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According to the DSM-IV-TR (p. 356), the two principal or required elements of depression include:
It is sufficient to have either of these symptoms in conjunction with four of a list of other symptoms. The diagnosis does not require “loss of interest in life, anhedonia”. Likewise, “lack of energy and motivation” is not at all a required symptom of Major Depression.
Often depression is accompanied by sleep disorders such as insomnia, including early-morning awakening and byfeelings of greatly lowered self-worth. Depression is often described as being unable to feel–even to feel many negative emotions such as sadness. Some depressed people may in fact experience an irresistible urge to sleep or rest all through the day because of their lowered state of awareness.
Other symptoms accompanying depression include: changes in appetite, feelings of guilt, failure, and worthlessness, thoughts of death, fatigue and difficulty concentrating, withdrawal, inactivity, slow speech, walking slow, irritability, confusion, crying easily, inability to enjoy things, insecurity, anxiety, sore shoulders and neck, pain in the lower back, lowered libido, binge eating of junk food, inability to show affection, disorganization, trouble getting dressed or choosing clothes, feelings of regret for past decisions, inability to function, feeling that no one understands, boredom,fear, desire to be taken care of, paranoia, irrational fears, and easy frustration. Of course, each person may show only some of these symptoms.
Most people who have not experienced clinical depression do not properly understand the concept, interpreting it instead as being similar to a “normal” sad or depressive mood. As the list of symptoms above indicates, clinical depression is a syndrome of interlocking symptoms which goes far beyond sad or painful feelings. A variety of biological indicators, including measurement of neurotransmitter levels, have shown that there are significant changes in brain chemistry with an overall reduction in brain activity. Because of this lack of understanding of its nature, depressed persons are often criticized by themselves and others as not trying to feel better. However, the more severe the depression is, the more the depression may take on an autonomous nature, responding neither to positive events nor to the person’s own efforts to feel better. It is imperative that the clinically depressed see a doctor. Also, the more movement or exercise a clinically depressed person can motivate or push themselves to do, the better.
Depression is currently treated, with varying degrees of success, in several ways including: psychotherapy (includingcognitive therapy, psychoanalysis, etc.), antidepressant medication, and electroconvulsive treatment (electroshock therapy). Some people stop their medication when they feel better, but this is risky since each depressive episode can be worse than the previous one. It is as risky as stopping the use of a heart medication when your heart starts feeling better.
Meditation, regular aerobic exercise (30 minutes, 5 times a week), good nutrition, proper sleep, and avoiding alcohol,caffeine and excessive sugar are extremely helpful in fighting depression. Exploration of one’s spirituality has also had an important impact for many people in healing their depression. Recording one’s thoughts in a regular journal often helps.
Self-help techniques have been shown to be effective in combating depression. These techniques are generally based on cognitive therapy, which helps the depressed individual recognize and reframe the negative thoughts and beliefs that commonly underlie depression. The most widely recommended and most commercially successful self-help book for depression is Feeling Good – The New Mood Therapy by David D. Burns (ISBN 0-380-81033-6). Clinical studies have demonstrated that reading this book alone, in the absence of any other intervention, will result in a significant improvement in a majority of individuals.
Note: The name “Melancholia” (derived from ‘black bile’, one of the imagined ‘humours’ of Hippocrates‘ four humourstheory of emotion) appears to be cognate with what is now called depression. It is also the name of an engraving byAlbrecht Dürer that allegorically depicts the symptoms of depression.
Psychiatrists have attempted to categorize depression in many ways, one older division was between “reactive” or “exogenous” depressions, which were thought to be depressions caused by other medical conditions or an identifiable life trauma or loss; and “endogenous” depressions in which it is difficult to find an external cause. Often depression is repressed anger (in a person who has been oppressed or controlled) or repressed fear (in a person who has been assaulted) and hence episodes of violence and/or major anxiety can alternate with episodes of major depression. Post-traumatic stress disorder, is a form of depression noticed in persons who have been raped, and/or assaulted, in prostitutes, and military personnel and others who have experienced a lot of violence.
Current psychiatric standards do not differentiate between exogenous and endogenous depressions since research appears to show that depressions with similar symptoms have a similar natural history and response to treatment regardless of trigger.
Depressions can also be categorised as being “unipolar depression,” or being part of bipolar disorder (also known as “manic depression”), where the patient cycles between a state of depression and a state of mania. It appears to have well-documented physical correlates. Though bipolar disorder often responds well to chemical treatment, it is sometimes more difficult to treat than clinical depression. This is partly because medication to treat depression can adversely effect mania, and vice-verse.
It is theorized that unipolar depression and unipolar mania are the opposite poles of a wider bipolar spectrum.
About 10% of women develop depression after giving birth; this is known as postpartum depression.
Abnormal neurotransmitter activity is associated with depression, especially so with serotonin. It has been suggested that many depressed individuals have low levels of this neurotransmitter, although this is not necessarily the case, with some depressed individuals possessing dysfunctionally high levels. This proposal is not always accepted, and some consider supporting evidence insufficent.
Some studies have linked cytokine levels and depression.
- manic depression
- seasonal affective disorder (SAD)
- List of people who have suffered from depression