blues, dejection, despondency, doldrums, gloom, gloominess, glumness, low spirits, melancholy, moodiness, mournfulness, sadness, unhappiness, ennui
Sounds delightful, don't it?

Depression is a psychiatric disorder characterized by feelings of worthlessness, guilt, sadness, helplessness, and hopelessness. In contrast to "normal" sadness or the grief accompanying the loss of a loved one, clinical depression is persistent and severe. It is accompanied by a variety of related symptoms, including disturbances in sleep and eating habits, loss of initiative, self-punishment, withdrawal and inactivity, and loss of pleasure. Community surveys show that as many as 20 in 100 people suffer from significant depressive symptoms at any one time; some 25 percent of the population may suffer from a depression over the course of a lifetime. The disorder strikes men and women of all ages, in all segments of society, but most studies indicate that women are more often afflicted.

Kinds.

In psychiatry, two major forms of depressive disorders are recognized. In both, the predominant symptom is a disturbance in mood. One form of the disorder, depressive disorder, is marked only by episodes of depression. The other, bipolar or manic depressive illness, is characterized by alternating depressed and manic episodes. In major depression or the depressed phase of bipolar illness, a depressed mood predominates, although the patient may not be aware of feeling sad. Typically, he or she loses all interest in and withdraws from usual activities. Symptoms include sleep disturbances (usually early-morning awakening); loss of appetite or greatly increased appetite; inability to concentrate or to make decisions; slowed thinking and decreased energy; feelings of worthlessness, guilt, hopelessness, and helplessness; diminished sexual interest; and recurrent thoughts of suicide and death, sometimes leading to actual suicide.

In the manic phase of bipolar illness, the patient's mood can be elevated, expansive, or irritable. Behavior is bizarre and sometimes obnoxious. Other symptoms include excessive talkativeness, racing thoughts, and grandiose ideas; greatly increased social, sexual, and work activity; distractability; loss of judgment; and a decreased need for sleep.

Occurrence.

Both depressive and bipolar disorders run in families. Almost certainly a predisposition to these disorders is genetically transmitted. Thus, the risk of a depressive disorder is greater in the families of depressive patients than in the population at large. The higher proportion of depression in women may be biologically induced, or it may be that women learn social roles that favor feelings of helplessness. Because women in trouble are more likely to seek help than men, statistics reporting a higher incidence of depression among women than among men may be explained, at least in part, by an underdiagnosis of depression in men.

Studies have suggested that genetic predisposition to depression may be linked with an abnormal sensitivity to the neurotransmitter acetylcholine.

Receptors for acetylcholine have been found to occur in excessive numbers in the skin of a number of patients suffering from depressive disorders.

Treatment.

The depressive disorders are among the most treatable in psychiatry. The usual treatment in modern practice involves administration of a drug plus supportive psychotherapy. Two major classes of drugs are used to treat depressive disorders: the tricyclic/tetracyclic antidepressants and the monoamine oxidase (MAO) inhibitors. The latter require following a special diet because they interact with tryamine, which is found in cheeses, beer, wine, chicken livers, and other foods, and causes elevation of blood pressure. The tricyclic antidepressants require no special diet; common generic drugs in this class are amitriptyline, desipramine, doxepin, and imipramine. Lithium carbonate, a common mineral, is used to control the manic phase of manic-depressive illness; in smaller doses, it regulates the mood fluctuations of this bipolar disorder.

Electroconvulsive therapy, or ECT, is considered most effective for depressions not responsive to drug therapy. Although controversial, ECT brings rapid relief from severe depression and can often prevent suicide.

ECT produces dramatic improvements in many psychotic symptoms. Initially tried in the late 1930s, ECT was the first form of therapy that reliably reduced severe depression (q.v.) . Until the introduction of the major antipsychotic drugs in the 1950s, ECT was used widely; it then fell into a decline. Recently, however, practitioners are again using the technique, largely because undesirable side effects accompany long-term use of psychotropic medications. When ECT was first used, patients frequently suffered fractures while having convulsions, but muscle relaxant drugs are now routinely used to prevent such fractures. Patients are also anesthetized, and they feel no shock. Another modern practice involves applying the electric current to only the nondominant side of the brain, thus reducing the loss of memory, which is the most troubling side effect of ECT. Unilateral ECT is, however, less effective than bilateral ECT. Because of the memory loss and the inherently unappealing nature of ECT, it has been among the most controversial treatments in psychiatry. It is effective in relieving severe depression, and therefore its use has continued.

Though clearly milder and less harmful than nicotine, alcohol or heroin, caffeine fits the criteria for addictive substances described by the American Psychiatric Association--according to a limited study of coffee cravers. Caffeine produces psychological and physical dependence, including withdrawal symptoms such as headaches, depression and fatigue.

Doctors know that athletes who start taking steroids are subject to erratic mood swings. But a study of 156 steroid users found that 25% developed more severe psychiatric disorders, ranging from depression to manic episodes. Symptoms eventually disappeared after steroid use stopped. Sources--GOOD: Journal of the National Cancer Institute; FDA. BAD: American Journal of Epidemiology, Archives of General Psychiatry

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