Depression
Medical Authors: Roxanne Dryden-Edwards, MD, and Dennis Lee, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Depression
What are the causes of depression?
 Some types of depression run in families, indicating that a biological vulnerability to depression can be inherited. This seems to be the case, especially with bipolar disorder. Families in which members of each generation develop bipolar disorder have been studied. The investigators found that those with the illness have a somewhat different genetic makeup than those who do not become ill. However, the reverse is not true. That is, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will develop the illness. Apparently, additional factors, possibly a stressful environment, are involved in its onset and protective factors are involved in its prevention.
Major depression also seems to occur in generation after generation in some families, although not as strongly as in bipolar I or II. Indeed, major depression can also occur in people who have no family history of depression.
An external event often seems to initiate an episode of depression. Thus, a serious loss, chronic illness, difficult relationship, financial problem, or any unwelcome change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Stressors that contribute to the development of depression sometimes affect some groups more than others. For example, minority groups who more often feel impacted by discrimination and are disproportionately represented. Socioeconomically disadvantaged groups have higher rates of depression compared to their advantaged counterparts. Immigrants to the United States may be more vulnerable to developing depression, particularly when isolated by language.
Learn more about depression causes »
What is a depressive disorder?
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
In the 1950s and '60s, depression was divided into two types, endogenous
and neurotic. Endogenous means that the depression comes from within the body,
perhaps of genetic origin, or comes out of nowhere. Neurotic or reactive
depression has a clear environmental precipitating factor, such as the death of
a spouse, or other significant loss, such as the loss of a job. In the 1970s and
'80s, the focus of attention shifted from the cause of depression to its effects
on the afflicted people. That is to say, whatever the cause in a particular
case, what are the symptoms and impaired functions that experts can agree make
up a depressive disorder? Although there is some argument even today (as in all
branches of medicines), most experts agree on the following:
- A depressive disorder is a syndrome (group of symptoms) that reflects a
sad and/or irritable mood exceeding normal sadness or grief. More specifically, the sadness of
depression is characterized by a greater intensity and duration and by more
severe symptoms and functional disabilities than is normal.
- Depressive signs and symptoms are characterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, crying spells, body aches, low energy or libido, as well as problems with eating, weight, or sleeping). The functional changes of clinical depression are often called neurovegetative signs. This means that the nervous system changes in the brain cause many physical symptoms that result in diminished participation and a decreased or increased activity level.
- Certain people with depressive disorder, especially bipolar depression
(manic depression),
seem to have an inherited vulnerability to this condition.
- Depressive disorders are a huge public-health problem, due to its affecting millions of people. About 10% of adults, up to 8% of teens and 2% of preteen children experience some kind of depressive disorder.
- The statistics on the costs due to depression in the United States include huge amounts of direct costs, which are for treatment, and indirect costs, such as lost productivity and absenteeism from work or school.
- Adolescents who suffer from depression are at risk for developing and maintaining obesity.
- In a major medical study, depression caused significant problems in the
functioning of those affected more often than did arthritis, hypertension,
chronic lung disease, and diabetes, and in
some ways as often
as coronary artery disease.
- Depression can increase the risks for developing coronary artery disease,
HIV, asthma, and
many other medical illnesses. Furthermore, it can increase the morbidity (illness/negative health effects) and mortality (death) from these and many other medical conditions.
- Depression can coexist with virtually every other mental health illness,
aggravating the status of those who suffer the combination of both
depression and the other mental illness.
- Depression in the elderly tends to be chronic, has a low rate of recovery, and is often undertreated.
This is of particular concern given that elderly men, particularly elderly white
men have the highest suicide rate.
- Depression is usually first identified in a primary-care setting, not in a
mental health practitioner's office. Moreover, it often assumes various
disguises, which causes depression to be frequently underdiagnosed.
- In spite of clear research evidence and clinical guidelines regarding
therapy, depression is often undertreated. Hopefully, this situation can change
for the better.
- For full recovery from a mood disorder, regardless of whether there is a
precipitating factor or it seems to come out of the blue, treatment with
medication and/or electroconvulsive therapy (ECT) (see discussion below) and
psychotherapy are necessary.
Next: What are myths about depression? »
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Lyme disease is a bacterial illness caused by a bacterium
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What is the history of Lyme disease?
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