Classification and external resources
|Vincent van Gogh's 1890 painting On the Threshold of Eternity may symbolize the despair and hopelessness of his depression; he committed suicide later that same year.|
Major depressive disorder, also known as major depression, unipolar depression, clinical depression, or simply depression, is a psychiatric disorder characterized by a pervasive low mood, loss of interest in a person's usual activities and diminished ability to experience pleasure. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The 2007 version of the ICD is available online at http//wwwwho The 2007 version of the ICD is available online at http//wwwwho The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as The diagnosis is made if a person has suffered one or more major depressive episodes. Major depressive episode is a key symptom of Major depressive disorder. The onset is usually in early- to mid-adulthood. Diagnosis is based on the patient's self-reported experiences and observed behavior. There is no laboratory test for major depression, although physicians often test for physical conditions that may cause similar symptoms before arriving at a diagnosis. The course varies widely: it can be a once-in-a-lifetime event or have multiple recurrences; it can appear either gradually or suddenly; and can either last for a few months or be a life-long disorder.
Although the term "depression" is commonly used by laypeople to describe a temporary depressed mood, when a person may feel sad or "down", major depression is a serious and often disabling condition that can significantly affect a person's work, family and school life, sleeping and eating habits, general health and ability to enjoy life. In the fields of Psychology and Psychiatry, the terms depression or depressed refer to both expected and pathologically chronic or severe  Depression is a major risk factor for suicide; in addition, people with depression suffer from higher mortality from other causes.  Clinical depression may be isolated or be a secondary result of a primary condition such as bipolar disorder or chronic pain. Chronic pain is defined as Pain that persists longer than the temporal course of natural healing associated with a particular type of injury or disease process When specific treatment is indicated, it usually consists of psychotherapy and antidepressants. Psychotherapy is an Interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression
A major depressive episode can manifest with a variety of symptoms, but almost all patients display a marked change in mood, a deep feeling of sadness, and a noticeable loss of interest or pleasure in favorite activities. Major depressive episode is a key symptom of Major depressive disorder. In Psychology, anhedonia ( Greek αν- an- without + ηδονή hēdonē pleasure) is an inability to experience The mood change symptoms may include persistent sad, anxious or "empty" moods, and feelings of worthlessness, inappropriate guilt, helplessness, hopelessness, and/or pessimism, and a sense of restlessness or irritability. Physical symptoms associated with depression include changes such as loss of appetite and/or weight loss (or conversely overeating and weight gain); insomnia, early morning awakening, or oversleeping; decreased energy, fatigue, feeling "slowed down" or sluggish; psychomotor agitation or psychomotor retardation; and persistent physical symptoms that do not respond to treatment, such as headaches, digestive problems, and chronic pain. Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity Psychomotor agitation is a series of unintentional and purposeless motions that stem from mental tension of an individual Psychomotor retardation comprises a slowing down of Thought and a reduction of physical movements in a person A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Digestion is the breaking down of chemicals in the body into a form that can be absorbed Chronic pain is defined as Pain that persists longer than the temporal course of natural healing associated with a particular type of injury or disease process
Other symptoms include:
Not all patients will suffer from every symptom. Death is the termination of the biological functions that define living Organisms It refers both to a specific The severity of symptoms will vary widely among individuals. Symptoms must, however, persist for at least two weeks before being considered a potential sign of depression, with the exception of suicidal thoughts or attempts. 
Diagnosis of an episode in children is more difficult than in adults and is often left undiagnosed, and thus untreated, because the symptoms in children are often written off as normal childhood moodiness. Diagnosis is also made difficult because children are more likely than adults to show different symptoms depending on the situation. 
While some children still function reasonably well, most who are suffering depression will suffer from a noticeable change in their social activities and life, a loss of interest in school and poor academic performance, and possibly drastic changes in appearance. They may also begin abusing drugs and/or alcohol, particularly past the age of 12. Drug abuse has a wide range of definitions related to taking a Psychoactive drug or Performance enhancing drug for a non-therapeutic or non-medical effect Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the use of Alcoholic beverages despite negative consequences Although much more rarely than adults, children with major depression may attempt suicide or have suicidal thoughts even before the age of 12. 
Depression and anxiety frequently co-occur; the National Comorbidity Survey (US) reports that 58 percent of those with major depression also suffer from lifetime anxiety. Even mild anxiety symptoms can have a major impact on the course of a depressive illness, and the commingling of any anxiety symptoms with the primary depression is important to consider. A pilot study by Ellen Frank et al. , at the University of Pittsburgh, found that depressed or bipolar patients with lifetime panic symptoms experienced significant delays in their remission. The University of Pittsburgh, commonly referred to as Pitt, is a non-sectarian coeducational independent state-related, "public" research University  These patients also had higher levels of residual impairment. On a similar note, Robert Sapolsky of Stanford University argues that the relationship between stress, anxiety, and depression could be measured and demonstrated biologically. Robert Maurice Sapolsky (born 1957) is the John A and Cynthia Fry Gunn Professor of Biological Sciences and Professor of Neurology and Neurological Sciences and by courtesy Leland Stanford Junior University, commonly known as Stanford University or simply Stanford, is a private Research university located in 
Before a diagnosis of major depressive disorder is made, a physician should perform a medical examination to rule out a physical cause for the suspected depression. A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health Although there are no biological tests which confirm major depression, tests are carried out to exclude medical illnesses; these include blood tests measuring TSH to exclude hypo- or hyperthyroidism, basic electrolytes and serum calcium to rule out a metabolic disturbance, full blood count including ESR to rule out a systemic infection or chronic disease, and serology to exclude syphilis or HIV infection; two commonly ordered investigations are EEG to exclude epilepsy, and a CT scan of the head to exclude brain lesions. Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a Peptide hormone synthesized and secreted by Thyrotrope cells in the Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland. Hyperthyroidism is the term for overactive tissue within the Thyroid gland resulting in overproduction and thus an excess of circulating free thyroid hormones Thyroxine A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 Inborn errors of metabolism comprise a large class of genetic Diseases involving disorders of Metabolism. A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is The erythrocyte sedimentation rate (ESR also called a sedimentation rate, sed rate, or Biernacki Reaction, is the rate at which Red blood cells Systemic infection is a generic term for Infection caused by Microorganisms in animals or plants where the Causal agent (the Microbe) has spread Serology is the scientific study of blood serum. In practice the term usually refers to the Diagnostic identification of antibodies in the serum Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Epilepsy is a common chronic Neurological disorder that is characterized by recurrent unprovoked seizures. Computed tomography (CT is a Medical imaging method employing Tomography. Early dementia may present with depressive symptoms in older patients.
If no such cause is found, a psychological evaluation should be done by the physician or by referral to a psychiatrist, social worker, or psychologist. A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders Social work is a discipline involving the application of Social theory and research methods to study and improve the lives of people groups and societies Mental health professional A psychologist is a practitioner of Psychology, the systematic investigation of the mind including Behavior, Cognition,  The evaluation will include a complete history of symptoms, a discussion of alcohol and drug use, and whether the patient has had or is having suicidal thoughts or thinking about death. Death is the termination of the biological functions that define living Organisms It refers both to a specific The evaluation will also include a family medical history to see if other family members suffer from any form of depression or similar mood disorder. 
Investigations are not generally repeated for a recurrent episode unless there is a specific medical indication. These may include measuring serum sodium if the person presents with polyuria and is on a selective serotonin reuptake inhibitor (SSRI). Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders Assessment and treatment are usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others.
There are several criteria lists and diagnostic tools that can also aid in the diagnosis of depression. Most are based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a book published by the American Psychiatric Association that defines the criteria used to diagnose various mental disorders, including depression. The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association The American Psychiatric Association (APA is the main Professional organization of Psychiatrists and trainee psychiatrists in the United States, and the Many are used in research or as screening tools. No screening tool should be used to confirm diagnosis in the absence of review by a medical practitioner or psychologist.
The Beck Depression Inventory, originally designed by psychiatrist Aaron T. Beck in 1961, is a 21-question patient completed survey that covers items related to the basic symptoms of depression, such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex. The Beck Depression Inventory ( BDI, BDI-II) created by Dr Aaron T Aaron Temkin Beck (born July 18 1921 is an American psychiatrist and a Professor emeritus at the department of Psychiatry at the University A self-report inventory is a type of Psychological test in which a patient fills out a survey or Questionnaire with or without the help of a mental health professional Cognition is a concept used in different ways by different disciplines but is generally accepted to mean the process of awareness or thought  The Beck Inventory is one of the most widely used diagnostic tools for self-diagnosis of depression, although its main purpose is not the diagnosis of depression, but determining the severity and presence of symptoms. Self-diagnosis is the process of diagnosing, or identifying medical conditions in oneself 
There are also two Patient Health Questionnaires available that are also self-administered questionnaires. The PHQ-2 has only two questions that asks about the frequency of depressed mood and a loss of interest in doing things, with a positive to either question indicating the need for further testing.  The PHQ-9 is a slightly more detailed nine question survey covering some of the major symptoms of depression and the frequency a person has experienced them. It is based directly on the diagnostic criteria listed in the DSM-IV and often used as a follow up to a positive PHQ-2 test. 
Other scales commonly used include the Geriatric Depression Scale, in older populations, the widely-used Hamilton Depression Rating Scale designed by psychiatrist Max Hamilton in 1960, and the Montgomery-Åsberg Depression Rating Scale (MADRS). The Geriatric Depression Scale (GDS is a 30-item self-report Assessment used to identify depression in the elderly The Hamilton Rating Scale for Depression ( HRSD) also known as the Hamilton Depression Rating Scale ( HDRS) or HAM-D, is a 21-question Multiple Professor Max Hamilton (1912–1988 was born on 9 February 1912 at Offenbach, near Frankfurt Germany The Montgomery-Åsberg Depression Rating Scale (abbreviated MADRS) is a ten-item diagnostic questionnaire which Psychiatrists use to measure the severity
The most widely used criteria for diagnosing depressive illneses are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, the current version being DSM-IV-TR, and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, currently the ICD-10. The American Psychiatric Association (APA is the main Professional organization of Psychiatrists and trainee psychiatrists in the United States, and the The Diagnostic and Statistical Manual of Mental Disorders' ( DSM) is published by the American Psychiatric Association The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The latter system is typically used in European countries while the DSM criteria are used in the USA or the rest of the world, as well as prevailing in research studies.
The DSM IV-TR diagnosis hinges on the presence of a major depressive episode, which may either be single or recurrent. Major depressive episode is a key symptom of Major depressive disorder. Further qualifiers are used to classify both the episode itself and the course of the illness. The ICD-10 system does not use the term major depressive disorder, but the diagnosis of depressive episode is very similar. The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings Minor depression is a less-used term for a subclinical depression that does not meet criteria for major depression but where there are at least two symptoms present for two weeks. It does not exist in DSM IV-TR.
A major depressive episode is a severely depressed mood that persists for at least two weeks. Major depressive episode is a key symptom of Major depressive disorder. Episodes may be isolated or recurrent and categorized as mild, major or severe. If the patient has already had an episode of mania or markedly elevated mood, a diagnosis of bipolar disorder is made instead. Mania (from Greek μανία and that from μαίνομαι - mainomai, "to rage to be furious" is a severe medical condition This article is an expansion of a section entitled '''Hypomania''' from within the main article Bipolar disorder. Depression without periods of elation or mania is therefore sometimes referred to as unipolar depression because the mood remains at one emotional state or "pole". The diagnosis usually excludes cases where the symptoms are a normal result of bereavement (though it is possible for normal bereavement to turn into a depressive episode). Grief is a multi-faceted response to loss Although conventionally focused on the emotional response to loss it also has physical cognitive behavioral social and philosophical
Diagnosticians recognize several possible subtypes:
Major depressive disorder affects about 8–17 percent of the population on at least one occasion in their lives, before the age of 40. In some countries, such as Australia, one in four women and one in six men will suffer from depression. For a topic outline on this subject see List of basic Australia topics. In Canada, major depression affects approximately 1. Country to "Dominion of Canada" or "Canadian Federation" or anything else please read the Talk Page 35 million people, and in the United States approximately 14 million adults per year. The United States of America —commonly referred to as the  An estimated 121 million people worldwide currently suffer from depression. 
People who have had one episode of depression may be more than normally likely to have more episodes in the future, so the first time a young person becomes depressed is important both as a personal and public health concern. 
About twice as many females as males report or receive treatment for clinical depression, though this imbalance is shrinking over the course of recent history; this difference seems to completely disappear after the age of 50–55. Clinical depression is currently the leading cause of disability in North America, and is expected to become the second leading cause of disability worldwide (after heart disease) by the year 2020, according to the World Health Organization. Heart disease is an Umbrella term for a variety for different diseases affecting the Heart. 
A recent study suggested that the diagnostic criteria for depression may be too broad, resulting in diagnosis of major depression in people who are not truly suffering from the disorder, but who have shown normal responses to negative events. 
Current theories regarding the risk factors and causes of clinical depression can be broadly classified into two categories, Physiological and Sociopsychological:
The tendency to develop depression may be inherited: according to the National Institute of Mental Health there is some evidence that depression may run in families. Social psychology is the scientific study of how people's Thoughts Feelings and Behaviors are influenced by the actual imagined or The National Institute of Mental Health ( NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in Most experts believe that both biological and psychological factors play a role.
Many modern antidepressant drugs change levels of certain neurotransmitters, namely serotonin and norepinephrine (noradrenaline). An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression A psychoactive drug or psychotropic substance is a Chemical substance that acts primarily upon the Central nervous system where it alters Brain See Chemical synapse for an introduction to concepts and terminology used in this article Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a However, the relationship between serotonin, SSRIs, and depression is typically greatly oversimplified when presented to the public, though this may be due to the lack of scientific knowledge regarding the mechanisms of action. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders  Evidence has shown the involvement of neurogenesis in depression, though the role is not exactly known. Neurogenesis ( birth of Neurons ' is the process by which neurons are created 
Recent research has suggested that there may be a link between depression and neurogenesis of the hippocampus. Neurogenesis ( birth of Neurons ' is the process by which neurons are created The hippocampus is a part of the Forebrain, located in the medial Temporal lobe.  This horseshoe-shaped structure is a center for both mood and memory. Loss of neurons in the hippocampus is found in depression and correlates with impaired memory and dysthymic mood. Neurons (ˈnjuːɹɒn also known as neurones and nerve cells) are responsive cells in the Nervous system that process and transmit information The hippocampus is a part of the Forebrain, located in the medial Temporal lobe. The most widely accepted explanation for this is that the drugs increase serotonin levels in the brain which in turn stimulate neurogenesis and therefore increase the total mass of the hippocampus and would in theory restore mood and memory, therefore assisting in the fight against the mood disorder.
Another theory regarding the cause of depression is that it is characterized by an overactive hypothalamic-pituitary-adrenal axis (HPA axis) that resembles the neuro-endocrine response to stress. The hypothalamic-pituitary-adrenal axis ( HPA or HTPA axis) also known as the Limbic -hypothalamic-pituitary-adrenal axis (LHPA axis is a complex set of direct influences These HPA axis abnormalities participate in the development of depressive symptoms, and antidepressants serve to regulate HPA axis function. 
About one-third of individuals diagnosed with attention-deficit hyperactivity disorder (ADHD), may develop comorbid depression. Attention-Deficit Hyperactivity Disorder (ADHD is a neurobehavioral developmental disorder affecting about 3-5% of the world's population In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to  Dysthymia, a form of chronic, low-level depression, is particularly common in adults with undiagnosed ADHD who have encountered years of frustrating ADHD-related problems with education, employment, and interpersonal relationships. Dysthymia (pronounced /dɪsˈθaɪmiə/ is a Mood disorder that falls within the depression spectrum. 
New evidence shows that individuals with clinical depression exhibit markedly higher levels of monoamine oxidase A (MAO-A) in the brain compared to people without depression. Monoamine oxidase A is an Isozyme of Monoamine oxidase. It preferentially deaminates Norepinephrine (noradrenaline and serotonin  MAO-A is an enzyme which reacts with and decreases the concentration of monoamines such as serotonin, norepinephrine and dopamine. Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins Monoamine neurotransmitters are Neurotransmitters and Neuromodulators that contain one Amino group that is connected to an aromatic ring by a
Certain illnesses, including cardiovascular disease, hepatitis, mononucleosis, hypothyroidism, fructose malabsorption, sleep apnea, and organic brain damage caused by degenerative conditions such as Parkinson disease, Multiple Sclerosis or by traumatic blunt force injury may contribute to depression, as may certain prescription drugs such as hormonal contraception methods and steroids. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Hepatitis (plural hepatitides) implies injury to the Liver characterized by the presence of Inflammatory cells in the tissue of Infectious mononucleosis, also known as Pfeiffer's disease, mono (in The United States of America) and more commonly known as glandular Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland. Fructose malabsorption or Dietary Fructose Intolerance is a digestive disorder of the Small intestine in which the Fructose carrier in Enterocytes Sleep apnea is a sleep disorder characterized by pauses in Breathing during Sleep. Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's Multiple sclerosis (abbreviated MS also known as disseminated sclerosis or encephalomyelitis disseminata) is an autoimmune condition in which the Hormonal contraception refers to Birth control methods that act on the hormonal system A steroid is a Terpenoid Lipid characterized by a Carbon skeleton with four fused rings generally arranged in a 6-6-6-5 fashion Depression also occurs in patients with chronic pain, such as chronic back pain, much more frequently than in the general population. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm Back pain (also known " dorsalgia " is Pain felt in the back that usually originates from the Muscles Nerves Bones Fibromyalgia sufferers also experience depression and anxiety. Fibromyalgia (FM is a disorder classified by the presence of chronic widespread Pain and tactile Allodynia.
Low self-esteem and self-defeating or distorted thinking are connected with depression. In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth However, it has been proposed that it is the result of depression and not necessarily the cause of it. This is still debated in the scientific community. Although it is not clear which is the cause and which is the effect, it is known that depressed persons who are able to make corrections in their thinking patterns can show improved mood and self-esteem (Cognitive Behavioral Therapy). In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth See also Cognitive Therapy Cognitive Behavioral Therapy ( CBT) is an umbrella-term for psychotherapeutic systems that deal with cognitions interpretations  Psychological factors related to depression include the complex development of one's personality and how one has learned to cope with external environmental factors, such as stress. Psychology (from Greek grc ψῡχή psȳkhē, "breath life soul" and grc -λογία -logia) is an Academic and 
Events such as the death of a parent, issues with biological development, school related problems, abandonment or rejection, neglect, chronic illness, and physical, psychological, or sexual abuse can also increase the likelihood of depression later in life. Child abandonment is the practice of abandoning offspring outside of legal Adoption. Physical abuse is abuse involving contact intended to cause feelings of intimidation Pain, Injury, or other physical Suffering or Harm. Psychological abuse or emotional abuse is a form of abuse characterized by a person subjecting or exposing another to behavior that is psychologically harmful Sexual abuse, also referred to as molestation, is the forcing of undesired sexual acts by one person upon another Post-traumatic stress disorder (PTSD) includes depression as one of its major locomotives symptoms. Post traumatic stress disorder It is a severe and ongoing emotional reaction to 
Stressful life experiences or circumstances may trigger a depressive episode, such as traumatic experiences such as rape, abortion, or grief over the death of a child, spouse, other family member or friends. Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. Rape, also referred to as Sexual assault, is an Assault by a person involving Sexual intercourse with or Sexual penetration of another person An Grief is a multi-faceted response to loss Although conventionally focused on the emotional response to loss it also has physical cognitive behavioral social and philosophical A depressive episode may also be triggered by other major changes such as unemployment, divorce, or a loss of religious faith. Unemployment occurs when a person is available to work and currently seeking work but the person is without work. Divorce or dissolution of marriage is the termination of a Marriage. Faith is a Belief in the trustworthiness of an Idea. Formal usage of the word "faith" is usually reserved for concepts of Religion, as in As well, a depressive episode may arise from ongoing issues, such as financial difficulties or poverty, ongoing major health problems (e. Poverty (also called penury) is deprivation of common necessities that determine the quality of life including food clothing shelter and safe Drinking water, and g. , eating disorders), addictions (e. An eating disorder is a compulsion to eat or avoid eating that negatively affects both one's physical and mental health g. , gambling addiction or drug addiction), sexual difficulties, or work-related stress. Problem gambling (ludomania is an urge to gamble despite harmful negative consequences or a desire to stop Sexual dysfunction or sexual malfunction (see also Sexual function) is difficulty during any stage of the Sexual act (which includes desire, Workplace stress is the harmful physical and emotional response that occurs when there is a poor match between job demands and the capabilities resources or needs of the worker
The three most often used conventional treatments are medication, psychotherapy, and electroconvulsive therapy.
A patient's doctor may have to change the antidepressant taken, adjust the dosages of medications, or try different combinations of antidepressants before finding the most effective option for the patient; response rates to the first agent administered may be as low as 50 percent. An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression  It may take anywhere from three to eight weeks after the start of medication before its therapeutic effects can be fully discovered. Patients are generally advised not to stop taking an antidepressant suddenly and to continue its use for at least four months to prevent the chance of recurrence. For patients that have chronic depression, medication may need to be continued for the remainder of their life. 
A wide range of antidepressant drugs can be prescribed to treat depression. An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression These drugs have historically been divided into four major groups: selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and other antidepressants. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders Tricyclic antidepressants (abbreviation TCAs) are a class of Antidepressant drugs first used in the 1950s Monoamine oxidase inhibitors ( MAOIs) are a class of powerful antidepressant drugs prescribed for the treatment of depression.
Selective serotonin reuptake inhibitors, such as sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) are the primary medications considered for patients, due to their relatively mild side effects and the broad effect on the depression and anxiety symptoms. Escitalopram (trade names Lexapro, Cipralex) is the pure (S Enantiomer of Citalopram and is a Selective serotonin reuptake inhibitor Paroxetine (trade names Seroxat, Paxil, Parotin, Aropax, Xetanor, ParoMerck, Rexetin) is a Selective serotonin Citalopram is an Antidepressant drug used to treat major depression associated with Mood disorders It is also used on occasion in the treatment Those who do not respond to the first SSRI tried, can be switched to another SSRI antidepressant. Such a switch results in improvement in almost 50% cases.  Another popular option is to switch the patient to an atypical antidepressant bupropion (Wellbutrin, Zyban) or to add bupropion to the existing therapy. Bupropion ( INN, previously known as amfebutamone; sold as Wellbutrin, Zyban, and several other Trade names is an atypical Antidepressant  There are indications that the remission rate is higher when non-responders to an SSRI receive bupropion as an add-on therapy rather than as a single medication.  The causing or worsening of insomnia is not uncommon with SSRIs; mirtazapine (Avanza, Zispin, Remeron) is an alternative, and the only available Noradrenergic and specific serotonergic antidepressant (NASSA). Mirtazapine is an Antidepressant introduced by Organon International in 1994 used for the treatment of moderate to severe depression. Noradrenergic and selective serotonergic antidepressants (abbreviated NaSSAs) are a relatively new class of Antidepressants They are thought to work by blocking presynaptic This is a newer class which purportedly works to increase norepinephrine (noradrenaline) and serotonin neurotransmission by blocking presynaptic alpha-2 adrenergic receptors while at the same time minimizing serotonin related side-effects by blocking certain serotonin receptors. Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a The adrenergic receptors (or adrenoceptors) are a class of G protein-coupled receptors that are targets of the Catecholamines Adrenergic receptors With strong antihistamine effects, it is a sedating medication which some patients appreciate.
Venlafaxine (Effexor) may be moderately more effective than SSRIs; however, it is not recommended as a first line treatment because of the high rate of the side effects. Venlafaxine (Effexor Efexor is an Antidepressant of the Serotonin-norepinephrine reuptake inhibitor (SNRI class first introduced by Wyeth in 1993  MAOIs may be the best medication for a small number of patients, however those patients will have to avoid a variety of foods and decongestant medications to reduce the chances of a hypertensive crisis. A decongestant is a broad class of Medications used to relieve Nasal congestion. A hypertensive emergency is severe Hypertension (high blood pressure with acute impairment of an Organ system (especially the Central nervous system 
A widely-reported meta-analysis combined 35 clinical trials submitted to the FDA before licensing of four newer antidepressants. The authors found that although the antidepressants were statistically superior to placebo they often did not exceed the NICE criteria for a 'clinically significant' effect. Statistics is a mathematical science pertaining to the collection analysis interpretation or explanation and presentation of Data. Placebo is a substance or procedure a patient accepts as medicine or therapy but which has no specific therapeutic activity In particular they found that the effect size was very small for moderate depression but increased with severity reaching 'clinical significance' for very severe depression.  This result is consistent with the earlier clinical studies where only patients with severe depression benefited from the treatment with a tricyclic antidepressant imipramine or from psychotherapy more than from the placebo treatment. Imipramine (sold as Antideprin, Deprenil, Deprimin, Deprinol, Depsonil, Dynaprin, Eupramin, Imipramil 
There are a number of different psychotherapies for depression, which may be provided individually or in a group format. Psychotherapy is an Interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living Psychotherapy can be delivered by a variety of mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers, or psychiatric nurses. Social work is a discipline involving the application of Social theory and research methods to study and improve the lives of people groups and societies The most studied form of psychotherapy for depression is Cognitive behavioral therapy. See also Cognitive Therapy Cognitive Behavioral Therapy ( CBT) is an umbrella-term for psychotherapeutic systems that deal with cognitions interpretations Several clinical trials have shown that CBT is as effective as anti-depressant medications, even among more severely depressed patients. While the precise mechanisms of change in CBT remain an active area of research, CBT is thought to work by teaching patients to learn a set of cognitive and behavioral skills, which they can employ on their own. This type of therapy attempts to teach people to learn healthier behaviors.
Interpersonal psychotherapy focuses on the social and interpersonal triggers that may cause depression. Interpersonal Psychotherapy (IPT is a time-limited Psychotherapy that focuses on the interpersonal context and on building interpersonal skills There is evidence that it is an effective treatment for depression. Here, the therapy takes a structured course with a set number of weekly sessions (often 12) as in the case of CBT, however the focus is on relationships with others. Therapy can be used to help a person develop or improve interpersonal skills in order to allow him or her to communicate more effectively and reduce stress. " Interpersonal skills " refers to mental and communicative Algorithms applied during social Communications and interactions in order to reach certain effects 
Psychodynamic psychotherapy is a more long-term therapy whereby recurring themes and subconscious issues are examined and reflected upon in great detail. Psychodynamic psychotherapy is a form of Depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate It is in this mode that child development, particularly early relationships and childhood trauma are examined. Child development refers to the biological and psychological changes that occur in human beings between birth and the end of Adolescence, as the individual Narrative therapy gives attention to each person's "dominant story" by means of therapeutic conversations, which also may involve exploring unhelpful ideas and how they came to prominence. Narrative Therapy was initially developed during the 1970s and 1980s largely by Australian Michael White ( Dulwich Centre and his friend and colleague David Epston, of New Possible social and cultural influences may be explored if the client deems it helpful.
Supportive therapy encourages people to discuss their problems and provides them with emotional support. The focus is on sharing information, ideas, and strategies for coping with daily life.
Earlier research initially suggested that psychotherapy, specifically cognitive-behavioral therapy, was not as effective as medication in the treatment of depression; however, recent research suggests that CBT can perform as well as anti-depressant medication in the treatment of moderate to severe depression treated on an outpatient basis. With more complex and chronic forms of depression the most effective treatment is often a combination of medication and psychotherapy. 
Electroconvulsive therapy (ECT), also known as electroshock, is a treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting Today, ECT is a last resort, and is most often used as a treatment for severe major depression which has not responded to other treatment. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression An estimated 1 million people worldwide receive ECT every year usually in a course of 6-12 treatments administered 2 or 3 times a week. In a study, ECT was shown clinically to be the most effective treatment for severe depression, and to result in improved quality of life in both short- and long-term. Quality of life is the degree of well-being felt by an individual or group of people  After treatment, drug therapy can be continued, and some patients receive continuation/maintenance ECT. Short-term memory loss, disorientation, and headache are very common side effects. Short-term memory, sometimes referred to as "primary" "working" or "active" Memory, is said to hold a small amount of information for about 20 Detailed neuropsychological testing in clinical studies has not been able to prove permanent effects on memory.
ECT offers the benefit of a very fast response; however, this response has been shown not to last unless maintenance electroshock or maintenance medication is used. Whereas antidepressants usually take around a month to take effect, the results of ECT have been shown to be much faster. For this reason, it is the treatment of choice in emergencies (e. g. , in catatonic depression in which the patient has ceased oral intake of fluid or nutrients). The American Psychiatric Association and the National Institute for Health and Clinical Excellence have concluded that the procedure does not cause brain damage. The American Psychiatric Association (APA is the main Professional organization of Psychiatrists and trainee psychiatrists in the United States, and the  Like all forms of psychiatric treatment, ECT can be given without a patient's consent, but this is subject to legal conditions dependent on the jurisdiction. In Oregon, patient consent is necessary by statute. Oregon ( is a state in the Pacific Northwest region of the United States. 
Cranial electrotherapy stimulation devices (CES devices) use electrodes placed on or just behind the ear to generate a very small electrical current. Cranial Electrotherapy Stimulation ( CES) is used in the treatment of Anxiety, depression, Insomnia, and Drug addiction; via a In normal healthy males this microcurrent has been shown to affect alpha wave and beta wave brain activity, which according to the authors,"suggest beneficial changes in mental state". Alpha waves are Electromagnetic oscillations in the frequency range of 8–12 Hz arising from synchronous and coherent ( in phase Beta wave, or beta rhythm is the term used to designate the Frequency range of Brain activity above 12 Hz (12 transitions or cycles per second  Unlike transcranial magnetic stimulation and vagus nerve stimulation, CES devices are small, relatively inexpensive, and are designed for home use. Unlike vagus nerve stimulation, no surgery is required.
Several double-blind studies of mixed groups of psychiatric patients have been conducted in the 1970s. The results were inconclusive and negative in one of these trials.  In another trial, no difference between the placebo and treatment groups were found on any of the five measures employed.  A third trial reported overall inconclusive results; however, four out of six clinically depressed patients dropped out of the study because of the massive worsening of depressive symptoms, with two of them becoming actively suicidal.  One of the authors of the third study cautioned that CES “should not be used as a treatment of choice” for the patients with the primary diagnosis of depression, “and should be used with caution if this diagnosis is suspected. ” Many preliminary, small-scale studies have been conducted which show the effectiveness of CES therapy; however, to date there exists no consensus or even prospective clinical trials to support its use.
All of the CES devices currently on the market have been granted marketing authorization by the FDA based on the legacy waver, that is because a sufficiently similar device had been marketed before 1976, when the new regulations requiring controlled testing were introduced.  Such approval is sometimes misunderstood as evidence of efficacy, it should only be taken as lack of evidence of harm. The FDA considers them to be the class III devices—"devices for which insufficient information exists to assure that general controls and special controls provide reasonable assurance of safety and effectiveness"
Recurrence is more likely if treatment has not resulted in full remission of symptoms. 4 In fact, current guidelines for antidepressant use recommend 4 to 6 months of continuing treatment after symptom resolution to prevent relapse. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression
Combined evidence from many randomized controlled trials indicates that continuing antidepressant medications after recovery substantially reduces (halves) the chances of relapse. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare This preventive effect probably lasts for at least the first 36 months of use. 
Anecdotal evidence suggests that chronic disease is accompanied by recurrence after prolonged treatment with antidepressants (tachyphylaxis). Tachyphylaxis is a medical term describing a rapidly decreasing response to a drug following administration of the initial doses Psychiatric texts suggest that physicians respond to recurrence by increasing dosage, complementing the medication with a different class, or changing the medication class entirely. The reason for recurrence in these cases is as poorly understood as the change in brain physiology induced by the medications themselves. Possible reasons may include aging of the brain or worsening of the condition. Most SSRI psychiatric medications were developed for short-term use (a year or less) but are widely prescribed for indefinite periods. 
In the Old Testament description of King Saul, has symptoms that resemble some elements in the modern diagnosis of depression; eventually he commits suicide. In Western Christianity, the Old Testament refers to the books that form the first of the two-part Christian Biblical canon. Saul (שאול המלך (or Sha'ul) ( Arabic: طالوت,Tālūt ( (reigned 1047 - 1007 BCE is identified in the Books of Samuel, 1 Chronicles In prehistory, ancient humans probably "saw mental illness as possession by supernatural forces. " Evidence of this theory is that "human skulls have been found with large holes in them", which may have been an attempt to "let evil spirits out.  The Greek scholar Empedocles (490-430 BC) proposed that humans experienced disease when their four humours were imbalanced. Empedocles ( Greek:, ca 490–430 BC was a Greek Pre-Socratic Philosopher and a citizen of Agrigentum, a Greek colony in The four humours were Fire(Blood); Earth (Phlegm); water (Yellow bile); and Air (Black bile). Empedocles' theories were further developed by Hippocrates (460-377 BC), who argued that "mental disorder must be explained on the basis of natural causes" such as the "sudden flow of bile to the brain". Hippocrates believed that the appropiate treatment for a mental disorder depended on which humor had caused the problem. Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca 
Plato (427-347 BC) argued that there were two types of mental illness: "divinely inspired" mental illness that gave the person prophetic powers, and a second type which was caused by a physical disease. Biography Early life Birth and family Plato was born in Athens Greece  Aristotle (384-322 BC), who studied under Plato, abandoned the divinely-caused mental illness theory, and proposed instead that all mental illness was caused by physical problems. The Roman physician Asclepiades claimed that emotional disturbances were “passions of sensations”. Asclepiades may refer to Asclepiades of Phlius, (4th-3rd century BC philosopher in the Eretrian school of Philosophy Asclepiades of Samos Arateus (ca AD 30-90) suggested that it is hard to pinpoint where a mental illness comes from. His contemporary Galen (AD 30-90) rehashed the Greek theories, proposing that there are "animal spirits" which cause melancholy. Galen ( Greek: Γαληνός Galēnos; Latin: Claudius Galenus, Aelius Galenus, Claudius Aelius Galenus, or The modern idea of depression appears similar to the much older concept of melancholia. The name melancholia derives from "black bile", one of the "four humours" postulated by Galen. Humorism, or humoralism, was a theory of the makeup and workings of the human body adopted by Greek and Roman physicians and philosophers
In the 16th century, though, the physician Johan Weyer (1515-1588) argued against the witchcraft theories. Juan Luis Vives (1492-1540) founded hospitals for mentally-ill people. With the turn of the 17th century, science gained increasing prestige, and emotions and anatomy were studied more closely. The philosopher Spinoza (1632-1677) argued that the mind and body are closely connected. Literary figures such as William Shakespeare (1564-1616) and Miguel de Cervantes (1547-1616) described mental illness in an insightful way in their works. Phillipe Pinel in France argued that insanity was caused by factors in the environment or in a person's background. Philippe Pinel ( April 20, 1745 - October 25, 1826) was a French physician who was instrumental in the development of a more humane psychological Franz Joesph Gall proposed a theory of “phrenology” which claimed that locations of the brain are connected to body parts. Phrenology (from Greek: φρήν phrēn, "mind" and λόγος Logos, "knowledge" is a defunct field of study once 
In the 19th century, Johann Christian Heinroth revived the claim that mental illness was caused by moral sins of the patient. But by the mid-19th century, scholars began to believe that mental illness was caused by physical, organic causes. The German psychiatrist Wilhelm Griesinger (1817-1868) argued that mental illnesses were caused by the brain. Wilhelm Griesinger ( July 29, 1817 - October 26, 1868) was a German Neurologist and Psychiatrist. Emil Kraeplin (1855-1926) argued that metabolic factors caused mental illness. Freud argued that each patient's unique life history and experiences caused their mental problems. Freud's psychoanalysis was one of the main theories of mental illness until the 1970s.
Clinical depression was originally considered to be a chemical imbalance in transmitters in the brain, a theory based on observations made in the 1950s of the effects of reserpine and isoniazid in altering monoamine neurotransmitter levels and affecting depressive symptoms. Chemical imbalance is a term used as a lay explanation of Mental illness or mental disorders Reserpine is an Indole Alkaloid Antipsychotic and Antihypertensive drug that has been used for the control of high blood pressure Isoniazid (also called isonicotinyl hydrazine or INH) is a first-line antituberculous medication used in the prevention and treatment of Tuberculosis  Since these suggestions, many other causes for clinical depression have been proposed. 
Psychiatrist David Healy has written of the growth of the diagnosis, along with perspectives on the development and promotion of antidepressants and the biological model since the late 1950s. David Healy is an Irish Psychiatrist who is currently a professor in Psychological Medicine at Cardiff University College of Medicine Wales. After the 1970s, scholars began to propose a range of "genetic, biochemical and neuropathological causes of mental disorder. "
Some medical professionals and anthropologists have formed several theories as to how depression may have evolutionary advantages, i. Major depression is the leading cause of disability worldwide and in 2000 was the fourth leading contributor to the global burden of disease ( DALYs) it is also an important e. , how it might have increased genetic fitness in ancestral populations. For example, psychic pain may have evolved in an analogous way to physical pain so that organisms avoid behaviour which hinders reproduction. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm This insight may be helpful in counselling therapy.  Proponents of the psychic pain theory tend to view clinical depression as a dysfunctional extreme of low mood or mild depression.
The former British Prime Minister Sir Winston Churchill, one of the most famous sufferers of depression, coined the term "The Black Dog" for it. Sir Winston Leonard Spencer-Churchill, KG, OM, CH, TD, FRS, PC, PC (Can ( 30 November 1874 Journeys with the Black Dog is an anthology of essays of sufferers writing on their experiences. Journeys with the Black Dog Inspirational Stories of Bringing Depression to Heel is a 2007 anthology edited by Tessa Wigney Kerrie Eyers and Gordon Parker The critically acclaimed 1980 film Ordinary People depicts a young man's torrid course of a severe depressive episode, while the 1956 Alfred Hitchcock film The Wrong Man has the protagonist's wife Rose suffering. Ordinary People is a 1980 American Motion picture drama and the directorial debut of Robert Redford. The Wrong Man is a 1956 Film by Alfred Hitchcock which stars Henry Fonda and Vera Miles. 
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