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Clinical depression
Depression
Classifications and external resources
ICD-10
- F, F33.
ICD-9
296
MedlinePlus
003213
Clinical depression (also called major depressive disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living. Although a low mood or state of dejection that does not affect functioning is often colloquially referred to as depression, clinical depression is a clinical diagnosis and may be different from the everyday meaning of "being depressed". Many people identify the feeling of being depressed as "being blue", "feeling sad for no reason", or "having no motivation to do anything". Clinical depression is generally acknowledged to be more serious than normal depressed feelings.
Vincent van Gogh, who himself suffered from depression and committed suicide, painted this picture in 1890 of a man that can symbolize the desperation and hopelessness felt in depression.
Contents[hide]
History
The modern idea of depression appears similar to the much older concept of melancholia. The name melancholia derives from "black bile", one of the "four humours" postulated by Galen.
Clinical depression was originally considered to be a chemical imbalance in transmitters in the brain, a theory based on observations made in the 1950s of the effects of reserpine and isoniazid in altering monoamine neurotransmitter levels and affecting depressive symptoms.[1] Since these suggestions, many other causes for clinical depression have been proposed.
Prevalence
Clinical depression affects about 16%[2] of the population on at least one occasion in their lives. In some countries, such as Australia, one in four women and one in eight men will suffer from depression. The mean age of onset, from a number of studies, is in the late 20s. About twice as many females as males report or receive treatment for clinical depression, though this imbalance is shrinking over the course of recent history; this difference seems to completely disappear after the age of 50 - 55, when most females have passed the end of menopause. It should be noted that these numbers are only for those who report or receive treatment for depression; men are less likely to report feeling depressed, and also less likely to seek treatment, possibly due to gender roles[citation needed]. Clinical depression is currently the leading cause of disability in North America as well as other countries, and is expected to become the second leading cause of disability worldwide (after heart disease) by the year 2020, according to the World Health Organization.[3]
Diagnosis
A diagnosis is made when an individual meets a sufficient number of the symptom criteria for the depression spectrum as suggested in the DSM-IV-TR or ICD-9/ICD-10. An individual is often seen to suffer from what is termed as a "clinical depression" without fully meeting the various criteria advanced for a specific diagnosis on the depression spectrum. Possible causes of depression are not taken into account in diagnosis, unless it may be due to an existing medical condition.
It is important to understand that there is no blood test or brain scan for depression. Therefore the term "clinical depression" can be misleading to those who erroneously believe that there is a medical test for this disorder. Laboratory tests can provide medical data for diseases such as diabetes and heart disease, but currently not for depression, bipolar disorder, schizophrenia and other mental disorders.
Symptoms
According to the DSM-IV-TR criteria for diagnosing a major depressive disorder (cautionary statement) one of the following two elements must be present for a period of at least two weeks:
It is sufficient to have either of these symptoms in conjunction with five of a list of other symptoms over a two-week period. These include:
- Feelings of overwhelming sadness and/or fear, or the seeming inability to feel emotion (emptiness).
- A decrease in the amount of interest or pleasure in all, or almost all, daily activities.
- Changing appetite and marked weight gain or loss.
- Disturbed sleep patterns, such as insomnia, loss of REM sleep, or excessive sleep (Hypersomnia).
- Psychomotor agitation or retardation nearly every day.
- Fatigue, mental or physical, also loss of energy.
- Intense feelings of guilt, helplessness, hopelessness, worthlessness, isolation/loneliness and/or anxiety.
- Trouble concentrating, keeping focus or making decisions or a generalized slowing and obtunding of cognition, including memory.
- Recurrent thoughts of death (not just fear of dying), desire to just "lay down and die" or "stop breathing", recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
- Feeling and/or fear of being abandoned by those close to one.
Other symptoms often reported but not usually taken into account in diagnosis include:
- Self-loathing.
- A decrease in self-esteem.
- Inattention to personal hygiene.
- Sensitivity to noise.
- Physical aches and pains, and the belief these may be signs of serious illness.
- Fear of 'going mad'.
- Change in perception of time.
- Periods of sobbing.
- Possible behavioral changes, such as aggression and/or irritability.
Depression in children is not as obvious as it is in adults. Here are some symptoms that children might display:
- Loss of appetite.
- Irritability.
- Sleep problems, such as recurrent nightmares.
- Learning or memory problems where none existed before.
- Significant behavioral changes; such as withdrawal, social isolation, and aggression.
An additional indicator could be the excessive use of drugs or alcohol. Depressed adolescents are at particular risk of further destructive behaviours, such as eating disorders and self-harm.
One of the most widely used instruments for measuring depression severity is the Beck Depression Inventory, a 21-question multiple choice survey.
It is hard for people who have not experienced clinical depression, either personally or by regular exposure to people suffering it, to understand its emotional impact and severity, interpreting it instead as being similar to "having the blues" or "feeling down." As the list of symptoms above indicates, clinical depression is a serious, potentially lethal systemic disorder characterized by the psychiatric industry as interlocking physical, affective, and cognitive symptoms that have consequences for function and survival well beyond sad or painful feelings.
Mnemonics
