What is depression ?
Depression is a term for a mood disorder characterized by a loss of vitality or severe depression. In common parlance, the term "depressed" used for a variety of moods, ranging from a brief dip to severe depression. Clinical depression describes a combination of symptoms and is not a cause or explanation for the loss of vitality or severe depression. Healthcare providers, insurers and policymakers talk of a clinical depression when it meets certain criteria as defined in the Diagnostic and Statistical handbook as ICD-10 of the World Health Organization, or used in the Netherlands and in the US DSM-IV TR. According to this classification is not every depressed, gloomy or sad mood mental illness.
Recurrent depressive disorder
A period in which arise depressive symptoms, is called a major depressive episode (see below for the criteria). If someone often has these episodes, one speaks of a (recurrent) depressive disorder. The risk of relapse after a first depression is approximately 30%. After a second depression takes this risk increased to 75% for people with three depressions is about 90% chance that they will once again be confronted with depression. Also, recovery from a depressive episode often incomplete, so-called "residual symptoms" persist that increase the risk of relapse into another depressive episode. The first depressive episode may occur at any age and the duration may vary. Today is also used the name unipolar depression as distinct from depression in bipolar disorder. Older descriptions as vital depression, melancholia or endogenous depression are broadly in line with the more severe forms of depression.
Depression in children
Depression in children is to be less easy to determine; symptoms in children include:
- Loss of appetite.
- Problems with sleep as nightmares.
- Problems with behavior or clearly poorer grades in school
- Significant behavioral changes; withdrawal, apathy, aggression.
A depression in the elderly is not expressed in gloom in many cases, older people are not accustomed to use this term. In most cases they will indicate to experience a loss of interest. Also, older people express faster physical complaints.
Triggers
The triggers for a person's depression can be manifold. Personality problems, environmental factors (including long-term incentive or combination of incentives where no influence can be exercised), or loss may play a role in the development of depression. A well-known risk factor for the development of a depression is high neuroticism. Also, the cause can be physical in nature. Often, more than one conditions play a role. It is not always easy to detect the psychological cause or a result of a depression. Is the result of a depression can be retrieved directly, this is called reactive depression.
In some cases develop depression itself from other psychological problems. Bereavement, for example, is a normal human process, but in some people restores the balance is not and depressive symptoms can occur. Also, drastic changes in the life adjustment problems associated with depression.
Scientific cross-cultural research shows that symptoms of depression occur worldwide in all cultures. This may suggest that a depression may initially start out as a physical condition and that patients here a psychological interpretation can give to the course of time. Body and mind, however, affect each other in two directions.
Several scientific studies have found statistical correlations between certain pesticides and depression. This phenomenon is marginal as a cause, and is sometimes found especially in developing countries.
Differential diagnosis
For diagnosis, it is important to determine whether in addition to depressive episodes also occurs mania or hypomania. In that case there could be a form of bipolar disorder. If there are psychotic features, make sure that fulfilled the criteria of schizoaffective disorder.
Dysthymic disorder
In addition to recurrent depressive disorder, there is a form of depression whose symptoms are less strong, but which can sometimes last for years. This is called dysthymia or dysthymic disorder.
Physical disorders and depression
In a number of physical conditions can develop depressive symptoms. This is often the case with serious or fatal diseases, such as cancer or AIDS. Neurological disorders (e.g., Parkinson's disease), endocrine disorders (e.g., hypothyroidism), certain viral diseases and so forth can also cause depressive symptoms. Such mood disorders in medical textbooks have a separate classification (see mood disorder).
Affective flattening
One of the worst features of a depression can affect the occurrence of flattening. This implies that the perception of feeling disappears partly or completely. This is similar to the incidence of deafness or blindness. The fact implies that the intensity of feelings greatly reduces; no experience more fun, happiness, pleasure, happiness. But also no experience of grief. With the lack of these feelings disappear meaning of life. Because there is nothing more that real emotional satisfaction may result. Precisely why are gloomy mood, but also loss of pleasure in daily activities, the two core symptoms of depression. Both refer namely to the problem to motivate themselves to do things.
Substance use and depression
Depression may result from use or abuse of certain resources, such as drugs, medicines or alcohol. It is often difficult to diagnose, because the use of resources also occurs as 'self-medication' for people who already have symptoms of depression. Also, these disorders are classified separately. Often must first substance use as an issue to be addressed before the depression can be treated.
Intercourse
Depression is something that is hard to describe. Someone thereby sees life in bleak, and neurotransmitters in the brains play a role. Where other people still have hope and see good things which are not seen in the experience of someone who is depressed. Therefore sometimes the environment has so little control over someone who is depressed, because those can not be forced to see positive things. It is better to discuss the issues and where possible to solve.
An additional problem is that the environment of the patient sometimes inadvertently contribute to a worsening of the situation. A patient will often receive comments from his immediate surroundings ranging from "do not be a" to "put you over it" and "just pretend nothing is going on." Such observations can be made for two reasons: they may be intended as a well-meaning advice and made with the best intentions, whether they are intended to patient persuade not to talk about his illness because the area does not wish to be confronted . Although the underlying ideas in these two scenarios differ materially they do have the same effect: someone who suffers from depression will therefore get the impression that his problem is not taken seriously, and as a result improves his situation worse rather than better.
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The patient loses sight of reality, he sees life in bleak, he does not see things that are seen generally. In a physical illness, the patient remains in contact with the people around him and has been understanding of his illness. Someone who suffers from endogenous depression, is totally alone in his great impotence and helplessness. The most distressing of this depression is the delayed effect of body and mind, this may take the form of a slight inertia to a stupor in severe depressions, where the patient loses all contact with the outside world. The respiratory, circulatory and digestive run extremely slow. The patient is there not usually self conscious and not understood by his surroundings. His depression is also difficult to understand. Compassion, distraction and comfort benefits typically not. Anxiety, despair and a feeling of total apathy alternate.
However, it is dangerous for the patient if he somewhat able to consciously act, because then there is a great risk of suicide. There he can do little against. The tendency to suicide where several depressed people suffer is often founded by outsiders (and also for the patient himself) logical reasoning. It is important to realize that when a depressed person rational processes in the brains at some point no longer able as 'brake' to act for the emotional processes. Often it is also clear how patients try to invent a solution, and then often desperate because each logical operation failed on the depression.
Depression treatment
Each depression is different and requires a different approach. There are various methods of treatment for depression. The most common treatments include cognitive behavioral therapy and medication using antidepressants. The combination may work better than the two separately. After termination of the cognitive behavioral therapy, or after stopping of the antidepressants, the chance exists that the depression after a period of time returns. However, recent research has shown in the context of a relapse prevention cognitive training, focused on cognition, daydreaming and fantasizing, can provide protection against a relapse in depression.
Cognitive behavioral therapy (CBT) teaches depressed patients that their thoughts are often unrealistic and dysfunctional. Part of treatment may include the patients to have a more active behave more positively into thinking (less worrying and times) in order to break the downward spiral of depression withdrawal behavior and gloomy thoughts about themselves, the future and the world. This treatment has been shown to be effective, in particular, in case of non-chronic depression.
CGT also forms the basis for proven effective online self-help focus on the treatment of mild-to-mild depression.
There are also newer treatments such as mindfulness-based cognitive therapy and acceptance and commitment therapy. Acceptance and commitment therapy has been recognized as evidence-based treatment for depression and mindfulness-based cognitive therapy has been recognized as evidence-based for preventing relapse into depression after at least three depressive episodes.
Behavioral activation is a specific form of therapy and is not to be confused with the mere activation of patients. Research shows that behavioral activation is at least as effective as medication for moderate and severe depression and a lot more effective than cognitive therapy. Behavioral activation is also recognized as evidence-based treatment for depression. Moreover, there is less downtime than with medication.
In mild and moderate depression antidepressants also appear not to be effective, only for severe depression have these substances sentence.
If the cause of depressive symptoms lies in a physical disorder or substance use (think of cocaine use), adjust the treatment in the first instance on the influence of these factors.
Regular intense exercise or sports for people with depression very favorable. It has been proven that running increases the amount of endorphins in the body. There are indications that endorphins and other naturally occurring in the body opioids exhibit anti-depressive effect. Therefore, there are treatments that focus specifically on activation, such as running therapy, a form of supervised exercise for people suffering from depression. The antidepressive effect occurs among others in intensive running, cycling and swimming. Intensive training means that it is difficult to speak during the activity due to wheezing. How long and how often sports? Ideally, 5 times per week, about 40 minutes or 3 times a week for about 1 hour. Quiet build-up of sport is advisable in connection with discouragement if they can not meet its targets. Consultation with the practitioner is recommended.
Electroconvulsive therapy (ECT) is in some cases an effective treatment for severe depression, even if it is accompanied by psychotic symptoms such as hallucinations. ECT is almost exclusively used in situations where treatment with antidepressants and psychotherapy are not effective. ECT can cause memory loss and is used only partly for this reason to treat the most severe cases.