Social predictors of depression are aspects of one's social environment that are related to an individual developing major depression . These risk factors include negative social life events, conflict, and low levels of social support , all of which have been found affect the likelihood of someone experiencing major depression, the length of the depression, or the severity of the symptoms.
165-491: 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 the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in
330-529: 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
495-480: A social context . Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting . There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health . The causes of mental disorders are often unclear. Theories incorporate findings from a range of fields. Disorders may be associated with particular regions or functions of
660-513: A "fuzzy prototype " that can never be precisely defined, or conversely that the concept always involves a mixture of scientific facts and subjective value judgments. Although the diagnostic categories are referred to as 'disorders', they are presented as medical diseases, but are not validated in the same way as most medical diagnoses. Some neurologists argue that classification will only be reliable and valid when based on neurobiological features rather than clinical interview, while others suggest that
825-437: 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
990-460: A category for enduring personality change after a catastrophic experience or psychiatric illness. If an inability to sufficiently adjust to life circumstances begins within three months of a particular event or situation, and ends within six months after the stressor stops or is eliminated, it may instead be classed as an adjustment disorder . There is an emerging consensus that personality disorders, similar to personality traits in general, incorporate
1155-442: A category of relational disorder , where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between children and their parents, between couples, or others. There already exists, under the category of psychosis, a diagnosis of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship with each other. There are
1320-786: 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
1485-501: 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
1650-423: 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,
1815-440: A dimension or spectrum of mood, is subject to some scientific debate. Patterns of belief, language use and perception of reality can become dysregulated (e.g., delusions , thought disorder , hallucinations ). Psychotic disorders in this domain include schizophrenia , and delusional disorder . Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders. Schizotypy
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#17330860705061980-476: A disorder, it generally needs to cause dysfunction. Most international clinical documents use the term mental "disorder", while "illness" is also common. It has been noted that using the term "mental" (i.e., of the mind ) is not necessarily meant to imply separateness from the brain or body . According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ), published in 1994,
2145-427: A disorder. Obsessive–compulsive disorder can sometimes involve an inability to resist certain acts but is classed separately as being primarily an anxiety disorder. Substance use disorder : This disorder refers to the use of drugs (legal or illegal, including alcohol ) that persists despite significant problems or harm related to its use. Substance dependence and substance abuse fall under this umbrella category in
2310-403: A dysfunction in the individual. DSM-IV predicates the definition with caveats, stating that, as in the case with many medical terms, mental disorder "lacks a consistent operational definition that covers all situations", noting that different levels of abstraction can be used for medical definitions, including pathology, symptomology, deviance from a normal range, or etiology, and that the same
2475-399: A few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders, and mood disorders emerge later in the mid-teens. Symptoms of schizophrenia typically manifest from late adolescence to early twenties. The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself, the individual as a whole, and
2640-471: 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,
2805-493: 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, the circadian rhythm , immunological dysfunction, HPA-axis dysfunction and structural or functional abnormalities of emotional circuits. Derived from
2970-483: 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
3135-423: 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;
3300-449: A mental disorder is a psychological syndrome or pattern that is associated with distress (e.g., via a painful symptom ), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however, it excludes normal responses such as the grief from loss of a loved one and also excludes deviant behavior for political, religious, or societal reasons not arising from
3465-416: A mixture of acute dysfunctional behaviors that may resolve in short periods, and maladaptive temperamental traits that are more enduring. Furthermore, there are also non-categorical schemes that rate all individuals via a profile of different dimensions of personality without a symptom-based cutoff from normal personality variation, for example through schemes based on dimensional models. An eating disorder
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#17330860705063630-410: 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
3795-463: A negative event. Another source for the heritability of depression likely comes through the heritability of the social stressors commonly associated with depression. This is true of both independent events and dependent events, with a review by Kendler and Baker (2007) showing heritabilites ranging from 7-39% for many social causes of the adversity associated with depression. When looking at major life events in general, this grows to 20-50% depending on
3960-407: A negative social event due to placing themselves into relationships where these events may be more common. Evidence for the association between negative life events and depression comes largely from case studies and studies that compare the frequency of these events in depressed individuals to rates in people who are representative of the larger population. Negative life events are often reported by
4125-500: A number of uncommon psychiatric syndromes , which are often named after the person who first described them, such as Capgras syndrome , De Clerambault syndrome , Othello syndrome , Ganser syndrome , Cotard delusion , and Ekbom syndrome , and additional disorders such as the Couvade syndrome and Geschwind syndrome . The onset of psychiatric disorders usually occurs from childhood to early adulthood. Impulse-control disorders and
4290-478: 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 ,
4455-513: 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
4620-499: A risk factor for depression, high levels are also widely considered to have protective effects. However, these results are not universal and often come from studies limited to self-reports from the depressed. In today's culture of social networks being tied to social media and with the high numbers of social media users, studies have been conducted recently to determine if there is a relationship between social media use and depression. This topic of research in regard to college students
4785-515: A role in depression. For example, in addition to depression tending to produce negative reactions from others after the fact people with low social support may simply be less interested or less skilled in developing social networks which may help buffer against negative life events. Therefore, a trait that lessons the extent of one's social network may also result in more social adversity or negatively impact one's risk of depression in other, indirect ways. In addition to low levels of support being
4950-693: A separate axis II in the case of the DSM-IV. A number of different personality disorders are listed, including those sometimes classed as eccentric , such as paranoid , schizoid and schizotypal personality disorders; types that have described as dramatic or emotional, such as antisocial , borderline , histrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidant , dependent , or obsessive–compulsive personality disorders. Personality disorders, in general, are defined as emerging in childhood, or at least by adolescence or early adulthood. The ICD also has
5115-414: A severe psychiatric disability. Disability in this context may or may not involve such things as: In terms of total disability-adjusted life years (DALYs), which is an estimate of how many years of life are lost due to premature death or to being in a state of poor health and disability, psychiatric disabilities rank amongst the most disabling conditions. Unipolar (also known as Major) depressive disorder
Major depressive disorder - Misplaced Pages Continue
5280-543: A sleep center for analysis, during which doctors ask for a detailed sleep history and sleep records. Doctors also use actigraphs and polysomnography . Doctors will do a multiple sleep latency test, which measures how long it takes a person to fall asleep. Sleep apnea, when breathing repeatedly stops and starts during sleep, can be a serious sleep disorder. Three types of sleep apnea include obstructive sleep apnea , central sleep apnea , and complex sleep apnea . Sleep apnea can be diagnosed at home or with polysomnography at
5445-644: A sleep center. An ear, nose, and throat doctor may further help with the sleeping habits. Sexual disorders include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others). Impulse control disorder : People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classified as having an impulse control disorder, and disorders such as kleptomania (stealing) or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as
5610-405: A social component. In general, women are at much higher risk of developing depression after a social loss than men. One explanation for this is that women tend to have larger networks of meaningful supporters than men where an important loss can happen. Evidence for this comes primarily from the finding that both sexes are equally likely to become depressed in response to conflict or death within
5775-560: A source of conflict. Both negative life events and chronic stress have each been shown to contribute to the onset of depression, and the two may combine to increase one's risk of depression. For example, acute and chronic stressors were found to increase the likelihood of depression to similar degrees in both men and women in a Spanish sample that compared a depressed group to controls. In addition to their direct effect on depression, both stressors have been suggested to interact, with either chronic stress making individuals more susceptible to
5940-518: A specific time frame. However, it is often hard to distinguish episodic stressors from chronic stressors as the length of many stressors is expected to vary based on individual, environmental, and cultural factors. However, the loss of a loved one can usually be considered a short-term discrete event, and such instances are estimated to result in depression 17-31% of the time. Other examples of episodic stressors include an unexpected loss of employment, robbery, and assault, all of which are known to increase
6105-688: 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
6270-451: A very similar definition. The terms "mental breakdown" or "nervous breakdown" may be used by the general population to mean a mental disorder. The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10 and are nearly absent from scientific literature regarding mental illness. Although "nervous breakdown"
6435-486: Is anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder. Commonly recognized categories include specific phobias , generalized anxiety disorder , social anxiety disorder , panic disorder , agoraphobia , obsessive–compulsive disorder and post-traumatic stress disorder . Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia, or despair
6600-462: Is insomnia , which is described as difficulty falling and/or staying asleep. Other sleep disorders include narcolepsy , sleep apnea , REM sleep behavior disorder , chronic sleep deprivation , and restless leg syndrome . Narcolepsy is a condition of extreme tendencies to fall asleep whenever and wherever. People with narcolepsy feel refreshed after their random sleep, but eventually get sleepy again. Narcolepsy diagnosis requires an overnight stay at
6765-444: 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
Major depressive disorder - Misplaced Pages Continue
6930-463: Is a category used for individuals showing some of the characteristics associated with schizophrenia, but without meeting cutoff criteria. Personality —the fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive . Although treated separately by some, the commonly used categorical schemes include them as mental disorders, albeit on
7095-556: 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
7260-445: 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
7425-422: Is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak.... The nervous patients of yesteryear are the depressives of today. That is the bad news.... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in
7590-474: Is a potential source of both important social support and conflict, both of which are associated with differences in the likelihood of depression. Multiple risk factors for adolescent depression have been identified within the family. Among the strongest is the degree to which conflict is present within a family, with more conflict being associated with greater risk of depression. In addition to this, parental responses to sadness or discontent are also tied to
7755-477: Is a serious mental health condition that involves an unhealthy relationship with food and body image. They can cause severe physical and psychological problems. Eating disorders involve disproportionate concern in matters of food and weight. Categories of disorder in this area include anorexia nervosa , bulimia nervosa , exercise bulimia or binge eating disorder . Sleep disorders are associated with disruption to normal sleep patterns. A common sleep disorder
7920-449: 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
8085-674: 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
8250-452: Is also negatively correlated with social support, but it is unclear whether longer bouts of depression lessen perceived or actual support or if social support helped the depressed return to normal faster. However, the degree to which the relationship between social support and depression is casual is still uncertain. Questions about causality often come from the possibility that social support levels may be tied to other traits that also play
8415-487: 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
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#17330860705068580-523: Is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but no longer by the DSM-IV. Factitious disorders are diagnosed where symptoms are thought to be reported for personal gain. Symptoms are often deliberately produced or feigned, and may relate to either symptoms in the individual or in someone close to them, particularly people they care for. There are attempts to introduce
8745-645: 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, 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
8910-671: Is available. Reactions to negative feedback and reassurance seeking often include increased likelihood of rejection and contribute to low self-esteem levels, potentially prolonging or increasing both one's depression symptoms and the degree to which the depressed engages in feedback seeking. Therefore, although the negativity of these social impacts may be minor relative to what triggered depression, their effects may be significant once symptoms are present. In terms of directly connection these behaviors to depression, reassurance seeking style has been reported to be associated with depression symptoms among those experiencing it. In addition to
9075-502: Is best seen through depressed individuals being more likely to experience more negative social events during their depression than non-depressed individuals or those with other conditions. In particular, depressed individuals are more likely to experience social rejection . However, it is unclear what effect increased rejection has on one's experience with depression. Of the ways depression might lead to increased social stressors, negative feedback seeking and reassurance seeking are two of
9240-700: 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
9405-404: Is currently little direct evidence for this. Although women are typically found to be more sensitive to social loss outside of the nuclear family as a risk factor for depression, supportive social networks have also been shown to be more protective against depression in women. For this reason, Kendler and colleagues suggest that differences in sensitivity to social stressors alone cannot explain
9570-443: 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
9735-444: 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
9900-779: 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,
10065-451: Is exacerbated by the fact that depression is a risk factor for suicide, thereby creating situations where treatment may be lifesaving. For this reason, proponents of the exclusion's removal argue that the judgement of clinicians needs to be unconstrained by whether or not an individual has lost a loved one and that this would be sufficient in preventing its overdiagnosis . A study by Wakefield (2007) compared depression patients whose diagnosis
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#173308607050610230-615: 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
10395-454: 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
10560-456: Is known as major depression (also known as unipolar or clinical depression). Milder, but still prolonged depression, can be diagnosed as dysthymia . Bipolar disorder (also known as manic depression) involves abnormally "high" or pressured mood states, known as mania or hypomania , alternating with normal or depressed moods. The extent to which unipolar and bipolar mood phenomena represent distinct categories of disorder, or mix and merge along
10725-554: Is largely thought to be causal, with the strongest evidence of causation coming from findings that negative events outside of one's control are strongly associated with depression, making it unlikely that depression symptoms had anything to do with the negative event. Additional support comes from twin studies, which allow for researchers to control for endogenous factors that may be related to its onset. However, noncausal associations are also likely as individuals who are more likely to be depressed may increase their chance of experiencing
10890-423: Is moderately heritable with about 35% of differences in one's susceptibility to divorce stemming from genetic differences. Negative social life events outside of the family are also heritable. This is seen in assault (including rape and mugging), troubles getting along with others in social networks, and job loss all being heritable. This connection between depression and heritable negative life events has led to
11055-843: Is negatively correlated with support levels in a longitudinal U.S. sample. This link between depression and a lack of social support and the heritability of aspects of social networks has led to the suggestion that part of depression's heritability likely stems from heritable differences in one's ability to form supportive social networks. As with predictors of depression, differences in the protective factors associated with social network size and satisfaction may be tied to differences in personality. In particular, differences in one's degree of extraversion are often highlighted as one potential mediator, as extraverts are likely to have larger social networks. In line with this reasoning, extraverts are more likely to experience positive life events, especially those that are dependent on one's behavior. However, it
11220-480: 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
11385-399: Is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder involving symptoms such as anxiety or depression, usually precipitated by external stressors . Many health experts today refer to a nervous breakdown as a mental health crisis . In addition to the concept of mental disorder, some people have argued for a return to
11550-659: Is of significant interest due to the high rates of depression reported in this group. For example, in the American College Health Association 's National College Health Assessment for Spring 2019, 46.2% of American undergraduate college students reported feeling "so depressed that it was difficult to function" at any time in the past 12 months. Studies published in the journals Social Science & Medicine in 2017 and Computers in Human Behavior in 2018 have found that problematic or addictive social media use
11715-559: 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
11880-557: 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
12045-659: 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
12210-426: 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
12375-518: Is relatively small compared to environmental differences. Like risk factors for depression, protective factors have also been shown to be heritable. This is seen in both satisfaction with social relationships and the size of supportive networks, with heritability estimates from 17 to 31% depending on the measure and the population. For example, both family and school connectedness are heritable and unable to be fully accounted for by differences in experience alone. They are also linked to depression, which
12540-512: Is seen in that although low parental support is predictive of depression within the family, high social support from one parent may not be enough to provide protective effects in response to conflict with the other. As with the depressed in general, responses to depressed family members are often aversive. This is seen in that parents of the depressed tend to provide less support and neglect their children more than parents of non-depressed individuals. However, depression has also been found to reduce
12705-431: 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,
12870-449: Is still plausible. The World Health Organization (WHO) concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century." A follow-up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery (no longer meeting criteria for
13035-570: Is strongly associated with depression or depressive symptoms. Meanwhile, a study from 2018 in the Journal of Social and Clinical Psychology found that university students who limited time spent on social media for an extended period of time had decreased levels of depression. Another study published in 2018 in the Journal of American College Health found that having close, real-life relationships with social media contacts "was significantly associated with decreased odds of depressive symptoms". The family
13200-498: Is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders. Different risk factors may be present at different ages, with risk occurring as early as during prenatal period. Social predictors of depression Negative social life events have been found to greatly increase one's risk of depression and clinicians are often quick to check if any major life events have preceded their patient's symptoms. This relationship
13365-404: Is that personality traits, especially neuroticism , lead to differences in how individuals respond to major life events due to mediators like rumination. In other words, certain individuals are likely to have lower thresholds for developing major depression due to how they experience different types of adversity, although even those at low risk of depression may experience depression in response to
13530-747: Is the third leading cause of disability worldwide, of any condition mental or physical, accounting for 65.5 million years lost. The first systematic description of global disability arising in youth, in 2011, found that among 10- to 24-year-olds nearly half of all disability (current and as estimated to continue) was due to psychiatric disabilities, including substance use disorders and conditions involving self-harm . Second to this were accidental injuries (mainly traffic collisions) accounting for 12 percent of disability, followed by communicable diseases at 10 percent. The psychiatric disabilities associated with most disabilities in high-income countries were unipolar major depression (20%) and alcohol use disorder (11%). In
13695-518: 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
13860-570: Is true for mental disorders, so that sometimes one type of definition is appropriate and sometimes another, depending on the situation. In 2013, the American Psychiatric Association (APA) redefined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning." The final draft of ICD-11 contains
14025-449: Is unclear whether positive life events are protective against depression. Social factors are also relevant when it comes to diagnosing depression. An exclusion for the diagnosis of depression due to bereavement was originally observed at the back of the DSM-III, noting that because "a full depressive syndrome frequently is a normal reaction to the death of a loved one", the patient's condition
14190-592: 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
14355-502: 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
14520-460: 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
14685-423: The community , Treatments are provided by mental health professionals. Common treatment options are psychotherapy or psychiatric medication , while lifestyle changes, social interventions, peer support , and self-help are also options. In a minority of cases, there may be involuntary detention or treatment . Prevention programs have been shown to reduce depression. In 2019, common mental disorders around
14850-458: 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
15015-472: 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 the person's reported experiences, behavior reported by relatives or friends, and a mental status examination . There is no laboratory test for
15180-466: The DSM and ICD, some approaches are not based on identifying distinct categories of disorder using dichotomous symptom profiles intended to separate the abnormal from the normal. There is significant scientific debate about the relative merits of categorical versus such non-categorical (or hybrid) schemes, also known as continuum or dimensional models. A spectrum approach may incorporate elements of both. In
15345-495: The DSM. Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped. Dissociative disorder : People with severe disturbances of their self-identity, memory, and general awareness of themselves and their surroundings may be classified as having these types of disorders, including depersonalization derealization disorder or dissociative identity disorder (which
15510-520: The ICD). Popular labels such as psychopath (or sociopath) do not appear in the DSM or ICD but are linked by some to these diagnoses. Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder. This includes somatization disorder and conversion disorder . There are also disorders of how a person perceives their body, such as body dysmorphic disorder . Neurasthenia
15675-683: The brain and body. That is the point. In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown. Nerves stand at the core of common mental illness, no matter how much we try to forget them. "Nervous breakdown" is a pseudo-medical term to describe a wealth of stress-related feelings and they are often made worse by the belief that there is a real phenomenon called "nervous breakdown". There are currently two widely established systems that classify mental disorders: Both of these list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that
15840-514: The brain. Disorders are usually diagnosed or assessed by a mental health professional , such as a clinical psychologist , psychiatrist , psychiatric nurse, or clinical social worker , using various methods such as psychometric tests , but often relying on observation and questioning. Cultural and religious beliefs, as well as social norms , should be taken into account when making a diagnosis. Services for mental disorders are usually based in psychiatric hospitals , outpatient clinics , or in
16005-450: The causal relationship between negative life events and depression, as with dependent events there is always the question of whether depression symptoms played a role in their occurrence. Like other types of negative life events, the social experiences that lead to higher probabilities of developing major depression, can either be one-time events or repeated. Episodic events are those with clear beginnings and endings, which usually involve
16170-502: The challenges that come with measuring them. This effect is most strongly felt in women, who tend to have larger support networks and are more likely to become depressed in response to conflict or loss in relationships outside the nuclear family. Depressed individuals tend to have lower levels of both perceived and actual support and may express this to others in ways that may exacerbate one's symptoms and put more strain on one's social relationships. Time spent in major depressive episodes
16335-427: The chance that a parent will act aggressively towards their child, an outcome that is compatible with evolutionary approaches emphasizing depression's role as a potential signal of need or a bargaining strategy. Major depression is estimated to have a moderate heritability of 31-42%, with women having higher estimates than men. One common explanation for why depression risk varies in response to genetic differences
16500-415: 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
16665-838: 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
16830-443: 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 ,
16995-481: 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
17160-409: 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
17325-796: The depressed, with up to 80% of cases of major depression are preceded by some major life event, and symptoms tend to occur within one month of the event if a diagnosis of major depression is made. This high frequency of negative events is also seen relative to representative samples of the non-depressed population, with studies often showing the depressed to have experienced twice as much of these negative experiences. In addition to this, depressed individuals are more likely to have experienced negative life events preceding their symptoms compared to other mental health issues like schizophrenia and bipolar disorder. Although negative social experiences are often reported as preceding depression, most people do not get diagnosed with major depression. Part of this stems from
17490-427: The developmental period. Stigma and discrimination can add to the suffering and disability associated with mental disorders, leading to various social movements attempting to increase understanding and challenge social exclusion . The definition and classification of mental disorders are key issues for researchers as well as service providers and those who may be diagnosed. For a mental state to be classified as
17655-424: The diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period. Less than half go on to experience a new episode of mania or major depression within the next two years. Some disorders may be very limited in their functional effects, while others may involve substantial disability and support needs. In this context,
17820-556: The differing ideological and practical perspectives need to be better integrated. The DSM and ICD approach remains under attack both because of the implied causality model and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years. The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models. Studying comorbidity between disorders have demonstrated two latent (unobserved) factors or dimensions in
17985-503: 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 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
18150-451: 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
18315-496: The eastern Mediterranean region, it was unipolar major depression (12%) and schizophrenia (7%), and in Africa it was unipolar major depression (7%) and bipolar disorder (5%). Suicide, which is often attributed to some underlying mental disorder, is a leading cause of death among teenagers and adults under 35. There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide. The predominant view as of 2018
18480-450: 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 is believed to be caused by a combination of genetic , environmental, and psychological factors, with about 40% of
18645-426: 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
18810-483: 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 a monoamine—can cause depression in those in remission or relatives of people who are depressed, suggesting that decreased serotonergic neurotransmission
18975-524: The effects of episodic events or by negative life events adding to levels of chronic stress. Major depression is about twice as common in women than in men. One often explored explanation for this is that women experience more negative social events than men; however, there is little evidence for this when looking at the relationship between negative events and depression as a whole. That being said, much variability exists when looking negative event type and risk of depression, particularly if they involve
19140-414: 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 ,
19305-477: 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
19470-654: 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
19635-436: 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
19800-452: The extent of marital problems. Although less studied, conflict outside of the family is also associated with depression. This is seen among the Tsimané , who are more likely to be depressed if they are currently in conflict with anyone, especially if that person is outside of their family. The relationship between conflict and depression is also seen through assault. This is seen primarily in
19965-905: The fact that grieving or sadness behavior is often seen as normal and healthy and not worthy of a diagnosis indicating pathology. However, one's history with major depression, levels of social support, gender, sex, and personality differences have all been suggested to play roles in mediating one's sensitivity to pathological depression. The negative life events that lead to depression are often classified as dependent or independent, with dependent events being those an individual has some control over and independent events being those which are mostly due to unavoidable chance. Dependent events typically involve most stressors that result from interactions with people in addition to variables like performance-based job security and avoidable financial problems. They are more strongly associated with depression than independent events when controlling for severity and may be
20130-404: The first time. However, the validity of this statement may be dependent on whether one is focusing on relapse or recurrence, with the evidence from recurrent major depression being more supportive. Although independent events are less associated with depression and social content, they are still positively associated with depression. In addition to this, they have helped contribute evidence for
20295-456: The globe include: depression , which affects about 264 million people; dementia , which affects about 50 million; bipolar disorder , which affects about 45 million; and schizophrenia and other psychoses , which affect about 20 million people. Neurodevelopmental disorders include attention deficit hyperactivity disorder (ADHD) , autism spectrum disorder (ASD) , and intellectual disability , of which onset occurs early in
20460-551: 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
20625-679: The internalizing-externalizing distinction, but also supports the formation of a third dimension of thought disorders such as schizophrenia. Biological evidence also supports the validity of the internalizing-externalizing structure of mental disorders, with twin and adoption studies supporting heritable factors for externalizing and internalizing disorders. A leading dimensional model is the Hierarchical Taxonomy of Psychopathology . There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered. An anxiety disorder
20790-636: 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
20955-437: The likelihood for depression. In addition to differences in the length of stressful events, researchers have also emphasized that different types of events may relate to differences in how stress is experienced. For example, episodic events like romantic breakups, economic hardship, or assault can result in long periods of chronic stress . This may be due to the likelihood that these events are often caused ongoing problems or
21120-433: The likelihood of major depression, with both increased aggression and suppressed aggression towards dysphoric children being associated with greater likelihoods of adolescent depression. Although conflict and social support are often viewed as opposites, it is likely that both are the result of different mechanisms so that high levels of conflict do not necessarily have the same impact as low levels of social support. This
21285-411: The loss of a loved one and major depression share many overlapping symptoms, they are not the same thing and that, therefore, bereavement should not prevent a depression diagnosis. Although depression could still be diagnosed with the bereavement clause in place if the individual was suicidal, psychotic, or had trouble with day to day tasks, proponents of its removal argue that underdiagnosis of depression
21450-407: The loss of a relationship with a loved one, conflict has also been suggested as another way social factors can bring about depression. Divorce, separation, and the threat of either often result in both conflict and depression, and serious marital problems and divorce are two of the strongest predictors of depression. Conflict with other family members is also predictive of depression, although not to
21615-625: The manuals are often broadly comparable, although significant differences remain. Other classification schemes may be used in non-western cultures, for example, the Chinese Classification of Mental Disorders , and other manuals may be used by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual . In general, mental disorders are classified separately from neurological disorders , learning disabilities or intellectual disability . Unlike
21780-448: 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
21945-561: 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
22110-615: The most explored. Both behaviors involve questioning social partners about oneself in ways that are aversive to others, differing in whether the feedback sought is positive or negative Evidence compatible with reassurance seeking and negative feedback seeking increasing social stress and depression symptoms comes from the frequency of these behaviors among the depressed and the responses of others that often accompany these actions. For example, depressed individuals have been found to engage more in both behaviors than non-depressed individuals and may fail to benefit from positive feedback when it
22275-521: The nuclear family, while women are more likely to become depressed in response to the loss of a friend and family members outside of the nuclear family. In addition to this, women may also be more sensitive to depression when conflict exists and is physically expressed as evidenced by women being more likely to be depressed after a physical attack but not men Another potential explanation is that women experience greater strain than men and have fewer ways to manage or lessen their difficulties. However, there
22440-558: The old-fashioned concept of nervous illness. In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, says: About half of them are depressed. Or at least that is the diagnosis that they got when they were put on antidepressants. ... They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains—and they tend to obsess about
22605-497: 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
22770-618: 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
22935-405: 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
23100-474: 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
23265-530: 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
23430-452: The public perception of the level of disability associated with mental disorders can change. Nevertheless, internationally, people report equal or greater disability from commonly occurring mental conditions than from commonly occurring physical conditions, particularly in their social roles and personal relationships. The proportion with access to professional help for mental disorders is far lower, however, even among those assessed as having
23595-436: The result in them, where a quick fix is often not possible. Although it is less often mentioned in case studies, a lack of social support has also been implicated as a form of chronic stress that increases the likelihood of major depression. Like with the previously mentioned example of romantic breakups, a lack of social support may become a form of chronic stress as it is often something that cannot be fixed quickly and may be
23760-419: The result of traits that lead individuals into situations that are more likely to result in depression. In addition to this, they are likely to be more directly related to interpersonal content, at least immediately following when the stressor is felt. Dependent events are also thought to be more strongly associated with major depression symptoms in people who have a history of it than those experiencing it for
23925-425: 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 a person's sleeping habits, eating habits, and general health. A person having a major depressive episode usually exhibits
24090-452: 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 a higher risk of developing clinical depression. There appears to be
24255-457: The risk of suicidal thoughts or attempts. Mental disorder A mental disorder , also referred to as a mental illness , a mental health condition , or a psychiatric disability , is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in
24420-414: The scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is normal ) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms). Common hybrid views argue that the concept of mental disorder is objective even if only
24585-861: 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
24750-437: The sex difference in depression on its own since the larger social networks of women likely reduce their risk of depression. In addition to negative life events leading to depression, researchers have suggested that depression may also worsen one's social environment, which can further elevate the symptoms of major depression and one's risk of experiencing negative events. This connection between depression and social stressors
24915-405: The short-term, with assault often being the event with the highest likelihood of being correlated with depression after the fact. However, long-term affects are also seen, in that childhood assaults (both sexual and physical) are correlated with greater likelihoods of depression later in life. Social support levels have a strong inverse relationship with one's risk of becoming depressed despite
25080-466: The social environment. Some disorders may last a brief period of time, while others may be long-term in nature. All disorders can have a varied course. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with many requiring no medication. While some have serious difficulties and support needs for many years, "late" recovery
25245-470: The stress of having to hide a condition in work or school, etc., by adverse effects of medications or other substances, or by mismatches between illness-related variations and demands for regularity. It is also the case that, while often being characterized in purely negative terms, some mental traits or states labeled as psychiatric disabilities can also involve above-average creativity, non- conformity , goal-striving, meticulousness, or empathy. In addition,
25410-428: The structure of mental disorders that are thought to possibly reflect etiological processes. These two dimensions reflect a distinction between internalizing disorders, such as mood or anxiety symptoms, and externalizing disorders such as behavioral or substance use symptoms. A single general factor of psychopathology, similar to the g factor for intelligence, has been empirically supported. The p factor model supports
25575-438: The study and the outcome being examined. Many examples for of the negative life events often associated with depression being heritable come from within the family and romantic relationships. Within the family, cohesion, organization, expressiveness, activity, control, and conflict are all heritable, with estimates ranging from 18 to 30% depending on the variable. Divorce, which may be particularly likely to result in depression,
25740-593: 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
25905-445: The suggestion that part of the heritability of depression stems from greater risk of experiencing environments more likely to lead to its occurrence. However, it is unlikely to be a complete explanation for the heritability of depression, with one estimate being that the heritability of negative life events account 10-15% of the total heritability of depression. Likewise, the effect of genetic polymoprhisms on negative life effents alone
26070-420: The terms psychiatric disability and psychological disability are sometimes used instead of mental disorder . The degree of ability or disability may vary over time and across different life domains. Furthermore, psychiatric disability has been linked to institutionalization , discrimination and social exclusion as well as to the inherent effects of disorders. Alternatively, functioning may be affected by
26235-469: The use of provisional qualifiers and the use of patient history to balance the risks of over- and under-diagnosis. They argue that by classifying someone as provisionally normal before the two-month cut-off of the bereavement clause and in the absence of dangers like suicidal behavior, a clinician can avoid the costs of a false-positive diagnosis while still monitoring their patient closely for signs of pathological depression as opposed to normal grief. To avoid
26400-449: The whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms—mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it
26565-558: Was better understood as Uncomplicated Beareavement. This exclusion became part of the diagnostic criteria in the DSM-III-R and DSM-IV , where individuals experiencing depression symptoms were not considered depressed if the symptoms were in response to the death of a loved one and ended within two months. However, this bereavement exclusion was removed under DSM V , allowing a depression diagnosis to be made under these conditions. Those in favor of this change argue that while grief related to
26730-447: Was important to prevent overdiagnosis. Like the proponents of removing the exclusion, they emphasize that grieving individuals often experience symptoms used to diagnose major depression; however, they argue that these symptoms can often be resolved without treatment and often fail to become the chronic or recurrent symptoms that should define major depression. Instead of removing the bereavement exclusion, Wakefield and First (2012) favor
26895-687: Was previously referred to as multiple personality disorder or "split personality"). Cognitive disorder : These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia ). Developmental disorder : These disorders initially occur in childhood. Some examples include autism spectrum disorder, oppositional defiant disorder and conduct disorder , and attention deficit hyperactivity disorder (ADHD), which may continue into adulthood. Conduct disorder, if continuing into adulthood, may be diagnosed as antisocial personality disorder (dissocial personality disorder in
27060-407: Was still a risk due to certain severe symptoms not meeting the criteria (e.g., insomnia , rapid weight loss, or trouble concentrating) and the concern that individuals may hide certain symptoms due to fears of being institutionalized. The major risk of underdiagnosis due to the bereavement clause is that it would prevent individuals from getting the treatment they could receive with a diagnosis. This
27225-424: Was triggered by death of a loved one and those whose diagnosis was triggered by a different kind of loss. The study found no major symptomatic difference between the two groups, suggesting the death of a loved one should not be treated differently than other losses. Critics of the change emphasize that the depressive symptoms seen during bereavement are often normal and that the inclusion of the bereavement exclusion
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