INDEX

1. OBJECTIVES
2. INTRODUCTION

3. WHAT IS DEPRESSION?
4.DEPRESSlON IS DIFFERENT FROM
SADNESS OR BEREAVEMENT
5. RISK FACTORS FOR DEPRESSION
6. HOW IS DEPRESSION TREATED
7. DEPRESSION IN VARIOUS PEOPLE
8. PSYCHODYNAMIC THEORIES
9. SUMMARY
10. CONCLUSION
11. BIBLIOGRAPHY
 I.OBJECTIVES
i)To understand the meaning of depression.
ii)To understand the symptoms of depression.
iii)To understand how depression is different from sadness.
iv)To understand the risk factors of depression.
v)To understand the methods of treatment of depression.
vi)To understand and analyze how depression occur in various
people.
 2. INTRODUCTION
Every year, 9.5 percent of the population, or about 18.8 million
adults, suffer from a depressive illness. The economic cost for this
disorder is high, but the cost in human suffering cannot be
estimated. Depressive illnesses often interfere with normal
functioning and cause pain and suffering not only to those who
have a disorder, but also to those who care about them. Serious
depression can destroy family life as well as the life of the ill
person. But much of this suffering is unnecessary.
Most people with a depressive illness do not seek treatment,
although the great majority—even those whose depression is
extremely severe—can be helped. Thanks to years of fruitful
research, there are now medications and psychosocial
therapies such as cognitive/behavioural, "talk" or
interpersonal that ease the pain of depression.
Unfortunately, many people do not recognize that depression
is a treatable illness. If you feel that you or someone you care
about is one of the many undiagnos d depressed people in this
country, the information prese here may help you take the
steps that may save your o or someone else's life.
 CHAPTERS
3. WHAT IS DEPRESSION?
Depression (major depressive disorder) is a common and serious medical
illness that negatively affects how you feel, the way you think and how you
act. Fortunately, it is also treatable. Depression causes feelings of sadness
and/or a loss of interest in activities once enjoyed. It can lead to a variety
of emotional and physical problems and can decrease a person's ability to
function at work and at home.
SYMPTOMS OF DEPRESSION
Depression symptoms can vary from mild to severe and can include:

Feeling sad or having a depressed mood

Loss of interest or pleasure in activities once enjoyed
Changes in appetite — weight loss or gain unrelated to dieting
Trouble sleeping or sleeping too
0 Loss of energy or increase igue
Increase in purposel physical activity (e.g., hand-wringing or
pacing) or slowed movements and speech (actions observable
by others)
Feeling worthless or guilty
Difficulty thinking, concentrating or making decisions Thoughts
of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression.

Also, medical conditions (e.g., thyroid problems, a brain tumour or vitamin
deficiency) can mimic symptoms of depression so it is important to rule
out general medical causes.
Depression affects an estimated one in 15 adults (6.7%) in any given year.
And one in six people (16.6%) will experience depression at some time in
their life. Depression can strike at any time, but on average, first appears
during the late teens to mid-20s. Wo en are more likely than men to
experience depression. Some s les show that one-third of women will
experience a major depre • e episode in their lifetime.
 4.Depression Is Different From
Sadness or Grief/Bereavement
The death of a loved one, loss of a job or the ending of a
relationship are difficult experiences for a person to endure.
It is normal for feelings of sadness or grief to develop in
response to such situations. Those experiencing loss often
might describe themselves as being "depressed."
But being sad is not the same as having depression. The
grieving process is natural and unique to each individual and
shares some of the same features of depression. Both grief
and depression may involve intense sadne and withdrawal
from usual activities. They are also diff nt in important ways:
0 In grief, painful feel' s come in waves, often intermixed with
positive memories of the deceased. In major depression,
mood and/or interest (pleasure) are decreased for most of
two weeks.
0 In grief, self-esteem is usually maintained. In major
depression, feelings of worthlessness and self-loathing
are common.
0 For some people, the death of a loved one can bring on
major depression. Losing a job or being a victim of a
physical assault or a major disaster can lead to
depression for some people. When grief and depression
co-exist, the grief is more severe and lasts longer than
grief without depression. Despite some overlap between
grief and depression, they are different. Dis • guishing
between them can help people get the p, support or
treatment they need.
 5.Risk Factors for Depression
Depression can affect anyone—even a person who
appears to live in relatively ideal circumstances.
Several factors can play a role in depression:
0 Biochemistry: Differences in rtain chemicals in the
brain may contra e to symptoms of depression.
Genetics: Depression can run in families. For
example, if one identical twin has depression, the
other has a 70 percent chance of having the illness
sometime in life.
0 Personality: People with low self-esteem, who are
easily overwhelmed by stress, or who are generally
pessimistic appear to be more likely to experience
depression.
Environmental factors: Continuous exposure to
violence, neglect, abuse or poverty may make
some people more vulnerable to d ession.
6. How Is Depression Treated?
Depression is among the most treatable of mental disorders.
Between 80 percent and 90 percent of people with depression
eventually respond well to treatment. Almost all patients gain
some relief from their symptoms.
Before a diagnosis or treatment, a health professional should
conduct a thorough diagnostic evaluation, including an interview
and possibly a physical examination. In some cases, a blood test
might be done to make sure the depression is not due to a
medical condition like a thyroid problem. The evaluation is to
identify specific sympto edical and family history, cultural factors
and enviro ental factors to arrive at a diagnosis and plan a course
o ction.
Medication: Brain chemistry may contribute to an individual's
depression and may factor into their treatment. For this reason,
antidepressants might be prescribed to help modify one's brain
chemistry. These medications are not sedatives, "uppers" or
tranquilizers. They are not habit-forming. Generally
antidepressant medications have no stimulating effect on people
not experiencing depression.
Antidepressants may produce some improvement within the first
week or two of use. Full benefits may not be seen for two to three
months. If a patient feels little or no improvement after several
weeks, his or her psychiatrist can alter the dose of the medication
or add or substitute another antidepressant. In some situations
other psychotropic medications may be helpful. It is important to
let your doctor know if a ication does not work or if you
experience side effects.
Psychiatrists usually recommend that patients continue to take
medication for six or more months after symptoms have
improved. Longer-term maintenance treatment may be
suggested to decrease the risk of future episodes for certain
people at high risk.
Psychotherapy: Psychotherapy, or "talk therapy," is
sometimes used alone for treatment of mild depression; for
moderate to severe depression, psychotherapy is often used
in along with antidepressant medications. Cognitive
behavioural therapy (CBT) has been found to be effective in
treating depression. CBT is a form of therapy focused on the
present and problem solving. CBT helps a person to reco
distorted thinking and then change behaviours and thin • g.
Psychotherapy may involve only the individual, but it can
include others. For example, family or couples therapy can
help address issues within these close relationships. Group
therapy involves people with similar illnesses.
Depending on the severity of the depression, treatment can
take a few weeks or much longer. In many cases, significant
improvement can be made in 10 to 15 sessions.
Electroconvulsive Therapy (ECT) is a medical treatment most
commonly used for patients with severe major depression or
bipolar disorder who have not responded to other
treatments. It involves a brief electrical stimulation of the
brain while the patient is under anaesthesia. A patient
typically receives ECT two to three times a week for a total of
six to 12 treatments. ECT has been used since the 1940s, and
many years of research have led to major improvements. It is
usually managed by a team of trained medical fessionals
including a psychiatrist, an anaesthesiologis nd a nurse or
physician assistant.
7.DEPRESSlON IN VARIOUS PEOPLE

i) Depression in women
Women experience depression about twice as often as men.
Many hormonal factors may contribute to the increased rate
of depression in women—particularly such factors as
menstrual cycle changes, pregnancy, miscarriage, postpartum
period, pre-menopause, and menopause. Many women also
face additional stresses such as respons• les both at work and
home, single parenthood, and c g for children and for aging
parents.
A recent NIMH study showed that in the case of severe
premenstrual syndrome (PMS), women with a pre-existing
vulnerability to PMS experienced relief from mood and physical
symptoms when their sex hormones were suppressed. Shortly
after the hormones were re-introduced, they again developed
symptoms of PMS. Women without a history of PMS reported no
effects of the hormonal manipulation.
Many women are also particularly vulnerable after the birth of a
baby. The hormonal and physical changes, as well as the added
responsibility of a new life, can be factors that lead to postpartum
depression in some women. While transient "blues" are common
in new mothers, a full-blown depressive episode is not a normal
occurrence and requires active intervention. Treatment by a
sympathetic physician and the family's emotional support for the
new mother are pr•me considerations in aiding her to recover
her physical a ental well-being and her ability to care for and
enjoy th ant.
ii) Depression in men
Although men are less likely to suffer from depression than
women, 3 to 4 million men in the United States are affected
by the illness. Men are less likely to admit to depression, and
doctors are less likely to suspect it. The rate of suicide in men
is four times that of women, tho more women attempt it. In
fact, after age 70, the rate men's suicide rises, reaching a peak
after age 85.
Depression can also affect the physical health in men
differently from women. A new 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.
Men's depression is often masked by alcohol or drugs, or by
the socially acceptable habit of working excessively long
hours. Depression typically shows up in men not as feeling
hopeless and helpless, but as being irritable, angry, and
discouraged; hence, depression may be difficult to recognize
as such in men. 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 worksite mental health programs can be o
ssistance in helping men understand and accept depre on as
a real illness that needs treatment.

iii) Depression in the Elderly

Some people have the mistaken idea that it is normal for the
elderly to feel depressed. On the contrary, most older people
feel satisfied with their lives. Sometimes, though, when
depression develops, it may be dismissed as a normal part of
aging. Depression in the elderly, undi osed and untreated,
causes needless suffering for the mily and for the individual
who could otherwise live a frui life. When he or she does go
to the doctor, the symptoms described are usually physical,
for the older person is often reluctant to discuss feelings of
hopelessness, sadness, loss of in s In normally pleasurable
activities, or extremely prolon grief after a loss.
Recognizing how depressive symptoms in older people are
often missed, many health care professionals are learning to
identify and treat the underlying depression. They recognize
that some symptoms may be side effects of medication the
older person is taking for a physical problem, or they may be
caused by a co-occurring illness. If a diagnosis of depression is
made, treatment with medication and/or psychotherapy will
help the depressed person return to a happier, more fulfilling
life. Recent research suggests that brief psychotherapy (talk
therapies that help a person in day-to-day relationships or in
learning to counter the distorted negative thinking that
commonly accompanies depression) is effective in reducing
symptoms in short-term depression in older persons who are
medically ill. Psychotherapy is also useful in older patients
who cannot or will not take medication. Efficacy studies show
that late-life depression can be treated with psychotherapy.
Improved recognition and treatment of depression in late life will
make those years more e le and fulfilling for the depressed elderly
person, th amily, and caretakers.

iv)Depression in Children & Teens

Children who develop depression often continue to have
episodes as they enter adulthood. Children who have
depression also are more likely to have other more severe
illnesses in adulthood.
A child with depression may pretend to be sick, refuse to go
to school, cling to a parent, or worry that a nt may die. Older
children may sulk, get into trouble school, be negative and
irritable, and feel misunderstood ecause these signs may be
viewed as normal mood swin typical of children as they move
through developmental stages, it may be difficult to accurately
diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop
depression. By age 15, however, are twice as likely as boys to
have had a major depr Ive episode.
Depression during the teen years comes at a time of great
personal change—when boys and girls are forming an identity
apart from their parents, grappling with gender issues and
emerging sexuality, and making independent decisions for the
first time in their lives. Depression in adolescence frequently
co-occurs with other disorders such as anxiety, eating
disorders, or substance abuse. It can also lead to increased risk
for suicide.
An NIMH-funded clinical trial of 439 adolescents with major
depression found that a combination of medication and
psychotherapy was the most effective treatment option. Other
NIMH-funded researchers are developing and testing ways to
prevent suicide in children and adolescents.
Childhood depression often persis ecurs, and continues into
adulthood, especially if left un ated.
8. Psychodynamic Theories
According to Freud, the conscious and unconscious parts of the
mind can come into conflict with one another, producing a
phenomena called repression (a state where you are unaware of
having certain troubling motives, wishes or desires but they
influence you negatively just the same). In general,
psychodynamic theories suggest that a person must successfully
resolve early developmental conflicts (e.g., gaining trust,
affection, successful interpersonal relationships, mastering body
functions, etc.). in order to overcome repression and achieve
mental health. illness, on the other hand, is a failure to resolve
the onflicts.
There are multiple explana ions that fall under the
psychodynamic "umbrella" that explain why a person
develops depressive symptoms. Psychoanalysts historically
believed that depression was caused by anger converted into
self-hatred ("anger turned inward"). A typical scenario
regarding how this transformation was thought to play out
may be helpful is further explaining this theory. Neurotic
parents who are inconsistent (both overindulgent and
demanding), lacking in warmth, inconsiderate, angry, or
driven by their own selfish needs create a unpredictable,
hostile world for a child. As a result, the child feels alone,
confused, helpless and ultimately, angry. However, the child
also knows that the powerful parents are his or her only
means of survival. So, out of fear, love, and guilt, the child
represses anger toward the parents and turns it inwards so
that it becomes an anger directed towards him or herself. A
"despised" self-concept starts to form, and the child finds it
comfortable to think thoughts along the lines of "l am an
unlovable and bad person." At the sa me, the child also strives
to present a perfect, ealized (and therefore acceptable)
facade to the par s as a means of compensating for perceived
weakne es that make him or her "unacceptable". Caug
etween the belief that he or she is unacceptable, and the
imperative to act perfectly to obtain parental love, the child
becomes "neurotic" or prone to experiencing exaggerated
anxiety and/or depression feelings. The child also feels a
perpetual sense that he or she is not good enough, no matter
how hard he or she tries.
According to object relations theory, depression is caused by
problems people have in developing representations of
healthy relationships. Depression is a consequence of an
ongoing struggle that depressed people endure in order to try
and maintain emotional contact with desired objects. There
are two basic ways that this process can play out: the anaclitic
pattern, and the introjective pattern. Even tho ese terms are
not currently used in the DSM, som erapists may still use them
to label different types of de ssion.
Anaclitic depression involves a person who feels dependent
upon relationships with others and who essentially grieves
over the threatened or actual loss of those relationships.
Anaclitic depression is caused by the disruption of a caregiving
relationship with a primary object and is characterized by
feelings of helplessness and weakness. A person with anaclitic
depression experiences intense fears of abandonment and
desperately struggles to maintain direct physical contact with
the need-gratifying object.
Introjective depression occurs when a person feels that they
have failed to meet their own standards or the standards of
important others and that therefore they are failures.
Introjective depression arises from a harsh, unrelenting,
highly critical superego that creates feelings of worthlessness,
guilt and a sense of having failure. A person with introjective
depression experiences intense fears of losing approval,
recognition, and love from a desired object.
Historically, psychodynamic theories re extensively criticized for
their lack of empiricism (e.g. eir disinterest in subjecting their
theories to scientific te •ng). However, this resistance to putting
psychodynamic ncepts on a scientific footing has started to
change cently. Another modern derivative of psychodynamic
theory, Coyne's interpersonal theory of depression has been
studied extensively, and forms the basis
of a very effective treatment option known as Interpersonal
Therapy or IPT. According to interpersonal theory a depressed
person's negative interpersonal behaviours cause other
people to reject them. In an escalating cycle, depressed
people, who desperately want reassurance from others, start
to make an increasing number of requests for reassurance,
and the other people (to whom those requests are made)
start to negatively evaluate, avoid, and reject the depressed
people (or become depressed themselves).. Depressed
people's symptoms then start to worsen as a result of other
people's rejection and avoidance of them. IPT has been
designe elp depressed people break out of this negative spir
e'll have more to say about IPT in the treatment sectio of this
document.
 9.SUMMARY
Depression is a mental state characterized by persistent low
mood, loss of interest and enjoyment in everyday activities,
neurovegetative disturbance, and reduced energy, causing
varying levels of social and occupational dysfunction.
Depressive disorders are common in people of all ages and
may be classified depending on the duration, severity, and
number of symptoms, and the degree of functional
impairment. In bipolar disorder, a manic episode may have
been preceded by and may be followed o manic or major
depressive episodes.
Major depressive disorder is characterized by at least 5
symptoms and can be classified along a spectrum of mild to
severe. Severe episodes may include psychotic symptoms
such as paranoia, hallucinations, or functional incapacitation.
One of the most common paediatric psychiatric disorders,
especially in girls during adolescence. Depression in children
and adolescents may have a more insidious onset than in
adults. It may be characterized more by irritability than
sadness, and it often occurs in association with other
conditions such as anxiety.
Suicide is an important cause of death globally. In people ages 15
to 44 years, suicide is the fourth-leading cause of death and the
sixth-leading cause of ill health and disability worldwide, making
suicide a significant public health concern. Suicide risk
management refers to the identification, assessment, and
treatment of a person exhibiting suicidal b viour. It is an ongoing
process in the treatment of a on who has a mental disorder, but
may also be releva or those with no previous psychiatric
diagnosis.
 10. CONCLUSION
Depression is one of the most common conditions in primary
care, but is often unrecognized, undiagnosed, and untreated.
Depression has a high rate of morbidity and mortality when
left untreated. Most patients suffering from depression do
not complain of feeling depressed, but rather anhedonia or
vague unexplained symptoms. All physicians should remain
alert to effectively screen for depression in their patients.
There are several screening tools for depression that are
effective and feasible in primary care settings. Antidepressant
medications' effectiveness is generally comparable acr classes
and within classes of medications. The me • ations differ in
side effect profiles, drug-drug interactions nd cost.
 1 1 BIBLIOGRAPHY
1.
https://www.psycholoqytoday.com/us/conditions/depressivedisord
ers
2. https://www.psychiatry.org/patients-families/depression/whatis-
depression
3. https://www.apa.orq/topics/depression/index.aspx
4. htt s://www.sim I s cholo .or /de ressio html
5.Psychology Textbook for Class Xll