What is depression and what are depressive disorders ?
When we talk about depression in everyday language, and even in clinical settings, we are actually referring to a depressive disorder.
The term depressive disorder defines a group of psychosis and mental disorders that primarily involve significant changes in a person’s mood, as well as other symptoms of both a somatic and psychological nature.
The overall picture of these symptoms and mood changes includes impairment of the individual’s social and functioning functioning.
Symptoms of Depression
How does it manifest itself and what are the symptoms of depression that are similar in different types of depressive disorder and that they are found transversely?
First, depression is characterized by a depressed mood and/or decreased interest and/or pleasure in daily activities (including decreased sexual desire).
Feelings of deep and constant sadness, hopelessness, apprehension, anger, apathy usually arise.
Crying leads to emotional lameness, thoughts of self-deprecation and guilt, pessimism, negative thoughts and low self-esteem;
Depression may also present thoughts of death, helplessness, and suicidal ideation/planning.
Along with mood swings, physical energy levels, fatigue, sleep quality, and appetite also vary.
In everyday life, the person may experience a feeling of overexertion and fatigue, there may be a marked difficulty in concentration and indecision in dealing with their tasks or simple tasks.
On a cognitive level, there is usually a recurrent rumination and/or contemplation.
In addition, a decrease or increase in body weight and appetite, as well as hypersomnia or insomnia are symptoms that can arise in the context of depression.
Depressive disorder (or unipolar depression) is characterized by the absence of manic or hypomanic episodes in the patient’s history.
Depression can manifest itself at different levels of severity:
Some people have mild and transient depressive symptoms, while others have more severe forms of depression and have extreme difficulty and trouble performing daily activities for long periods of time. .
Types of depression: depressive disorder
Talking about depression can technically refer to specific depressive disorders (or we might say, different types of depression) which include:
Major depressive episode:
Within the group of depressive disorders, single episodes of altered mood can occur and tracing the onset of such episodes over time is extremely relevant for diagnostic purposes.
So, for example, when we talk about depression it can be a major depressive episode that is characterized by the presence –
During a period of at least two weeks – at least five of the following symptoms ( One of the first symptoms of which) are two essential for the diagnosis of a major depressive episode):
depressed mood for most of the day, almost every day (as reported by the individual or as observed by others);
a significant decrease in interest or pleasure in all, or almost all, activities for most of the day;
Not caused by significant weight loss, diet, or weight gain (eg, more than 5% change of body weight in one month) or decreased or increased appetite;
- insomnia or hypersomnia on most days;
- psychomotor agitation or slowing down almost every day;
- tiredness or lack of energy most days;
- Feelings of self-deprecation or excessive or undue guilt, almost every day
- impaired ability to think or concentrate, or indecision most days;
- Recurrent thoughts of death, recurrent thoughts of suicide without a specific plan, or attempted suicide, or any specific plans to commit suicide
To be diagnosed with a major depressive episode, symptoms must result in significant distress or impairment in social, occupational, or other important areas of functioning.
In addition, the episode of mood changes is not due to the physical effects of a substance or any other general medical condition.
The average duration of a major depressive episode can last from 6 months to a year, depending on the severity (Blaney & Milne, 2009).
Major depressive disorder
In the context of disorders, the equivalent of a major depressive episode is the type of depression that is defined in the literature as major depressive disorder.
To be diagnosed with major depressive disorder, at least one major depressive episode must be present in the person’s history and they must be excluded in one.
Manic or hypomanic amnesia episodes.
When diagnosing major depression, it is important to note that periods of sadness and irritability are aspects of the human experience and are physiological.
Being very sad and energetic, emptiness, the feeling of having lost all interest after the loss of a loved one (e.g. momentarily.
Therefore, such periods should not be diagnosed as depression unless the criteria for severity, duration and clinical
Stress is met; in addition, mild depression often has clinical pictures that we can define as subliminal.
Symptoms of depression are present, but the criteria for each disorder are the duration, intensity.
Persistent depressive disorder (dysthymia)
In this case, the disturbed mood has been present almost every day for at least 2 years.
Persistent depressive disorder has at least 2 of the following symptoms associated with a depressed mood:
Loss of appetite or hyperphagia, insomnia or hypersomnia, asthenia, low self-esteem, difficulty concentrating or making decisions, hopelessness.
There are no thoughts of death, but the person has strong feelings of weakness and ineffectiveness, negative thoughts about themselves and their future, low self-esteem, difficulty experiencing joy, and difficulties coping with daily life.
Disturbing mood disorder
Dissociative mood disorder is a disorder characterized by severe and recurring outbursts of verbal and / or behaviorally manifest anger that are highly disproportionate to the intensity or duration of the illness.
The frequency of tantrums averages three or more times a week.
The person between one outburst and another is constantly irritable or angry almost every day and may be noticed by others.
To speak of dissociative mood disorder, these angry expressions must have been present for at least 12 months, and during this time interval there cannot be more than 3 consecutive months or more of a period without any symptoms.
We can say that the protagonists in this context are anger and anger and the resulting interpersonal and relational difficulties associated with this dynamic of mood swings, irritability and emotional dysregulation.
To be diagnosed with PMS, most menstrual cycles require at least 5 symptoms in the week before menstruation (these symptoms usually get better within days after menstruation starts and in the week after menstruation).
In this type of dysphoric depressive disorder related to the menstrual cycle we find: pronounced affective dysfunction
(e.g. feelings of hopelessness or self-critical thoughts, fear, tension and / or sensation on the skin, difficulty concentrating or making decisions, feelings of hopelessness.
Depressive disorder with anxiety
The comorbidity between symptoms of depression and anxiety is very common, so up to the previous version of the DSMIV there was a mixed anxiety-depressive disorder characterized by dysphoric mood lasting for at least a month, including:
There were at least four symptoms: difficulty concentrating, difficulty sleeping, Fatigue, lack of energy, irritability, anxiety, easy crying, over-alertness, negative predictions, hopelessness, low self-esteem, and self-loathing.
To this day, this diagnostic category has been retained in other classification systems (eg ICD-10), while in DSM5 this clinical picture no longer bears this name, but each individual “with concern” can be added. Type of depressive disorder.
Depression due to pharmacological conditions
In addition, there may be some forms of depression that are actually due to the use of substances or drugs, or are related to other medical conditions, and may have symptoms similar to those of other depressive disorders, but the etiology and onset of which are clear.
Be associated with certain pharmacopharmacological disorders or substance abuse.
A depressive episode can take shape as part of a bipolar affective disorder. Because of this
It is always necessary to turn to specialists in psychiatry and psychiatry to conduct an accurate anamnestic and clinical investigation.
Depressive disorders are often associated with other mental disorders such as substance abuse, anxiety disorders, personality disorders, etc.
In some cases, psychotic symptoms are associated with major depression and other depressive disorders.
Onset and course of depression
In terms of timing, depressive disorders have an onset that can be triggered by childhood, adolescence, and throughout adulthood.
The onset of depression may appear in relation to an “obvious” triggering condition
(for example, loss of a loved one, loss of job or financial difficulties, loss of emotional connection, a physical illness/disability), but it is a necessary condition.
According to the ESEMED study (European Study of the Epidemiology of Mental Disorders), the prevalence of depressive disorders throughout life in Italy is 11.2% (14.9% in women and 7.2% in men).
Above 65 years of age, depressive disorder (understood in the study as major depression and dysthymia) has a prevalence of 4.5%.
Other epidemiological research shows that 2% of children and 4% of adolescents have one episode of depression in one year.
In women, depression can appear at certain stages of life, such as during the postpartum period or the transition to menopause.
When the onset is located in the peripartum, that is, during pregnancy or 4 weeks after childbirth, we are talking about a specific subtype of depression called postpartum depression.
The course of depressive disorders is extremely variable depending on the individual clinical picture and co-morbidities with other psychotic disorders.
For example, a major depressive episode typically lasts at least six months (between a period of 3 to 12 months).
In most cases, complete remission occurs, and the person’s functioning returns to premorbid levels. 5-10% of cases become chronic.
Most subjects who have a first episode of major depression, however, will experience reappearances of the disorder even if they have recovered from the initial episode:
major depression is a disorder characterized by a recurrent course in most subjects. Recurrent episodes of major depression are common and the highest relapse rate occurs in the first 6 months after recovery.
In general, depressive disorders often have a cyclic and periodic time course;
This does not mean that depressive disorders are incurable or chronic, but that they have a good chance of recurrence.
It is therefore essential to take a longitudinal perspective in the assessment, treatment and follow-up phase in order to make an accurate diagnosis and make recurrence prevention interventions.
Depression can have significant effects on daily life:
a person’s school or work activity may be significantly affected, especially as a result of the concentration, indecision and memory problems that are part of the disorder.
This disorder also leads to withdrawal and isolation, which over time can lead to relational and social problems.
Not to be forgotten that depression can have harmful consequences, as it involves the risk of suicide: just imagine that among the diagnostic criteria for episode
Major depressive disorder is the likelihood that recurrent thoughts of death occur. , as well as thoughts and suicidal plans.
While it is not a necessary condition for the diagnosis of any depressive disorder, it is certainly an aspect that should always be evaluated at the diagnostic and therapeutic stage.
Due to depression
The causes of the onset of depressive disorder are complex.
To date, the scientific literature recognizes a multifactorial etiopathogenesis involving a combination of genetic, biological, environmental and psychological factors
Which may constitute risk and protective factors with respect to disease initiation and maintenance.
As in the case of major depressive disorder, it is not possible to establish a direct relationship between mood quality and a specific neurotransmitter with respect to biological causes;
However, various studies conducted have confirmed that stressful events, especially prolonged ones, reduce the rate of certain neurotransmitters such as :
Serotonin and noradrenaline and activate the hypothalamic-pituitary-adrenal axis with a resultant increase in cortisol in the blood.
Ngue with results in mood regulation.
Other factors influencing the development of a depressive picture are eco-psychologists, which question each of the subjective experiences and specific modes of emotional regulation and relationships with the world and with others that we learn much of.
Beginning childhood in the context of our life. In particular, it appears that certain negative early experiences may facilitate the development of susceptibility to depression and feelings of hopelessness about the future.
However, the causes listed are not factors that necessarily lead to depression.
Among the motivating factors, psychological factors play an important role in initiating the depressive picture, that is, the way the individual interprets events and mobilizes resources. with them.
psychopathological constructs of depression
From a cognitive point of view, patients with different types of depression have common cognitive-emotional psychological characteristics.
First, a tendency toward negative self-evaluations, self-criticism, and self-condemnation: the person feels unsuccessful, inadequate, of low value and/or unfortunate and/or victimized in the face of daily events and difficulties. Secondly, pessimism is evident:
there is often a tendency to view ourselves, the world, and the future in an extremely negative way; Negative predictions are made about the world and the future, focusing only on the negative aspects of ourselves and our experiences.
Patients with depressive disorders
They have specific ways of thinking and behaving that favor the development of a vicious cycle and, therefore, maintain a depressed mood over time.
In keeping with cognitive processes, depressive disorders have rumination, which is a repetitive way of thinking about the causes and consequences of one’s problems and difficulties, with a particular focus on past events.
Studies have shown that rumination plays a major role in maintaining depression because it prevents us from looking to the future and developing strategies for dealing with problems and difficulties.
Another behavior often implemented in periods of depression is the tendency to withdraw, reduce, or avoid social interactions, normal daily activities and tasks.
There is a marked decrease in motivation and an increase in passivity, in which the idea of not being capable prevails.
Some depressed people, for example, experience too much effort dealing with daily tasks, begin to postpone them and feel more incapable and unsuccessful.
This avoidance/isolation tendency helps to maintain a depressed mood, not allowing the individual to experience brief positive mental states or to experience pleasant and rewarding ones.
As in the case of bipolar disorder, it has been found that interpersonal metacognitive aspects also play an important role in complex disease models of depression, characterized by
difficulties recognizing other people’s emotions or self-regulating, as well as in neuropsychological functions.
characteristic of change. Such as dysfunction of attention, memory, ability to plan, cognitive flexibility and abstraction.
Depression treatment and treatment
Depressive disorders can be effectively treated through a psychotherapeutic and/or pharmacological approach.
In Italy, only 29% of subjects with major depression seek help for depression and seek treatment in the same year in which it arises (Wang et al., 2007).
Unrecognized and/or untreated depression can affect the affected individual with serious consequences, including work disability, apathy, affective-relational flattening, isolation, and a significant worsening of the overall symptomatology in general.
It is therefore essential to be aware of and recognize the symptoms of depressive disorders and to consult a psychiatrist or psychiatrist to avoid more serious consequences of the illness.
Scientific studies suggest that currently the most effective treatment for depression is drug therapy combined with cognitive-behavioral psychotherapy.
The integration between pharmacological treatment and cognitive-behavioral psychotherapy is assessed by a specialist clinician according to the general clinical picture, the type of depressive disorder, and its severity.
Some cases are treated exclusively through psychotherapy, others through a combined approach in which pharmacological intervention is also fundamental.
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