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Depression

ShyamprofileDr. Shyamprasad

Depression

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being People with depressed mood can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, ashamed or restless. They may lose interest in activities that were once pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present. 

Depressed mood is a feature of some psychiatric syndromes such as major depressive disorder, but it may also be a normal reaction to life events such as bereavement, a symptom of some bodily ailments or a side effect of some drugs and medical treatments.

Causes

Life events

Adversity in childhood, such as bereavement, neglect, unequal parental treatment of siblings, physical abuse or sexual abuse, significantly increases the likelihood of experiencing depression over the life course. 

Life events and changes that may precipitate depressed mood include childbirth, menopause, financial difficulties, job problems, a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved one, natural disasters, social isolation, relationship troubles, jealousy, separation, and catastrophic injury.[Adolescents may be especially prone to experiencing depressed mood following social rejection. 

Medical treatments

Certain medications are known to cause depressed mood in a significant number of patients. These include interferontherapy for hepatitis C. 

Non-psychiatric illnesses

Depression (differential diagnoses)

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions and physiological problems, including hypoandrogenism (in men), Addison's disease, Lyme disease, multiple sclerosis, chronic pain, stroke, diabetes, cancer, sleep apnea, and disturbed circadian rhythm. It is often one of the early symptoms of hypothyroidism (reduced activity of the thyroid gland).


Psychiatric syndromes

Depressive mood disorders

A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (MDD; 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 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 When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as 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 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; and posttraumatic stress disorder, an anxiety disorder that sometimes follows trauma, is commonly accompanied by depressed mood. 

Substance use disorder

Depression is sometimes associated with substance use disorder. Both legal and illegal drugs can cause substance use disorder. 

Assessment

Questionnaires and checklists such as the Beck Depression Inventory or the Children's Depression Inventory can be used to detect and assess the severity of depression. 

Treatment

Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition, e.g. of a mood disorder, which may benefit from treatment. Different sub-divisions of depression have different treatment approaches. In the United States, it has been estimated that two thirds of people with depression do not actively try to receive 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. 

Deep brain stimulation (DBS) is a neurosurgical treatment which entails the application of a device into certain parts of the brain. This treatment is still undergoing controlled trials, but it is showing very promising results in regard to treatment for resistant depression,(Soure:Wikepedia)


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