may help some people with depressive disorders or elevated levels of depression, but more research is needed.[61][62]
Reminiscence of old and fond memories is another alternative form of treatment, especially for the elderly who have lived longer and have more experiences in life. It is a method that causes a person to recollect memories of their own life, leading to a process of self-recognition and identifying familiar stimuli. By maintaining one's personal past and identity, it is a technique that stimulates people to view their lives in a more objective and balanced way, causing them to pay attention to positive information in their life stories, which would successfully reduce depressive mood levels.[63]
There is limited evidence that continuing antidepressant medication for one year reduces the risk of depression recurrence with no additional harm.[64] Recommendations for psychological treatments or combination treatments in preventing recurrence are not clear.[64]
Epidemiology
Depression is the leading cause of disability worldwide, the United Nations (UN) health agency reported, estimating that it affects more than 300 million people worldwide – the majority of them women, young people and the elderly. An estimated 4.4 percent of the global population has depression, according to a report released by the UN World Health Organization (WHO), which shows an 18 percent increase in the number of people living with depression between 2005 and 2015.[65][66][67]
Depression is a major mental-health cause of disease burden. Its consequences further lead to significant burden in public health, including a higher risk of dementia, premature mortality arising from physical disorders, and maternal depression impacts on child growth and development.[68] Approximately 76% to 85% of depressed people in low- and middle-income countries do not receive treatment;[69] barriers to treatment include: inaccurate assessment, lack of trained health-care providers, social stigma and lack of resources.[4]
The stigma comes from misguided societal views that people with mental illness are different from everyone else, and they can choose to get better only if they wanted to.[70] Due to this more than half of the people with depression do not receive help with their disorders. The stigma leads to a strong preference for privacy. An analysis of 40,350 undergraduates from 70 institutions by Posselt and Lipson found that undergraduates who perceived their classroom environments as highly competitive had a 37% higher chance of developing depression and a 69% higher chance of developing anxiety.[71] Several studies have suggested that unemployment roughly doubles the risk of developing depression.[72][73][74][75][76]
The World Health Organization has constructed guidelines – known as The Mental Health Gap Action Programme (mhGAP) – aiming to increase services for people with mental, neurological and substance-use disorders.[4] Depression is listed as one of conditions prioritized by the programme. Trials conducted show possibilities for the implementation of the programme in low-resource primary-care settings dependent on primary-care practitioners and lay health-workers.[77] Examples of mhGAP-endorsed therapies targeting depression include Group Interpersonal Therapy as group treatment for depression and "Thinking Health", which utilizes cognitive behavioral therapy to tackle perinatal depression.[4] Furthermore, effective screening in primary care is crucial for the access of treatments. The mhGAP adopted its approach of improving detection rates of depression by training general practitioners. However, there is still weak evidence supporting this training.[68]
According to 2011 study, people who are high in hypercompetitive traits are also likely to measure higher for depression and anxiety.[78]
History
The term depression was derived from the Latin verb deprimere, "to press down".[79] From the 14th century, "to depress" meant to subjugate or to bring down in spirits. It was used in 1665 in English author Richard Baker's Chronicle to refer to someone having "a great depression of spirit", and by English author Samuel Johnson in a similar sense in 1753.[80]
In Ancient Greece, disease was thought due to an imbalance in the four basic bodily fluids, or humors. Personality types were similarly thought to be determined by the dominant humor in a particular person. Derived from the Ancient Greek melas, "black", and kholé, "bile",[81] melancholia was described as a distinct disease with particular mental and physical symptoms by Hippocrates in his Aphorisms, where he characterized all "fears and despondencies, if they last a long time" as being symptomatic of the ailment.[82]
During the 18th century, the humoral theory of melancholia was increasingly being challenged by mechanical and electrical explanations; references to dark and gloomy states gave way to ideas of slowed circulation and depleted energy.[83] German physician Johann Christian Heinroth, however, argued melancholia was a disturbance of the soul due to moral conflict within the patient.
In the 20th century, the German psychiatrist Emil Kraepelin distinguished manic depression. The influential system put forward by Kraepelin unified nearly all types of mood disorder into manic–depressive insanity. Kraepelin worked from an assumption of underlying brain pathology, but also promoted a distinction between
Other psycho-dynamic theories were proposed.
Researchers theorized that depression was caused by a
In July 2022, British psychiatrist Joanna Moncrieff, also psychiatrist Mark Horowtiz and others proposed in a study on academic journal Molecular Psychiatry that depression is not caused by a serotonin imbalance in the human body, unlike what most of the psychiatry community points to, and that therefore anti-depressants do not work against the illness.[90][91] However, such study was met with criticism from some psychiatrists, who argued the study's methodology used an indirect trace of serotonin, instead of taking direct measurements of the molecule.[92] Moncrieff said that, despite her study's conclusions, no one should interrupt their treatment if they are taking any anti-depressant.[92]
See also
- Alain Ehrenberg, French sociologist, author of Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age
- Attribution (psychology) – The process by which individuals explain the causes of behavior and events
- Biopsychosocial model – Explanatory model emphasizing the interplay among causal forces
- Depression in childhood and adolescence – Pediatric depressive disorders
- Diathesis–stress model – Psychological theory
- Existential crisis – Inner conflict due to perceived meaninglessness
- Feeling – Conscious subjective experience of emotion
- Locus of control – Concept in psychology
- Melancholia – Historical view of extreme depression
- Mixed anxiety–depressive disorder – Diagnostic category in the ICD-10
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External links
- Media related to Depression (mood) at Wikimedia Commons