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. Depressed people may feel sad, anxious, empty, hopeless, worried, helpless, worthless, guilty, irritable, hurt, or restless. They may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details, or making decisions, and may contemplate or attempt suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains, or digestive problems that are resistant to treatment may also be present.
Depressed mood is not necessarily a psychiatric disorder. It 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. Depressed mood is also a primary or associated feature of certain psychiatric syndromes such as clinical depression.
Life events and changes that may precipitate depressed mood include childbirth, menopause, financial difficulties, job problems, relationship troubles, separation, bereavement and catastrophic injury.
Certain medications are known to cause depressed mood in a significant number of patients. These include hepatitis C drug therapy and some drugs used to treat high blood pressure, such as beta-blockers or reserpine.
Depressed mood can be the result of a number of infectious diseases, 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). For a discussion of non-psychiatric conditions that can cause depressed mood, see Depression (differential diagnoses).
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 depressive episodes. 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 commonly features depressed 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.
There is an increasing focus on prevention of mental disorders. Research has shown a reduction in incidence of new cases of depressive disorders when people participated in therapeutic interventions, for instance by 22% and 38% in meta-analyses. In a study of patients with sub-threshold depression, those who received minimal-contact psychotherapy had an incidence of a major depressive disorder one year later a third lower (an incidence rate of 12% rather than 18%) than the control group. Such interventions also save costs. The Netherlands mental health care system provides preventive interventions, such as the Coping with Depression course for people with subthreshold depression.
A meta-analysis showed that people who followed this course had a 38% lower incidence of developing a major depressive disorder than the control group. A stepped-care intervention (watchful waiting, Cognitive behavioral therapy (CBT) and medication for some) achieved a 50% lower incidence rate in a patient group aged 75 or older. One study on depression found a neutral effect compared to personal, social, and health education, and included a comment on potential for increased depression scores from people who have received CBT due to greater self recognition and acknowledgement of existing symptoms of depression and especially negative thinking styles. Another study also saw a neutral result.
A depression rating scale is a psychiatric measuring instrument having descriptive words and phrases that indicate the severity of depression symptoms for a time period.[1] When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis. Several rating scales are used for this purpose.
A full patient medical history, physical assessment, and thorough evaluation of symptoms helps determine the cause of the depression. Standardized questionnaires can be helpful such as the Hamilton Rating Scale for Depression, and the Beck Depression Inventory.
A doctor generally performs a medical examination and selected investigations to rule out other causes of symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism, basic electrolytes, and serum calcium to rule out 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 are often ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism, a cause of depression in men. Subjective cognitive complaints appear in older depressed people, but they can also be indicative of 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. Investigations are not generally repeated for a subsequent episode unless there is a medical indication.
A depressed mood may not require any professional treatment. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition by a counselor or doctor, which may benefit from treatment. Different sub-divisions of depression have different treatment approaches.
About 44% of American college students report feeling symptoms of depression. This data suggests that traditional college aged students may be at high risk for depression or depressed mood.
Each year 44 colleges and universities use random sampling to administer the American College Health Association's (ACHA) National College Health Assessment (NCHA) survey to 28,000 students. This assessment surveys students' health status and behavior, including depression and depressive symptoms, for their previous academic year. Based on the findings, the rates of students reporting having been diagnosed with depression have increased from 10% in 2000 to 21% in 2011. In 2011, female students reported depressive symptoms, including 22% feeling that things were hopeless; 23% feeling lonely; and 26% feeling very sad within the preceding two weeks to 21% in 2011. Women are at higher risk than men to experience depression.
Offenders have very high rates of mental ill health with recent estimates suggesting that between 50-70% of individuals serving custodial sentences have some diagnosable unipolar depression. The way depression is managed in prisons has also been the topic of much discussion. An American study of 5,305 Texan prisoners with a diagnosed depressive disorder noted considerable variation in prescribing patterns and use of psychosocial interventions between prison instituitions. The study showed that just over a fifth of patients with depression remained untreated despite a confirmed diagnosis. Similar concerns have been voiced in the UK by John Podmore, the former Head of Community Prisons and Transitional Facilities, noting that, 'Even the best prisons with the best regimes and most committed staff will struggle to create an environment where anxiety and depression do not flourish.'
It is important that clinicians/healthcare workers working with patients within the criminal justice system, assess and manage patients with depression effectively and ensure that underlying prejudices that they may have do not prejudice the care they provide. According to UK national clinical guidelines, both pharmacological and non-pharmacological treatments should be provided to incarcerated patients in the same manner as all other patients.
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