56 seasonal affective disorder, a type of depression associated with seasonal changes in sunlight, is thought to be the result of decreased sunlight. 57 Pathophysiology further information: biology of depression The pathophysiology of depression is not yet understood, but the current theories center around monoaminergic systems, the circadian rhythm, immunological dysfunction, hpa axis dysfunction and structural or functional abnormalities of emotional circuits. The monoamine theory, derived from the efficacy of monoaminergic drugs in treating depression, was the dominant theory until recently. The theory postulates that insufficient activity hazlitt of monoamine neurotransmitters is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas. Firstly, acute depletion of tryptophan, a necessary precursor of serotonin, a monoamine, can cause depression in those in remission or relatives of depressed patients; this suggests that decreased serotonergic neurotransmission is important in depression. 58 Secondly, the correlation between depression risk and polymorphisms in the 5-httlpr gene, which codes for serotonin receptors, suggests a link. Third, decreased size of the locus coeruleus, decreased activity of tyrosine hydroxylase, increased density of alpha-2 adrenergic receptor, and evidence from rat models suggest decreased adrenergic neurotransmission in depression. 59 Furthermore, decreased levels of homovanillic acid, altered response to dextroamphetamine, responses of depressive symptoms to dopamine receptor agonists, decreased dopamine receptor D1 binding in the striatum, 60 and polymorphism of dopamine receptor genes implicate dopamine in depression.
However, since the 1990s results have been inconsistent, with three recent reviews finding an effect and two finding none. Other genes that have been linked to a gene-environment interaction include crhr1, fkbp5 and bdnf, the first two of which are related to the stress reaction of the hpa axis, and the latter of which is involved in neurogenesis. A 2018 study found 44 areas within the chromosomes that were linked to mdd. 49 Other health problems Depression may also come secondary to a chronic or terminal medical condition such as hiv/aids, or asthma and may be labeled "secondary depression". 50 51 It is unknown if the underlying diseases induce depression through effect on quality of life, of through shared etiologies (such as degeneration of the basal ganglia in parkinson's disease or immune dysregulation in asthma ). 52 Depression may also be iatrogenic (the result of healthcare such as drug induced depression. Therapies associated with depression include interferon therapy, beta-blockers, isotretinoin, contraceptives, 53 cardiac agents, anticonvulsants, antimigraine drugs, you antipsychotics, and hormonal agents agents such as gonadotropin-releasing hormone agonist. 54 Drug abuse in early age is also associated with increased risk of developing depression later in life. 55 Depression that occurs as a result of pregnancy is called postpartum depression, and is thought to be the result of hormonal changes associated with pregnancy.
39 cause The cause of major depressive disorder is unknown. The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression. 3 40 The diathesisstress model specifies that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either genetic, 41 42 implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood. 43 Childhood abuse, either physical, sexual or psychological, are all risk factors for depression, among other psychiatric issues that co-occur such as anxiety and drug abuse. Childhood trauma also correlates with severity of depression, lack of response to treatment and length of illness. However, some are more susceptible to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility. 44 Genetics The 5-httlpr, or serotonin transporter promoter gene's short allele has been associated with increased risk of depression.
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32 There are increased rates of alcohol and drug abuse and particularly dependence, 33 and around a third of individuals diagnosed with adhd essays develop comorbid depression. 34 Post-traumatic stress disorder and depression often co-occur. 19 Depression may also coexist with attention deficit hyperactivity disorder (adhd complicating the diagnosis and treatment of both. 35 Depression is also frequently comorbid with alcohol abuse and personality disorders. 36 Depression and pain often co-occur.
One or more pain symptoms are present in 65 of depressed patients, and anywhere from 5 to 85 of patients with pain will be suffering from depression, depending on the setting; there is a lower prevalence in general practice, and higher in specialty clinics. The diagnosis of depression is often delayed or missed, and the outcome can worsen if the depression is noticed but completely misunderstood. 37 Depression is also associated with.5- to 2-fold increased risk of cardiovascular disease, independent of other known risk factors, and is itself linked directly or indirectly to risk factors such as smoking and obesity. People with major depression are less likely to follow medical recommendations for treating and preventing cardiovascular disorders, which further increases their risk of medical complications. 38 In addition, cardiologists may not recognize underlying depression that complicates a cardiovascular problem under their care.
26 A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries, according to the world health Organization 's criteria for depression. 27 Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. 21 Family and friends may notice that the person's behavior is either agitated or lethargic. 25 Older depressed people may have cognitive symptoms of recent onset, such as forgetfulness, 23 and a more noticeable slowing of movements. 28 Depression often coexists with physical disorders common among the elderly, such as stroke, other cardiovascular diseases, parkinson's disease, and chronic obstructive pulmonary disease.
29 Depressed children may often display an irritable mood rather than a depressed mood, 21 and show varying symptoms depending on age and situation. 30 Most lose interest in school and show a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure. 25 diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness. 21 Associated conditions Major depression frequently co-occurs with other psychiatric problems. The 199092 National Comorbidity survey (US) reports that half of those with major depression also have lifetime anxiety and its associated disorders such as generalized anxiety disorder. 31 Anxiety symptoms can have a major impact on the course of a depressive illness, with delayed recovery, increased risk of relapse, greater disability and increased suicide attempts.
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21 In severe cases, depressed people may have symptoms of psychosis. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant. 22 Other symptoms of depression include poor concentration and memory (especially in those oliver with melancholic or psychotic features 23 withdrawal from social situations and activities, reduced sex drive, irritability, 24 and thoughts of death or suicide. Insomnia is common among the depressed. In the typical pattern, a person wakes very early and cannot get back to sleep. 25 Hypersomnia, or oversleeping, can also happen. 25 Some antidepressants may also cause insomnia due to their stimulating effect.
16 The most common time of onset is in a person's 20s and 30s. 3 4 Females are affected about twice as often as males. 3 4 The American Psychiatric Association added "major depressive disorder" to the diagnostic and Statistical Manual of Mental Disorders (dsm-iii) in 1980. 17 It was a split of the previous depressive neurosis in the dsm-ii, which also encompassed the conditions now known as dysthymia and adjustment disorder with depressed mood. 17 Those currently or previously affected may be stigmatized. 18 Contents Signs and symptoms An 1892 lithograph of a woman diagnosed with depression Major depression significantly affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health. 19 Its impact on functioning and well-being has been compared to that of other chronic medical conditions such as diabetes. 20 A person having a major depressive episode usually exhibits a very low mood, which pervades all aspects of life, and an inability to experience pleasure in activities that were presentation formerly enjoyed. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred.
and interpersonal therapy. 1 14 If other measures are not effective, electroconvulsive therapy (ECT) may be tried. 1 Hospitalization may be necessary in cases with a risk of harm to self and may occasionally occur against a person's wishes. 15 Major depressive disorder affected approximately 216 million people (3 of the world's population) in 2015. 5 The percentage of people who are affected at one point in their life varies from 7 in Japan to 21 in France. 4 Lifetime rates are higher in the developed world (15) compared to the developing world (11). 4 It causes the second most years lived with disability, after low back pain.
1, risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse. 1 3 About 40 of the risk appears to be related to genetics. 3 The diagnosis of major depressive disorder is based on the person's reported experiences and a mental status examination. 7 There is no laboratory test for major depression. 3 Testing, however, may be done to rule out physical conditions that can cause similar symptoms. 7 Major depression should be differentiated from sadness, which is a normal part of life and is less severe. 3 The United States Preventive services Task force (uspstf) recommends screening for depression among those over using the age 12, 8 9 while a prior Cochrane review found that the routine use of screening questionnaires have little effect on detection or treatment. 10 Typically, people are treated with counseling and antidepressant medication.
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For other types of depression, see. Not to be confused with, depression (mood). Major depressive disorder mdd also known simply as depression, is a mental disorder characterized by at least two weeks of low mood that is present across most situations. It is often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause. 1, people may also occasionally have false beliefs or see or hear things that others cannot. 1, some people have periods of depression separated by years in which they are normal, while others nearly always have symptoms present. 3, short major depressive disorder can negatively affect a person's personal, work, or school life as well as sleeping, eating habits, and general health. 1 3, between 27 of adults with major depression die by suicide, 2 and up to 60 of people who die by suicide had depression or another mood disorder. 6, the cause is believed to be a combination of genetic, environmental, and psychological factors.