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Signs and symptoms An lithograph of a woman diagnosed with depression Major depression significantly affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health.
Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred.
These symptoms include delusions or, less commonly, hallucinationsusually unpleasant. Insomnia is common among the depressed. In the typical pattern, a person wakes very early and cannot get back to sleep. They may be described as clingy, demanding, dependent, or insecure.
The —92 National Comorbidity Survey US reports that half of those with major depression also have lifetime anxiety and its associated disorders such as generalized anxiety disorder. Depression and pain often co-occur. The diagnosis of depression is often delayed or missed, and the outcome can worsen if the depression is noticed but completely misunderstood.
People with major depression are less likely to follow medical recommendations for treating and preventing cardiovascular disorderswhich further increases their risk of medical complications.
The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression. The preexisting vulnerability can be either genetic  implying an interaction between nature and nurtureor schematicresulting from views of the world learned in childhood.
Childhood trauma also correlates with severity of depression, lack of response to treatment and length of illness. However, some are more susceptible to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility.
However, since the s, results have been inconsistent, with three recent reviews finding an effect and two finding none. A study found 44 areas within the chromosomes that were linked to MDD. Therapies associated with depression include interferonsbeta-blockersisotretinoincontraceptives cardiac agents, anticonvulsantsantimigraine drugsantipsychoticsand hormonal agents such as gonadotropin-releasing hormone agonist.
Biology of depression and Epigenetics of depression The pathophysiology of depression is not yet understood, but the current theories center around monoaminergic systems, the circadian rhythmimmunological dysfunction, HPA axis dysfunction and structural or functional abnormalities of emotional circuits.
The monoamine theory, derived from the efficacy of monoaminergic drugs in treating depression, was the dominant theory until recently. The theory postulates that insufficient activity of monoamine neurotransmitters is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas.
Firstly, acute depletion of tryptophana necessary precursor of serotonina monoamine, can cause depression in those in remission or relatives of depressed patients; this suggests that decreased serotonergic neurotransmission is important in depression.
Third, decreased size of the locus coeruleusdecreased activity of tyrosine hydroxylaseincreased density of alpha-2 adrenergic receptorand evidence from rat models suggest decreased adrenergic neurotransmission in depression.
Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive that controls, the finding of increased jugular 5-HIAA in depressed patients that normalized with SSRI treatment, and the preference for carbohydrates in depressed patients.
The first model proposed is the "Limbic Cortical Model", which involves hyperactivity of the ventral paralimbic regions and hypoactivity of frontal regulatory regions in emotional processing. Rating scales for depression A diagnostic assessment may be conducted by a suitably trained general practitioneror by a psychiatrist or psychologist who records the person's current circumstances, biographical history, current symptoms, and family history.
The broad clinical aim is to formulate the relevant biological, psychological, and social factors that may be impacting on the individual's mood. The assessor may also discuss the person's current ways of regulating mood healthy or otherwise such as alcohol and drug use.
The assessment also includes a mental state examinationwhich is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimismself-harm or suicide, and an absence of positive thoughts or plans.
A review found that non-psychiatrist physicians miss about two-thirds of cases, though this has improved somewhat in more recent studies. 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.
Testosterone levels may be evaluated to diagnose hypogonadisma cause of depression in men. No biological tests confirm major depression. There are several potential biomarkers, including brain-derived neurotrophic factor and various functional MRI fMRI techniques.
One study developed a decision tree model of interpreting a series of fMRI scans taken during various activities. However, much more research is needed before these tests can be used clinically. At least one of these must be present to make a diagnosis of major depressive episode.
The category Depressive Disorder Not Otherwise Specified is diagnosed if the depressive episode's manifestation does not meet the criteria for a major depressive episode.
The ICD system does not use the term major depressive disorder but lists very similar criteria for the diagnosis of a depressive episode mild, moderate or severe ; the term recurrent may be added if there have been multiple episodes without mania.
Major depressive episode A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks.The latest news on healthcare advancements and research, as well as personal wellness tips.
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