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What is a depressive disorder?

Depressive disorders have been with man since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that accounted for the basic medical physiology of that time. Depression has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the nineteenth century, depression was seen as an inherited weakness of temperament. In the first half of the twentieth century, Freud linked the development (pathogenesis) of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.

In the 1950's and 60's, depression was divided into two types, endogenous and neurotic. Endogenous means that the depression comes from within the body, perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive depression has a clear environmental precipitating factor, such as the death of a spouse, or other significant loss, such as the loss of a job. In the 1970's and 80's, the focus of attention shifted from the cause of depression to its effects on the afflicted people. That is to say, whatever the cause in a particular case, what are the symptoms and impaired functions that experts can agree make up a depressive disorder? Although there is some argument even today (as in all branches of medicines), most experts agree that:

  1. A depressive disorder is a syndrome (group of symptoms) that reflects a sad mood exceeding normal sadness or grief. More specifically, the sadness of depression is characterized by a greater intensity and duration and by more severe symptoms and functional disabilities than is normal.
  2. Depression symptoms are characterized not only by negative thoughts, moods, and behaviors, but also by specific changes in bodily functions (e.g., eating, sleeping, and sexual activity). The functional changes are often called neurovegetative signs.
  3. Certain people with depressive disorder, especially bipolar depression (manic depression), seem to have an inherited vulnerability to this condition.
  4. Depressive disorders are a huge public health problem.
  • In 1990, depression cost the United States 43 billion dollars in both direct costs, which are the treatment costs, and indirect costs, such as lost productivity and absenteeism.
  • In a major medical study, depression caused significant problems in the functioning of those affected more often than did arthritis, hypertension, chronic lung disease, and diabetes, and in two categories of problems, as often as coronary artery disease.
  • Depression can increase the risks for developing coronary artery disease, HIV, asthma, and some other medical illnesses. Furthermore, it can increase the morbidity (illness) and mortality (death) from these conditions.
  1. Depression is usually first identified in a primary care setting, not in a mental health practitioner's office. Moreover, it often assumes various disguises, which causes depression to be frequently under-diagnosed.
  2. In spite of clear research evidence and clinical guidelines regarding therapy, depression is often under-treated. Hopefully, this situation can change for the better.
  3. For full recovery from a mood disorder, regardless of whether there is a precipitating factor or it seems to come out of the blue, treatments with medications and/or electroconvulsive therapy (ECT) (see discussion below) and psychotherapy are necessary.

What are the types of depression?

Depressive disorders come in different forms, just as do other illnesses, such as heart disease and diabetes. Three of the most common types of depressive disorders are discussed below. However, remember that within each of these types, there are variations in the number, severity, and persistence of symptoms.

Major Depression

Major depression is characterized by a combination of symptoms, including sad mood (see symptom list), that interfere with the ability to work, sleep, eat, and enjoy once-pleasurable activities. Disabling episodes of depression can occur once, twice, or several times in a lifetime.

Dysthymia

Dysthymia is a less severe type of depression. It involves long-term (chronic) symptoms that do not disable, but yet prevent the affected person from functioning at "full steam" or from feeling good. Sometimes, people with dysthymia also experience episodes of major depression. This combination of the two types of depression is referred to as double-depression.

Bipolar Disorder (Manic Depression)

Another type of depression is bipolar disorder, which was formerly called manic-depressive illness or manic depression. This condition shows a particular pattern of inheritance. Not nearly as common as the other types of depressive disorders, bipolar disorder involves cycles of depression and mania, or elation. Bipolar disorder is often a chronic, recurring condition. Sometimes, the mood switches are dramatic and rapid, but most often they are gradual.

When in the depressed cycle, the person can experience any or all of the symptoms of a depressive disorder. When in the manic cycle, any or all of the symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when an individual is in a manic phase.

A significant variant of bipolar disorder is designated as bipolar II. (The usual form of bipolar disorder is referred to as bipolar I.) Bipolar II is a syndrome in which the affected person has repeated depressive episodes punctuated by what is called hypomania (mini-highs). These euphoric states in bipolar II do not fully meet the criteria for the complete manic episodes that occur in bipolar I.

For more information about this condition, please read the Bipolar Disorder artcile.

Symptoms of depression and mania

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms and some many symptoms. The severity of symptoms also varies with individuals.

Depression Symptoms of Manic Depression

  • Persistently sad, anxious, or "empty" mood.
  • Feelings of hopelessness, pessimism.
  • Feelings of guilt, worthlessness, helplessness.
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex.
  • Insomnia, early-morning awakening, or oversleeping.
  • Decreased appetite and/or weight loss, or overeating and weight gain.
  • Fatigue, decreased energy, being "slowed down."
  • Thoughts of death or suicide, suicide attempts.
  • Restlessness, irritability.
  • Difficulty concentrating, remembering, making decisions.
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

Mania Symptoms of Manic Depression

  • Inappropriate elation.
  • Inappropriate irritability.
  • Severe insomnia.
  • Grandiose notions.
  • Increased talking speed and/or volume.
  • Disconnected and racing thoughts.
  • Increased sexual desire.
  • Markedly increased energy.
  • Poor judgment.
  • Inappropriate social behavior.

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