What is Depression Disorder Main Stress

What is Depression Disorder Main Stress

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What is Depression Disorder Main StressWhat is Depression Disorder Main Stress
What is Depression Disorder Main Stress are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Exact cause is unknown but probably involves heredity, changes in neurotransmitter levels, altered neuroendocrine function, and psychosocial factors. Diagnosis is based on history. Treatment consists of drugs, psychotherapy or both and sometimes electroconvulsive therapy.

The term depression is often used to describe the low or discouraged mood that results from disappointments (eg, financial calamity, natural disaster, serious illness) or losses (eg, death of a loved one). However, better terms for such moods are demoralization and grief.

However, events and stressors that cause demoralization and grief can also precipitate a major depressive episode, particularly in vulnerable people (eg, those with a past history or family history of major depression).

Etiology
Exact cause of depressive disorders is unknown, but genetic and environmental factors contribute.

Heredity accounts for about half of the etiology (less so in late-onset depression). Thus, depression is more common among 1st-degree relatives of depressed patients, and concordance between identical twins is high.

Other theories focus on changes in neurotransmitter levels, including abnormal regulation of cholinergic, catecholaminergic (noradrenergic or dopaminergic), glutamatergic, and serotonergic (5-hydroxytryptamine) neurotransmission (1). Neuroendocrine dysregulation may be a factor, with particular emphasis on 3 axes: hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, and growth hormone.

Psychosocial factors also seem to be involved. Serious life depression, especially separations and losses, commonly precede episodes of major stresses; however, such events do not any cause lasting, severe depression except in people predisposed to a mood disorder.

People who have had an episode of major depression are at higher risk of subsequent episodes. People who are less resilient and/or who have anxious tendencies may be more likely to develop a depressive disorder. Such people often do not create the their skills to adjust to life pressures. Depression may also develop in people with other mental disorders.

Depression causes cognitive, psychomotor, and other types of dysfunction (eg, poor concentration, fatigue, loss of sexual desire, loss of interest or pleasure in nearly all activities that were previously enjoyed, sleep disturbances), as well as a depressed mood. People with a depressive disorder frequently have thoughts of suicide and may attempt suicide. Other mental symptoms or disorders (eg, anxiety and panic attacks) commonly coexist, sometimes complicating diagnosis and treatment.

Patients with all forms of depression are more likely to abuse alcohol or other recreational drugs in an attempt to self-treat sleep disturbances or anxiety symptoms; however, depression is a less common cause of alcoholism and drug abuse than was once thought. Patients are also more likely to become heavy smokers and to neglect their health, increasing the risk of development or progression of other disorders (eg, COPD).

Depression may reduce protective immune responses. Depression increases risk of cardiovascular disorders, MIs, and stroke, perhaps because in depression, cytokines and factors that increase blood clotting are elevated and heart rate variability is decreased—all potential risk factors for cardiovascular disorders.

Major depression (unipolar disorder)
Patients may appear miserable, with tearful eyes, furrowed brows, down-turned corners of the mouth, slumped posture, poor eye contact, lack of facial expression, little body movement, and speech changes (eg, soft voice, lack of prosody, use of monosyllabic words). Appearance may be confused with Parkinson disease. In some patients, depressed mood is so deep that tears dry up; they report that they are unable to experience usual emotions and feel that the world has become colorless and lifeless.

Nutrition may be severely impaired, requiring immediate intervention.

Some depressed patients neglect personal hygiene or even their children, other loved ones, or pets.

For diagnosis of major depression, ≥ 5 of the following must have been present nearly every day during the same 2-wk period, and one of them must be depressed mood or loss of interest or pleasure:

Depressed mood most of the day
Markedly diminished interest or pleasure in all or almost all activities for most of the day
Significant (> 5%) weight gain or loss or decreased or increased appetite
Insomnia (often sleep-maintenance insomnia) or hypersomnia

Feelings of worthlessness or excessive or inappropriate guiltDiminished ability to think or concentrate or indecisivenessRecurrent thoughts of death or suicide, a suicide attempt, or a specific plan for committing suicidePersistent depressive disorderDepressive symptoms that persist for ≥ 2 yr without remission are classified as persistent depressive disorder (PDD), a category that consolidates disorders formerly termed chronic major depressive disorder and dysthymic disorder.
Psychomotor agitation or retardation observed by others (not self-reported)
Fatigue or loss of energy

Symptoms typically begin insidiously during adolescence and may persist for many years or decades. The number of symptoms often fluctuates above and below the threshold for major depressive episode.

Affected patients may be habitually gloomy, pessimistic, humorless, passive, lethargic, introverted, hypercritical of self and others, and complaining. Patients with PDD are also more likely to have underlying anxiety, substance use, or personality (ie, borderline personality) disorders.

Women are at higher risk, but no theory explains why. Possible factors include the following:

Greater exposure to or heightened response to daily stresses
Higher levels of monoamine oxidase (the enzyme that degrades neurotransmitters considered important for mood)
Higher rates of thyroid dysfunction
Endocrine changes that occur with menstruation and at menopause
In peripartum-onset depression, symptoms develop during pregnancy or within 4 wk after delivery (postpartum depression); endocrine changes have been implicated, but the specific cause is unknown.

In seasonal affective disorder, symptoms develop in a seasonal pattern, typically during autumn or winter; the disorder tends to occur in climates with long or severe winters.

The negative feelings of demoralization and grief, unlike those of depression, do the following:

Occur in waves that tend to be tied to thoughts or reminders of the inciting event
Resolve when circumstances or events improve
May be interspersed with periods of positive emotion and humor
Are not accompanied by pervasive feelings of worthlessness and self-loathing
The low mood usually lasts days rather than weeks or months, and suicidal thoughts and prolonged loss of function are much less likely.

However, events and stressors that cause demoralization and grief can also precipitate a major depressive episode, particularly in vulnerable people (eg, those with a past history or family history of major depression).

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