Depressive Disorders Health Article

Definition

Depression and depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. Disturbance in sleep, appetite, and mental processes are common symptoms of depression.

Description

Everyone experiences feelings of unhappiness and sadness occasionally. However, when these depressed feelings start to dominate everyday life and cause physical and mental deterioration, they become what are known as depressive disorders.

There are two main categories of depressive disorders: major depressive disorder and dysthymic disorder. Major depressive disorder is a moderate to severe episode of depression lasting two or more weeks. Individuals experiencing this major depressive episode may have trouble sleeping, lose interest in activities they once took pleasure in, experience a change in weight, have difficulty concentrating, feel worthless and hopeless, or have a preoccupation with death or suicide. In children, the major depression may often appear as irritability.

While major depressive episodes may be acute (intense but short-lived), dysthymic disorder is an ongoing, chronic depression that lasts two or more years (one or more years in children) and has an average duration of 16 years. The mild to moderate depression of dysthymic disorder may rise and fall in intensity, and those afflicted with the disorder may experience some periods of normal, non-depressed mood of up to two months in length. Its onset is gradual, and dysthymic patients may not be able to pinpoint exactly when they started feeling depressed. Individuals with dysthymic disorder may experience a change in sleeping and eating patterns, low self-esteem, fatigue, trouble concentrating, and feelings of hopelessness. Parents of children suffering from dysthymic disorder may notice their child experience a fall in grades and a lack of interest in extracurricular activities that were once enjoyable.

Depression also can occur in bipolar disorder, an affective mental illness that causes radical emotional changes and mood swings, from manic highs to depressive lows. The majority of bipolar individuals experience alternating episodes of mania and depression.

Demographics

The Substance Abuse and Mental Health Services Administration (SAMSHA) estimates that one out of every 33 children may suffer from depression. Among adults 18 and older, depressive disorders affect an estimated 18.8 million Americans each year. Women are twice as likely to suffer from a depressive disorder than men; approximately 12.4 million American women and 6.4 million men deal with depression. The average age a first depressive episode occurs is in the mid-20s, although the disorder strikes all age groups indiscriminately, from children to the elderly.

According to the U.S. Surgeon General, major depression occurs in about 5 percent of children between age nine and 17, and at any one point in time, 10 to 15 percent of U.S. children and adolescents experience some symptoms of depression.

Causes and symptoms

The causes behind depression are complex and as of 2004 not fully understood. While an imbalance of certain neurotransmitters—the chemicals in the brain that transmit messages between nerve cells—is believed to be key to depression, external factors such as upbringing may be as important. For example, it is speculated that, if an individual is abused and neglected throughout childhood and adolescence, a pattern of low self-esteem and negative thinking may emerge. From that, a lifelong pattern of depression may follow.

Heredity seems to play a role in who develops depressive disorders. Individuals with major depression in their immediate family are up to three times more likely to have the disorder themselves. It would seem that biological and genetic factors may make certain individuals pre-disposed to depressive disorders, but environmental circumstances often may trigger the disorder as well.

External stressors and significant life changes such as chronic medical problems, death of a loved one, or divorce or estrangement of parents also can result in a form of depression known as adjustment disorder. Although periods of adjustment disorder usually resolve themselves, occasionally they may evolve into a major depressive disorder.

Common red flags that children may be experiencing a depressive disorder include a sudden decline in grades and/or disinterest in schoolwork, avoidance of friends, loss of interest in extracurricular activities, and withdrawal from family.

Major depressive episode

Individuals experiencing a major depressive episode have a depressed mood and/or a diminished interest or pleasure in activities. Children experiencing a major depressive episode may appear or feel irritable rather than depressed. In addition, five or more of the following symptoms will occur on an almost daily basis for a period of at least two weeks:

• significant change in weight
• insomnia or hypersomnia (excessive sleep)
• psychomotor agitation or retardation
• fatigue or loss of energy
• feelings of worthlessness or inappropriate guilt
• diminished ability to think or to concentrate, or indecisiveness
• recurrent thoughts of death or suicide and/or suicide attempts