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Depressive Disorders

Depression is a disorder that is caused by an imbalance of brain chemicals. It is not a ‘bad mood’, or a case of the ‘blues’. Patients can’t just ‘snap out of it’. A depressive disorder affects the body, mood, and thought patterns of the patient. It affects how a person eats and sleeps, the way they feel about themselves, and the way they think about their life. Depressive disorders are categorized to capture the various sets of symptoms and the severity of the disorder. Major depression interferes with work, study, sleep, and eating habits, and prevents patients from participating in once pleasurable activities.
Disabling episodes of this depression can occur once but are more commonly chronic, occurring several times in a patient’s lifetime.

Dysthymia is a long-term, chronic disorder that does not disable the patient, but prevents them from functioning at optimum levels. Many Dysthymic patients also experience major depressive episodes at some time in their lives. Bipolar Disorder, also known as manic-depression is not nearly as common as other forms of depressive disorders. It is characterized by cycles of mood changes, from very high (mania) to very low (depression). For more information on these three sub-categories of depressive disorders, see the title articles on the related topics.

Depressive disorders can run in families, specifically in those families with a history of bipolar disorder. But not everyone with a hereditary history will suffer from bipolar disorder or depressive disorders in general. There are additional factors, like environment and stress that may affect a person’s predisposition to these disorders. For example, people with low self-esteem, pessimistic people and people who have suffered serious medical conditions like cancer, stroke or heart attack may also be more disposed to depressive disorders.

What are the symptoms?

The symptoms of Depressive Disorders vary with the type of disorder and the severity and frequency of the episodes.

For detailed information on each of the three sub-categories of Depressive Disorders, see the title article for these related disorders. Symptoms can include:

• Sadness or unexplained crying spells
• Irritable, angry, worried, anxious
• Feelings of guilt, worthlessness, hopelessness
• Unable to take pleasure from former interests, socially withdrawn
• Recurring thoughts of suicide or death
• Changes in appetite and sleep habits
• Apathy, indifference, loss of energy
• Inability to concentrate or focus, feeling indecisive
• Non-specific, unexplained physical complaints
• Poor memory

How is it diagnosed and treated?

Doctors will perform a physical exam to rule out other illnesses and disorders, physical and mental. To diagnose a Depressive Disorder, doctors will look for specific symptoms and signs, as described in the detailed articles for each of the sub-categories of Depressive Disorders. Generally, these signs will include at least five of the following, and they must be present nearly every day, throughout the day for at least two weeks. At least one of the signs must include a depressed mood of interesting activities and pleasure.

• Depressed mood nearly all day, every day for at least 2 weeks, seen by subjective report or observation made by others. Children or adolescents, can exhibit irritable mood
• Insomnia, inability to stay asleep, change in sleep patterns
• Anxiety or lethargy observed by others
• Recurrent thoughts of death or suicide without a specific plan, suicide attempt or specific plan to commit suicide
• Symptoms are not due to the direct effects of a drug or other substance or a general medical condition
• Weight loss or weight gain of more than 5% of body weight in a month, decrease or increase in appetite. Children may fail to make expected weight gain
• Feelings of worthlessness, excessive or inappropriate guilt
• Symptoms cause distress or impairment in social, work or family activities
• Inability to focus, subjective or observed by others diminished interest or pleasure in nearly all activities as indicated by subjective account or observation
• Symptoms are not accounted for by grieving from the loss of a loved one

Treatment is dictated by the specific Depressive Disorder. Treatment(s) can include:

• Medications like antidepressants, Serotonin Reuptake Inhibitors (SSRIs), tricyclics, Monoamine Oxidase Inhibitors (MAOIs), anti-anxiety medications, and occasionally stimulants, anti-convulsants, lithium
• Electroconvulsive Therapy (ECT) in severe cases
• Psychodynamic Therapy
• Cognitive Behavioral Therapy
• Psychotherapy

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