Depression is amental state of lowmood and aversion to activity.[3] It affects about 3.5% of theglobal population, or about 280 million people worldwide, as of 2020.[4] Depression affects a person'sthoughts,behavior,feelings, andsense of well-being.[5] The pleasure or joy that a person gets from certain experiences is reduced, and the afflicted person often experiences a loss of motivation or interest in those activities.[6] People with depression may experiencesadness, feelings of dejection or hopelessness, difficulty in thinking and concentration, or a significant change in appetite or time spent sleeping;suicidal thoughts can also be experienced.
Depression can have multiple, sometimes overlapping, origins. Depression can be a symptom of somemood disorders, some of which are also commonly calleddepression, such asmajor depressive disorder,bipolar disorder anddysthymia.[7] Additionally, depression can be a normal temporary reaction to life events, such as the loss of a loved one. Depression is also a symptom of some physical diseases and a side effect of some drugs and medical treatments.
Adversity in childhood, such as bereavement, neglect, mental abuse, physical abuse, sexual abuse, or unequal parental treatment of siblings, can contribute to depression in adulthood.[8][9] Childhood physical or sexual abuse in particular significantly correlates with the likelihood of experiencing depression over the survivor's lifetime.[10] People who have experienced four or moreadverse childhood experiences are 3.2 to 4.0 times more likely to suffer from depression.[11] Poor housing quality, non-functionality, lack ofgreen spaces, and exposure to noise and air pollution are linked to depressive moods, emphasizing the need for consideration in planning to prevent such outcomes.[12] Locality has also been linked to depression and other negative moods. The rate of depression among those who reside in large urban areas is shown to be lower than those who do not.[13] Likewise, those from smaller towns and rural areas tend to have higher rates of depression, anxiety, and psychological unwellness.[14]
Studies have consistently shown that physicians have had the highest depression and suicide rates compared to people in many other lines of work—for suicide, 40% higher for male physicians and 130% higher for female physicians.[15][16][17]
Life events and changes that may cause depressed mood includes, but are not limited to, childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education, military service, family, living conditions, marriage, etc.), a medical diagnosis (cancer, HIV, diabetes, etc.), bullying, loss of a loved one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation, orcatastrophic injury.[18][19][20][21][22] Similar depressive symptoms are associated withsurvivor's guilt.[23] Adolescents may be especially prone to experiencing a depressed mood followingsocial rejection, peer pressure, or bullying.[24]
Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral dyscontrol instead of the more common sad, empty, or hopeless feelings seen with adults.[25] Children who are under stress, experiencing loss, or have other underlying disorders are at a higher risk for depression. Childhood depression is often comorbid withmental disorders outside of other mood disorders; most commonlyanxiety disorder andconduct disorder. Depression also tends to run in families.[26]
Personality
Depression is associated with lowextraversion,[27] and people who have high levels ofneuroticism are more likely to experience depressive symptoms and are more likely to receive a diagnosis of a depressive disorder.[28] Additionally, depression is associated with low conscientiousness. Some factors that may arise from low conscientiousness include disorganization and dissatisfaction with life. Individuals may be more exposed to stress and depression as a result of these factors.[29]
Side effect of medical treatment
It is possible that some early generationbeta-blockers induce depression in some patients, though the evidence for this is weak and conflicting. There is strong evidence for a link betweenalpha interferon therapy and depression. One study found that a third of alpha interferon-treated patients had developed depression after three months of treatment. (Beta interferon therapy appears to have no effect on rates of depression.) There is moderately strong evidence thatfinasteride when used in the treatment of alopecia increases depressive symptoms in some patients. Evidence linkingisotretinoin, an acne treatment, to depression is strong.[30] Other medicines that seem to increase the risk of depression includeanticonvulsants,antimigraine drugs,antipsychotics andhormonal agents such asgonadotropin-releasing hormone agonist.[31]
Substance-induced
Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from chronic use. These include alcohol, sedatives (including prescriptionbenzodiazepines), opioids (including prescription pain killers and illicit drugs such as heroin), stimulants (such as cocaine and amphetamines), hallucinogens, andinhalants.[32]
Studies have found that anywhere from 30 to 85 percent of patients suffering from chronic pain are also clinically depressed.[37][38][39] A 2014 study by Hooley et al. concluded that chronic pain increased the chance of death by suicide by two to three times.[40] In 2017, the British Medical Association found that 49% of UK chronic pain patients also had depression.[41]
As many as 1/3 of stroke survivors will later developpost-stroke depression. Because strokes may cause damage to the parts of the brain involved in processing emotions, reward, and cognition, stroke may be considered a direct cause of depression.[42]
A number of psychiatric syndromes feature depressed mood as a main symptom. Themood disorders are a group of disorders considered to be primary disturbances of mood. These includemajor depressive disorder (commonly called major depression or clinical depression) where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all activities; anddysthymia, a state of chronic depressed mood, the symptoms of which do not meet the severity of amajor 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.[43] Individuals with bipolar depression are often misdiagnosed with unipolar depression.[44] When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as aseasonal affective disorder.
Outside the mood disorders:borderline personality disorder often features an extremely intense depressive mood;adjustment disorder with depressed mood is a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode;[45] andposttraumatic stress disorder, a mental disorder that sometimes followstrauma, is commonly accompanied by depressed mood.[46]
Inflammatory processes can be triggered by negative cognition or their consequences, such as stress, violence, or deprivation. Negative cognition may therefore contribute to inflammation, which in turn can lead to depression. A 2019 meta-analysis found that chronic inflammation is associated with a 30% increased risk of developingmajor depressive disorder, supporting the link between inflammation andmental health.[47]
Historical legacy
Research suggests possible associations betweenNeanderthal genetics and some forms of depression.[48]
Psychogeographical depression overlaps somewhat with the theory of "deprejudice", a portmanteau of "depression" and "prejudice" proposed by Cox, Abramson, Devine, and Hollon in 2012,[52] who argue for an integrative approach to studying the often comorbid experiences. Cox, Abramson, Devine, and Hollon are concerned with the ways in which socialstereotypes are ofteninternalized, creating negativeself-stereotypes that then produce depressive symptoms.
Unlike the theory of "deprejudice", a psychogeographical theory of depression attempts to broaden study of the subject beyond an individual experience to one produced on a societal scale, seeing particular manifestations of depression as rooted in dispossession; historical legacies ofgenocide,slavery, and colonialism are productive of segregation, both material and psychic material deprivation,[53] and concomitant circumstances of violence, systemic exclusion, and lack of access to legal protections. The demands of navigating these circumstances compromise the resources available to a population to seek comfort, health, stability, and sense of security. The historical memory of thistrauma conditions the psychological health of future generations, making psychogeographical depression anintergenerational experience as well.[citation needed]
This work is supported by recent studies in genetic science which has demonstrated anepigenetic link between the trauma suffered byHolocaust survivors and genetic reverberations in subsequent generations.[54][non-primary source needed]
Measures
Measures of depression include, but are not limited to:Beck Depression Inventory-11 and the 9-item depression scale in thePatient Health Questionnaire (PHQ-9).[55] Both of these measures are psychological tests that ask personal questions of the participant, and have mostly been used to measure the severity of depression. The Beck Depression Inventory is a self-report scale that helps a therapist identify the patterns of depression symptoms and monitor recovery. The responses on this scale can be discussed in therapy to devise interventions for the most distressing symptoms of depression.[6]
Depressed mood may not require professional treatment, and may be a normal temporary reaction to life events, a symptom of some medical condition, or aside 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 which may benefit from treatment.
Physical activity has a protective effect against the emergence of depression in some people.[59] Increased daily step counts have been associated with lower depressive symptoms.[60]
There is limited evidence suggesting yoga may help some people with depressive disorders or elevated levels of depression, but more research is needed.[61][62]
Reminiscence of old and fond memories is another alternative form of treatment, especially for the elderly who have lived longer and have more experiences in life.[63] It is a method that causes a person to recollect memories of their own life, leading to a process of self-recognition and identifying familiar stimuli. By maintaining one's personal past and identity, it is a technique that stimulates people to view their lives in a more objective and balanced way, causing them to pay attention to positive information in their life stories, which would successfully reduce depressive mood levels.[64]
There is limited evidence that continuing antidepressant medication for one year reduces the risk of depression recurrence with no additional harm.[65] Recommendations for psychological treatments or combination treatments in preventing recurrence are not clear.[65]
Depression is the leading cause of disability worldwide, the United Nations (UN) health agency reported, estimating that it affects more than 300 million people worldwide – the majority of them women, young people and the elderly. An estimated 4.4 percent of the global population has depression, according to a report released by the UN World Health Organization (WHO), which shows an 18 percent increase in the number of people living with depression between 2005 and 2015.[66][67][68]
Depression is a major mental-health cause ofdisease burden. Its consequences further lead to significant burden inpublic health, including a higher risk ofdementia, premature mortality arising from physical disorders, and maternal depression impacts on child growth and development.[69] Approximately 76% to 85% of depressed people in low- and middle-income countries do not receive treatment;[70] barriers to treatment include: inaccurate assessment, lack of trained health-care providers,social stigma and lack of resources.[4]
The stigma comes from misguided societal views that people with mental illness are different from everyone else, and they can choose to get better only if they wanted to.[71] Due to this more than half of the people with depression do not receive help with their disorders. The stigma leads to a strong preference for privacy. An analysis of 40,350 undergraduates from 70 institutions by Posselt and Lipson found that undergraduates who perceived their classroom environments as highly competitive had a 37% higher chance of developing depression and a 69% higher chance of developing anxiety.[72] Several studies have suggested that unemployment roughly doubles the risk of developing depression.[73][74][75][76][77]
The World Health Organization has constructed guidelines – known as The Mental Health Gap Action Programme (mhGAP) – aiming to increase services for people with mental, neurological and substance-use disorders.[4] Depression is listed as one of conditions prioritized by the programme. Trials conducted show possibilities for the implementation of the programme in low-resource primary-care settings dependent on primary-care practitioners and lay health-workers.[78]Examples of mhGAP-endorsed therapies targeting depression include Group Interpersonal Therapy as group treatment for depression and "Thinking Health", which utilizescognitive behavioral therapy to tackle perinatal depression.[4] Furthermore, effective screening in primary care is crucial for the access of treatments. The mhGAP adopted its approach of improving detection rates of depression by training general practitioners. However, there is still weak evidence supporting this training.[69]
According to 2011 study, people who are high inhypercompetitive traits are also likely to measure higher for depression and anxiety.[79]
The termdepression was derived from the Latin verbdeprimere, "to press down".[80] From the 14th century, "to depress" meant to subjugate or to bring down in spirits. It was used in 1665 in English authorRichard Baker'sChronicle to refer to someone having "a great depression of spirit", and by English authorSamuel Johnson in a similar sense in 1753.[81]
In Ancient Greece, disease was thought due to an imbalance in the four basic bodily fluids, orhumors. Personality types were similarly thought to be determined by the dominant humor in a particular person. Derived from theAncient Greekmelas, "black", andkholé, "bile",[82]melancholia was described as a distinct disease with particular mental and physical symptoms byHippocrates in hisAphorisms, where he characterized all "fears and despondencies, if they last a long time" as being symptomatic of the ailment.[83]
During the 18th century, the humoral theory of melancholia was increasingly being challenged by mechanical and electrical explanations; references to dark and gloomy states gave way to ideas of slowed circulation and depleted energy.[84] German physicianJohann Christian Heinroth, however, argued melancholia was a disturbance of the soul due to moral conflict within the patient.
In the 20th century, the German psychiatrist Emil Kraepelin distinguished manic depression. The influential system put forward by Kraepelin unified nearly all types of mood disorder intomanic–depressive insanity. Kraepelin worked from an assumption of underlying brain pathology, but also promoted a distinction betweenendogenous (internally caused) andexogenous (externally caused) types.[85]
Other psycho-dynamic theories were proposed.Existential andhumanistic theories represented a forceful affirmation of individualism.[86] Austrian existential psychiatristViktor Frankl connected depression to feelings of futility andmeaninglessness.[87] Frankl'slogotherapy addressed the filling of an "existential vacuum" associated with such feelings, and may be particularly useful for depressed adolescents.[88][89]
Researchers theorized that depression was caused by achemical imbalance in neurotransmitters in the brain, a theory based on observations made in the 1950s of the effects ofreserpine andisoniazid in altering monoamine neurotransmitter levels and affecting depressive symptoms.[90] During the 1960s and 70s, manic-depression came to refer to just one type of mood disorder (now most commonly known asbipolar disorder) which was distinguished from (unipolar) depression. The terms unipolar and bipolar had been coined by German psychiatristKarl Kleist.[85]
In July 2022, British psychiatristJoanna Moncrieff, also psychiatrist Mark Horowtiz and others proposed in a study on academic journalMolecular Psychiatry that depression is not caused by a serotonin imbalance in the human body, unlike what most of the psychiatry community points to, and that therefore anti-depressants do not work against the illness.[91][92] However, such study was met with criticism from some psychiatrists, who argued the study's methodology used an indirect trace of serotonin, instead of taking direct measurements of the molecule.[93] Moncrieff said that, despite her study's conclusions, no one should interrupt their treatment if they are taking any anti-depressant.[93]
See also
Alain Ehrenberg, French sociologist, author ofWeariness of the Self: Diagnosing the History of Depression in the Contemporary Age
^American Psychiatric Association (2013).Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association.[page needed]
^Heim C, Newport DJ, Mletzko T, Miller AH, Nemeroff CB (July 2008). "The link between childhood trauma and depression: insights from HPA axis studies in humans".Psychoneuroendocrinology.33 (6):693–710.doi:10.1016/j.psyneuen.2008.03.008.PMID18602762.S2CID2629673.
^Lindert J, von Ehrenstein OS, Grashow R, Gal G, Braehler E, Weisskopf MG (April 2014). "Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis".International Journal of Public Health.59 (2):359–72.doi:10.1007/s00038-013-0519-5.PMID24122075.S2CID24138761.
^Schmidt PJ (December 2005). "Mood, depression, and reproductive hormones in the menopausal transition".The American Journal of Medicine.118 (12B):54–8.doi:10.1016/j.amjmed.2005.09.033.PMID16414327.
^Davey CG, Yücel M, Allen NB (2008). "The emergence of depression in adolescence: development of the prefrontal cortex and the representation of reward".Neuroscience and Biobehavioral Reviews.32 (1):1–19.doi:10.1016/j.neubiorev.2007.04.016.PMID17570526.S2CID20800688.
^Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J, Dahl RE, et al. (November 1996). "Childhood and adolescent depression: a review of the past 10 years. Part I".Journal of the American Academy of Child and Adolescent Psychiatry.35 (11):1427–1439.doi:10.1097/00004583-199611000-00011.PMID8936909.S2CID11623499.
^"The Depressed Child".Facts for Families. No. 4. The American Academy of Child and Adolescent Psychiatry. July 2013.
^Kotov R, Gamez W, Schmidt F, Watson D (September 2010). "Linking "big" personality traits to anxiety, depressive, and substance use disorders: a meta-analysis".Psychological Bulletin.136 (5):768–821.doi:10.1037/a0020327.PMID20804236.
^American Psychiatric Association (2013).Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Association.[page needed]
^Murray ED, Buttner N, Price BH. (2012) "Depression and Psychosis in Neurological Practice". In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth HeinemannISBN978-1437704341[page needed]
^Rustad JK, Musselman DL, Nemeroff CB (October 2011). "The relationship of depression and diabetes: pathophysiological and treatment implications".Psychoneuroendocrinology.36 (9):1276–86.doi:10.1016/j.psyneuen.2011.03.005.PMID21474250.S2CID32439196.
^Li M, Fitzgerald P, Rodin G (April 2012). "Evidence-based treatment of depression in patients with cancer".Journal of Clinical Oncology.30 (11):1187–96.doi:10.1200/JCO.2011.39.7372.PMID22412144.
^American Psychiatric Association (2000).Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc. p. 355.ISBN978-0890420256.
^Whitley, David S. (24 July 2019). "The archaeology of madness". In Henley, Tracy B.; Rossano, Matt J.; Kardas, Edward P. (eds.).Handbook of Cognitive Archaeology: Psychology in Prehistory. New York: Routledge. p. 462.ISBN9780429950032. Retrieved13 December 2024.As Simonti et al. observed: 'The significant replicated association of Neanderthal SNPs [single nucleotide polymorphisms] with mood disorders, in particular depression, is intriguing since Neanderthal alleles are enriched near genes associated with long-term depression, and human–Neanderthal DNA and methylation differences have been hypothesized to influence neurological and psychiatric phenotypes. [...]' (2016, p. 737)
^Cvetkovich A (2012).Depression: A Public Feeling. Durham, NC: Duke University Press Books. pp. 126–127.ISBN978-0-8223-5238-9.As a story about gaps in the historical record,Lose Your Mother sheds light on the gaps in my own efforts to track the relation between depression and the histories of slavery, genocide, and colonialism that lie at the heart of the founding of U.S. culture. I want depression, too, to be considered part of the 'afterlife of slavery,' but it can be hard to trace the connections between contemporary everyday feelings (especially those of white middle-class people) and the traumatic violence of the past - they might emerge as ghosts or feelings of hopelessness, rather than as scientific evidence or existing bodies of research or material forms of deprivation. [...]Lose Your Mother not only puts the category of depression in contact with histories of racism and colonialism but also lends itself to being read as a text of political depression.
^Cox, William T.L.; Abramson, Lyn Y.; Devine, Patricia G.; Hollon, Steven D. (September 2012). "Stereotypes, Prejudice, and Depression: The Integrated Perspective".Perspectives on Psychological Science.7 (5):427–449.doi:10.1177/1745691612455204.PMID26168502.S2CID1512121.Social psychologists fighting prejudice and clinical psychologists fighting depression have long been separated by the social–clinical divide, unaware that they were facing a common enemy. Stereotypes about others leading to prejudice (e.g., Devine, 1989) and schemas about the self leading to depression (e.g., A. T. Beck, 1967) are fundamentally the same type of cognitive structure.
^Cvetkovich, Ann (2012).Depression: A Public Feeling. Durham, NC: Duke University Press. p. 25.ISBN978-0822352389.OCLC779876753.…the histories of genocide, slavery, and exclusion and oppression of immigrants that seep into our daily lives of segregation, often as invisible forces that structure comfort and privilege for some and lack of resources for others, inequities whose connection to the past frequently remain obscure. These are depressing conditions, indeed, ones that make depression seem not so much a medical or biochemical dysfunction as a very rational response to global conditions.
^Cox, William T.L.; Abramson, Lyn Y.; Devine, Patricia G.; Hollon, Steven D. (September 2012). "Stereotypes, Prejudice, and Depression: The Integrated Perspective".Perspectives on Psychological Science.7 (5):427–49.doi:10.1177/1745691612455204.PMID26168502.S2CID1512121.
^Clark, L.; Watson, D. (1991). "Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications".Journal of Abnormal Psychology.100 (3):316–336.doi:10.1037/0021-843X.100.3.316.PMID1918611.
^Cramer H, Lauche R, Langhorst J, Dobos G (November 2013). "Yoga for depression: a systematic review and meta-analysis".Depression and Anxiety.30 (11):1068–83.doi:10.1002/da.22166.PMID23922209.S2CID8892132.
^Viguer P, Satorres E, Fortuna FB, Meléndez JC (November 2017). "A Follow-Up Study of a Reminiscence Intervention and Its Effects on Depressed Mood, Life Satisfaction, and Well-Being in the Elderly".The Journal of Psychology.151 (8):789–803.doi:10.1080/00223980.2017.1393379.PMID29166223.S2CID21839684.
^Posselt, Julie R.; Lipson, Sarah Ketchen (2016). "Competition, Anxiety, and Depression in the College Classroom: Variations by Student Identity and Field of Study".Journal of College Student Development.57 (8):973–989.doi:10.1353/csd.2016.0094.S2CID151752884.Project MUSE638561.
^Jackson SW (July 1983). "Melancholia and mechanical explanation in eighteenth-century medicine".Journal of the History of Medicine and Allied Sciences.38 (3):298–319.doi:10.1093/jhmas/38.3.298.PMID6350428.
^Blair RG (October 2004). "Helping older adolescents search for meaning in depression".Journal of Mental Health Counseling.26 (4):333–347.doi:10.17744/mehc.26.4.w8u9h6uf5ybhapyl.
^Schildkraut JJ (1965). "The catecholamine hypothesis of affective disorders: A review of supporting evidence".American Journal of Psychiatry.122 (5):509–22.doi:10.1176/ajp.122.5.509.PMID5319766.
