a city of sadness

Depression----TheMentalIllness

whatisdepression

Depressionisamentalhealthdisorder,apsychiatric

condition，characterizedbysadness,lossofinterestor

pleasure,feelingsofguiltorlowlf-worth,disturbedsleep

orappetite,feelingsoftiredness,andpoorconcentration.

Specifically,itisamooddisordercharacterizedby

persistentlylowmoodinwhichthereisafeelingofsadness

andlostofinterest.

Depressionisdifferentfromthefluctuationsinmoodthat

weallexperienceasapartofanormalandhealthylife.

Temporaryemotionalresponstothechallengesofeveryday

lifedonotconstitutedepression.

AccordingtotheUSCentersforDiaPreventionand

Control(CDC),8%ofpeopleovertheageof12yearshas

depressioninanytwo-weekperiod.

TheWorldHealthOrganization(WTO)putsdepressionatthetop

ofthelist-itisthemostcommonillnessworldwideandthe

leadingceaoforganizationestimatesthat350million

peoplearoundtheworldareaffectedbydepression.

MajorDepressivedisorder

Majordepressivedisorder(MDD),alsoknownsimplyas

depression,isamentaldisordercharacterizedbyatleasttwo

isoftenaccompaniedbylowlf-esteem,lossofinterestin

normallyenjoyableactivities,lowenergy,andpainwithouta

clearmayalsooccasionallyhavefalbeliefsoreorhear

thingsthatotherspeoplehaveperiodsofdepression

paratedbyyearsinwhichtheyarenormalwhileothersnearly

epressivedisordercan

negativelyaffectsaperson'sfamily,workorschoollife,

sleepingoreatinghabits,n2-7%of

adultswithmajordepressiondiebysuicide,andupto60%of

peoplewhodiebysuicidehaddepressionoranothermood

disorder.

Thecauisbelievedtobeacombinationofgenetic,

environmental,ctorsinclude

afamilyhistoryofthecondition,majorlifechanges,certain

medications,chronichealthproblems,andsubstance40%of

gnosisof

majordepressivedisorderisbadontheperson'sreported

sno

g,however,maybe

donetoruleoutphysicalconditionsthatcancausimilar

depressionshouldbedifferentiatedfromsadnesswhichisa

normalpartoflifeandislessUnitedStatesPreventive

ServicesTaskForce(USPSTF)recommendsscreeningfor

depressionamongthoovertheage12,whileapriorCochrane

reviewfoundinsufficientevidenceforscreening.

Typically,peoplearetreatedwithcounllingand

antidepressantappearstobeeffective,buttheeffectmay

ofcounllingudincludecognitivebehavioraltherapy(CBT)

rmeasuresarenoteffective

electroconvulsivetherapy(ECT)alization

maybenecessaryincaswithariskofharmtolfandmay

occasionallyoccuragainstaperson'swishes.

Majordepressivedisorderaffectedapproximately253million%)

centageofpeoplewhoareaffected

atonepointintheirlifevariesfrom7%inJapanto21%in

meratesarehigherinthedevelopedworld(15%)

comparedtothedevelopingworld(11%).Itcausthecond

t

s

rican

PsychiatricAssociationadded"majordepressivedisorder"to

theDiagnosticandStatisticalManualofMentalDisorders

(DSM-III)splitofthepreviousdepressive

neurosisintheDSM-IIwhichalsoencompasdtheconditions

nowknownasdysthymiaandadjustmentdisorderwithdepresd

urrentlyorpreviouslyaffectedmaybe

stigmatized.

Whatarethesignsandsymptomsofdepression

depressionmaybetriggeredbystressfullifeevents,other

illness,certaindrugsormedications,orinheritedtraits.

althoughcausofdepressionarenotentirelyunderstood,we

e

imbalanceiscorrected,symptomsofdepressiongenerally

improve

Peoplewithdepressiveillnessdonotallexperiencethesame

erity,frequencyanddurationofsymptomswill

varydependingontheindividualandhisorherparticular

illness.

Symptomsinclude:

Persistentsad,anxiousor"empty"feelings

Feelingsofhopelessnessand/orpessimism

Feelingsofguilt,worthlessnessand/orhelplessness

Irritability,restlessness

Lossofinterestinactivitiesorhobbiesoncepleasurable,

includingx

Fatigueanddecreadenergy

Difficultyconcentrating,rememberingdetailsandmaking

decisions

Insomnia,early–morningwakefulness,orexcessivesleeping

Overeating,orappetiteloss

Thoughtsofsuicide,suicideattempts

Persistentachesorpains,headaches,crampsordigestive

problemsthatdonoteaevenwithtreatment

Allofthesymptomscaninterferewithyourqualityoflife.

Evenifyoudon’thavemajordepression,ifyouhave

experienceafewofthesymptomsforatleasttwoweeksyou

mayhavelessvereformofdepressionthatstillrequires

treatment.

thesymptomsofslightandmajordepression

Depressionisamedicalconditioninwhichapersonfeelsvery

sadandanxiousandoftenhasphysicaldepressioncouldbea

portionofmajordepression,sothecriteriaforthisdia

areimportanttoconsiderandexamineforpeoplewiththe

epressionisonlyminor,itwillnothaveall

ofthecomponentsofmajordepressionandthereforewouldbe

treateddifferentlyfromthemoreriousversionofthemost

commondiagnosticcriteriaareencapsulatedinthemnemonic

eintheorderoftheletters,Sleep

problems,lackofInterest,Guiltyfeelings,lackofEnergy,

problemswithConcentration,Appetiteandweightdisturbances,

Psychomotorretardation,

apersonhasfiveorsixitemsinthiscriteriaitisverylikely

thattheyhavemajordepressionandtheyshouldbetreatedfor

onlyhaveoneortwoofthemtheymighthavealess

riousversionofthedia,butitstillmayrequire

ydifferenceisthatitcouldbemoreminor.

Byaskingaboutthedifferentsymptoms,peopleperforma

basicdiagnosistesttoevaluatethemlvesortheirpatients.

Thesymptomsofrioustoslightdepressionmaybevery

debilitatingtoapatientandidentificationoftheproblemis

ditionofdepressive

disordersisprevalentthroughallwalksoflifeanditis

expectedthatthemajorityofpersonswillexperiencesymptoms

r,

sincemostpeopleexperiencethesymptomsatsomepoint,

extendedrearchhasbeendonetodeterminethebestwayto

treatthespecificconditionsandmanysolutionsare

availabletosufferers.

Tothetissues,whichraisthecarbondioxidelevel,causing

generalDepression.

Associatedconditions

Majordepressionfrequentlyco-occurswithotherpsychiatric

1990–92NationalComorbiditySurvey(US)

reportsthathalfofthowithmajordepressionalsohave

lifetimeanxietyanditsassociateddisorderssuchas

ysymptomscanhaveamajor

impactonthecourofadepressiveillness,withdelayed

recovery,increadriskofrelap,greaterdisabilityand

increadsuicideneuroendocrinologistRobertSapolsky

similarlyarguesthattherelationshipbetweenstress,anxiety,

anddepressioncouldbemeasuredanddemonstratedare

increadratesofalcoholanddrugabuandparticularly

dependence,andaroundathirdofindividualsdiagnodwith

-traumaticstress

disorderanddepressionoftenmayalsocoexistwithattention

deficithyperactivitydisorder(ADHD),complicatingthe

diagnosisandtreatmentofboth.

orepainsymptoms

areprentin65%ofdepresdpatients,andanywherefrom5

to85%ofpatientswithpainwillbesufferingfromdepression,

dependingonthetting;thereisalowerprevalenceingeneral

practice,gnosisof

depressionisoftendelayedormisd,andtheoutcomeworns.

Theoutcomecanalsowornifthedepressionisnoticedbut

completelymisunderstood.

Depressionisalsoassociatedwithato2-foldincreadrisk

ofcardiovasculardia,independentofotherknownrisk

factors,andisitlflinkeddirectlyorindirectlytorisk

withmajor

depressionarelesslikelytofollowmedicalrecommendations

fortreatingandpreventingcardiovasculardisorders,which

addition,cardiologistsmaynotrecognizeunderlying

depressionthatcomplicatesacardiovascularproblemunder

theircare.

Management

Thethreemostcommontreatmentsfordepressionare

psychotherapy,medication,andelectroconvulsivetherapy.

Psychotherapyisthetreatmentofchoice(overmedication)for

ationalInstituteforHealthandCare

Excellence(NICE)2004guidelinesindicatethat

antidepressantsshouldnotbeudfortheinitialtreatment

ofmilddepression,

guidelinesrecommendthatantidepressantstreatmentin

combinationwithpsychosocialinterventionsshouldbe

consideredfor:

Peoplewithahistoryofmoderateorveredepression

Thowithmilddepressionthathasbeenprentforalong

period

Asacondlinetreatmentformilddepressionthatpersists

afterotherinterventions

Asafirstlinetreatmentformoderateorveredepression

Lifestyle

Physicalexerciisrecommendedformanagementofmild

depression,has

alsobeenfoundtobeeffectivefor(unipolar)majordepression.

Itiquivalenttotheuofmedicationsorpsychological

lderpeopleitdoesappear

todecreamayberecommendedtopeoplewhoarewilling,

motivated,andphysicallyhealthyenoughtoparticipateinan

exerciprogramastreatment.

Thereisasmallamountofevidencethatskippinganight's

sleepmayimprovedepressivesymptoms,withtheeffectsusually

fectisusuallytemporary.

Besidessleepiness,thismethodcancauasideeffectofmania

orhypomania.

Inobrvationalstudiessmokingcessationhasbenefitsin

depressionaslargeasorlargerthanthoofmedications

Range

Majordepressivedisorderaffectsapproximately253million

peoplein2013%oftheglobalpopulation).Thepercentageof

peoplewhoareaffectedatonepointintheirlifevariesfrom

7%inJapanto21%inmostcountriesthenumberofpeoplewho

havedepressionduringtheirlivesfallswithinan8–18%range.

InNorthAmerica,theprobabilityofhavingamajordepressive

episodewithinayear-longperiodis3–5%formalesand8

–10%fordepressiontobeabouttwiceascommoninwomenas

inmen,althoughitisunclearwhythisisso,andwhether

ative

increainoccurrenceisrelatedtopubertaldevelopment

ratherthanchronologicalage,reachesadultratiosbetweenthe

agesof15and18,andappearsassociatedwithpsychosocialmore

sionisamajorcauof

disabilityworldwide.

Peoplearemostlikelytodeveloptheirfirstdepressive

episodebetweentheagesof30and40,andthereisacond,

smallerpeakofincidencebetweenages50andriskofmajor

depressionisincreadwithneurologicalconditionssuchas

stroke,Parkinson'sdia,ormultiplesclerosis,andduring

thefirstyearafterisalsomorecommonaftercardiovascular

illness,andisrelatedmoretoapooroutcomethantoabetter

conflictontheprevalenceofdepressionintheelderly,but

mostdatasuggestthereisareductioninthisagegroup.

Depressivedisordersaremorecommontoobrveinurbanthan

inruralpopulationandtheprevalenceisingroupswith

ssness.