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109-455: MDD may refer to: Major depressive disorder , a mental disorder involving persistent low mood, low self-esteem and loss of interest. It is also known as clinical depression. Mate-Demate Device , a specialized crane used to piggyback the Space Shuttle onto an airplane Mammal Diversity Database, online checklist of mammal species maintained by

218-532: A metabolic disturbance ; and a full blood count including ESR to rule out a systemic infection or chronic disease. Adverse affective reactions to medications or alcohol misuse may be ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism , a cause of depression in men. Vitamin D levels might be evaluated, as low levels of vitamin D have been associated with greater risk for depression. Subjective cognitive complaints appear in older depressed people, but they can also be indicative of

327-442: A 2019 study found 102 variants in the genome linked to depression. However, it appears that major depression is less heritable compared to bipolar disorder and schizophrenia. Research focusing on specific candidate genes has been criticized for its tendency to generate false positive findings. There are also other efforts to examine interactions between life stress and polygenic risk for depression. Depression can also arise after

436-791: A chronic or terminal medical condition, such as HIV/AIDS or asthma , and may be labeled "secondary depression". It is unknown whether the underlying diseases induce depression through effect on quality of life, or through shared etiologies (such as degeneration of the basal ganglia in Parkinson's disease or immune dysregulation in asthma). Depression may also be iatrogenic (the result of healthcare), such as drug-induced depression. Therapies associated with depression include interferons , beta-blockers , isotretinoin , contraceptives , cardiac agents, anticonvulsants , antimigraine drugs , antipsychotics , and hormonal agents such as gonadotropin-releasing hormone agonist (GnRH agonist). Celiac disease

545-506: A combination of medication and psychotherapy may be used. There is moderate-quality evidence that psychological therapies are a useful addition to standard antidepressant treatment of treatment-resistant depression in the short term. Psychotherapy has been shown to be effective in older people. Successful psychotherapy appears to reduce the recurrence of depression even after it has been stopped or replaced by occasional booster sessions. The most-studied form of psychotherapy for depression

654-422: A court hearing, or sentencing as part of a criminal trial. Indefinite commitment is rare and is usually reserved for individuals who are violent or present an ongoing danger to themselves and others. New York City officials under several administrations have implemented programs involving the involuntary hospitalization of people with mental illnesses in the city. Some of these policies have involved reinterpreting

763-501: A danger to self or others. Other jurisdictions have broader criteria. The legal process by which commitment takes place varies between jurisdictions. Some jurisdictions have a formal court hearing where testimony and other evidence may also be submitted and the subject of the hearing is typically entitled to legal counsel and may challenge a commitment order through habeas corpus . Other jurisdictions have delegated these power to physicians, though may provide an appeal process that involves

872-424: A depressed state mediated by increased serotonin. Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive than controls, the finding of increased jugular 5-HIAA in people who are depressed that normalized with selective serotonin reuptake inhibitor (SSRI) treatment, and the preference for carbohydrates in people who are depressed. Already limited,

981-615: A determination about potential risk and apply treatment protocols. Observation is sometimes used to determine whether a person warrants involuntary commitment. It is not always clear on a relatively brief examination whether a person should be committed. Austria, Belgium, Germany, Israel, the Netherlands, Northern Ireland, the Republic of Ireland, Russia, Taiwan, Ontario (Canada), and the United States have adopted commitment criteria based on

1090-474: A higher chance of developing depression, which shows the two are connected. There is even evidence suggesting that altering the microbes in the gut can have regulatory effects on developing depression. Theories unifying neuroimaging findings have been proposed. The first model proposed is the limbic-cortical model, which involves hyperactivity of the ventral paralimbic regions and hypoactivity of frontal regulatory regions in emotional processing. Another model,

1199-411: A higher risk of developing clinical depression. There appears to be a link between air pollution and depression and suicide. There may be an association between long-term PM2.5 exposure and depression, and a possible association between short-term PM10 exposure and suicide. The pathophysiology of depression is not completely understood, but current theories center around monoaminergic systems,

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1308-557: A lifelong disorder with recurrent major depressive episodes . Those with major depressive disorder are typically treated with psychotherapy and antidepressant medication . Medication appears to be effective, but the effect may be significant only in the most severely depressed. Hospitalization (which may be involuntary ) may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. Electroconvulsive therapy (ECT) may be considered if other measures are not effective. Major depressive disorder

1417-821: A long-term or indefinite form of commitment applicable to people convicted of some sexual offences . United Nations General Assembly Resolution 46/119, " Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care ", is a non-binding resolution advocating certain broadly drawn procedures for the carrying out of involuntary commitment. These principles have been used in many countries where local laws have been revised or new ones implemented. The UN runs programs in some countries to assist in this process. The potential dangers of institutions have been noted and criticized by reformers/ activists almost since their foundation. Charles Dickens

1526-426: A major role in the development of depression. Family and twin studies find that nearly 40% of individual differences in risk for major depressive disorder can be explained by genetic factors . Like most psychiatric disorders, major depressive disorder is likely influenced by many individual genetic changes. In 2018, a genome-wide association study discovered 44 genetic variants linked to risk for major depression;

1635-771: A monoamine—can cause depression in those in remission or relatives of people who are depressed, suggesting that decreased serotonergic neurotransmission is important in depression. Second, the correlation between depression risk and polymorphisms in the 5-HTTLPR gene, which codes for serotonin receptors, suggests a link. Third, decreased size of the locus coeruleus , decreased activity of tyrosine hydroxylase , increased density of alpha-2 adrenergic receptor , and evidence from rat models suggest decreased adrenergic neurotransmission in depression. Furthermore, decreased levels of homovanillic acid , altered response to dextroamphetamine , responses of depressive symptoms to dopamine receptor agonists, decreased dopamine receptor D1 binding in

1744-415: A more noticeable slowing of movements. Depressed children may often display an irritable rather than a depressed mood; most lose interest in school and show a steep decline in academic performance. Diagnosis may be delayed or missed when symptoms are interpreted as "normal moodiness". Elderly people may not present with classical depressive symptoms. Diagnosis and treatment is further complicated in that

1853-616: A person's sleeping habits, eating habits, and general health. A person having a major depressive episode usually exhibits a low mood, which pervades all aspects of life, and an inability to experience pleasure in previously enjoyable activities. Depressed people may be preoccupied with or ruminate over thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness or hopelessness. Other symptoms of depression include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive , irritability, and thoughts of death or suicide. Insomnia

1962-482: A promising intervention in youth. Problem solving therapy , cognitive behavioral therapy, and interpersonal therapy are effective interventions in the elderly. Psychoanalysis is a school of thought, founded by Sigmund Freud , which emphasizes the resolution of unconscious mental conflicts. Psychoanalytic techniques are used by some practitioners to treat clients presenting with major depression. A more widely practiced therapy, called psychodynamic psychotherapy ,

2071-523: A rally in support of the anarchists. Throughout the 1940s and 1950s in Canada , 20,000 Canadian children, called the Duplessis orphans , were wrongfully certified as being mentally ill and as a result were committed to psychiatric institutions where they were allegedly forced to take psychiatric medication that they did not need and were abused. They were named after Maurice Duplessis , the premier of Quebec at

2180-518: A range of related diagnoses, including dysthymia , which involves a chronic but milder mood disturbance; recurrent brief depression , consisting of briefer depressive episodes; minor depressive disorder , whereby only some symptoms of major depression are present; and adjustment disorder with depressed mood , which denotes low mood resulting from a psychological response to an identifiable event or stressor . The DSM-5 recognizes six further subtypes of MDD, called specifiers , in addition to noting

2289-404: A similar manner to twin studies . In these studies people with schizophrenia are found to be between 1.3 and 1.8 times more likely to engage in violent behaviour. People with certain types of personality disorders can occasionally present a danger to themselves or others. This concern has found expression in the standards for involuntary commitment in every US state and in other countries as

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2398-691: A treatment comparing favorably to other psychotherapies. The most common and effective treatments for depression are psychotherapy, medication, and electroconvulsive therapy (ECT); a combination of treatments is the most effective approach when depression is resistant to treatment. American Psychiatric Association treatment guidelines recommend that initial treatment should be individually tailored based on factors including severity of symptoms, co-existing disorders, prior treatment experience, and personal preference. Options may include pharmacotherapy, psychotherapy, exercise, ECT, transcranial magnetic stimulation (TMS) or light therapy . Antidepressant medication

2507-446: Is CBT, which teaches clients to challenge self-defeating, but enduring ways of thinking (cognitions) and change counter-productive behaviors. CBT can perform as well as antidepressants in people with major depression. CBT has the most research evidence for the treatment of depression in children and adolescents, and CBT and interpersonal psychotherapy (IPT) are preferred therapies for adolescent depression. In people under 18, according to

2616-558: Is a history of prior episodes, with no history of mania). ICD-11 symptoms, present nearly every day for at least two weeks, are a depressed mood or anhedonia , accompanied by other symptoms such as "difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue." These symptoms must affect work, social, or domestic activities. The ICD-11 system allows further specifiers for

2725-446: 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. Other disorders need to be ruled out before diagnosing major depressive disorder. They include depressions due to physical illness, medications , and substance use disorders . Depression due to physical illness

2834-566: Is a quite recent development. A mental health first aid training course was developed in Australia in 2001 and has been found to improve assistance provided to persons with an alleged mental illness or mental health crisis. This form of training has now spread to a number of other countries (Canada, Finland, Hong Kong, Ireland, Singapore, Scotland, England, Wales, and the United States). Mental health triage may be used in an emergency room to make

2943-454: Is activated by stressful life events. The preexisting vulnerability can be either genetic , implying an interaction between nature and nurture , or schematic , resulting from views of the world learned in childhood. American psychiatrist Aaron Beck suggested that a triad of automatic and spontaneous negative thoughts about the self , the world or environment , and the future may lead to other depressive signs and symptoms. Genes play

3052-675: Is also a connection between the gut microbiome and the central nervous system, otherwise known as the Gut-Brain axis , which is a two-way communication system between the brain and the gut. Experiments have shown that microbiota in the gut can play an important role in depression as people with MDD often have gut-brain dysfunction. One analysis showed that those with MDD have different bacteria living in their guts. Bacteria Bacteroidetes and Firmicutes were most affected in people with MDD, and they are also impacted in people with irritable bowel syndrome . Another study showed that people with IBS have

3161-490: Is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimism , self-harm or suicide, and an absence of positive thoughts or plans. Specialist mental health services are rare in rural areas, and thus diagnosis and management is left largely to primary-care clinicians. This issue is even more marked in developing countries. Rating scales are not used to diagnose depression, but they provide an indication of

3270-399: Is another possible contributing factor. Substance use in early age is associated with increased risk of developing depression later in life. Depression occurring after giving birth is called postpartum depression and is thought to be the result of hormonal changes associated with pregnancy . Seasonal affective disorder , a type of depression associated with seasonal changes in sunlight,

3379-467: Is appropriate or necessary. Civil commitment procedures may take place in a court or only involve physicians. If commitment does not involve a court there is normally an appeal process that does involve the judiciary in some capacity, though potentially through a specialist court. For most jurisdictions, involuntary commitment is applied to individuals believed to be experiencing a mental illness that impairs their ability to reason to such an extent that

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3488-417: Is believed to be caused by a combination of genetic , environmental, and psychological factors, with about 40% of the risk being genetic. Risk factors include a family history of the condition, major life changes, childhood traumas, certain medications, chronic health problems , and substance use disorders . It can negatively affect a person's personal life, work life, or education, and cause issues with

3597-705: Is common; in the typical pattern, a person wakes very early and cannot get back to sleep. Hypersomnia , or oversleeping, can also happen, as well as day-night rhythm disturbances, such as diurnal mood variation . Some antidepressants may also cause insomnia due to their stimulating effect. In severe cases, depressed people may have psychotic symptoms. These symptoms include delusions or, less commonly, hallucinations , usually unpleasant. People who have had previous episodes with psychotic symptoms are more likely to have them with future episodes. A depressed person may report multiple physical symptoms such as fatigue , headaches, or digestive problems; physical complaints are

3706-444: Is diagnosed as a mood disorder due to a general medical condition . This condition is determined based on history, laboratory findings, or physical examination . When the depression is caused by a medication, non-medical use of a psychoactive substance, or exposure to a toxin , it is then diagnosed as a specific mood disorder (previously called substance-induced mood disorder ). Preventive efforts may result in decreases in rates of

3815-425: Is different from Wikidata All article disambiguation pages All disambiguation pages Major depressive disorder Major depressive disorder ( MDD ), also known as clinical depression , is a mental disorder characterized by at least two weeks of pervasive low mood , low self-esteem , and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in

3924-444: Is either depressed mood or loss of interest or pleasure. Depressed mood occurs nearly every day as subjective feelings like sadness, emptiness, and hopelessness or observations made by others (e.g. appears tearful). Loss of interest or pleasure occurs in all, or almost all activities of the day, nearly every day. These symptoms, as well as five out of the nine more specific symptoms listed, must frequently occur for more than two weeks (to

4033-784: Is equivalent to the use of medications or psychological therapies in most people. In older people it does appear to decrease depression. Sleep and diet may also play a role in depression, and interventions in these areas may be an effective add-on to conventional methods. In observational studies, smoking cessation has benefits in depression as large as or larger than those of medications. Talking therapy (psychotherapy) can be delivered to individuals, groups, or families by mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers , counselors, and psychiatric nurses. A 2012 review found psychotherapy to be better than no treatment but not other treatments. With more complex and chronic forms of depression,

4142-456: Is in the tradition of psychoanalysis but less intensive, meeting once or twice a week. It also tends to focus more on the person's immediate problems, and has an additional social and interpersonal focus. In a meta-analysis of three controlled trials of Short Psychodynamic Supportive Psychotherapy, this modification was found to be as effective as medication for mild to moderate depression. Conflicting results have arisen from studies that look at

4251-484: Is not adequate as a diagnosis tool, because its sensitivity is only 44%. These stress-related abnormalities are thought to be the cause of hippocampal volume reductions seen in people who are depressed. Furthermore, a meta-analysis yielded decreased dexamethasone suppression, and increased response to psychological stressors. Further abnormal results have been obscured with the cortisol awakening response , with increased response being associated with depression. There

4360-562: Is often difficult. Development of mental health services is minimal in many countries; depression is viewed as a phenomenon of the developed world despite evidence to the contrary, and not as an inherently life-threatening condition. There is insufficient evidence to determine the effectiveness of psychological versus medical therapy in children. Physical exercise has been found to be effective for major depression, and may be recommended to people who are willing, motivated, and healthy enough to participate in an exercise program as treatment. It

4469-564: Is particularly beneficial in preventing relapse. Cognitive behavioral therapy and occupational programs (including modification of work activities and assistance) have been shown to be effective in reducing sick days taken by workers with depression. Several variants of cognitive behavior therapy have been used in those with depression, the most notable being rational emotive behavior therapy , and mindfulness-based cognitive therapy . Mindfulness-based stress reduction programs may reduce depression symptoms. Mindfulness programs also appear to be

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4578-663: Is recommended as an initial treatment choice in people with mild, moderate, or severe major depression, and should be given to all people with severe depression unless ECT is planned. There is evidence that collaborative care by a team of health care practitioners produces better results than routine single-practitioner care. Psychotherapy is the treatment of choice (over medication) for people under 18, and cognitive behavioral therapy (CBT), third wave CBT and interpersonal therapy may help prevent depression. The UK National Institute for Health and Care Excellence (NICE) 2004 guidelines indicate that antidepressants should not be used for

4687-430: Is recommended. People with chronic depression may need to take medication indefinitely to avoid relapse. SSRIs are the primary medications prescribed, owing to their relatively mild side-effects, and because they are less toxic in overdose than other antidepressants. People who do not respond to one SSRI can be switched to another antidepressant , and this results in improvement in almost 50% of cases. Another option

4796-434: Is some evidence for a similar effect in mild depression. Similarly, a Cochrane systematic review of clinical trials of the generic tricyclic antidepressant amitriptyline concluded that there is strong evidence that its efficacy is superior to placebo. Antidepressants work less well for the elderly than for younger individuals with depression. To find the most effective antidepressant medication with minimal side-effects,

4905-634: Is thought to be triggered by decreased sunlight. Vitamin B 2 , B 6 and B 12 deficiency may cause depression in females. Adverse childhood experiences (incorporating childhood abuse , neglect and family dysfunction ) markedly increase the risk of major depression, especially if more than one type. Childhood trauma also correlates with severity of depression, poor responsiveness to treatment and length of illness. Some are more susceptible than others to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility. Couples in unhappy marriages have

5014-521: Is to augment the atypical antidepressant bupropion to the SSRI as an adjunctive treatment. Venlafaxine , an antidepressant with a different mechanism of action, may be modestly more effective than SSRIs. However, venlafaxine is not recommended in the UK as a first-line treatment because of evidence suggesting its risks may outweigh benefits, and it is specifically discouraged in children and adolescents as it increases

5123-608: The American Psychiatric Association (APA) strongly oppose the practice. The Task Force on Sexually Dangerous Offenders, a component of APA's Council on Psychiatry and Law, reported that "in the opinion of the task force, sexual predator commitment laws represent a serious assault on the integrity of psychiatry, particularly with regard to defining mental illness and the clinical conditions for compulsory treatment. Moreover, by bending civil commitment to serve essentially non-medical purposes, statutes threaten to undermine

5232-593: The American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization 's International Statistical Classification of Diseases and Related Health Problems (ICD). The latter system is typically used in European countries, while the former is used in the US and many other non-European nations, and the authors of both have worked towards conforming one with

5341-682: The American Society of Mammalogists Medical Devices Directive Mernda railway station , Melbourne Midland Airpark (IATA: MDD), a public use airport in Midland, Texas Mine detection dogs Ministry of Defence (Italy) , known natively as Ministero della Difesa Mirrored Drive Door, a case design for the Power Mac G4 Model-driven development , a software engineering discipline Movement for Direct Democracy , defunct Venezuelan political party. Topics referred to by

5450-503: The Internet . The Netherlands mental health care system provides preventive interventions, such as the "Coping with Depression" course (CWD) for people with sub-threshold depression. The course is claimed to be the most successful of psychoeducational interventions for the treatment and prevention of depression (both for its adaptability to various populations and its results), with a risk reduction of 38% in major depression and an efficacy as

5559-462: The National Institute for Health and Clinical Excellence , medication should be offered only in conjunction with a psychological therapy, such as CBT , interpersonal therapy , or family therapy . Several variables predict success for cognitive behavioral therapy in adolescents: higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions. CBT

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5668-484: The circadian rhythm , immunological dysfunction, HPA-axis dysfunction and structural or functional abnormalities of emotional circuits. Derived from the effectiveness of monoaminergic drugs in treating depression, the monoamine theory posits that insufficient activity of monoamine neurotransmitters is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas. First, acute depletion of tryptophan —a necessary precursor of serotonin and

5777-462: The striatum , and polymorphism of dopamine receptor genes implicate dopamine , another monoamine, in depression. Lastly, increased activity of monoamine oxidase , which degrades monoamines, has been associated with depression. However, the monoamine theory is inconsistent with observations that serotonin depletion does not cause depression in healthy persons, that antidepressants instantly increase levels of monoamines but take weeks to work, and

5886-469: The UK. The haste of these closures, driven by the Conservative governments led by Margaret Thatcher and John Major , led to considerable criticism in the press, as some individuals slipped through the net into homelessness or were discharged to poor quality private sector mini-institutions. There are instances in which mental health professionals have wrongfully deemed individuals to have been displaying

5995-404: The abolition or substantial reduction of involuntary commitment, a trend known as deinstitutionalisation . In many currents, individuals can voluntarily admit themselves to a mental health hospital and may have more rights than those who are involuntarily committed. This practice is referred to as voluntary commitment . In the United States, Kansas v. Hendricks established the procedures for

6104-441: The agents of the law, state, or courts determine that decisions will be made for the individual under a legal framework. In some jurisdictions, this is a proceeding distinct from being found incompetent . Involuntary commitment is used in some degree for each of the following although different jurisdictions have different criteria. Some jurisdictions limit involuntary treatment to individuals who meet statutory criteria for presenting

6213-502: The authority of the mental institutions, culminating in their closure. During the 1970s and 1990s the hospital population started to fall rapidly, mainly because of the deaths of long-term inmates. Significant efforts were made to re-house large numbers of former residents in a variety of suitable or otherwise alternative accommodation. The first 1,000+ bed hospital to close was Darenth Park Hospital in Kent , swiftly followed by many more across

6322-578: The body appeared in an earlier form in 1841. At the turn of the century, England and France combined had only a few hundred individuals in asylums. By the late 1890s and early 1900s, those so detained had risen to the hundreds of thousands. However, the idea that mental illness could be ameliorated through institutionalization was soon disappointed. Psychiatrists were pressured by an ever-increasing patient population. The average number of patients in asylums kept increasing. Asylums were quickly becoming almost indistinguishable from custodial institutions, and

6431-523: The circumstances under which a person may be committed or treated against their will as such actions have been ruled by the United States Supreme Court and other national legislative bodies as a violation of civil rights and/or human rights . The Supreme Court case O'Connor v. Donaldson established that the mere presence of mental illness and the necessity for treatment are not sufficient by themselves to justify involuntary commitment, if

6540-546: The city won on appeal she was ultimately released after a subsequent case determined she could not be forcibly medicated. In 2022, Mayor Eric Adams announced a similar compulsory hospitalization program, relying on similar legal interpretations. Historically, until the mid-1960s in most jurisdictions in the United States , all committals to public psychiatric facilities and most committals to private ones were involuntary. Since then, there have been alternating trends towards

6649-462: The closure of all NHS asylums and their replacement by wards in general hospitals: "There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside - the asylums which our forefathers built with such immense solidity to express the notions of their day. Do not for a moment underestimate their powers of resistance to our assault. Let me describe some of

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6758-557: The community, a shift known as "deinstitutionalization". Because the shift was typically not accompanied by a commensurate development of community-based services, critics say that deinstitutionalization has led to large numbers of people who would once have been inpatients as instead being incarcerated or becoming homeless. In some jurisdictions, laws authorizing court-ordered outpatient treatment have been passed in an effort to compel individuals with chronic, untreated severe mental illness to take psychiatric medication while living outside

6867-417: The concentration of quinolinic acid correlates to the severity of depressive symptoms. A diagnostic assessment may be conducted by a suitably trained general practitioner , or by a psychiatrist or psychologist , who records the person's current circumstances, biographical history, current symptoms, family history, and alcohol and drug use. The assessment also includes a mental state examination , which

6976-846: The condition of between 22 and 38%. Since 2016, the United States Preventive Services Task Force (USPSTF) has recommended screening for depression among those over the age 12; though a 2005 Cochrane review found that the routine use of screening questionnaires has little effect on detection or treatment. Screening the general population is not recommended by authorities in the UK or Canada. Behavioral interventions, such as interpersonal therapy and cognitive-behavioral therapy , are effective at preventing new onset depression. Because such interventions appear to be most effective when delivered to individuals or small groups, it has been suggested that they may be able to reach their large target audience most efficiently through

7085-445: The cortico-striatal model, suggests that abnormalities of the prefrontal cortex in regulating striatal and subcortical structures result in depression. Another model proposes hyperactivity of salience structures in identifying negative stimuli, and hypoactivity of cortical regulatory structures resulting in a negative emotional bias and depression, consistent with emotional bias studies. The newer field of psychoneuroimmunology ,

7194-484: The criteria for a major depressive episode. A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks. Episodes may be isolated or recurrent and are categorized as mild (few symptoms in excess of minimum criteria), moderate, or severe (marked impact on social or occupational functioning). An episode with psychotic features—commonly referred to as psychotic depression —is automatically rated as severe. If

7303-411: The current depressive episode: the severity (mild, moderate, severe, unspecified); the presence of psychotic symptoms (with or without psychotic symptoms); and the degree of remission if relevant (currently in partial remission, currently in full remission). These two disorders are classified as "Depressive disorders", in the category of "Mood disorders". According to DSM-5, at least one of the symptoms

7412-424: The danger to self or others standard, sometimes supplemented by the requirement that the danger be imminent. In some jurisdictions, the danger to self or others standard has been broadened in recent years to include need-for-treatment criteria such as "gravely disabled". Starting in the 1960s, there has been a worldwide trend toward moving psychiatric patients from hospital settings to less restricting settings in

7521-465: The defenses which we have to storm." Scandal after scandal followed, with many high-profile public inquiries. These involved the exposure of abuses such as unscientific surgical techniques such as lobotomy and the widespread neglect and abuse of vulnerable patients in the US and Europe. The growing anti-psychiatry movement in the 1960s and 1970s led in Italy to the first successful legislative challenge to

7630-454: The dosages can be adjusted, and if necessary, combinations of different classes of antidepressants can be tried. Response rates to the first antidepressant administered range from 50 to 75%, and it can take at least six to eight weeks from the start of medication to improvement. 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

7739-427: The effectiveness of antidepressants in people with acute, mild to moderate depression. A review commissioned by the National Institute for Health and Care Excellence (UK) concluded that there is strong evidence that SSRIs , such as escitalopram , paroxetine , and sertraline , have greater efficacy than placebo on achieving a 50% reduction in depression scores in moderate and severe major depression, and that there

7848-421: The elderly are often simultaneously treated with a number of other drugs, and often have other concurrent diseases. The etiology of depression is not yet fully understood. The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression. The diathesis–stress model specifies that depression results when a preexisting vulnerability, or diathesis ,

7957-479: The existence of atypical antidepressants which can be effective despite not targeting this pathway. One proposed explanation for the therapeutic lag, and further support for the deficiency of monoamines, is a desensitization of self-inhibition in raphe nuclei by the increased serotonin mediated by antidepressants. However, disinhibition of the dorsal raphe has been proposed to occur as a result of decreased serotonergic activity in tryptophan depletion, resulting in

8066-656: The experimental treatment of ketamine with treatment-resistant depression. With this, in MDD, people will more likely have a Th-1 dominant immune profile, which is a pro-inflammatory profile. This suggests that there are components of the immune system affecting the pathology of MDD. Another way cytokines can affect depression is in the kynurenine pathway , and when this is overactivated, it can cause depression. This can be due to too much microglial activation and too little astrocytic activity. When microglia get activated, they release pro-inflammatory cytokines that cause an increase in

8175-489: The extent in which it impairs functioning) for the diagnosis. Major depressive disorder is classified as a mood disorder in the DSM-5. The diagnosis hinges on the presence of single or recurrent major depressive episodes . Further qualifiers are used to classify both the episode itself and the course of the disorder. The category Unspecified Depressive Disorder is diagnosed if the depressive episode's manifestation does not meet

8284-588: The first school for intellectually disabled people. His method of treatment was based on the idea that intellectually disabled people did not suffer from disease. In the United Kingdom, provision for the care of the mentally ill began in the early 19th century with a state-led effort. Public mental asylums were established in Britain after the passing of the 1808 County Asylums Act . This empowered magistrates to build rate-supported asylums in every county to house

8393-422: The general public. However, because other confounding factors such as childhood adversity and poverty are correlated with both schizophrenia and violence it can be difficult to determine whether this effect is due to schizophrenia or other factors. In an attempt to avoid these confounding factors, researchers have tried comparing the rates of violence amongst people diagnosed with schizophrenia to their siblings in

8502-474: The hospital (e.g. Laura's Law , Kendra's Law ). In a study of 269 patients from Vermont State Hospital done by Courtenay M. Harding and associates, about two-thirds of the ex-patients did well after deinstitutionalization. In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. Édouard Séguin developed a systematic approach for training individuals with mental deficiencies, and, in 1839, he opened

8611-553: The initial treatment of mild depression because the risk-benefit ratio is poor. The guidelines recommend that antidepressants treatment in combination with psychosocial interventions should be considered for: The guidelines further note that antidepressant treatment should be continued for at least six months to reduce the risk of relapse , and that SSRIs are better tolerated than tricyclic antidepressants . Treatment options are more limited in developing countries, where access to mental health staff, medication, and psychotherapy

8720-552: The judiciary but may also involve physicians. For example, in the UK a mental health tribunal consists of a judge, a medical member, and a lay representative. Training is gradually becoming available in mental health first aid to equip community members such as teachers, school administrators, police officers, and medical workers with training in recognizing, and authority in managing, situations where involuntary evaluations of behavior are applicable under law. The extension of first aid training to cover mental health problems and crises

8829-637: The length, severity and presence of psychotic features: To confirm major depressive disorder as the most likely diagnosis, other potential diagnoses must be considered, including dysthymia , adjustment disorder with depressed mood, or bipolar disorder . Dysthymia is a chronic, milder mood disturbance in which a person reports a low mood almost daily over a span of at least two years. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression (sometimes referred to as double depression ). Adjustment disorder with depressed mood

8938-486: The local police secretly arrested and involuntarily committed him to a mental hospital for 12 days. Patients are able to sue if they believe that they have been wrongfully committed. In one instance, Junius Wilson, an African American man, was committed to Cherry Hospital in Goldsboro, North Carolina in 1925 for an alleged crime without a trial or conviction. He was castrated. He continued to be held at Cherry Hospital for

9047-480: The many "pauper lunatics". Nine counties first applied, and the first public asylum opened in 1812 in Nottinghamshire . Parliamentary Committees were established to investigate abuses at private madhouses like Bethlem Hospital - its officers were eventually dismissed and national attention was focused on the routine use of bars, chains and handcuffs and the filthy conditions in which the inmates lived. However, it

9156-460: The mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability , after lower back pain . The diagnosis of major depressive disorder is based on

9265-450: The monoamine hypothesis has been further oversimplified when presented to the general public. A 2022 review found no consistent evidence supporting the serotonin hypothesis, linking serotonin levels and depression. HPA-axis abnormalities have been suggested in depression given the association of CRHR1 with depression and the increased frequency of dexamethasone test non-suppression in people who are depressed. However, this abnormality

9374-566: The most common presenting problem in developing countries, according to the World Health Organization 's criteria for depression. Appetite often decreases, resulting in weight loss, although increased appetite and weight gain occasionally occur. Major depression significantly affects a person's family and personal relationships , work or school life, sleeping and eating habits, and general health. Family and friends may notice agitation or lethargy . Older depressed people may have cognitive symptoms of recent onset, such as forgetfulness, and

9483-483: The next 67 years of his life. It turned out he was deaf rather than mentally ill. In many U.S. states, sex offenders who have completed a period of incarceration can be civilly committed to a mental institution based on a finding of dangerousness due to a mental disorder. Although the United States Supreme Court determined that this practice does not constitute double jeopardy , organizations such as

9592-502: The onset of a dementing disorder , such as Alzheimer's disease . Cognitive testing and brain imaging can help distinguish depression from dementia. A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. No biological tests confirm major depression. In general, investigations are not repeated for a subsequent episode unless there is a medical indication . The most widely used criteria for diagnosing depressive conditions are found in

9701-668: The other. Both DSM and ICD mark out typical (main) depressive symptoms. The most recent edition of the DSM is the Fifth Edition, Text Revision (DSM-5-TR), and the most recent edition of the ICD is the Eleventh Edition (ICD-11). Under mood disorders, ICD-11 classifies major depressive disorder as either single episode depressive disorder (where there is no history of depressive episodes, or of mania ) or recurrent depressive disorder (where there

9810-405: The patient is capable of surviving in freedom and does not present a danger of harm to themselves or others. Criteria for involuntary commitment are generally set by the individual states, and often have both short- and long-term types of commitment. Short-term commitment tends to be a few days or less, requiring an examination by a medical professional, while longer-term commitment typically requires

9919-406: The person has had an episode of mania or markedly elevated mood , a diagnosis of bipolar disorder is made instead. Depression without mania is sometimes referred to as unipolar because the mood remains at one emotional state or "pole". Bereavement is not an exclusion criterion in the DSM-5, and it is up to the clinician to distinguish between normal reactions to a loss and MDD. Excluded are

10028-434: The person's reported experiences, behavior reported by relatives or friends, and a mental status examination . There is no laboratory test for the disorder, but testing may be done to rule out physical conditions that can cause similar symptoms. The most common time of onset is in a person's 20s, with females affected about twice as often as males. The course of the disorder varies widely, from one episode lasting months to

10137-475: The person, provider, and/or the medical system. Non-psychiatrist physicians have been shown to miss about two-thirds of cases, although there is some evidence of improvement in the number of missed cases. A doctor generally performs a medical examination and selected investigations to rule out other causes of depressive symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism ; basic electrolytes and serum calcium to rule out

10246-407: The presumed danger of the defendant to self or to others. People with suicidal thoughts may act on these impulses and harm or kill themselves. People with psychosis are occasionally driven by their delusions or hallucinations to harm themselves or others. Research has found that those with schizophrenia are between 3.4 and 7.4 times more likely to engage in violent behaviour than members of

10355-531: The production of COX 2 . This, in turn, causes the production of PGE 2 , which is a prostaglandin , and this catalyzes the production of indolamine , IDO. IDO causes tryptophan to get converted into kynurenine and kynurenine becomes quinolinic acid . Quinolinic acid is an agonist for NMDA receptors, so it activates the pathway. Studies have shown that the post-mortem brains of patients with MDD have higher levels of quinolinic acid than people who did not have MDD. With this, researchers have also seen that

10464-641: The provisions of the Act; the compulsory construction of asylums in every county, with regular inspections on behalf of the Home Secretary . All asylums were required to have written regulations and to have a resident qualified physician . A national body for asylum superintendents - the Medico-Psychological Association - was established in 1866 under the Presidency of William A. F. Browne , although

10573-760: The reputation of psychiatry in the medical world had was at an extreme low. Sectioning is now regulated by the Mental Health Act 2007 in England and Wales, the Mental Health (Care and Treatment) (Scotland) Act 2003 in Scotland and other legislation in Northern Ireland. In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. The Utica State Hospital

10682-432: The rest of society. British playwright Tom Stoppard wrote Every Good Boy Deserves Favour about the relationship between a patient and his doctor in one of these hospitals. Stoppard was inspired by a meeting with a Russian exile. In 1927, after the execution of Sacco and Vanzetti in the United States, demonstrator Aurora D'Angelo was sent to a mental health facility for psychiatric evaluation after she participated in

10791-503: The risk of suicidal thoughts or attempts. Involuntary commitment Criteria for civil commitment are established by laws which vary between nations. Commitment proceedings often follow a period of emergency hospitalization, during which an individual with acute psychiatric symptoms is confined for a relatively short duration (e.g. 72 hours) in a treatment facility for evaluation and stabilization by mental health professionals who may then determine whether further civil commitment

10900-403: The same term [REDACTED] This disambiguation page lists articles associated with the title MDD . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=MDD&oldid=1257541607 " Category : Disambiguation pages Hidden categories: Short description

11009-865: The severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis. Several rating scales are used for this purpose; these include the Hamilton Rating Scale for Depression , the Beck Depression Inventory or the Suicide Behaviors Questionnaire-Revised . Primary-care physicians have more difficulty with underrecognition and undertreatment of depression compared to psychiatrists. These cases may be missed because for some people with depression, physical symptoms often accompany depression. In addition, there may also be barriers related to

11118-493: The standard of "harm to themselves or others" to include neglecting their own well-being or posing a harm to themselves or others in the future. In 1987–88, a homeless woman named Joyce Brown worked with the New York Civil Liberties Union to challenge her forced hospitalization under a new Mayor Ed Koch administration program. The trial, which attracted significant media attention, ended in her favor, and while

11227-597: The study between the immune system and the nervous system and emotional state, suggests that cytokines may impact depression. Immune system abnormalities have been observed, including increased levels of cytokines -cells produced by immune cells that affect inflammation- involved in generating sickness behavior , creating a pro-inflammatory profile in MDD. Some people with depression have increased levels of pro-inflammatory cytokines and some have decreased levels of anti-inflammatory cytokines. Research suggests that treatments can reduce pro-inflammatory cell production, like

11336-555: The symptoms of a mental disorder , and committed the individual for treatment in a psychiatric hospital upon such grounds. Claims of wrongful commitment are a common theme in the anti-psychiatry movement . In 1860, the case of Elizabeth Packard , who was wrongfully committed that year and filed a lawsuit and won thereafter, highlighted the issue of wrongful involuntary commitment. In 1887, investigative journalist Nellie Bly went undercover at an asylum in New York City to expose

11445-560: The terrible conditions that mental patients at the time had to deal with. She published her findings and experiences as articles in New York World , and later made the articles into one book called Ten Days in a Mad-House . In the first half of the twentieth century there were a few high-profile cases of wrongful commitment based on racism or punishment for political dissenters . In the former Soviet Union , psychiatric hospitals were used as prisons to isolate political prisoners from

11554-517: The time, who deliberately committed these children to misappropriate additional subsidies from the federal government. Decades later in the 1990s, several of the orphans sued Quebec and the Catholic Church for the abuse and wrongdoing. In 1958, black pastor and activist Clennon Washington King Jr. tried enrolling at the University of Mississippi , which at the time was white, for summer classes;

11663-415: Was an outspoken and high-profile early critic, and several of his novels, in particular Oliver Twist and Hard Times demonstrate his insight into the damage that institutions can do to human beings. Enoch Powell , when Minister for Health in the early 1960s, was a later opponent who was appalled by what he witnessed on his visits to the asylums, and his famous "water tower" speech in 1961 called for

11772-630: Was not until 1828 that the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 was a landmark in the treatment of the mentally ill, as it explicitly changed the status of mentally ill people to patients who required treatment. The Act created the Lunacy Commission , headed by Lord Shaftesbury , focusing on reform of the legislation concerning lunacy. The commission consisted of eleven Metropolitan Commissioners who were required to carry out

11881-586: Was opened approximately in 1850. The creation of this hospital, as of many others, was largely the work of Dorothea Lynde Dix , whose philanthropic efforts extended over many states, and in Europe as far as Constantinople . Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan , an architectural style meant to have curative effect. In the United States and most other developed societies, severe restrictions have been placed on

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