Depression - Signs And Symptoms, Risk Factors And Treatment

Depression is a mental disorder that affects how you think, behave, feel and act. It usually accompanies a low mood and and aversion to activity. The Diagnostic and Statistical Manual of Mental Disorders defines a depressed person as experiencing feelings of sadness, helplessness and hopelessness.
The term "clinical depression" is used by Doctors to describe the more severe, persistent form of depression also known as "major depression" or "major depressive disorder." It is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities.
The Signs and symptoms of clinical depression may include crying for no apparent reason, Persistent feeling of sadness or emptiness, sleep problems, loss of interest in daily activities, Significant weight loss or gain, Suicidal thoughts or behavior, become fatigued, feel worthless, have headaches or even backache .
The most common time of onset is between the ages of 20 and 30 years, with a later peak between 30 and 40 years. Major depression is reported about twice as frequently in women as in men, and women attempt suicide more often, although men are at higher risk for completing suicide.

Symptoms And Signs Of Depression

Major depression is a serious illness that affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health. Its impact on functioning and well-being has been equated to that of chronic medical conditions such as diabetes.
Slight depression is of minor consequence. One may become slightly depressed over a loss of a job; break up of a romantic relationship or divorce. Other causes of slight depressions include loss of a parent, sibling, marital stress, job anxiety, moving or not having a great job. Slight depression may present with feelings of sadness, sleeping problems, irritability, being easily annoyed and feeling tired. Slight depression is reversible and short term. Most people get over slight depression with time and supportive therapy.
A person suffering a major depressive episode usually exhibits a very low mood, which pervades all aspects of life, and an inability to experience pleasure in activities that formerly were enjoyed. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred. In severe cases, depressed people may have symptoms of psychosis. These symptoms include delusions or, less commonly, hallucinations, usually of an unpleasant nature. Other symptoms of depression include poor concentration and memory (especially in those with melancholic or psychotic features), withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide.
Insomnia is common among the depressed. In the typical pattern, a person wakes very early and is unable to get back to sleep. Hypersomnia, or oversleeping, is less common.
Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. The person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries, according to the World Health Organization's criteria for depression. Family and friends may notice that the person's behavior is either agitated or lethargic.
Depressed children often display an irritable rather than a depressed mood, and show varying symptoms depending on age and situation. Most exhibit a loss of interest in school and a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure. Diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness. Depression may also coincide with attention-deficit hyperactivity disorder (ADHD), complicating the diagnosis and treatment of both.
Older depressed persons may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements. Depression often coexists with physical disorders common among the elderly, such as stroke, other cardiovascular diseases, Parkinson's disease, and chronic obstructive pulmonary disease.

Causes Of Depression

It is estimated that about 1 out of 6 adults suffer from depression. Although depression does not have a single cause, many things contribute to the feeling of depression, such as family history, pessimistic personality, trauma and stress, physical conditions, and other psychological disorders.
Gender may additionally be a contributing factor. Women and men may experience depression in different ways.

Depression - Risk factors

* Having a family member or relative with depression. * Having a family member who has committed suicide. * Stressful events like losing a job, death of a loved one, financial difficulties. * Having depression as a child or teenager. * Having a chronic illness like heart disease, Alzheimer's disease, AIDS, or cancer. * Having a personality where one has low self-esteem, no confidence, being dependent on others or being criticized all the time. * Having just delivered a baby (postpartum depression). * Having little or no money and being of a low socioeconomic status. Slight and mild depression may not cause any complications. But severe depression can have an agonizing toll on the individual and the family. When severe depression is untreated it can quickly lead to disability and suicidal thinking. Severe depression can also cause deep emotional turmoil, changes in behavior, and legal and monetary problems.
Biological influences of depression are varied, but may relate to malnutrition, heredity, hormones, seasons, stress, illness, drug or alcohol use, neurotransmitter malfunction, long-term exposure to dampness and mold, back injury, and to aerosol exposure. There are also correlations between long term sleep difficulties and depression. Up to 90% of patients with depression are found to have sleep difficulties.


When depression is neglected or severe, it can lead to: * Suicide. * Substance abuse. * Alcoholism. * Anxiety. * Heart problems. * Weight problems. * Work-related problems. * Family conflicts. * Interpersonal difficulties. * Social isolation and loneliness.

Treatments For Depression

There exists a number of different treatments for depression: Antidepressants include clinical drugs like Prozac and herbal remedies like St John's Wort. Physical activity has been linked to the increase in blood serotonin after exercise, similar to the effects of selective serotonin reuptake inhibitors (SSRI).
Research published by the American Medical Association concludes: Findings are consistent with a beneficial effect of physical activity on feelings of sadness and suicidal behaviors in Hispanic and non-Hispanic white boys and girls.
Various initiatives promote dialogue and non-drug therapy, arguing that drugs should be only used as last resort in cases of depression.


Psychotherapy can be delivered, to individuals or groups, by mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers, counselors, and psychiatric nurses. With more complex and chronic forms of depression, a combination of medication and psychotherapy may be used.
In people under 18, according to the National Institute for Health and Clinical Excellence, medication should only be offered in conjunction with a psychological therapy, such as CBT, interpersonal therapy, or family therapy. Psychotherapy has been shown to be effective in older people. Successful psychotherapy appears to reduce the recurrence of depression even after it has been terminated or replaced by occasional booster sessions.


The effects of prescription antidepressants are somewhat superior to those of psychotherapy, especially in cases of chronic major depression, although in short-term trials more patients especially those with less serious forms of depression cease medication than cease psychotherapy, most likely due to adverse effects from the medication and to patients' preferences for psychological therapies over pharmacological treatments. Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation is recommended. People with chronic depression may need to take medication indefinitely to avoid relapse.
Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, escitalopram, fluoxetine, paroxetine, and citalopram are the primary medications prescribed owing to their effectiveness, relatively mild side effects, and because they are less toxic in overdose than other antidepressants.
Venlafaxine, an antidepressant with a different mechanism of action, may be modestly more effective than SSRIs. However, venlafaxine is not recommended as a first-line treatment because of evidence suggesting its risks may outweigh benefits, and it is specifically discouraged in children and adolescents.

Pharmacological Augmentation

A doctor may add a medication with a different mode of action to bolster the effect of an antidepressant in cases of treatment resistance. Medication with lithium salts has been used to augment antidepressant therapy in those who have failed to respond to antidepressants alone.
Furthermore, lithium dramatically decreases the suicide risk in recurrent depression. Addition of a thyroid hormone, triiodothyronine may work as well as lithium, even in patients with normal thyroid function. Addition of atypical antipsychotics when the patient has not responded to an antidepressant is also known to increase the effectiveness of antidepressant drugs, albeit offset by increased side effects.

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