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Depression (emotion)

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Depression, or, more properly, a depressed emotional state or mood, refers to a state of non-clinical melancholia that is shorter than 2 weeks in duration and distinctly differentiated from a diagnosis of major depression (clinical depression).

In the field of psychiatry the word depression can also have this meaning but more specifically refers to major depression (and its associated subtypes) a mental disorder which has reached a clinically significant severity and duration to warrant a diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that a depressed mood is often reported as being: "... depressed, sad, hopeless, discouraged, or 'down in the dumps'."

Depressed mood may be accompanied by an aversion to activity and this can affect a person's thoughts, behavior, feelings and sense of 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 or attempt suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains, or digestive problems that are resistant to treatment may also be present.[2]

In a clinical setting, a depressed mood can be something a patient reports (a symptom), or something a clinician observes (a sign), or both.

Determinants of moodEdit

Depression can be the result of many factors, individually and acting in concert. A depressed mood is generally situational and reactive, and associated with grief, loss, or a major life events. A change of residence, marriage, divorce, the break-up of a significant relationship, graduation, or job loss are all examples of instances that might trigger a depressed mood.

Causes Edit

Life events Edit

Life events and changes that may precipitate depressed mood include childbirth, menopause, financial difficulties, job problems, loss of a loved one/family member or friend, marriage, natural disasters such as earthquakes, hurricanes, tornadoes, etc. relationship troubles, separation, bereavement and catastrophic injury.[3][4]

Medical treatments Edit

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 Edit

Depressed mood can be the result of a number of infectious diseases, neurological conditions [5] and physiological problems including hypoandrogenism (in men), Addison's disease, Lyme disease, multiple sclerosis, chronic pain, stroke,[6] diabetes,[7] cancer,[8] sleep apnea, and disturbed circadian rhythm. It is often one of the early symptoms of hypothyroidism (reduced activity of the thyroid gland). For a discussion of non-psychiatric conditions that can cause depressed mood, see Depression (differential diagnoses).

Psychiatric syndromes Edit

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 mood, cognition and energy levels, but may also involve one or more depressive episodes.[9] 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: 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;[10]:355 and posttraumatic stress disorder, an anxiety disorder that sometimes follows trauma, is commonly accompanied by depressed mood.[11]

Adaptive benefits of depressionEdit

While a depressed mood is usually seen as deleterious, it may have adaptive benefits. The loss of a loved spouse, child, friend or relation, a physical illness or loss of lifestyle, tends to lead to feelings of depression. Freud noted the similarities between mourning and depression (then called melancholia) in a now famous paper entitled, "Mourning and Melancholia". The depressed mood is adaptive in that it leads the person towards altering their thought patterns and behavior or way of living or else continues until such a time as they do so. It can be argued that depression and clinical depression is in fact the refusal of a person to heed the call to change from within their own mind. For example, in mourning it is essential that one must eventually let go of the dead person and return to the world and other relationships.

Depression appears to have the effect of stopping a person in their tracks and forcing them to turn inwards and engage in a period of self reflection; it is a deeply introspective state. During this period, which can last anything from days to years, the individual must find a new way to interpret their thoughts and feelings and reassess the extent to which their appraisal of their reality is a valid one.

TreatmentEdit

Main article: Management of depression

A depressed mood may not require any professional treatment. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition by a counselor or doctor, which may benefit from treatment.[12] Different sub-divisions of depression have different treatment approaches.[13]


See alsoEdit

References Edit

  1. Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need, People's Medical Society.
  2. NIMH · Depression. nimh.nih.gov. URL accessed on 15 October 2012.
  3. Schmidt, Peter (2005). Mood, Depression, and Reproductive Hormones in the Menopausal Transition. The American Journal of Medicine 118 Suppl 12B (12): 54–8.
  4. (2008). Life Events and Depression. Annals of Punjab Medical College 2 (1).
  5. Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012. ISBN 978-1437704341
  6. (2009). Drawing up guidelines for the attendance of physical health of patients with severe mental illness. L'Encephale 35 (4): 330–9.
  7. (2011). The relationship of depression and diabetes: Pathophysiological and treatment implications. Psychoneuroendocrinology 36 (9): 1276–86.
  8. (2012). Evidence-based treatment of depression in patients with cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30 (11): 1187–96.
  9. Gabbard, Glen O.. Treatment of Psychiatric Disorders, 3rd, Washington, DC: American Psychiatric Publishing.
  10. American Psychiatric Association (2000a). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision: DSM-IV-TR, Washington, DC: American Psychiatric Publishing, Inc..
  11. (May 2006). Posttraumatic Stress Disorder: Clinical Features, Pathophysiology, and Treatment. Am. J. Med. 119 (5): 383–90.
  12. Cheog J et al. for PsychCentral.com. Last reviewed August 26, 2010. Frequently Asked Questions About Depression Accesed May 11, 2013
  13. Staff, UK National Institute for Health and Clinical Excellence (NICE) October 2009. Depression

Further ReadingEdit

  • (2003) Kaplan & Sadock's Synopsis Of Psychiatry: Behavioral Sciences/Clinical Psychiatry, Philadelphia: Lippincott Williams & Wilkins.
  • Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012. ISBN 978-1437704341


External links Edit


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