Depression is also known as an affective disorder, melancholia, hypothymia or a nervous breakdown. It is a medical condition, not just a state of mind that affects 30% of people at some time in their life. Patients are not able to pull themselves together and overcome the depression without medical aid, although a determination to improve the situation certainly helps the outcome.
Depression may be a symptom (having a bad day and feeling sad), personality type (inherited with the genes), reaction (depressed because of loss of job, death in family etc.) or a disease (depression due to chemical imbalances in the brain). It is usually a mixture of several of these.
There are two main types of depression, endogenous and reactive, with very different causes.
Endogenous depression has no obvious reason for the constant unhappiness, and patients slowly become sadder and sadder, more irritable, unable to sleep, lose appetite and weight, and feel there is no purpose in living. They may feel unnecessarily guilty, have a very poor opinion of themselves, feel life is hopeless and find it difficult to think or concentrate. After several months they usually improve, but sometimes it can take years. It is due to an imbalance of the chemicals (neurotransmitters) that normally occur in the brain to control mood. The neurotransmitters include serotonin, noradrenaline and dopamine. If too little of any one is produced, the patient becomes depressed – if too much, the patient may become manic.
Endogenous depression can be further subdivided, depending on the combination of neurotransmitters that are too low. The subtypes are:-
|Type||Neurotransmitter level too low||Characteristics|
|Non-melancholic depression||Serotonin||Obsession, panic, compulsions, anxiety,
lack of energy, tired unmotivated, no pleasures, lack of concentration, no insight.
|Non-psychotic melancholia||Serotonin, noradrenaline|
|Psychotic melancholia||Serotonin, noradrenaline, dopamine|
Those patients with endogenous depression are not able to pull themselves together and overcome the depression without medical aid, but doctors can alter the abnormal chemical balance by giving antidepressant medications. When they do start to improve, some patients with depression go too far the other way and become over-happy or manic. These patients are said to be manic depressive, have bipolar personality (generally severe swings of mood) or cyclothymic disorder (milder mood changes).
Reactive depression is the sadness that occurs after a death in the family, loss of a job, a marriage break-up or other disaster. Patients are depressed for a definite reason, and with time, will be often be able to cope with the situation, although some patients do require medical help.
There are no diagnostic blood tests or brain scans to prove these diagnoses, and the final diagnosis depends on the clinical understanding of the doctor.
There are many other causes of depression that overlap between the two types above or have totally independent causes.
The elderly often become depressed because they are confused, ill, unable to sleep as well as they would like, in discomfort, have no pleasure in life and can see no future. A change in attitude, environment and a bit of medication may often change their outlook dramatically.