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Depressive disorder
Last reviewed: 29.11.2021
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Depressive disorder is characterized by a decrease in mood, so pronounced or prolonged that the functioning is disrupted, and sometimes the interest or ability to enjoy activity is reduced. The exact cause is unknown, but heredity, changes in the level of neurotransmitters, disorders of neuroendocrinal functioning and psychosocial factors are probably important. The diagnosis is based on anamnestic information. Treatment usually consists of taking medication, psychotherapy, their combination and sometimes in electroconvulsive therapy.
The term "depression" is often used for a number of depressive disorders. Three of these are highlighted in the Manual on Statistics and Diagnosis of Mental Disorders, fourth edition (DSM-IV) for specific symptoms: major depressive disorder (often called major depression), dysthymia and depressive disorder, nowhere else classified. The other two are distinguished by etiology: a depressive disorder due to a general physical condition and a depressive disorder induced by medication.
Depressive disorder occurs in different age periods, but more often develops in middle age, in 20-30-year-olds. In the primary care arm, about 30% of patients report depressive symptoms, but a large depression is observed in less than 10%.
The term "depression" is often used to describe a reduced or depressed mood due to disappointment or loss. In English, the term "demoralization" is used to describe this mood. Negative emotions in this state, in contrast to depression, go away when the situation that caused them improves; Mood decline, as a rule, lasts for days, not weeks and months, and suicidal thoughts and a prolonged loss of normal functioning are much less likely.
[Cause of depressive disorder
The exact cause of the depressive disorder is unknown. Heredity plays an unclear role; Depression is more common among relatives of a patient with a depression of the 1st degree of kinship, a high concordance between monozygotic twins. Hereditary genetic polymorphism of the activity of the carrier of serotonin in the brain can be triggered by stress. People who have experienced violence in childhood or other severe stresses and have a short allele of this vector are twice as likely to develop depression as compared to those with a long allele.
Symptoms of a depressive disorder
Depression is characterized not only by a depressed mood, but also leads to cognitive, psychomotor and other impairments (eg, poor concentration, fatigue, loss of sexual desire, disruption of the menstrual cycle). Other mental symptoms or disorders (eg, anxiety or panic attacks) often occur simultaneously with depression, which sometimes makes diagnosis and treatment difficult. Patients with all forms of depression are prone to abuse of alcohol and other psychoactive substances in order to cure sleep disorders or anxiety symptoms; However, depression is less likely to cause alcoholism and substance abuse than is considered.
Diagnosis of a depressive disorder
Diagnosis of a depressive disorder is based on the identification of the symptoms and signs described above. There are a number of short questionnaires for screening. They help in establishing some depressive symptoms, but can not be used alone to establish a diagnosis. Specific closed-ended questions help in determining the patient's symptoms required by the DSM-IV criteria for the diagnosis of major depression.
The severity of the condition is determined by the degree of suffering and disruption of functioning (physical, social and professional), as well as the duration of the symptoms. The presence of suicidal risk (manifested in suicidal thoughts, plans or attempts) indicates the severity of the disorder.
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Prognosis and treatment of depressive disorder
With appropriate treatment, symptoms often disappear. Mild depression can be treated using general support and psychotherapy. Moderate and severe depression is treated with medication, psychotherapy or a combination of them, and sometimes with the use of electroconvulsive therapy. Some patients need more than one medication or combination of drugs. To improve the condition, it may take 1 to 4 weeks for the drug to be taken at the recommended dose. Depression, especially in patients who have had more than one episode, is prone to reappearance; so in severe cases, long-term maintenance medication is needed.
Most patients with depression are treated on an outpatient basis. Patients with severe suicidal intentions, especially if there is insufficient support from the family, need to be hospitalized; also hospitalization is necessary in the presence of psychotic symptoms or physical exhaustion.