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130-797: Prevalence rates are estimated at 2% to 5% in adults, though the condition typically manifests in childhood with symptoms worsening in advanced age, at which point collected items have grown excessive and family members who would otherwise help to maintain and control the levels of clutter have either died or moved away. People with hoarding disorder commonly live with other complex and/or psychological disorders such as depression , anxiety , obsessive compulsive disorder (OCD), autism spectrum disorder (ASD), and/or attention deficit hyperactivity disorder (ADHD). Other factors often associated with hoarding include alcohol dependence and paranoid, schizotypal and avoidant traits. Collecting and hoarding may seem similar, but there are distinct characteristics that set

260-532: 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

390-428: A seasonal affective disorder . Outside the mood disorders: borderline personality disorder often features an extremely intense depressive mood; adjustment disorder with depressed mood is 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; and posttraumatic stress disorder ,

520-544: A "rational response to global conditions", according to Ann Cvetkovich . Psychogeographical depression overlaps somewhat with the theory of "deprejudice", a portmanteau of depression and prejudice proposed by Cox, Abramson, Devine, and Hollon in 2012, who argue for an integrative approach to studying the often comorbid experiences. Cox, Abramson, Devine, and Hollon are concerned with the ways in which social stereotypes are often internalized , creating negative self-stereotypes that then produce depressive symptoms. Unlike

650-442: 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

780-791: 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

910-420: A combination of genetic and environmental factors. Rates of hoarding increase significantly with age, and people over the age of 54 are three times as likely to meet criteria for hoarding disorder. However, hoarding symptoms typically manifest in early childhood, and worsen to the point of becoming clinically significant during middle age. Over half of hoarders report the onset of hoarding as being associated with

1040-506: 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

1170-424: 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,

1300-420: A diagnosis of a psychiatric or medical condition which may benefit from treatment. The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, because the risk-benefit ratio is poor. Physical activity has a protective effect against the emergence of depression in some people. There

1430-687: A distinct form of hoarding in which they were more likely to hoard "bizarre items" and perform compulsive rituals associated with their hoarding behavior, such as rituals around checking items or rituals to be performed before discarding them. However, the majority of hoarders do not show OCD symptoms. Hoarding has been found to be correlated with depression , social anxiety , compulsive grooming disorders such as trichotillomania , bipolar disorder , reduced cognitive and affective empathy and compulsive shopping . Hoarders have higher than average rates of traumatic past events, particularly those associated with loss or deprivation. Past events which occurred before

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1560-561: A distinction between endogenous (internally caused) and exogenous (externally caused) types. Other psycho-dynamic theories were proposed. Existential and humanistic theories represented a forceful affirmation of individualism. Austrian existential psychiatrist Viktor Frankl connected depression to feelings of futility and meaninglessness . Frankl's logotherapy addressed the filling of an "existential vacuum" associated with such feelings, and may be particularly useful for depressed adolescents. Researchers theorized that depression

1690-415: A greater lifetime incidence of having possessions taken by force, forced sexual activity as either an adult or a child, including forced sexual intercourse, and being physically handled roughly during childhood, thus proving traumatic events are positively correlated with the severity of hoarding. For each five years of life the participant would rate the severity of their hoarding symptoms from 1 to 4, 4 being

1820-550: A group of US clinicians in 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

1950-474: 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,

2080-411: 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,

2210-462: A hoarding state. A UK charity called Hoarding UK has found that people have very different ideas about what it means to have a cluttered home. For some, a small pile of things in the corner of an otherwise well-ordered room constitutes serious clutter. For others, only when the narrow pathways make it hard to get through a room does the clutter register. To ensure an accurate sense of a clutter problem and encourage people to get support, Hoarding UK uses

2340-557: 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

2470-489: A loss of motivation or interest in those activities. Depressed mood is a symptom of some mood disorders , also categorized and called depression , such as major depressive disorder , bipolar disorder and dysthymia . It is a normal temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical diseases and a side effect of some drugs and medical treatments. It may feature sadness , difficulty in thinking and concentration, or

2600-410: A main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (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

2730-426: 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;

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2860-439: A medical diagnosis (cancer, HIV, diabetes, etc.), bullying, loss of a loved one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation, or catastrophic injury . Similar depressive symptoms are associated with survivor's guilt . Adolescents may be especially prone to experiencing a depressed mood following social rejection , peer pressure, or bullying. Depression in childhood and adolescence

2990-447: A mental disorder that sometimes follows trauma , is commonly accompanied by depressed mood. Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may create depressive conditions. Given the lived experiences of marginalized peoples, ranging from conditions of migration , class stratification , cultural genocide , labor exploitation , and social immobility , depression can be seen as

3120-771: 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

3250-931: A more anxiously attached interpersonal style is associated with more compulsive buying and greater acquisition of free items and these relationships are mediated by stronger distress intolerance and greater anthropomorphism . Anthropomorphism has been shown to increase both the sentimental value and perceived utility of items. These findings indicate that individuals may over-value their possessions to compensate for thwarted interpersonal needs. Feeling alone and/or disconnected from others may impair people's ability to tolerate distress and increase people's tendencies to see human-like qualities in objects. The humanness of items may increase their perceived value and individuals may acquire these valued objects to alleviate distress. Individuals with hoarding problems have been shown to have greater interpersonal problems than individuals who only excessively acquire possessions, which provides some support for

3380-415: 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

3510-616: 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

3640-436: A process of self-recognition and identifying familiar stimuli. By maintaining one's personal past and identity, it is a technique that stimulates people to view their lives in a more objective and balanced way, causing them to pay attention to positive information in their life stories, which would successfully reduce depressive mood levels. There is limited evidence that continuing antidepressant medication for one year reduces

3770-482: 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 ,

3900-518: 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

4030-472: A result of these factors. It is possible that some early generation beta-blockers induce depression in some patients, though the evidence for this is weak and conflicting. There is strong evidence for a link between alpha interferon therapy and depression. One study found that a third of alpha interferon-treated patients had developed depression after three months of treatment. ( Beta interferon therapy appears to have no effect on rates of depression.) There

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4160-436: A rotating cast of professional psychologists and organizers who specialize in hoarding disorder. A similar show, Hoarding: Buried Alive ran from 2010 to 2014 on TLC . Hoarders: Canada followed a similar format to Hoarders and Hoarding: Buried Alive. Britain's Biggest Hoarders is an ongoing series hosted by Jasmine Harman , the daughter of a hoarder, and follows her as she and a team of experts seek to help others with

4290-508: A significant increase or decrease in appetite and time spent sleeping. People experiencing depression may have feelings of dejection or hopelessness and may experience suicidal thoughts . Depression can either be short term or long term. Adversity in childhood , such as bereavement, neglect, mental abuse, physical abuse, sexual abuse, or unequal parental treatment of siblings, can contribute to depression in adulthood. Childhood physical or sexual abuse in particular significantly correlates with

4420-434: A study on academic journal Molecular Psychiatry that depression is not caused by a serotonin imbalance in the human body, unlike what most of the psychiatry community points to, and that therefore anti-depressants do not work against the illness. However, such study was met with criticism from some psychiatrists, who argued the study's methodology used an indirect trace of serotonin, instead of taking direct measurements of

4550-459: A traumatic life event, and in this portion of hoarders, the age of onset is much higher. Epidemiological studies have found that hoarding is twice as common in males, although clinical studies on hoarding tend to be predominantly female, suggesting that male hoarders are a significantly understudied and under-treated population. Hoarding is a significant problem around the world and can pose a public health risk when hoarding escalates enough to damage

4680-691: 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

4810-446: 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

4940-400: Is a mental state of low mood and aversion to activity. It affects about 3.5% of the global population , or about 280 million people of all ages (as of 2020). Depression affects a person's thoughts , behavior , feelings , and sense of well-being . Experiences that would normally bring a person pleasure or joy gives reduced pleasure or joy, and the afflicted person often experiences

5070-558: 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

5200-446: 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

5330-454: 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

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5460-675: 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

5590-490: 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

5720-399: 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,

5850-404: Is associated with social phobia , post-traumatic stress disorder , body dysmorphic disorder , and compulsive grooming behaviors like nail-biting and skin-picking . In a 2010 study using data from self-reports of hoarding behavior from 751 participants, it was found most reported the onset of their hoarding symptoms between the ages of 11 and 20 years old, with 70% reporting the behaviors before

5980-445: Is associated with low extraversion , and people who have high levels of neuroticism are more likely to experience depressive symptoms and are more likely to receive a diagnosis of a depressive disorder. Additionally, depression is associated with low conscientiousness. Some factors that may arise from low conscientiousness include disorganization and dissatisfaction with life. Individuals may be more exposed to stress and depression as

6110-446: Is based on 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

6240-417: 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

6370-705: 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

6500-496: Is crucial for the access of treatments. The mhGAP adopted its approach of improving detection rates of depression by training general practitioners. However, there is still weak evidence supporting this training. According to 2011 study, people who are high in hypercompetitive traits are also likely to measure higher for depression and anxiety. The term depression was derived from the Latin verb deprimere , "to press down". From

6630-444: 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

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6760-444: 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

6890-784: 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,

7020-456: 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

7150-404: Is limited evidence suggesting yoga may help some people with depressive disorders or elevated levels of depression, but more research is needed. Reminiscence of old and fond memories is another alternative form of treatment, especially for the elderly who have lived longer and have more experiences in life. It is a method that causes a person to recollect memories of their own life, leading to

7280-794: Is moderately strong evidence that finasteride when used in the treatment of alopecia increases depressive symptoms in some patients. Evidence linking isotretinoin , an acne treatment, to depression is strong. Other medicines that seem to increase the risk of depression include anticonvulsants , antimigraine drugs , antipsychotics and hormonal agents such as gonadotropin-releasing hormone agonist . Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from chronic use. These include alcohol, sedatives (including prescription benzodiazepines ), opioids (including prescription pain killers and illicit drugs such as heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants . Depressed mood can be

7410-484: 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

7540-562: 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

7670-564: 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

7800-663: 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

7930-430: 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

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8060-660: Is shown to be lower than those who do not. Likewise, those from smaller towns and rural areas tend to have higher rates of depression, anxiety, and psychological unwellness. Studies have consistently shown that physicians have had the highest depression and suicide rates compared to people in many other lines of work—for suicide, 40% higher for male physicians and 130% higher for female physicians. Life events and changes that may cause depressed mood includes, but are not limited to, childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education, military service, family, living conditions, marriage, etc.),

8190-541: Is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral dyscontrol instead of the more common sad, empty, or hopeless feelings seen with adults. Children who are under stress, experiencing loss, or have other underlying disorders are at a higher risk for depression. Childhood depression is often comorbid with mental disorders outside of other mood disorders; most commonly anxiety disorder and conduct disorder . Depression also tends to run in families. Depression

8320-434: 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,

8450-469: Is the study of how epigenetics (heritable characteristics that do not involve changes in DNA sequence) contribute to depression. Behavioral theories of depression explain the etiology of depression with behavioral science ; adherents promote the use of behavioral therapies for treatment. Evolutionary approaches to depression are attempts by evolutionary psychologists and evolutionary psychiatrists to use

8580-634: 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

8710-521: 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

8840-492: Is unwilling to part with any of his items even when he becomes destitute. He dies with his collection intact. In Charles Dickens 's Bleak House (1862), London shop owner Krook hoards items, primarily legal documents. He continues to buy items but doesn't sell any, even though he claims he buys to sell later for a profit. Several documents that would resolve a legal case central to the novel's plot are lost among his hoard. Hoarders Depression (mood) Depression

8970-593: 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

9100-540: The DSM-IV , hoarding was listed as a symptom of obsessive–compulsive personality disorder and obsessive–compulsive disorder ; however, hoarding was found to have a relatively weak connection to OCD or OCPD compared to their other symptoms. Due to this evidence, hoarding disorder was separated as its own disorder in the DSM-5 . However, hoarding does frequently co-occur with OCD. OCD patients with hoarding symptoms were found to display

9230-503: 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

9360-462: 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

9490-501: The Patient Health Questionnaire (PHQ-9). Both of these measures are psychological tests that ask personal questions of the participant, and have mostly been used to measure the severity of depression. The Beck Depression Inventory is a self-report scale that helps a therapist identify the patterns of depression symptoms and monitor recovery. The responses on this scale can be discussed in therapy to devise interventions for

9620-484: 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

9750-462: 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

9880-498: The 14th century, "to depress" meant to subjugate or to bring down in spirits. It was used in 1665 in English author Richard Baker's Chronicle to refer to someone having "a great depression of spirit", and by English author Samuel Johnson in a similar sense in 1753. In Ancient Greece, disease was thought due to an imbalance in the four basic bodily fluids, or humors . Personality types were similarly thought to be determined by

10010-559: The Clutter Image Rating, created by R. O. Frost and G. Steketee, a series of pictures of rooms in various stages of clutter – from completely clutter-free to very severely cluttered. The prevalence of hoarding disorder is estimated to be between 2 and 6 percent, although some surveys indicate the lifetime prevalence may be as high as 14%. First-degree relatives of those with hoarding disorder are significantly more likely to report hoarding symptoms, and hoarding likely comes about due to

10140-449: The age of 21. Fewer than 4% of people reported the onset of their symptoms after the age of 40. The data showed that compulsive hoarding usually begins early, but often does not become more prominent until after age 40. Different reasons have been given for this, such as the effects of family presence earlier in life and limits on hoarding imposed by housing situation and lifestyle. The understanding of early onset hoarding behavior may help in

10270-475: The assumption that individuals with hoarding problems may have a stronger motivation to hang onto possessions for support. As possessions cannot provide support in the way humans can and because saving excessively can frustrate other people due to its impact on their quality of life, individuals with hoarding disorder may be caught in a feedback loop. They may save to alleviate distress, but this saving may cause distress, which may lead them to keep saving to alleviate

10400-433: The behaviors apart. Collecting is a hobby often involving the targeted search and acquisition of specific items that form—at least from the perspective of the collector—a greater appreciation, deeper understanding, or increased synergistic value when combined with other similar items. Hoarding, by contrast, typically appears haphazard and involves the overall acquiring of common items that would not be especially meaningful to

10530-545: The chance of death by suicide by two to three times. In 2017, the British Medical Association found that 49% of UK chronic pain patients also had depression. As many as 1/3 of stroke survivors will later develop post-stroke depression . Because strokes may cause damage to the parts of the brain involved in processing emotions, reward, and cognition, stroke may be considered a direct cause of depression. A number of psychiatric syndromes feature depressed mood as

10660-485: The clinician: Likewise, certain cases are assisted by professional organizers as well. Emily Maguire wrote Love Objects in 2021, a novel about a woman with hoarding disorder that focused on the behavior and the consequences of a hoarder being exposed. There have been several television shows that focused on those suspected to have hoarding disorder. Hoarders , an ongoing series by A&E , focuses on helping one or two individual "hoarders" per episode and features

10790-417: 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

10920-846: 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

11050-445: 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 ,

11180-484: 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

11310-411: 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

11440-573: The diagnosis was created. In Nikolai Gogol ’s book Dead Souls (1842), wealthy Plyushkin displays hoarding behaviors. For example, he serves an old cake from years ago to a business partner, having a servant scrape off the mold. He is famous among the locals for his compulsion to find and keep items. Le Cousin Pons , a novella written by Honoré de Balzac in 1846, features Pons, who hoards art and antiques. He collected relatively low-value items, hoping they would become more valuable with time. However, he

11570-587: The disorder. The Hoarder Next Door is a four-part series based in Britain that followed a group of hoarders participating in a treatment program led by psychotherapist Stelios Kiosses. Confessions: Animal Hoarding is a six-episode series aired on Animal Planet that focused on those who hoard animals and their living conditions. Hoarder House Flippers is more focused on the hoarded house, where teams work hard to flip properties that have been hoarded. There have been possible depictions of hoarding in literature before

11700-744: The distress. Only 5% of people with hoarding behaviours receive help (Singh, 2012) and the interventions they do receive focus on clearing items, not treating the disorder. Cognitive-behavioral therapy (CBT) is a commonly implemented therapeutic intervention for compulsive hoarding. As part of cognitive behavior therapy, the therapist may help the patient to: This modality of treatment usually involves exposure and response prevention to situations that cause anxiety and cognitive restructuring of beliefs related to hoarding. Furthermore, research has also shown that certain CBT protocols have been more effective in treatment than others. CBT programs that specifically address

11830-486: The dominant humor in a particular person. Derived from the Ancient Greek melas , "black", and kholé , "bile", melancholia was described as a distinct disease with particular mental and physical symptoms by Hippocrates in his Aphorisms , where he characterized all "fears and despondencies, if they last a long time" as being symptomatic of the ailment. During the 18th century, the humoral theory of melancholia

11960-454: 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

12090-427: 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

12220-421: 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 ,

12350-479: 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

12480-656: 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

12610-489: 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

12740-675: The future to better distinguish hoarding behavior from "normal" childhood collecting behaviors. A second key part of this study was to determine if stressful life events are linked to the onset of hoarding symptoms. Similar to self-harming , traumatized persons may create a problem for themselves in order to avoid their real anxiety or trauma. Facing their real issues may be too difficult for them, so they create an artificial problem (in their case, hoarding) and prefer to battle with it rather than determine, face, or do something about their real anxieties. Hoarders may suppress their psychological pain by hoarding. The study shows that adults who hoard report

12870-404: The genetic reverberations for subsequent generations. Likewise, research by scientists at Emory University suggests that memories of trauma can be inherited, rendering offspring vulnerable to psychological predispositions for stress disorders , schizophrenia , and PTSD . Measures of depression include, but are not limited to: Beck Depression Inventory-11 and the 9-item depression scale in

13000-1030: The global population has depression, according to a report released by the UN World Health Organization (WHO), which shows an 18 percent increase in the number of people living with depression between 2005 and 2015. Depression is a major mental-health cause of disease burden . Its consequences further lead to significant burden in public health , including a higher risk of dementia , premature mortality arising from physical disorders, and maternal depression impacts on child growth and development. Approximately 76% to 85% of depressed people in low- and middle-income countries do not receive treatment; barriers to treatment include: inaccurate assessment, lack of trained health-care providers, social stigma and lack of resources. The stigma comes from misguided societal views that people with mental illness are different from everyone else, and they can choose to get better only if they wanted to. Due to this more than half of

13130-553: 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

13260-522: The integrity of a structure or attract vermin . Accumulated items can block exits during fires and increase the risk of injury. In Japan, hoarder houses are known as "garbage mansions" (ごみ屋敷, gomi yashiki ), and have become a topic of public alarm in Japanese mass media. In the Eastern United States, they are sometimes called Collyer mansions or Collyers, after the infamous Collyer brothers . Under

13390-637: 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

13520-558: The likelihood of experiencing depression over the survivor's lifetime. People who have experienced four or more adverse childhood experiences are 3.2 to 4.0 times more likely to suffer from depression. Poor housing quality, non-functionality, lack of green spaces , and exposure to noise and air pollution are linked to depressive moods, emphasizing the need for consideration in planning to prevent such outcomes. Locality has also been linked to depression and other negative moods. The rate of depression among those who reside in large urban areas

13650-450: The molecule. Moncrieff said that, despite her study's conclusions, no one should interrupt their treatment if they are taking any anti-depressant. 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

13780-450: 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

13910-566: 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

14040-560: The most distressing symptoms of depression. There are multiple schools of depression theory. Beck's cognitive triad theorizes that an individual with depression has "automatic, spontaneous, and seemingly uncontrollable negative thoughts" about the self, the world or environment, and the future. The Tripartite Model of Anxiety and Depression helps to explain the common comorbidity of anxiety and depression by separating symptoms into three groups: negative affect, positive affect, and physiological hyperarousal. The epigenetics of depression

14170-426: The most severe. Of the participants, 548 reported a chronic course, 159 an increasing course and 39 people, a decreasing course of illness. The incidents of increased hoarding behavior were usually correlated to five categories of stressful life events. Although excessive acquiring is not a diagnostic criterion of hoarding, at least two-thirds of individuals with hoarding disorder excessively acquire possessions. Having

14300-905: The motivation of the affected person, organization, acquiring new clutter, and removing current clutter from the home have shown promising results. This type of treatment typically involves in-home work with a therapist combined with between-session homework , the completion of which is associated with better treatment outcomes. Research on internet-based CBT treatments for the disorder (where participants have access to educational resources, cognitive strategies, and chat groups) has also shown promising results both in terms of short- and long-term recovery. Other therapeutic approaches that have been found to be helpful: Individuals with hoarding behaviors are often described as having low motivation and poor compliance levels, and as being indecisive and procrastinators , which may frequently lead to premature termination (i.e., dropout) or low response to treatment. Therefore, it

14430-502: 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

14560-422: The onset of hoarding are correlated to a subject's emotional attachment to physical objects, and past events after the onset of hoarding increase a subject's anxiety around memory. Hoarders are also more likely to have a past with alcohol abuse. The prevalence of different comorbidities is influenced by gender. In men, hoarding is associated with generalized anxiety disorder and tics , while among women, hoarding

14690-668: 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

14820-454: The people with depression do not receive help with their disorders. The stigma leads to a strong preference for privacy. An analysis of 40,350 undergraduates from 70 institutions by Posselt and Lipson found that undergraduates who perceived their classroom environments as highly competitive had a 37% higher chance of developing depression and a 69% higher chance of developing anxiety. Several studies have suggested that unemployment roughly doubles

14950-406: 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

15080-493: The person who is gathering such items in large quantities. People who hoard keep common items that hold little to no meaning or value to others, unlike some collectors, whose items may be of great value to select people. Most hoarders are disorganized, and their living areas are crowded and in disarray. Most collectors can afford to store their items systematically or to have enough room to display their collections. Age, mental state, or finances have caused some collectors to fall into

15210-475: 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

15340-531: 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

15470-440: The resources available to a population to seek comfort, health, stability, and sense of security. The historical memory of this trauma conditions the psychological health of future generations, making psychogeographical depression an intergenerational experience as well. This work is supported by recent studies in genetic science which has demonstrated an epigenetic link between the trauma suffered by Holocaust survivors and

15600-601: The result of a number of infectious diseases, nutritional deficiencies , neurological conditions, and physiological problems, including hypoandrogenism (in men), Addison's disease , Cushing's syndrome , pernicious anemia , hypothyroidism , hyperparathyroidism , Lyme disease , multiple sclerosis , Parkinson's disease , celiac disease , chronic pain, stroke, diabetes, cancer, and HIV. Studies have found that anywhere from 30 to 85 percent of patients suffering from chronic pain are also clinically depressed. A 2014 study by Hooley et al. concluded that chronic pain increased

15730-489: The risk of depression recurrence with no additional harm. Recommendations for psychological treatments or combination treatments in preventing recurrence are not clear. Depression is the leading cause of disability worldwide, the United Nations (UN) health agency reported, estimating that it affects more than 300 million people worldwide – the majority of them women, young people and the elderly. An estimated 4.4 percent of

15860-783: The risk of developing depression. The World Health Organization has constructed guidelines – known as The Mental Health Gap Action Programme (mhGAP) – aiming to increase services for people with mental, neurological and substance-use disorders. Depression is listed as one of conditions prioritized by the programme. Trials conducted show possibilities for the implementation of the programme in low-resource primary-care settings dependent on primary-care practitioners and lay health-workers. Examples of mhGAP-endorsed therapies targeting depression include Group Interpersonal Therapy as group treatment for depression and "Thinking Health", which utilizes cognitive behavioral therapy to tackle perinatal depression. Furthermore, effective screening in primary care

15990-475: 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 episodes of depression. Individuals with bipolar depression are often misdiagnosed with unipolar depression. When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as

16120-865: 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

16250-597: 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

16380-523: The theory of evolution to further understand mood disorders . The biology of depression is the attempt to identify a biochemical origin of depression, as opposed to theories that emphasize psychological or situational causes. Depressed mood may not require professional treatment, and may be a normal temporary reaction to life events, a symptom of some medical condition, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to

16510-558: The theory of "deprejudice", a psychogeographical theory of depression attempts to broaden study of the subject beyond an individual experience to one produced on a societal scale, seeing particular manifestations of depression as rooted in dispossession; historical legacies of genocide , slavery , and colonialism are productive of segregation, both material and psychic material deprivation, and concomitant circumstances of violence, systemic exclusion, and lack of access to legal protections. The demands of navigating these circumstances compromise

16640-637: Was caused by a chemical imbalance in neurotransmitters 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. During the 1960s and 70s, manic-depression came to refer to just one type of mood disorder (now most commonly known as bipolar disorder ) which was distinguished from (unipolar) depression. The terms unipolar and bipolar had been coined by German psychiatrist Karl Kleist . In July 2022, British psychiatrist Joanna Moncrieff , also psychiatrist Mark Horowtiz and others proposed in

16770-673: Was increasingly being challenged by mechanical and electrical explanations; references to dark and gloomy states gave way to ideas of slowed circulation and depleted energy. German physician Johann Christian Heinroth , however, argued melancholia was a disturbance of the soul due to moral conflict within the patient. In the 20th century, the German psychiatrist Emil Kraepelin distinguished manic depression. The influential system put forward by Kraepelin unified nearly all types of mood disorder into manic–depressive insanity . Kraepelin worked from an assumption of underlying brain pathology, but also promoted

16900-671: Was suggested that future treatment approaches, and pharmacotherapy in particular, be directed to address the underlying mechanisms of cognitive impairments demonstrated by individuals with hoarding symptoms. Mental health professionals frequently express frustration regarding hoarding cases, mostly due to premature termination and poor response to treatment. Patients are frequently described as indecisive, procrastinators, recalcitrant, and as having low or no motivation, which can explain why many interventions fail to accomplish significant results. To overcome this obstacle, some clinicians recommend accompanying individual therapy with home visits to help

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