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Depression

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 'Factors:

Life events: Unexpected losses, events or challenging situations are part of all our lives, and can cause significant stress. A single stressful event or a series of ongoing events may trigger depression or anxiety at any point in life, even many years later. ‘Traumatic events’ are terrible, unexpected events like accidents, natural disasters, a sudden death or being attacked. These events can result in emotional and psychological trauma, and this can have an impact on all aspects of our wellbeing. While you may not have control over the events themselves, you can control what you do about them. Ignoring them may only make things worse.

Personality: Understanding the association between personality and depression has implications for elucidating etiology and comorbidity, identifying at-risk individuals, and tailoring treatment. We discuss seven major models that have been proposed to explain the relation between personality and depression, and we review key methodological issues, including study design, the heterogeneity of mood disorders, and the assessment of personality. We then selectively review the extensive empirical literature on the role of personality traits in depression in adults and children. Current evidence suggests that depression is linked to traits such as neuroticism/negative emotionality, extraversion/positive emotionality, and conscientiousness. Moreover, personality characteristics appear to contribute to the onset and course of depression through a variety of pathways. Implications for prevention and prediction of treatment response are discussed, as well as specific considerations to guide future research on the relation between personality and depression. A number of research designs can be useful in studying the relation between personality and depressive disorders. The common cause, continuum/spectrum, precursor, and predisposition models would all be supported by family studies demonstrating personality differences between nonaffected relatives of probands with and without a history of depression. The common cause, continuum/spectrum, and precursor models would be supported by twin and genetic association studies demonstrating that the same genes predispose to both personality and depressive disorders. The pathoplasticity model can be evaluated in longitudinal studies of persons with depressive disorders by examining the associations among personality traits and clinical features, course, and treatment response. Specifically, the pathoplasticity model posits that the trait would predict these outcomes even after controlling for initial illness severity and other prognostic factors. Of note, an alternative explanation of such results is that the personality trait is a marker for a more severe, chronic, or etiologically distinct subgroup, rather than having a causal influence on the expression of the disorder.

Medical treatments: Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem. Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it's functioning properly. Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Substance-induced: The relationship between the two disorders is bi-directional, meaning that people who abuse substances are more likely to suffer from depression, and vice versa. People who are depressed may drink or abuse drugs to lift their mood or escape from feelings of guilt or despair. But substances like alcohol, which is a depressant, can increase feelings of sadness or fatigue. Conversely, people can experience depression after the effects of drugs wear off or as they struggle to cope with how the addiction has impacted their life.

Non-psychiatric illnesses: Although depression is recognized as a common problem in primary care, that it is frequently associated with non-psychiatric disorders is not well known. In this study, the charts of all 157 patients at a university family practice center diagnosed with depression during a 12-month period were reviewed retrospectively. In addition to demographic data, the presence of non-psychiatric conditions known to be associated with depression and the physician's initial diagnosis were determined and statistically analyzed. At least one associated non-psychiatric disorder was evident in 47.8 percent of the patients. The use of at least one drug known to be associated with depression was noted in 43.3 percent of the patients. Yet, only 7.6 percent of the charts indicated a recognition by the physicians that the patients had an associated non-psychiatric disorder.

Psychiatric syndromes: The term depression is often used to describe the low or discouraged mood that results from disappointments (eg, financial calamity, natural disaster, serious illness) or losses (eg, death of a loved one). However, better terms for such moods are demoralization and grief. Heredity accounts for about half of the etiology (less so in late-onset depression). Thus, depression is more common among 1st-degree relatives of depressed patients, and concordance between identical twins is high. Also, genetic factors probably influence the development of depressive responses to adverse events. Psychosocial factors also seem to be involved. Major life stresses, especially separations and losses, commonly precede episodes of major depression; however, such events do not usually cause lasting, severe depression except in people predisposed to a mood disorder. People who have had an episode of major depression are at higher risk of subsequent episodes. People who are less resilient and/or who have anxious tendencies may be more likely to develop a depressive disorder. Such people often do not develop the social skills to adjust to life pressures. Depression may also develop in people with other mental disorders.

Historical legacy: Depression and its unipolar varieties are one of the oldest emotional and psychological illnesses known to man. Currently, the World Health Organization estimates that over 300 million people across the globe suffer from the disease. Since written and recorded history began several millennia ago, depression has been diagnosed, treated, and studied. The first recorded instance of the disease was written in Mesopotamian texts in the second century B.C. Understandings of mental illnesses were rudimentary, at best. Ancient Mesopotamians, Chinese, and Egyptian civilizations thought demonic influences caused depression. Depression sufferers were exorcised by priests, shamans, and religious leaders and authorities. Treatments in societies where mental disorders were thought to have their origins in the demonic world and the dark arts were barbaric. Sufferers were put in leg irons, beaten, or starved. In medieval Europe, people thought to have depression were also drowned or burned as witches. Medieval Europeans thought the disorder was contagious, and all sufferers needed to either be destroyed or locked away like prisoners. While the majority of ancient and medieval societies believed depression was something caused by demons and witchcraft, there was always an alternative, enlightened school of thought running throughout recorded history. The ancient Romans and several Greek physicians thought depression was a mental disorder, caused by grief or blood and bile imbalances. The cure was exercise, music, hydrotherapy, or a primitive form of behavioral therapy, where good behavior was rewarded. In the 18th and 19th centuries, views on depression took a rather grim turn. During this period, people with the disorder were thought to have a weak temperament which was inherited; therefore, there was no cure and nothing anyone could do for people with the disease. Patients were locked up in asylums or condemned to a life of poverty and homelessness.

In the latter part of the 19th century, the medical community began to experiment with different techniques for treating the disorder. Immersion therapy, spinning stools, lobotomies, and electroshock therapy (ECT) were all invented and deployed at this time.

Lobotomies and ECT were in their infancy, and use was primitive. Lobotomy patients were sometimes rendered comatose or even killed with a botched procedure. With ECT, inexperienced doctors sometimes used too high of a voltage or failed to take necessary safety precautions which are commonplace with the practice now.

In the early 1900s, Sigmund Freud proffered the theory that depression had its roots in the concept of ‘loss,’ either real or perceived within the patient’s subconscious. Freud was one of the first psychologists of the modern era who developed a form of talk therapy for depressed patients. During Freud’s time, other schools of thought, mainly physicians, still believed depression had its roots in imbalanced brain chemistry.

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Measures: The SCID is a semi-structured interview for making the major Axis I DSM-III-R diagnoses. It is administered by a clinician and includes an introductory overview followed by nine modules, seven of which represent the major axis I diagnostic classes. Because of its modular construction, it can by adapted for use in studies in which particular diagnoses (e.g., depression only) are of interest. The output of the SCID is recorded as the presence or absence of each of the disorders being considered, for current episode (past month) and for lifetime occurrence. The reader is referred to Spitzer et al. (1992) and Williams et al. (1992) for more detailed information about the interview and its psychometrics. The Beck Depression Inventory (BDI) is a list of 21 symptoms and attitudes that are each rated in intensity. Examples include: mood, pessimism, sense of failure, lack of satisfaction, guilt feelings, self-dislike, etc. It is scored by summing the ratings given to the 21 items. Although originally designed to be administered by trained interviewers, it is most often self-administered and takes 5-10 minutes. This instrument has been used to measure severity of depression in depressed samples but has also been used to assess depression in general population samples. It is also associated with other self-report measures of depression. The reader is referred to Beck, Steer & Garbin (1988) for an overview of the measure and its applications.

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Connections

Alcoholism: Alcohol abuse and depression are very closely correlated. Many depression sufferers, especially ones who have not been properly diagnosed, often turn to alcohol to escape. Desperate to feel better or numb the pain, even for a little while, depression sufferers often use the pleasurable effects of alcohol for that purpose. People are often seduced by the sedative effects of alcohol and use it as a kind of medication to help distract them from persistent feelings of sadness. Alcohol may appear to temporarily relieve some of the symptoms of depression. However, it ultimately worsens depression on a long-term basis. As consequences of alcohol abuse persist, depression worsens. This often leads to a damaging cycle of abusing alcohol to self-medicate symptoms of depression while the depression worsens due to the continued alcohol abuse. Alcohol is a central nervous system depressant that slows the body down. Studies have consistently shown that alcohol use increases both the duration and the severity of depressive episodes. It also increases the likelihood, frequency, and severity of suicidal thoughts. Alcohol can also cause other stressors in life such as career and family problems that worsen depression. If the depressed person than turns to alcohol to make themselves feel better, a vicious cycle has started that can be extremely difficult to break out of.

Bullying: The effects of bullying can be catastrophic and depression can be a major side-effect. Depression, if left untreated, can cause major problems throughout your child's life- from the teenage years and well into adulthood. He or she will not only do poorly in school, which can affect their ability to attend college, but they may also have a difficult time navigating life in general. As they grow older, the depression will often get worse and many will turn to alcohol and drugs as a coping mechanism. This can lead to serious mental health issues.

Creative thinking: Perhaps mood disorder is a boon to creativity, but this benefit is typically buried under a host of disadvantages and so doesn’t show up in most studies. (Compare with the clutch of successful people who attribute their success to struggles in early life; their existence doesn’t mean that we should expect disadvantage to reliably yield success.) If low mood does have a (often hidden) beneficial effect on creativity, one possibility is that it can initiate reflections that lead to new ways of seeing the world. This could explain why the deep dives of depression were associated with higher creativity but the chronic, less extensive dip of dysthemia was not. Moreover, by combining lows with motivation-charged highs, perhaps bipolar disorder combines the deep dives with a return to the surface, giving a chance for these insights to manifest.

Stress management techniques: Stress management techniques are useful in coping with depression. Stress relief can also help prevent depressive symptoms from developing. “A depressed person is compromised in dealing with problematic situations,” says Stacey Stickley, a licensed professional counselor practicing in Ashburn, Virginia. “When a person is dealing with depression, things may seem more negative than they really are. Events that would have been taken in stride may seem more problematic or impossible to handle. The idea of taking action on things may require more of a person’s resources, resources that are already compromised due to the depression.” Stress can result from many personal, professional, and environmental causes. The best way to cope with stress is by managing the stressors that are within your control. For example, you could walk away from toxic relationships or leave a stressful job. You can also practice accepting or coping with the stressors that are out of your control, with actions like meditating or drinking less caffeine and alcohol.

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Epidemiology: Epidemiological data are reviewed on the prevalence, course, socio-demographic correlates, and societal costs of major depression throughout the world. Major depression is estimated in these surveys to be a commonly-occurring disorder. Although estimates of lifetime prevalence and course vary substantially across countries for reasons that could involve both substantive and methodological processes, the cross-national data are clear in documenting meaningful lifetime prevalence with wide variation in age-of-onset and high risk of lifelong chronic-recurrent persistence. Depending on the way it is defined depression can be seen as a state of mood, as a symptom, as a syndrome or as a clinical diagnosis. Epidemiological studies show that depression is the most common mental disorder in man. Up to 4% of men and 8% of women suffer from a clinically significant depressive disorder, while depressive symptoms are much more common. The occurrence of depression is associated with factors such as age, marital status, social class, and social conditions. In Finland, only one third of persons suffering from depression are actually being treated for their disorder.

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