Depression

Medical Author: Peter J. Panzarino, Jr., MD, F.A.P.A.
Medical Editor: Leslie J. Schoenfield, MD, PhD
Medical Revising Author: Dennis Lee, MD
Medical Revising Editor: William C. Shiel, Jr, MD, F.A.C.P., F.A.C.R.

• What is a depressive disorder?
• What are the types of depression?
  • Major Depression
  • Dysthymia
  • Bipolar Disorder (Manic Depression)
    • Symptoms of bipolar disorder and mania
    • Depression Symptoms of Manic Depression
    • Mania Symptoms of Manic Depression
• What are the causes of depression?
• Postpartum Depression
• How is depression diagnosed?
• What treatments are available for depression?
  • Antidepressant medications
  • Electroconvulsive therapy (ECT)
  • Psychotherapies
• What is the general approach to treating depression?
  • What about sexual dysfunction related to antidepressants?
  • What about discontinuing antidepressants?
• What about self-help?
• How can someone help a person who is depressed?
• Where can one seek help for depression?
• What's in the future for depression?
• Depression At A Glance
• Related depression articles on WebMD:
  Depression
  Clinical depression

Women and Depression Medical Author: Carolyn Janet Crandall, MD, FACP Medical Editor: William C. Shiel Jr., MD, FACP, FACR Depression is a complex matter. In recent years, with burgeoning research progress, we are finding out that depression is much more common than many of us thought. At least 15% (and likely more) of women take an antidepressant during their lifetime. Depression is much more common in women than in men, but the reason for this female predominance is unclear. Besides the fact that woman suffer from depression more often than do men, women often think they can "work through" a depression on their own. They may misunderstand the low risk associated with medication treatment of depression, or else they believe that because they are intelligent hard-working people a counselor or psychologist will be of no help. These mistaken beliefs are, unfortunately, common. Medications for depression may sometimes have annoying side effects, such as agitation, insomnia, or drowsiness, but serious reactions are extremely unusual. Women with a true depression are suffering. Such bothersome, non-life threatening side effects, which may lessen soon anyway, are likely to be much more tolerable than untreated depression for many women. Time and again, studies have shown that either counseling or medication therapy, or optimally both together, are extremely effective in safely relieving depression in both women and men. Learn about treatments for depression » Top Searched Depression Terms: symptoms, teen depression, postpartum depression, depression test, signs, types, bipolar depression, suicide

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.

5. 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.
6. In spite of clear research evidence and clinical guidelines regarding therapy, depression is often under-treated. Hopefully, this situation can change for the better.
7. 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.

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Glossary

Depression Center

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