
interest in almost all activities, loss of self confidence, fatigue, and a sense of worthlessness. Usually depression is episodic - that is, bouts of illness are separated by periods of full recovery. Some 20 million plus Americans experience depression, the world’s number one cause of chronic disability. Mood disorders such as depression most often surface between ages 20 and 30 but can occur at any age. The average length of an untreated episode of major depression is usually eight to nine months. This period can be shortened significantly with early diagnosis and treatment, which generally leads to a more rapid remission approximately 80% of the time. Causes The specific cause of depression is unknown in most cases, but the disorder appears to result from some combination of genetic predisposition and psychological and medical factors. Changes in the Brain: Chemical changes occur in the brain during depression, and researchers believe that these changes are linked to the symptoms of depression. The brain is composed of distinct regions-each with particular functions-made up of networks of nerve cells, or neurons. Messages pass from one neuron to another. One region thought to be involved in depression is the limbic system, which is concerned with emotional behavior. An area within this system called the hypothalamus regulates the pituitary gland and may be involved in the hormonal imbalances sometimes associated with depression. Because individual neurons are separated from others by small gaps (synaptic clefts) at each end, chemicals called neurotransmitters are needed to bridge the synaptic cleft and pass messages from one neuron to the next. Of particular concern in depression are the neurotransmitters norepinephrine, serotonin, and dopamine. Imbalances in the amounts of these substances in the brain appear to contribute to depression or bipolar disorder. Genetic Factors: Genetic factors are clearly important in the development of depression. Research shows that when on identical twin has a mood disorder, there is about a 50% chance that the other will develop the illness at some time. Genetics also plays a role in treatment. Some evidence shows that patients have a better chance of responding to the same antidepressant medication that a depressed first degree relative (a parent, sibling, or child) has responded to. Other Causes In up to 15% of cases, mood disorders are caused by medication, illegal drugs, or neurological or medical abnormalities. For example, depression can result from the chronic use of beta blockers, reserpine derivatives (for high blood pressure), steroid mediations such as prednisone (Deltasone), benzodiazepines (for anxiety), or anti cancer drugs. Withdrawal from central nervous system stimulants, like amphetamines or cocaine, can also precipitate depression. Patients with dementing brain disorders, such as Alzheimer’s disease and Huntington’s disease, are susceptible to depression. Depression can also be a consequence of stroke, affecting about 25% of people who have had a stroke in the left frontal area of the brain.
cortisol by the adrenal gland (Cushing Syndrome) can cause either depression or mania in some patients. Deficiencies in folic acid, vitamin B6, or vitamin B12 may also cause depression. In study of 700 women published in 2000, those who had a vitamin B12 deficiency were two times more likely to be severely depressed than women who did not have a vitamin B12 deficiency.
to differentiate the milder (and more common) forms of depression from the emotional changes that are part of everyday life. The dominant form of depression is major depression, which clinicians distinguish from other forms of the disorder,such as dysthymia grief, and atypical depression. Unlike most medial disorder, depression is not associated with any characteristic laboratory changes or tissue abnormalities that can be used to confirm a diagnosis. The American Psychiatric Association has established diagnostic classification systems to allow consistent diagnosis of major depression. The criteria are contained in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Major Depression: According to DSM-IV, a person is suffering from a major depressive episode if he or she exhibits either the first or second of the following nine symptoms: * Depressed mood with overwhelming feelings of sadness and grief * Loss of interest and pleasure in activities formerly enjoyed * Insomnia, early morning waking, or oversleeping nearly every day * Decreased energy; fatigue * Noticeable changes in appetite and weight (significant loss or gain) * Inability to concentrate; indecisiveness * Physical symptoms of restlessness or being slowed down * Feelings of guilt, worthlessness, and helplessness * Recurrent thoughts of death and suicide; suicide attempts The diagnosis is more certain when these criteria are supplemented by either a positive family history, a prior episode of depression or mania, or the presence of a precipitating factor such as a recent stroke or the use of medications known to cause mood disorders.
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