06/12/2013 by admin | Psychiatry

Definition: a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities.

Classification / type of disease:

  • Melancholic depression is characterized by a loss of pleasure in most or all activities. S&S = early morning waking, psychomotor retardation, excessive weight loss, excessive guilt…

  • Atypical depression is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite, excessive sleep, a sensation of heaviness in limbs and significant social impairment

  • Catatonic depression is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. S&S = mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements.

  • Postpartum depression occurs within the puerperium.

  • Seasonal affective disorder (SAD) is a form of depression in which depressive episodes come on in the autumn or winter, and resolve in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times, over a two-year period or longer.


  • 8-12% suffers from depression in their lifetime – although this does vary geographically.

  • Most have 1st episode in 30-40s.

Presenting symptoms / signs: depressed mood > 2/52, strained family / personal relationships, early morning waking (~2 hours earlier than normal), anhedonia, ruminatory (preoccupied by) feelings of hopelessness, worthlessness, pointlessness, social withdrawel, poor concentration/memory, reduced libido, reduced appetite and weight loss

In severe cases = psychosis, delusions, hallucinations, idealation of suicide.

Diagnostic investigations:

  • Patient’s self-reported experiences

  • Behavior reported by relatives or friends

  • MMS – special attention to mood, thought content, risk assess for self-harm / suicide.

  • Also complete FBC and TFT to rule out: thyroid disease, metabolic disturbance, systemic illness/infection, consider degenerative diseases in elderly.

  • Can use ICD-10 and/or DSM-4 to diagnose classification of depression.


  • Biopsychosocial causes…

  • Biological = monoamine hypothesis, neurogenesis of the hippocampus, overactive HPA axis, cytokine regulation.

  • Psychological = personality, emotionality, distorted view/processing, self-blame..

  • Social = poverty, isolation, abuse..

  • Evolution = ability to adapt to pressures/stresses…

  • Drug and alcohol use = alcohol, benzodiazepines (sedatives)…

  • The diathesis-stress model (pre-exiting diathesis which is then activated by a stressful life event).

  • Long-term substance use (inc sedatives and hypnotic drugs).

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