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Clinical depression
Major depression is also known as clinical depression, unipolar
depression, and major depressive disorder. People who experience
major depression feel persistently sad. They do not take pleasure
in activities that were once enjoyable. Other physical and
mental problems often experienced include sleep problems,
loss of appetite, inability to concentrate, memory problems,
and aches and pains. People who suffer from this condition
often feel worthless, helpless, and hopeless about their ability
to fix things. They often welcome sleep and experience their
waking life as a living nightmare. No matter how hard they
try to snap out of it, they feel as though they are falling
into an abyss with nothing to hold on to.
Clinical depression usually strikes people between the ages
of 25 and 44, although it can affect any person at any age.
For most people, episodes of major depression last from six
to nine months. Sometimes, even if major depression goes untreated,
it will run its course and leave by itself. Doctors are not
sure why this happens, but it is often attributed to the body’s
tendency to correct abnormal situations.
What Causes Clinical Depression
The dramatic success of antidepressant drug therapy for severe
major depression has made many scientists question if depression
has a strong biological, rather than psychological, basis.
Thus many are questioning whether genetics or stress plays
the major role in causing major depression. Recent research
has shown that both play a major role in major depression.
Surprisingly, stress has been shown to play a major role
in the patient's first two episodes of major depression, but
not in later episodes. Genetics and temperament appear to
play the most important role for later episodes of a patient's
depression.
It appears that major depression often requires stress to
"get the ball rolling", but after a few episodes,
the illness develops its own momentum and no longer needs
stress to "keep rolling". This is a familiar pattern
seen in many medical illnesses. Thus, the treatment of major
depression must address the major contribution that stress,
genetics and temperament play in this disorder. Unfortunately,
most current therapies lack this well-rounded approach.
Symptoms of Clinical Depression
Five (or more) of the following symptoms have been present
during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either:
(1) depressed mood or (2) loss of interest or pleasure. (Note:
Do not include symptoms that are clearly due to a general
medical condition, or mood-incongruent delusions or hallucinations.)
- depressed mood most of the day, nearly every day, as
indicated by either subjective report (e.g., feels sad or
empty) or observation made by others (e.g., appears tearful).
Note: In children and adolescents, can be irritable mood.
- markedly diminished interest or pleasure in all, or almost
all, activities most of the day, nearly every day (as indicated
by either subjective account or observation made by others)
- significant weight loss when not dieting or weight gain
(e.g., a change of more than 5% of body weight in a month),
or decrease or increase in appetite nearly every day. Note:
In children, consider failure to make expected weight gains.
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly every day
(observable by others, not merely subjective feelings of
restlessness or being slowed down)
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive or inappropriate
guilt (which may be delusional) nearly every day (not merely
self-reproach or guilt about being sick)
- diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed
by others)
- recurrent thoughts of death (not just fear of dying),
recurrent suicidal ideation without a specific plan, or
a suicide attempt or a specific plan for committing suicide
The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
The symptoms are not due to the direct physiological effects
of a substance (e.g., a drug of abuse, a medication) or a
general medical condition (e.g., hypothyroidism).
The symptoms are not better accounted for by bereavement,
i.e., after the loss of a loved one, the symptoms persist
for longer than 2 months or are characterized by marked functional
impairment, morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms, or psychomotor retardation.
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