Depression

Alternative names:

blues; dejected; discouragement; gloom; mood changes; sadness

Definition:

Depression is a term that people commonly use to refer to states involving sadness, dejection, lack of self-esteem, and lack of energy. In this overview, several types of depression are identified:

1. Depressed mood: An emotional state dominated by feelings of sadness, gloominess, or emptiness, which may be associated with lack of energy. This mood state may be a temporary response to an unhappy or stressful event, or it may be persistent.
2. Chronic low-grade depression, also known as dysthymia: Depressed mood is present most of the time for a period of two years, and is accompanied by changes in energy, appetite, or sleep, as well as low self-esteem and feelings of hopelessness. These symptoms cause distress and difficulty in functioning, but are not as severe as in major depression (see dysthymia for further information).
3. Major depression: Severe, persistent depressed mood and loss of interest or pleasure in normal activities, accompanied by decreased energy, changes in sleep and appetite, and feelings of guilt or hopelessness. These symptoms must be present for at least two weeks, cause significant distress, and be severe enough to interfere with functioning. If the depression is very severe, it may be accompanied by psychotic symptoms or by suicidal thoughts or behaviors (see major depression for more information).
4. People who suffer from dysthymia are at increased risk for episodes of major depression. This produces a situation in which mild depression is present most of the time, with occasional periods of more severe depressive symptoms. This is commonly called "double depression."

See also depression in the elderly; adolescent depression.

Considerations:

Most depression is a reaction to an unhappy event. It is natural to have some depression after a loss such as the death of a relative, or after a major disappointment at home or at work.

Short-term episodes of depression or other mood changes can occur with hormone changes, including those that accompany pregnancy or premenstrual syndrome (PMS, and those occurring shortly after the birth of a baby (postpartum depression). Sleep disruption and lack of sunlight during the winter months are other biological factors that can precipitate depressive symptoms.

Distorted thought patterns, characterized by excessive self-blame, pessimism, and lack of a sense of control over one's life are called "depressive cognition," and can be a risk factor for depression.

It appears that a tendency toward depression is often genetic, but that stressful life circumstances usually play a major role in bringing on depressive episodes. Problems with depression usually begin in adolescence, and are about twice as common in women as in men.

Common causes:

• loss of a friend or relative
• substantial disappointment at home or at work
• prolonged or chronic illness
• drugs such as tranquilizers, high blood pressure medicines, steroids (prednisone), codeine, and indomethacin
• alcohol intoxication
• alcohol withdrawal
• drug intoxication
• drug withdrawal

Note: There may be other causes of depression. Use the Symptom Analysis option to explore the possible explanations for depression, occurring alone or in combination with other problems.

Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director, Utah Health Informatics and adam.com editorial