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Clinical Depression

Clinical Depression is a health condition of depression with mental and physical components reaching criteria generally accepted by clinicians. Although nearly any mood with some element of sadness may colloquially be termed a depression, clinical depression is more than just a temporary state of sadness. Symptoms of clinical depression lasting two weeks or longer in duration, and of a severity that they begin to interfere with daily living, can generally be said to constitute clinical depression.

Using DSM-IV-TR terminology, someone with a major depressive disorder can, by definition, be said to be suffering from clinical depression.

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 2 times 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 undergone 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.

clinical depression symptoms

According to the DSM-IV-TR criteria for diagnosing a major depressive disorder one or both of the following two required elements need to be present:

  • Depressed mood, or
  • Loss of interest or pleasure.

It is sufficient to have either of these symptoms in conjunction with four of a list of other clinical depression symptoms, which include:

  • Feelings of overwhelming sadness or fear, or seeming inability to feel emotion.
  • Marked decrease of interest in pleasurable activities.
  • Changing appetite and marked weight gain or weight loss.
  • Disturbed sleep patterns, either insomnia or sleeping more than normal.
  • Changes in activity levels, restless or moving significantly slower than normal.
  • Fatigue, both mental and physical.
  • Feelings of guilt, helplessness, anxiety, and/or fear.
  • Lowered self-esteem.
  • Decreased ability to concentrate or make decisions.
  • Thinking about death or suicide. Depression in children is not as obvious as it is in adults; symptoms children demonstrate include:
  • Loss of appetite.
  • Sleep problems such as nightmares.
  • Problems with behavior or grades at school where none existed before.
  • Significant behavioral changes; becoming withdrawn, sulky, aggressive.

    In older children and adolescents, an additional symptom of clinical depression may be the use of drugs or alcohol. Moreover, depressed adolescents are at risk for 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 syndrome of interlocking symptoms which goes far beyond sad or painful feelings. A variety of biological indicators, including measurement of neurotransmitter levels, have shown that there are significant changes in brain chemistry and an overall reduction in brain activity. One consequence of a lack of understanding of its nature is that depressed individuals are often criticized by themselves and others for not making an effort to help themselves. However, the very nature of depression alters the way people think and react to situations to the point where they may become so pessimistic that they can do little or nothing about their condition. Because of this profound and often overwhelmingly negative outlook, it is imperative that the depressed individual seek professional help. Untreated depression is typically characterized by progressively worsening episodes separated by plateaus of temporary stability or remission. If left untreated it will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. In many cases (but not all) treatment can shorten the period of distress to a matter of weeks. While depressed, the person may damage themselves socially (e.g. the break up of relationships), occupationally (e.g. loss of a job), financially and physically. Treatment of depression can significantly reduce the incidence of this damage, including reducing the risk of suicide which is otherwise a common and tragic outcome. For all of these reasons, treatment of clinical depression is seen by many as very useful and at times life saving.

    Some people can experience anhedonia for long periods of time before they discover it is a mental illness. The inability to feel pleasure can advance negativity already present in a depressed person's mental state.

    types of major clinical depression (separated out by symptoms)

    Major depression is also referred to as major depressive disorder or biochemical, clinical, endogenous, unipolar, or biological depression. It is characterized by a severely depressed mood that persists for at least two weeks. Episodes of depression may start suddenly or slowly and can occur several times through a person's life. Major depressive disorder may be categorized as "single episode" or "recurrent" depending on whether previous episodes have been experienced before.

    Clinicians recognise several subtypes of major depression.

    • Psychotic depression is accompanied by hallucinations or delusions.
    • Melancholic depression (what used to be referred to as endogenous depression) is characterized by insomnia, poor appetite and weight loss, less responsive mood, and morning worsening.
    • Atypical depression is characterized by "reversed vegetative symptoms" which include oversleeping, overeating, leaden paralysis, rejection sensitivity and temporary brightening of mood in response to positive events. It may overlap with anxiety and panic attacks. It is often more chronic than melancholic depression.
    • Dysthymia is a long-term, mild depression that lasts for at least two years. By definition the symptoms are not as severe as in major depression, although those with dysthymia are highly likely to have superimposed major depressive episodes (known as "double depression"). It often begins in adolescence and spans several decades.

    Major depression may also be referred to as unipolar affective disorder, a term which emphasizes its relatedness to bipolar disorder.

    unipolar vs bipolar disorder

    Bipolar disorder is a cyclical illness in which moods fluctuate between mania (extreme happiness or giddiness and frantic activity) and clinical depression. Bipolar disorder has also been commonly called "manic depression", although this usage is now unpopular with psychiatrists, who have standardised on Kraepelin's usage of the term "manic depression" to describe the whole bipolar spectrum that includes both bipolar disorder and unipolar depression; they now usually use the term bipolar disorder. This then leaves the term unipolar depression which is used to differentiate it from bipolar disorder.

    Posted by Staff at June 5, 2005 7:33 PM

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