Depressive Disorder

Depressive Disorder
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What is Depressive Disorder?

A depressive disorder is an illness that involves the body, mood, and thoughts. It interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.

A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Depression is a common but serious illness, and most people who experience it need treatment to get better. Appropriate treatment, however, can help most people who suffer from depression.

Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. Three of the most common types of depressive disorders are described here. However, within these types there are variations in the number of symptoms as well as their severity and persistence.

Major depression also called Unipolar depression or Major Depressive Disorder:  is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Persistent depressive disorder also called Dysthymic disorder, or dysthymia: If you have depression that lasts for 2 years or longer, it’s called persistent depressive disorder. This term is used to describe two conditions previously known as dysthymia (low-grade persistent depression) and chronic major depression.

Perinatal depression also called Postpartum Depression: is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:

Psychotic depression: which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions. The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

Seasonal affective disorder (SAD): which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.

Melancholic depression: often exhibit the most typical signs of depression including weight loss and decreased interest in activities they once loved. You might experience a depressed mood similar to losing someone you love or intense grief. Atypical depression is often directly related to your mood and your interactions with others. Symptoms include hypersomnia, heaviness in the limbs, and social anxiety.

Catatonic depression: you are most likely experiencing motor problems and behavioral issues. You might be immobilized or have involuntary movements. According to the US National Library of Medicine National Institute of Health, it is a “psychotic disorder presents significant risk to the patient’s well-being, as well as an additional barrier to treating the underlying disorder. The signs and symptoms of catatonia interfere severely with essential activities of daily living.”

Premenstrual Dysphoric Disorder (PMDD) depression: Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Like PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins. PMS refers to a wide range of physical or emotional symptoms that most often occur about 5 to 11 days before a woman starts her monthly menstrual cycle. In most cases, the symptoms stop when, or shortly after, her period begins.

Symptoms

Major Depressive Disorder (Unipolar Depression)

At least one of the following three abnormal moods which significantly interfered with the person’s life:

  • Abnormal depressed mood most of the day, nearly every day, for at least 2 weeks.
  • Abnormal loss of all interest and pleasure most of the day, nearly every day, for at least 2 weeks.
  • If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least 2 weeks.

At least five of the following symptoms have been present during the same 2 week depressed period.

  • Abnormal depressed mood (or irritable mood if a child or adolescent) [as defined in criterion A].
  • Abnormal loss of all interest and pleasure [as defined in criterion A2].
  • Appetite or weight disturbance, either:
    • Abnormal weight loss (when not dieting) or decrease in appetite.
    • Abnormal weight gain or increase in appetite.
  • Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.
  • Activity disturbance, either abnormal agitation or abnormal slowing (observable by others).
  • Abnormal fatigue or loss of energy.
  • Abnormal self-reproach or inappropriate guilt.
  • Abnormal poor concentration or indecisiveness.
  • Abnormal morbid thoughts of death (not just fear of dying) or suicide.

The symptoms are not due to a mood-incongruent psychosis.

There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.

The symptoms are not due to physical illness, alcohol, medication, or street drugs.

Major depressive disorder causes the following mood symptoms

Abnormal Depressed Mood

Sadness is usually a normal reaction to loss. However, in Major Depressive Disorder, sadness is abnormal because it:

  • Persists continuously for at least 2 weeks.
  • Causes marked functional impairment.
  • Causes disabling physical symptoms (e.g., disturbances in sleep, appetite, weight, energy, and psychomotor activity).
  • Causes disabling psychological symptoms (e.g., apathy, morbid preoccupation with worthlessness, suicidal ideation, or psychotic symptoms).

The sadness in this disorder is often described as a depressed, hopeless, discouraged, “down in the dumps,” “blah,” or empty. This sadness may be denied at first. Many complain of bodily aches and pains, rather than admitting to their true feelings of sadness.

Abnormal Loss of Interest And Pleasure Mood

The loss of interest and pleasure in this disorder is a reduced capacity to experience pleasure which in its most extreme form is called anhedonia.

The resulting lack of motivation can be quite crippling.

Abnormal Irritable Mood

This disorder may present primarily with irritable, rather than depressed or apathetic mood. This is not officially recognized yet for adults, but it is recognized for children and adolescents.

Unfortunately, irritable depressed individuals often alienate their loved ones with their cranky mood and constant criticisms.

Persistent Depressive Disorder

You may have symptoms such as:

  • Change in your appetite (not eating enough or overeating)
  • Sleep too much or too little
  • Lack of energy, or fatigue
  • Low self-esteem
  • Trouble concentrating or making decisions
  • Appetite and/or weight loss, or overeating and weight gain
  • Restlessness, irritability
  • Feelings of guilt, hopeless, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Suicidal thoughts or behavior

Psychotic Depression

The symptoms of psychotic depression includes

  • Hallucinations (seeing or hearing things that aren’t there)
  • Delusions (false beliefs)
  • Paranoia (wrongly believing that others are trying to harm you)

Perinatal (Postpartum) Depression

Normal pregnancy shares some symptoms and signs of depression. For instance, with either, you’re likely to be tired, have some insomnia, experience emotional changes, and gain weight. That means your pregnancy can mask any symptoms of depression.

To help you recognize depression during pregnancy, it’s worth talking with your doctor about any of these symptoms:

  • frequent crying or weepiness
  • trouble sleeping not because of frequent urination
  • fatigue or low energy
  • changes in appetite
  • loss of enjoyment in once pleasurable activities
  • increased anxiety
  • trouble feeling connected to your developing baby (called poor fetal attachment)

If you had depression before pregnancy, your symptoms may be more significant during it than they were before.

Symptoms of the ‘Baby Blues’

As many as 80 percent of women are affected by what is known as the “baby blues.”

During pregnancy, your levels of estrogen and progesterone rise dramatically. They’re needed to help your uterus expand and to sustain the placenta. These hormones are also associated with mood.

Within 48 hours after your baby’s arrived, the levels of both hormones plummet drastically. Many researchers believe this “postpartum hormonal crash” causes the baby blues.

For about 1 or 2 weeks after your baby’s born, you may have symptoms of the baby blues. They usually go away after that. Until then, you may feel especially:

  • irritable
  • anxious
  • frustrated
  • overwhelmed
  • likely to have rapid mood changes (elation one moment, weeping the next)
  • exhausted
  • sleepy, like you want to sleep all the time (hypersomnia)
  • unable to sleep (insomnia)
Symptoms of postpartum depression

Experts think the same plunge of estrogen and progesterone after delivering a baby may make some women more susceptible to postpartum depression. Postpartum depression affects between 10 and 20 percent of new mothers.

One difference between the baby blues and postpartum depression is duration. Symptoms of postpartum depression last for more than 2 weeks after your baby’s born. They include feeling:

  • overwhelmed
  • intensely anxious
  • weepy or like you’re crying all the time
  • irritable or angry
  • sad all the time
  • extremely tired and without energy
  • worthless, hopeless, or guilty
  • like you want to sleep or eat more or less than you usually do
  • unable to concentrate or forgetful
  • intensely worried about your baby
  • uninterested in your newborn or doing things you used to enjoy
  • headache or pain in your chest or like you can’t catch your breath (hyperventilate)
Symptoms of postpartum psychosis

A more severe form of postpartum depression is called postpartum psychosis. It is an extremely rare condition that affects between 1and 2 women per 1,000.

Common symptoms of postpartum psychosis include

  • either auditory or visual hallucinations
  • delusions, which is believing something that isn’t true
  • suicidal thoughts
  • thoughts about harming your baby

Postpartum psychosis is an extremely serious condition. It requires immediate emergency care. A mother may be hospitalized for her own safety as well as her baby’s.

Symptoms of Premenstrual dysphoric disorder (PMDD)

Psychological symptoms

  • Irritability
  • Nervousness
  • Lack of control
  • Agitation
  • Anger
  • Insomnia
  • Difficulty in concentrating
  • Depression
  • Severe fatigue
  • Anxiety
  • Confusion
  • Forgetfulness
  • Poor self-image
  • Paranoia
  • Emotional sensitivity
  • Crying spells
  • Moodiness
  • Trouble sleeping

Fluid retention

  • Swelling of the ankles, hands, and feet
  • Periodic weight gain
  • Diminished urine output
  • Breast fullness and pain

Respiratory problems

  • Allergies
  • Infections

Eye complaints

  • Vision changes
  • Eye infection

·Gastrointestinal symptoms

  • Abdominal cramps
  • Bloating
  • Constipation
  • Nausea
  • Vomiting
  • Pelvic heaviness or pressure
  • Backache

Skin problems

  • Acne
  • Skin inflammation with itching
  • Aggravation of other skin disorders, including cold sores

Neurologic and vascular symptoms

  • Headache
  • Dizziness
  • Fainting
  • Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs
  • Easy bruising
  • Heart palpitations
  • Muscle spasms

Other

  • Decreased coordination
  • Painful menstruation
  • Diminished sex drive
  • Appetite changes
  • Food cravings
  • Hot flashes

Causes of Depressive Disorder

There is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors.

Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite, and behavior appear to function abnormally. In addition, important neurotransmitters—chemicals that brain cells use to communicate—appear to be out of balance. But these images do not reveal why the depression has occurred.

Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of it as well. Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other factors.

In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger.

Depression in Women

Women experience depression about twice as often as men. Biological, life cycle, hormonal, and other factors unique to women may be linked to their higher depression rate. Researchers have shown that hormones directly affect brain chemistry that controls emotions and mood. Some women may be susceptible to a severe form of premenstrual syndrome called premenstrual dysphoric disorder (PMDD). Women affected by PMDD typically experience depression, anxiety, irritability, and mood swings the week before menstruation, in such a way that interferes with their normal functioning. Women with debilitating PMDD do not necessarily have unusual hormone changes, but they do have different responses to these changes. They may also have a history of other mood disorders and differences in brain chemistry that cause them to be more sensitive to menstruation-related hormone changes. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.

For example, women are particularly vulnerable to depression after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. Many new mothers experience a brief episode of the “baby blues,” but some will develop postpartum depression, a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience postpartum depression have had prior depressive episodes. Treatment by a sympathetic physician and the family’s emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being as well as her ability to care for and enjoy the infant.

Many women also face additional stresses of work and home responsibilities, single parenthood and caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women faced with enormous challenges develop depression, while others with similar challenges do not.

Depression in Men

Researchers estimate that at least 6 million men in the United States suffer from a depressive disorder every year. Research and clinical evidence reveal that while both women and men can develop the standard symptoms of depression, they often experience depression differently and may have different ways of coping with the symptoms. Men may be more willing to acknowledge fatigue, irritability, loss of interest in work or hobbies, and sleep disturbances rather than feelings of sadness, worthlessness, and excessive guilt. Some researchers question whether the standard definition of depression and the diagnostic tests based upon it adequately capture the condition as it occurs in men.

Depression can also affect the physical health in men differently from women. One study shows that, although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate.

Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, angry, irritable, and, sometimes, violently abusive. Some men deal with depression by throwing themselves compulsively into their work, attempting to hide their depression from themselves, family, and friends. Other men may respond to depression by engaging in reckless behavior, taking risks, and putting themselves in harm’s way.

More than four times as many men as women die by suicide in the United States, even though women make more suicide attempts during their lives. In light of the research indicating that suicide is often associated with depression, the alarming suicide rate among men may reflect the fact that many men with depression do not obtain adequate diagnosis and treatment that may be life saving.

Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or work-site mental health programs can be of assistance in helping men understand and accept depression as a real illness that needs treatment.

Depression in the Elderly

Some people have the mistaken idea that it is normal for the elderly to feel depressed. On the contrary, older people feel satisfied with their lives. Sometimes, though, when depression develops, it may be dismissed as a normal part of aging. However, when older adults do have depression, it may be overlooked because seniors may show different, less obvious symptoms, and may be less inclined to experience or acknowledge feelings of sadness or grief.

In addition, older adults may have more medical conditions such as heart disease, stroke or cancer, which may cause depressive symptoms, or they may be taking medications with side effects that contribute to depression. Some older adults may experience what doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the body’s organs, including the brain. Those with vascular depression may have, or be at risk for, a co-existing cardiovascular illness or stroke.

The majority of older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both. Research has shown that medication alone and combination treatment are both effective in reducing the rate of depressive recurrences in older adults. Psychotherapy alone also can be effective in prolonging periods free of depression, especially for older adults with minor depression, and it is particularly useful for those who are unable or unwilling to take antidepressant medication.

Improved recognition and treatment of depression in late life will make those years more enjoyable and fulfilling for the depressed elderly person, the family, and caretakers.

Causes of PMDD

The American College of Obstetricians and Gynecologists estimates that at least 85 percent of menstruating women have at least one PMS symptom as part of their monthly cycle. PMS is much more common than PMDD. You must have 5 or more of the symptoms listed above to be diagnosed with PMDD.

Biologic, psychological, environmental, and social factors all seem to play a part in PMDD. It is important to note that PMDD is not the fault of the woman suffering from it or the result of a “weak” or unstable personality. It is also not something that is “all in the woman’s head.” Rather, PMDD is a medical illness that impacts only 3% to 8% of women. Fortunately, it can be treated by a health care professional with behavioral and pharmaceutical options.

Many women with this condition have:

  • Anxiety
  • Severe depression
  • Seasonal affective disorder (SAD)

Other factors that may play a role include:

  • Alcohol or substance abuse
  • Thyroid disorders
  • Being overweight
  • Having a mother with a history of the disorder
  • Lack of exercise

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