Depression (mood)

Depression is a mental state of low mood and aversion to

Depression
activity.[3] It affects more than 280 million people of all ages (about
3.5% of the global population).[4] Depression affects a person's
thoughts, behavior, feelings, and sense of well-being.[5] Depressed
people often experience loss of motivation or interest in, or reduced
pleasure or joy from, experiences that would normally bring them
pleasure or joy.[6] Depressed mood is a symptom of some mood
disorders such as major depressive disorder and dysthymia;[7] it is a
normal temporary reaction to life events, such as the loss of a loved
one; and it is also a symptom of some physical diseases and a side
effect of some drugs and medical treatments. It may feature
sadness, difficulty in thinking and concentration and a significant
increase or decrease in appetite and time spent sleeping. People
experiencing depression may have feelings of dejection or
hopelessness and may experience suicidal thoughts. It can either be Lithograph of a person diagnosed
short term or long term. with melancholia and strong suicidal
tendency in 1892
Contributing factors Specialty Psychiatry,
psychology
Symptoms Low mood, aversion
Life events
to activity, loss of

Adversity in childhood, such as bereavement, neglect, mental interest, loss of

abuse, physical abuse, sexual abuse, or unequal parental treatment feeling pleasure
of siblings can contribute to depression in adulthood.[8][9] Causes Brain chemistry,
Childhood physical or sexual abuse in particular significantly genetics, life events,
correlates with the likelihood of experiencing depression over the medical conditions,
survivor's lifetime.[10] People who have experienced four or more personality[1]
adverse childhood experiences are 3.2 to 4.0 times more likely to
Risk Stigma of mental
suffer from depression.[11] Poor housing quality, non-functionality,
lack of green spaces, and exposure to noise and air pollution are factors health disorder[2]
linked to depressive moods, emphasizing the need for Diagnostic Patient Health
consideration in planning to prevent such outcomes.[12] method Questionnaire, Beck
Depression Inventory
Studies have consistently shown that physicians have had the
highest depression and suicide rates compared to people in many Differential Anxiety, bipolar
other lines of work—for suicide, 40% higher for male physicians diagnosis disorder, borderline
and 130% higher for female physicians.[13][14][15] personality disorder
Prevention Social connections,
Life events and changes that may cause depressed mood include physical activity
(but are not limited to): childbirth, menopause, financial difficulties,
unemployment, stress (such as from work, education, military Treatment Psychotherapy,
service, family, living conditions, marriage, etc.), a medical psychopharmacology
diagnosis (cancer, HIV, diabetes, etc.), bullying, loss of a loved one,
natural disasters, social isolation, rape, relationship troubles,
jealousy, separation, drug abuse, alcohol abuse, or catastrophic
injury.[16][17][18][19][20] Adolescents may be especially prone to
experiencing a depressed mood following social rejection, peer
pressure, or bullying.[21]

Childhood and adolescence

Depression in childhood and adolescence is similar to adult major

depressive disorder, although young sufferers may exhibit increased
irritability or behavioral dyscontrol instead of the more common
sad, empty, or hopeless feelings seen with adults.[22] Children who
are under stress, experiencing loss, or have other underlying
disorders are at a higher risk for depression. Childhood depression
is often comorbid with mental disorders outside of other mood
disorders; most commonly anxiety disorder and conduct disorder.
Depression also tends to run in families.[23]
Allegory on melancholy, from
Personality c. 1729–1740, etching and engraving,
in the Metropolitan Museum of Art
(New York City)
Depression is associated with low extraversion,[24] and people who
have high levels of neuroticism are more likely to experience
depressive symptoms and are more likely to receive a diagnosis of a
depressive disorder.[25]

Side effect of medical treatment

It is possible that some early-generation beta-blockers induce depression in some patients, though the
evidence for this is weak and conflicting. There is strong evidence for a link between alpha interferon
therapy and depression. One study found that a third of alpha interferon-treated patients had developed
depression after three months of treatment. (Beta interferon therapy appears to have no effect on rates of
depression.) There is moderately strong evidence that finasteride when used in the treatment of alopecia
increases depressive symptoms in some patients. Evidence linking isotretinoin, an acne treatment, to
depression is strong.[26] Other medicines that seem to increase the risk of depression include
anticonvulsants, antimigraine drugs, antipsychotics and hormonal agents such as gonadotropin-releasing
hormone agonist.[27]

Substance-induced

Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from
chronic use. These include alcohol, sedatives (including prescription benzodiazepines), opioids (including
prescription pain killers and illicit drugs such as heroin), stimulants (such as cocaine and amphetamines),
hallucinogens, and inhalants.[28]

Non-psychiatric illnesses
Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological
conditions, and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's
syndrome, pernicious anemia, hypothyroidism, hyperparathyroidism, Lyme disease, multiple sclerosis,
Parkinson's disease, celiac disease,[29] chronic pain, stroke, diabetes, cancer, and HIV.[30][31][32]

Studies have found that anywhere from 30 to 85 percent of patients suffering from chronic pain are also
clinically depressed.[33][34][35] A 2014 study by Hooley et al. concluded that chronic pain increased the
chance of death by suicide by two to three times.[36] In 2017, the British Medical Association found that
49% of UK chronic pain patients also had depression.[37]

Psychiatric syndromes

A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a
group of disorders considered to be primary disturbances of mood. These include major depressive disorder
(commonly called major depression or clinical depression) where a person has at least two weeks of
depressed mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic
depressed mood, the symptoms of which do not meet the severity of a major depressive episode. Another
mood disorder, bipolar disorder, features one or more episodes of abnormally elevated mood, cognition, and
energy levels, but may also involve one or more episodes of depression.[38] When the course of depressive
episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be
described as a seasonal affective disorder.

Outside the mood disorders: borderline personality disorder often features an extremely intense depressive
mood; adjustment disorder with depressed mood is a psychological response to an identifiable event or
stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria
for a major depressive episode;[39] and posttraumatic stress disorder, a mental disorder that sometimes
follows trauma, is commonly accompanied by depressed mood.[40]

Inflammation

There is evidence for a link between inflammation and depression.[41] Inflammatory processes can be
triggered by negative cognitions or their consequences, such as stress, violence, or deprivation. Thus,
negative cognitions can cause inflammation that can, in turn, lead to depression.[42][43] In addition, there is
increasing evidence that inflammation can cause depression because of the increase of cytokines, setting the
brain into a "sickness mode".[44] Classical symptoms of being physically sick, such as lethargy, show a
large overlap in behaviors that characterize depression. Levels of cytokines tend to increase sharply during
the depressive episodes of people with bipolar disorder and drop off during remission.[45] Furthermore, it
has been shown in clinical trials that anti-inflammatory medicines taken in addition to antidepressants not
only significantly improves symptoms but also increases the proportion of subjects positively responding to
treatment.[46]

Inflammations that lead to serious depression could be caused by common infections such as those caused
by a virus, bacteria or even parasites.[47]

Historical legacy
Researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism
may create depressive conditions.[48][49]

Measures
Measures of depression include, but are not limited to: Beck Depression Inventory-11 and the 9-item
depression scale in the Patient Health Questionnaire (PHQ-9).[50] Both of these measures are psychological
tests that ask personal questions of the participant, and have mostly been used to measure the severity of
depression. The Beck Depression Inventory is a self-report scale that helps a therapist identify the patterns
of depression symptoms and monitor recovery. The responses on this scale can be discussed in therapy to
devise interventions for the most distressing symptoms of depression.[6]

Theories
Schools of depression theories include:

Cognitive theory of depression

Tripartite Model of Anxiety and Depression
Behavioral theories of depression
Evolutionary approaches to depression
Biology of depression
Epigenetics of depression

Management
Depressed mood may not require professional treatment, and may be a normal temporary reaction to life
events, a symptom of some medical condition, or a side effect of some drugs or medical treatments. A
prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a
psychiatric or medical condition which may benefit from treatment. Many have linked depression to a life
falling short of expectations and have blamed influencers for setting unrealistic expectations.[51][52][53]

The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicate that
antidepressants should not be routinely used for the initial treatment of mild depression, because the risk-
benefit ratio is poor.[54]

Physical activity has a protective effect against the emergence of depression in some people.[55]

There is limited evidence suggesting yoga may help some people with depressive disorders or elevated
levels of depression, but more research is needed.[56][57]

Reminiscence of old and fond memories is another alternative form of treatment, especially for the elderly
who have lived longer and have more experiences in life. It is a method that causes a person to recollect
memories of their own life, leading to a process of self-recognition and identifying familiar stimuli. By
maintaining one's personal past and identity, it is a technique that stimulates people to view their lives in a
more objective and balanced way, causing them to pay attention to positive information in their life stories,
which would successfully reduce depressive mood levels.[58]
There is limited evidence that continuing antidepressant medication for one year reduces the risk of
depression recurrence with no additional harm.[59] Recommendations for psychological treatments or
combination treatments in preventing recurrence are not clear.[59]

Epidemiology
Depression is the leading cause of disability worldwide, the United Nations (UN) health agency reported,
estimating that it affects more than 300 million people worldwide – the majority of them women, young
people and the elderly. An estimated 4.4 percent of the global population has depression, according to a
report released by the UN World Health Organization (WHO), which shows an 18 percent increase in the
number of people living with depression between 2005 and 2015.[60][61][62]

Depression is a major mental-health cause of disease burden. Its consequences further lead to significant
burden in public health, including a higher risk of dementia, premature mortality arising from physical
disorders, and maternal depression impacts on child growth and development.[63] Approximately 76% to
85% of depressed people in low- and middle-income countries do not receive treatment;[64] barriers to
treatment include: inaccurate assessment, lack of trained health-care providers, social stigma and lack of
resources.[4]

The stigma comes from misguided societal views that people with mental illness are different from everyone
else, and they can choose to get better only if they wanted to.[65] Due to this more than half of the people
with depression do not receive help with their disorders. The stigma leads to a strong preference for privacy.
An analysis of 40,350 undergraduates from 70 institutions by Posselt and Lipson found that undergraduates
who perceived their classroom environments as highly competitive had a 37% higher chance of developing
depression and a 69% higher chance of developing anxiety.[66] Several studies have suggested that
unemployment roughly doubles the risk of developing depression.[67][68][69][70][71]

The World Health Organization has constructed guidelines – known as The Mental Health Gap Action
Programme (mhGAP) – aiming to increase services for people with mental, neurological and substance-use
disorders.[4] Depression is listed as one of conditions prioritized by the programme. Trials conducted show
possibilities for the implementation of the programme in low-resource primary-care settings dependent on
primary-care practitioners and lay health-workers.[72] Examples of mhGAP-endorsed therapies targeting
depression include Group Interpersonal Therapy as group treatment for depression and "Thinking Health",
which utilizes cognitive behavioral therapy to tackle perinatal depression.[4] Furthermore, effective
screening in primary care is crucial for the access of treatments. The mhGAP adopted its approach of
improving detection rates of depression by training general practitioners. However, there is still weak
evidence supporting this training.[63]

According to 2011 study, people who are high in hypercompetitive traits are also likely to measure higher
for depression and anxiety.[73]

As of 2021, Iranians were one of the most depressed peoples on Earth, with the government reporting a
70% depression rate.[74][75][76][77][78][79]

History
The term depression was derived from the Latin verb deprimere, "to press down".[80] From the
14th century, "to depress" meant to subjugate or to bring down in spirits. It was used in 1665 in English
author Richard Baker's Chronicle to refer to someone having "a great depression of spirit", and by English
author Samuel Johnson in a similar sense in 1753.[81]
In Ancient Greece, disease was thought due to an imbalance in the four basic bodily fluids, or humors.
Personality types were similarly thought to be determined by the dominant humor in a particular person.
Derived from the Ancient Greek melas, "black", and kholé, "bile",[82] melancholia was described as a
distinct disease with particular mental and physical symptoms by Hippocrates in his Aphorisms, where he
characterized all "fears and despondencies, if they last a long time" as being symptomatic of the ailment.[83]

During the 18th century, the humoral theory of melancholia was increasingly being challenged by
mechanical and electrical explanations; references to dark and gloomy states gave way to ideas of slowed
circulation and depleted energy.[84] German physician Johann Christian Heinroth, however, argued
melancholia was a disturbance of the soul due to moral conflict within the patient.

In the 20th century, the German psychiatrist Emil Kraepelin distinguished manic depression. The influential
system put forward by Kraepelin unified nearly all types of mood disorder into manic–depressive insanity.
Kraepelin worked from an assumption of underlying brain pathology, but also promoted a distinction
between endogenous (internally caused) and exogenous (externally caused) types.[85]

Other psycho-dynamic theories were proposed. Existential and humanistic theories represented a forceful
affirmation of individualism.[86] Austrian existential psychiatrist Viktor Frankl connected depression to
feelings of futility and meaninglessness.[87] Frankl's logotherapy addressed the filling of an "existential
vacuum" associated with such feelings, and may be particularly useful for depressed adolescents.[88][89]

Researchers theorized that depression was caused by a chemical imbalance in neurotransmitters 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.[90] During the 1960s and 70s,
manic-depression came to refer to just one type of mood disorder (now most commonly known as bipolar
disorder) which was distinguished from (unipolar) depression. The terms unipolar and bipolar had been
coined by German psychiatrist Karl Kleist.[85]

In July 2022, British psychiatrist Joanna Moncrieff, also psychiatrist Mark Horowtiz and others proposed in
a study on academic journal Molecular Psychiatry that depression is not caused by a serotonin imbalance in
the human body, unlike what most of the psychiatry community points to, and that therefore anti-
depressants do not work against the illness.[91][92] However, such study was met with criticism from some
psychiatrists, who argued the study's methodology used an indirect trace of serotonin, instead of taking
direct measurements of the molecule.[93] Moncrieff said that, despite her study's conclusions, no one should
interrupt their treatment if they are taking any anti-depressant.[93]

See also
Alain Ehrenberg, French sociologist, author of Weariness of the Self: Diagnosing the History
of Depression in the Contemporary Age
Attribution (psychology) – The process by which individuals explain the causes of behavior
and events
Biopsychosocial model – Explanatory model emphasizing the interplay among causal forces
Depression in childhood and adolescence – Pediatric depressive disorders
Diathesis–stress model – Psychological theory
Existential crisis – Inner conflict due to perceived meaninglessness
Feeling – Conscious subjective experience of emotion
Locus of control – Concept in psychology
Melancholia – Historical view of extreme depression
 Mixed anxiety–depressive disorder – Diagnostic category in the ICD-10

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External links
Media related to Depression (mood) at Wikimedia Commons

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