Depression: chronic depression or depression?

Definition of depression

Depression is a disease which is characterized in particular by great sadness, a feeling of hopelessness (depressed mood), loss of motivation and decision-making faculties, a decrease in the feeling of pleasure, eating and sleep disorders, morbid thoughts and the feeling of having no value as an individual.

In medical circles, the term major depression is often used to refer to this disease. Depression usually occurs as periods of depression that can last for weeks, months or even years. Depending on the intensity of the symptoms, the depression will be classified as mild, moderate or major (severe). In the most severe cases, depression can lead to suicide.

Depression affects mood, thoughts and behavior, but also the body. Depression can be expressed in the body by back pain, stomach aches, headaches; It also explains that a person who suffers from depression may be more vulnerable to colds and other infections, as their immune system is weakened.

For example, feeling sad after the loss of a loved one or feeling unsuccessful when having problems at work is normal. But when these moods come back every day for no particular reason or persist for a long time even with an identifiable cause, it may be depression. Depression is in fact a chronic disease, meeting specific diagnostic criteria.

In addition to sadness, the depressed person maintains negative and devaluing thoughts: “I am really bad”, “I will never be able to do it”, “I hate what I am”. She feels worthless and has trouble projecting herself into the future. She is no longer interested in activities that were once popular.

Prevalence

Depression is one of the most common psychiatric disorders. According to a survey conducted by Quebec public health authorities, approximately 8% of people aged 12 and over reported having experienced a period of depression in the past 12 months1. According to Health Canada, approximately 11% of Canadians and 16% of Canadian women will suffer from major depression in their lifetime. And 7.5% of French people aged 15 to 85 have experienced a depressive episode during the past 12 months90.

According to the World Health Organization (WHO), by 2020, depression will become the second leading cause of disability worldwide, after cardiovascular disorders2.

Depression can occur at any age, including childhood, but it first appears most often in late adolescence or early adulthood.

What are the Causes of depression?

It is not clear exactly what causes depression, but it is likely a complex disease involving several factors related to heredity, biology, life events, and background and habits. of life.

Genetic

Long-term studies on families as well as on twins (separated or not at birth) have shown that depression has a certain genetic component, although it has not been identified. specific genes involved in this disease. Thus, a history of depression in the family may be a risk factor.

Biology

Although the biology of the brain is complex, people with depression show a deficit or an imbalance of certain neurotransmitters such as serotonin. These imbalances disrupt communication between neurons. Other problems, such as a hormonal disturbance (hypothyroidism, taking birth control pills for example), can also contribute to depression.

Environment and lifestyle

Poor lifestyle habits (smoking, alcoholism, little physical activity, excess of television88 or video games, etc.) and living conditions (precarious economic conditions, stress, social isolation) are likely to have a profound effect on the individual. psychological state. For example, the build-up of stress at work can lead to burnout and ultimately depression.

Life events

The loss of a loved one, divorce, illness, loss of a job or any other trauma can trigger depression in people predisposed to the disease. Likewise, mistreatment or trauma experienced in childhood makes depression more susceptible to adulthood, in particular because it permanently disrupts the functioning of certain stress-related genes.

What are the different forms of depression?

Depressive disorders are classified into several groups: major depressive disorders, dysthymic disorders and unspecified depressive disorders.

Major depressive disorder

It is characterized by one or more Major Depressive Episodes (depressed mood or loss of interest for at least two weeks associated with at least four other symptoms of depression).

Dysthymic Disorder (dys = dysfunctional and thymia = mood)

It is characterized by depressed mood present most of the time for at least two years, associated with depressive symptoms that do not meet the criteria for a Major Depressive Episode. It is a depressive tendency, without there being a major depression.

Nonspecific Depressive Disorder is a depressive disorder that does not meet the criteria for major depressive disorder or dysthymic disorder. It may be, for example, an adjustment disorder with depressed mood or an adjustment disorder with both anxious and depressed mood.

Other terms are used alongside this classification from DSM4 (Mental Disorders Classification Manual):

Anxious depression. Adding to the usual symptoms of depression are excessive apprehension and anxiety.

Bipolar disorder previously referred to as manic depression.

This psychiatric disorder is characterized by periods of major depression, with manic or hypomanic episodes (exaggerated euphoria, over-excitement, reverse form of depression).

Seasonal depression.

Depressive state that manifests itself cyclically, usually during the few months of the year when the sun is at its lowest.

Postpartum depression

In 60% to 80% of women, a state of sadness, nervousness and anxiety manifests itself in the days after childbirth. We are talking about baby blues which lasts between a day and 15 days. Usually, this negative mood resolves on its own. However, in 1 in 8 women, real depression sets in immediately or appears within a year of giving birth.

Depression following bereavement. In the weeks following the loss of a loved one, signs of depression are common, and it is part of the grieving process. However, if these signs of depression persist for more than two months, or if they are very marked, a specialist should be consulted.

What are the Complications?

There are several possible complications related to depression:

  • Depression recurrence : It is frequent since it concerns 50% of people who have experienced depression. Management considerably reduces this risk of recurrence.
  • The persistence of residual symptoms: these are cases where the depression is not completely cured and where even after the depressive episode, signs of depression persist.
  • The transition to chronic depression.
  • Suicide risk: Depression is the leading cause of suicide: around 70% of people who die by suicide suffered from depression. Depressed men over the age of 70 are the most at risk of suicide. One of the signs of depression is thoughts of suicide, sometimes called “dark thoughts”. Even if most people with thoughts of suicide don’t make an attempt, it is a red flag. People with depression think about suicide to stop suffering that they find unbearable.

Disorders associated with depression : Depression has physical or psychological links with other health problems:

  • Anxiety,
  • Addiction: Alcoholism; abuse of substances such as cannabis, ecstasy, cocaine; dependence on certain drugs such as sleeping pills or tranquilizers …
  • Increased risk of certain diseases : cardiovascular disease and diabetes. This is because depression is associated with a higher risk of heart problems or strokes . In addition, suffering from depression could slightly accelerate the onset of diabetes in people already at risk 70 . Researchers argue that people with depression are also less likely to exercise and eat well. In addition, some medications can increase appetite and cause weight gain. All of these factors increase the risk of type 2 diabetes.

what depression symptoms

According to the definition of DSM4-R, the main characteristic of depression is

  • depressed mood
  • with a loss of interest or pleasure in almost all activities,
  • lasting at least two weeks.

In a child or adolescent who is depressed, we may sometimes observe irritability rather than sadness. For depression to be effective, for a diagnosis to be made, the person must also present at least four additional symptoms:

A change in appetite or weight, sleep and psychomotor activity;
– A reduction in energy;
– Ideas of worthlessness or guilt;
– Difficulty thinking, concentrating or making decisions.

Other symptoms may be present:

  • Unusual aggressive behavior or great irritability.
  • Excessive emotional sensitivity (nothing causes tears).
  • Restlessness, with the impossibility of remaining seated, wandering, wriggling of the hands, manipulation and friction of the skin, clothes or other objects) or on the contrary the impression of thinking and acting “in slow motion”.
  • A drop in libido.
  • Headaches, stomach pain or back pain.
  • A feeling of emptiness,
  • An impression of not feeling anything anymore.

These symptoms of depression are accompanied by significant distress or impaired functioning in social, occupational, or other important areas.

Note that severe depression is often accompanied by other psychiatric problems, such as anxiety disorders, eating disorders (anorexia, bulimia) or even drug or alcohol abuse 76 . Indeed, many people with depression use these substances to relieve their symptoms, which can create other health problems (mental or physical).

In the elderly , depression is also common. It often goes unnoticed because the symptoms (fatigue, loss of motivation, isolation) can be attributed to aging. A significant portion of this population would not be diagnosed or treated 5 . Some symptoms of depression are more common in older people than in younger people, in particular:

  • Aggression and anger.
  • Various and unexplained pains (back pain, headache …).
  • Isolation, withdrawal into oneself.
  • Confusion and memory impairment.
  • Feeling of being useless, frequent suicidal ideation.

Recognizing Depression in Children and Adolescents

In children . Depression is quite rare (0.5%) in their case. However, we must be particularly attentive to any sudden change in behavior and to signs of withdrawal, absence, or on the contrary, irritability or restlessness:
– he no longer wants to play, go out or see his friends;
– he is very irritable and cries often;
– he complains of headaches or stomach aches;
– he says that he no longer wants to live or that he should not have been born;
– he suffers exclusion and failures at school;
– it grows, but takes very little weight.

In adolescents . Depression can be difficult to distinguish from the moments of crisis or confrontation specific to this stage of life. It affects 3% to 4% of adolescents, especially girls. The following signs should be watched for:
– alcohol, drug or medication abuse,
– a state of agitation,
– verbal violence,
– apparent indifference,
– a tendency to be isolated;
– a disinvestment in studies;
– signs of self-harm;
– verbalization of suicidal thoughts.

Who are at risk for depression ?

No one is immune to depression. The following people would be slightly more at risk.

  • People with a family or personal history of depression.
  • People who take certain medications , such as psychostimulants, steroids, corticosteroids, anabolics, anticonvulsants, or the birth control pill. This is because the progestins in the birth control pill can affect your mood 3 . If so, discuss it with your doctor.

From a sociological point of view, the following groups are more affected by depression.

  • Women . About twice as many women as men will experience depression at least once in their lifetime , although some marginal studies have sometimes found an equivalent frequency in both sexes. Women are more likely than men to consult when they have symptoms of depression, which could partly explain why the disease is more often diagnosed in them. Also, we put forward at least two hypotheses to explain the phenomenon:
    – the hormonal system of women, more likely to influence brain chemistry; thus, menopause can be associated with the onset of depression ;
    – more frequent problems of poverty and domestic violence .
  • Men living alone .
  • Young people. The first depression often occurs in late adolescence or early adulthood. Suicide is the 2 th leading cause of death among young people after road accidents  .
  • The elderly . Between 15% and 20% of the elderly experience periods of depression . They often go unnoticed. Among the possible causes:
    – loneliness;
    – death of spouse or friends;
    – physiological factors linked to aging, such as a significant drop in serotonin and other metabolic changes;
    – undernourishment, which can cause nutritional deficiencies contributing to depression (especially in folic acid and vitamin B12).
  • Homosexual people . Several data, a large cohort study in New Zealand, show that gays, lesbians and bisexuals are at higher risk of mental health problems, particularly depression, anxiety disorders and suicidal behavior .
  • People with chronic illness . Having chronic pain (migraine or back pain, for example) or a disabling illness (diabetes, stroke, etc.) greatly increases the risk of depression, especially among young people .

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