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'''Clinical depression''' (also called '''severe depressive disorder''', '''major depressive disorder''')
==History==erhasbdn gggggggggggggggggggggggggggggggggggggggggggggggg
The [[Ebers papyrus]] (ca 1550 BC) contains a short description of
The modern idea of depression appears similar to the much older concept of
▲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 theory|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.<ref>{{cite journal | last = Schildkraut | first = J.J. | date = 1965 | title = The catecholamine hypothesis of affective disorders: a review of supporting evidence | journal = Am J Psychiatry | volume = 122 | issue = 5 | pages = 509-22}}</ref> Since these suggestions, many other causes for clinical depression have been proposed.
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==Prevalence==
'''Clinical depression''' affects about 16%<ref>{{cite journal | url = http://www.cpa-apc.org/Publications/Archives/PDF/1997/May/BLAND.pdf | last = Bland | first = R.C. | date = 1997 | title = Epidemiology of Affective Disorders: A Review | journal = Can J Psychiatry | volume = 42 | pages = 367?377 }}</ref> of the population on at least one occasion in their lives. In some countries, such as Australia, one in four women and one in eight men will suffer from depression. The [[mean]] age of onset, from a
==Diagnosis==
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A diagnosis is made when an individual meets a sufficient number of the symptom 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 as a "clinical depression" without fully meeting the various criteria advanced for a specific diagnosis on the depression spectrum. Possible causes of depression are not taken into account in diagnosis, unless it may be due to an existing medical condition.
It is important to understand that there is no blood test or
===Symptoms===
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* [[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:gggggggggggggggggggggggggggg
* Feelings of overwhelming [[sadness]] and/or [[fear]], or the seeming inability to feel [[emotion]] ([[emptiness]]).
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* [[Fatigue (physical)|Fatigue]], mental or physical, also loss of energy.
* Intense feelings of [[guilt]], helplessness, hopelessness, worthlessness, isolation/loneliness and/or [[anxiety]].
* Trouble concentrating, keeping focus or making decisions or a generalized slowing and obtunding of cognition, including memory.gggggggggggggggggggggggggggggggggggggggggggg
* Recurrent thoughts of death (not just fear of dying), desire to just "lay down and die" or "stop breathing", recurrent [[suicidal ideation]] without a specific plan, or a [[Parasuicide|suicide attempt]] or a specific plan for committing [[suicide]].
* Feeling and/or fear of being abandoned by those close to one.
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* Fear of 'going mad'.
* Change in perception of time.
* Periods of sobbing.gggggggggggggggggggggggggggggggggg
* Possible behavioral changes, such as [[aggression]] and/or irritability.
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An additional indicator could be the excessive use of drugs or [[Alcoholic beverage|alcohol]]. Depressed adolescents are at particular risk of further destructive behaviours, such as [[eating disorder]]s and [[self-harm]].
One of the most widely used instruments for measuring depression
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 the psychiatric industry as 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'''<ref>Carlat DJ. The Psychiatric Review of Symptoms: A Screening Tool for Family Physicians. American Family Physician. Vol. 58/No. 7 ([[November 1]] [[1998]]). Available at: [http://www.aafp.org/afp/981101ap/carlat.html http://www.aafp.org/afp/
==Types of depression==
The diagnostic category ''major depressive disorder'' appears in the [[Diagnostic and Statistical Manual of Mental Disorders]] of the [[American Psychiatric Association]]. The term is generally not used in countries which instead use the ICD-10 system, but the diagnosis of ''depressive episode'' is very similar to an episode of major depressggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggion. ''Clinical depression'' also usually refers to acute or chronic depression severe enough to need treatment. ''Minor depression'' is a less-used term for a subclinical depression that does not meet criteria for major depression but 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there are at least two symptoms present for two weeks.
===Major clinical depression===
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[[Postpartum Depression]] or ''Post-Natal Depression'' is clinical depression that occurs within two years of childbirth. Owing to physical, mental and emotional exhaustion combined with sleep-deprivation, motherhood can "set women up", so to speak, for clinical depression.<ref name="Kathy Fray">Fray, Kathy: "Oh Baby...Birth, Babies & Motherhood Uncensored", pages 367-381. Random House NZ, 2005, ISBN 1-86941-713-5</ref>
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Premenstrual dysphoriais is a pattern of recurrent depressive symptoms tied to the menstrual cycle. The premenstrual decline in brain serotonin function is strongly correlated with the concomitant worsening of self-rated cardinal mood symptoms.<ref> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=16515859&query_hl=2&itool=pubmed_docsum</ref> Of considerable clinical importance, the recent understanding of premenstrual dysphoria as depression points directly to effective treatment with [[Selective serotonin reuptake inhibitor]] (SSRI) antidepressants. Previously, disrupting ovarian cyclicity had been the only recognized treatment. A recent review of studies of a number of SSRIs has revealed that they can effectively ameliorate symptoms of premenstrual dysphoria and may actually work best when taken only during the part of the menstrual cycle when dysphoric symptoms are evident.<ref> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=10471170&query_hl=1&itool=pubmed_docsum
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[[Image:synapse.png|thumbnail|200px|right|Brain chemicals called neurotransmitters allow electrical signals to move from the axon of one nerve cell to the neuron of another. A shortage of neurotransmitters impairs brain communication.]]
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'''[[Physiology]]''' – There may be changes or imbalances in chemicals that transmit information in the brain, called [[neurotransmitters]]. Many modern [[antidepressant]] [[Psychoactive drug|drug]]s increase levels of certain neurotransmitters, such as [[serotonin]] and [[norepinephrine]]. Although the causal relationship is unclear, it is known that antidepressant medications can relieve certain symptoms of depression, although critics point out that the relationship between [[serotonin]], [[Selective serotonin reuptake inhibitor|SSRIs]], and depression usually is typically greatly oversimplified when presented to the public (see [http://medicine.plosjournals.org/archive/1549-1676/2/12/pdf/10.1371_journal.pmed.0020392-L.pdf here]). Recent research has suggested that there may be a link between depression and [[neurogenesis]] of the [[hippocampus]]. This horseshoe-shaped structure is a center for both mood and memory. Loss of neurons in the hippocampus is found in depression and correlates with impaired memory and dysthemic mood. The hippocampus regains mass when exposed to treatments that increase brain serotonin, and when regrown, mood and memory tend to be restored.
*[[Seasonal affective disorder]] (SAD) is a type of depressive disorder that occurs in the winter when daylight hours are short. It is believed that the body's production of [[melatonin]], which is produced at higher levels in the dark, plays a major part in the onset of SAD and that many sufferers respond well to bright light therapy, also known as [[phototherapy]].
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:* '''Social navigation or niche change theory''': The social navigation, bargaining, or niche change hypothesis [http://biology.unm.edu/Biology/pwatson/public_html/dp1.htm] suggests that depression, operationally defined as a combination of prolonged anhedonia and psychomotor retardation or agitation, provides a focused sober perspective on socially imposed constraints hindering a person’s pursuit of major fitness enhancing projects. Simultaneously, publicly displayed symptoms, which reduce the depressive's ability to conduct basic life activities, serve as a social signal of need; the signal's costliness for the depressive certifies its honesty. Finally, for social partners who find it uneconomical to respond helpfully to an honest signal of need, the same depressive symptoms also have the potential to extort relevant concessions and compromises. Depression’s extortionary power comes from the fact that it retards the flow of just those goods and services such partners have come to expect from the depressive under status quo socioeconomic arrangements.<p>Thus depression may be a social adaptation especially useful in motivating a variety of social partners, all at once, to help the depressive initiate major fitness-enhancing changes in their socioeconomic life. There are extraordinarily diverse circumstances under which this may become necessary in human social life, ranging from loss of rank or a key social ally which makes the current social niche uneconomic to having a set of creative new ideas about how to make a livelihood which begs for a new niche. The social navigation hypothesis emphasizes that an individual can become tightly ensnared in an overly restrictive matrix of social exchange contracts, and that this situation sometimes necessitates a radical contractual upheaval that is beyond conventional methods of negotiation. Regarding the treatment of depression, this hypothesis calls into question any assumptions by the clinician that the typical cause of depression is related to maladaptive perverted thinking processes or other purely endogenous sources. The social navigation hypothesis calls instead for a penetrating analysis of the depressive’s talents and dreams, identification of relevant social constraints (especially those with a relatively diffuse non-point source within the social network of the depressive), and practical social problem-solving therapy designed to relax those constraints enough to allow the depressive to move forward with their life under an improved set of social contracts.<ref>{{cite journal | last = Watson | first = PJ | coauthors = Andrews PW | title = Toward a revised evolutionary adaptationist analysis of depression: the social navigation hypothesis | journal = Journal of Affective Disorders | date = October 2002| volume = 72 | pages = 1-14}}</ref>
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'''Bargaining theory''': This theory is similar to the honest signaling, niche change, and social navigation theory. It basically adds one additional element to honest signaling theory. The fitness of social partners is generally correlated. When a wife suffers depression and reduces her investment in offspring, for example, the husband's fitness is also put at risk. Thus, not only do the symptoms of major depression serve as costly and therefore honest signals of need, they also compel social partners to respond to that need in order to prevent their own fitness from being reduced. See, e.g., [http://itb1.biologie.hu-berlin.de/~hagen/papers/ppd.pdf Hagen 1999], [http://itb1.biologie.hu-berlin.de/~hagen/papers/Dahlem.pdf Hagen 2003].
==Treatment==
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''[[Selective serotonin reuptake inhibitor]]s'' (SSRIs) are a family of antidepressant considered to be the current standard of drug treatment. It is thought that one cause of depression is an inadequate amount of [[serotonin]], a chemical used in the brain to transmit signals between neurons. SSRIs are said to work by preventing the reabsorption of serotonin by the nerve cell, thus maintaining the levels the brain needs to function effectively, although two researchers recently demonstrated that this is a marketing technique rather than a scientific portrayal of how the drugs actually work. [http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020392]. Recent research indicates that these drugs may interact with transcription factors known as "clock genes"[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15994025&query_hl=24], which may be important for the addictive properties of drugs of abuse and possibly in obesity[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16094306&query_hl=27][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16288309&query_hl=24].
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''[[Norepinephrine reuptake inhibitor]]s'' such as [[reboxetine]] (Edronax) act via norepinephrine (also known as ''noradrenaline''). NeRIs are thought to have a positive effect on concentration and motivation in particular. Drugs such as [[Bupropion]] can help with smoking cessation. It is also known to inhibit the neuronal reuptake of dopamine.
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Note that before beginning an exercise regime, it is wise to consult a doctor. He or she can establish whether a person has any health problems that could contraindicate some types of exercise.
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===Deep brain stimulation===
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