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| History The Ebers papyrus (ca 1550 BC) contains a short description of clinical depression. Though full of incantations and foul applications meant to turn away disease-causing demons and other superstition, it also evinces a long tradition of empirical practice and observation. The modern idea of depression appears similar to the much older concept of melancholia. The name melancholia derives from 'black bile', one of the 'four humours' postulated by Galen. Clinical depression was originally considered to be a chemical imbalance in transmitters in the brain, a theory based on observations made in the 1950s of the effects of reserpine and isoniazid in altering monoamine neurotransmitter levels and affecting depressive symptoms . Since these suggestions, many other causes for clinical depression have been proposed. Prevalence Clinical depression affects about 16% of the population on at least one occasion in their lives. The mean age of onset, from a number of studies, is in the late 20s. About twice as many females as males report or receive treatment for clinical depression, though this imbalance is shrinking over the course of recent history; this difference seems to completely disappear after the age of 50 - 55, when most females have passed the end of menopause. Clinical depression is currently the leading cause of disability in the US as well as other countries, and is expected to become the second leading cause of disability worldwide (after heart disease) by the year 2020, according to the World Health Organization. Diagnosis The diagnosis may be applied when an individual meets a sufficient number of the symptomatic criteria for the depression spectrum as suggested in the DSM-IV-TR or ICD-9/ICD-10. An individual is often seen to suffer from what is termed a "clinical depression" without fully meeting the various criteria advanced for a specific diagnosis on the depression spectrum. There is an ongoing debate regarding the relative importance of genetic or environmental factors, or gross brain problems versus psychosocial functioning. Symptoms According to the DSM-IV-TR criteria for diagnosing a major depressive disorder (cautionary statement) one of the following two elements must be present for a period of at least two weeks: * Depressed mood, or * Anhedonia It is sufficient to have either of these symptoms in conjunction with five of a list of other symptoms over a two-week period. These include: * Feelings of overwhelming sadness or fear or the seeming inability to feel emotion (emptiness). * A decrease in the amount of interest or pleasure in all, or almost all, activities of the day, nearly every day. * Changing appetite and marked weight gain or loss. * Disturbed sleep patterns, such as insomnia, loss of REM sleep, or excessive sleep (Hypersomnia). * Psychomotor agitation or retardation nearly everyday. * Fatigue, mental or physical, also loss of energy. * Feelings of guilt, helplessness, hopelessness, anxiety, or fear. * Trouble concentrating or making decisions or a generalized slowing and obtunding of cognition, including memory. * 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. Other symptoms sometimes reported but not usually taken into account in diagnosis include: * A decrease in self-esteem. * Inattention to personal hygiene. * Sensitivity to noise. * Physical aches and pains, and the belief these may be signs of serious illness. * Fear of 'going mad'. * Change in perception of time. Depression in children is not as obvious as it is in adults. Here are some symptoms that children might display: * Loss of appetite. * Irritability. * Sleep problems, such as recurrent nightmares. * Learning or memory problems where none existed before. * Significant behavioral changes; such as withdrawal, social isolation, and aggression. An additional indicator could be the excessive use of drugs or alcohol. Depressed adolescents are at particular risk of further destructive behaviours, such as eating disorders and self-harm. One of the most widely used instruments for measuring depression severity is the Beck Depression Inventory, a 21-question multiple choice survey. It is hard for people who have not experienced clinical depression, either personally or by regular exposure to people suffering it, to understand its emotional impact and severity, interpreting it instead as being similar to "having the blues" or "feeling down." As the list of symptoms above indicates, clinical depression is a serious, potentially lethal systemic disorder characterized by interlocking physical, affective, and cognitive symptoms that have consequences for function and survival well beyond sad or painful feelings. Mnemonics Mnemonics commonly used to remember the DSM-IV criteria are SIGECAPS (sleep, interest (anhedonia), guilt, energy, concentration, appetite, psychomotor, suicidality) and DEAD SWAMP (depressed mood, energy, anhedonia, death (thoughts of), sleep, worthlessness/guilt, appetite, mentation, psychomotor). |