Depression: Causes, Triggers, Symptoms & Classification

Depression is generally characterized by a constant low mood, as well as a general aversion toward any activity. This state can have a negative effect on an individual’s thoughts and behavior, which can ultimately affect even physical well-being.

People suffering from depression may feel sad (sometimes with no apparent reason), empty, hopeless, anxious, worried, helpless, worthless, hurt, angry, guilty, desperate, restless or irritable.

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Depressed people often lose interest in most if not all activities, even those which once made them happy. They also experience either a loss in appetite or a compelling urge to overeat, have difficulties concentrating, making decisions and remembering things, and in some cases attempt suicide, seen as the ultimate solution to all problems. Other signs and symptoms of depression include insomnia or excessive sleeping, loss of energy, fatigue, digestive problems, aches, pains.

Feeling depressed is not necessarily a psychiatric disorder. A depressed mood can occur as a reaction to certain life events, as a symptom of some medical condition, or as a side effect of certain medical treatments. A depressed mood is, however, an associated or even a primary feature of psychiatric symptoms such as clinical depression.

What Triggers Depression?

Certain life events or negative changes may trigger a normal mood of depression. Such instances may include losing a job, having financial difficulties, reaching menopause, losing someone close, experiencing relationship troubles or going through a breakup, suffering a catastrophic injury, and other such negative impacts.

There are also certain medical treatments known to cause depression in a significant number of patients. Such treatments include Hepatitis C drug therapy, as well as some drugs used to treat high blood pressure, such as reserpine or beta-blockers.

A depressed mood can also stem from certain infectious diseases and psychological problems such as hypoandrogenism (in men), Addison’s disease, Lyme disease, sleep apnea, multiple sclerosis, and disturbed circadian rhythm. Depressed mood is also among the early symptoms of hypertiroidism. Chronic pain can also cause non-psychiatric depression.


Depression & Psychiatric Symptoms

Depressed mood can be a main symptom of several psychiatric syndromes. Disorders considered to be primary disturbances of mood are broadly classified into a group called the mood disorders. These include major depressive disorder (MDD), also known as major depression or clinical depression, considered as such when a person has at least two weeks of depressed mood or experienced a loss of interest and pleasure in most, if not all activities. Dysthymia, a state of chronic depressed mood, is also part of this group, and is characterized by symptoms which don’t reach the severity of a major depressive episode. Bipolar disorder is a mood disorder as well, characterized by two or more episodes of extremely elevated energy levels, cognition, mood changes, and may also involve depressive episodes. Depressive episodes may also follow a seasonal pattern, in which cas the disorder is referred to as a seasonal affective disorder.

Conditions that are not included in the mood disorders include borderline personality disorder, which often includes depressed mood; adjustment disorder with depressed mood, which appears as a psychological response to a certain identifiable event or trigger (stressor), in which the subsequent emotional or behavioral symptoms are serious, but not severe enough to meet the criteria of a major depressive episode; post-traumatic stress disorder (PTSD), an anxiety disorder that results from trauma and commonly includes depressed mood.

Assessing Depression

In trying to determine the underlying cause of depression, it typically helps to have a full patient medical history, as well as a thorough evaluation of symptoms. Standardized questionnaires such as the Hamilton Rating Scale for Depression and the Beck Depression Inventory can also prove helpful.

Depression is a broad and often ambiguous, which leads to a misuse in many cases. To assess the severity of a depressive state, doctors generally perform a medical examination and certain investigations to rule out other causes for the symptoms experienced. Such selected investigations typically include blood tests measuring TSH and thyroxine to rule out hypothyroidism, basic electrolytes and serum to rule out a metabolic disturbance, and a full blood count (complete with ESR) to exclude a systemic infection or chronic disease. Side effects to certain medications or excessive alcohol intake are also ruled out quite often.

Doctors may also assess testosterone levels to diagnose hypogonadism, which can cause depression in men. When subjective cognitive complaints are associated with older depressed people, they may indicate the onset of a dementive disorder such as Alzheimer’s disease.

Brain imaging and cognitive testing can help distinguish depression from dementia. A CT scan, meanwhile, can rule out brain pathology in patients, with psychotic, rapid-onset, or other unusual symptoms. While such tests and investigations may rule out other causes for the symptoms in question, major depression cannot be confirmed by any biological tests.


Major or Clinical Depression

Major depressive disorder (MDD) is commonly referred to as major depression, clinical depression, unipolar depression, unipolar disorder, or, in the case of repeated episodes, recurrent depression. MDD is a mental disorder characterized by episodes of low mood, low self-esteem and loss of interest and pleasure in nearly all activities. A set of symptoms is called a syndrome.

The ambiguous term “depression” is often used to denote this syndrome, but may also refer to other mood disorders or lower mood states that do not have a clinical significance. Clinical depression is an extremely severe, disabling condition that affects a person’s life, family, work or school life, sleeping, eating habits, and physical well-being. Roughly 3.4 percent of people with major depression in the U.S. commit suicide, while up to 60 percent of all people who commit suicide suffered from depression or another mood disorder before taking the last step.

A major depression diagnosis is based on the experiences reported by the patient, behavior reported by people close to the patient (relatives, friends), as well as a mental status evaluation. Physicians typically request tests for physical conditions that may cause similar symptoms, but there is no lab test that can diagnose major depression. Major depressive disorder commonly starts between the ages of 20 and 30, with a subsequent peak between the ages of 30 and 40.

Patients are generally treated with antidepressant medication, in many cases coupld with psychotherapy or counseling. The effectiveness of medical treatment in mild or moderate cases of depression, however, remains questionable.

In cases associated with self-neglect or a high risk of harming oneself or others, hospitalization may be required. A small percentage of patients are also treated with electroconvulsive therapy (ECT), but it is not a common practice.

The course of clinical depression can vary widely. A person can experience one episode lasting for weeks, or a lifelong disorder with recurrent major depressive episodes. People suffering from depression also have a shorter life expectancy compared to individuals without depression, partly because depressed people are more susceptible to medical illnesses and suicide. It remains unclear at this point whether medications affect the risk or suicide.

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