A depression, if it is not primarily a reaction to a life event, is called in psychiatry a major depressive disorder (MDD). It is a condition characterized by at least two weeks of low mood that is present across most situations. It is often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and psychological pain without a clear cause. There may also be false beliefs and – in the more severe cases – acoustic or visual hallucinations. Major depression needs to be differentiated from sadness. Depression often actually means the subjective absence of feelings, such as sadness. Those afflicted with depression often cannot feel themselves anymore as before, which can cause additional anxiety.
Major depressive disorder affected approximately 253 million (3.6%) of people in 2013.  The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France.  Lifetime rates are higher in the developed world (15%) compared to the developing world (11%).  Depression causes the second most years lived with a disability after low back pain.  The most common time of onset is in a person in their 20s and 30s. Females are affected about twice as often as males.
The many forms of depression
Depression can come in many forms and guises. A mental health professional can help you to identify more closely if you are suffering from depression and form which form. Some ups and downs are a normal part of life. Life does not come in a straight line, which is actually good news, because a straight line would mean that we miss out on the excitement, the feeling alive, that life also offers. However, if the lows, or the highs in those suffering from a bipolar condition, take on intensity or frequency that reduces your quality of life or ability to perform everyday tasks, you should consult a mental health professional.
Melancholia is sometimes seen as a mild form. The cliche image is sitting curled up by a window on a rainy day. Dysthymia is usually the term for episodes of depression that stay just below the clinical threshold. While major forms of depression can occur in one episode or in multiple episodes. Still, however intense it feels, talking to someone about it is usually a good idea, even in milder cases. The view from the outside can be helpful. We may be caught so much by our feeling low that it begins to feel normal. Good indications for depression are not just the feelings one experiences, which in severe forms of depression can be almost absent, but also one’s daily activities and interactions with others. This is where the view from the outside can be helpful. Some people have only one episode of depression in their life, some have episodes of depression separated by years in which they feel normal, while others have symptoms almost constantly. But in all these different forms, from the single case to the recurring depression, treatment is usually effective.
DSM-5 Diagnostic Criteria
The DSM-V, the Diagnostic and Statistical Manual of Mental Disorders in its 5th edition, published by the American Psychiatric Association outlines the following criteria for a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, without a specific plan, or a suicide attempt or a specific plan for committing suicide.
A diagnosis always needs to be carried out by a trained mental health professional.
Another form of depression is reactive depression, which occurs as part of a number of conditions, such as post-traumatic stress disorder (PTSD). I discuss these forms of depression within the articles on these conditions. For PTSD, for example, you may want to look at one of my articles on PTSD:
Communication-Focused Therapy (CFT) for PTSD (2)
Intepersonal Psychotherapy and Exposure Therapies for PTSD (1)
Suicidal thoughts can be quite common when one feels low or helpless. However, it should always be taken seriously and a mental health professional should be consulted. It does not automatically one has to stay in a hospital. Rather, it should be seen as a sign that something needs to be done quickly to address the mental health condition and raise the quality of life. Between 2-7% of adults with major depression die by suicide  and up to 60% of people who die by suicide had depression or another mood disorder . With the right treatment early enough most of these suicides could have been prevented. Unfortunately, access to healthcare, particularly in the mental health area, is not the same everywhere. But in any case, if you experience suicidal thoughts, you should consult a healthcare professional right away. You can always call and go to an A&E. If none is available quickly, then you should contact a suicide hotline while making arrangements to see a mental health professional in person as soon as possible. Many people have experienced suicidal thoughts in their life, and it can be a strong starting point for very successful therapy.
A Vicious Cycle
Many people with milder forms of depression eventually come out of an episode, either spontaneously or because they have a good support network, are able to manage their stress in life, look after their sleep hygiene, exercise (in healthy moderation), and meditate, for example. However, psychotherapy or counselling is helpful at all levels of depression, and it can help prevent another episode. The problem is that depression can lead to a vicious cycle. The consequences of depression on one’s social life, for example, can make it more difficult to get out of the depression. Major depressive disorder can negatively affect a person’s family, work or school life, sleeping or eating habits, and general health, which distances us from an important resource for better mental health, other people.
The cause is believed to be a combination of genetic, environmental, and psychological factors.  Risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse.   About 40% of the risk appears to be related to genetics. 
Some other common symptoms of depression
Major depression significantly affects a person’s family and personal relationships, work or school life, sleeping and eating habits, and general health.  Its impact on functioning and well-being has been compared to that of other chronic medical conditions such as diabetes. A person having a major depressive episode usually exhibits a very low mood, which pervades all aspects of life, and unhedonia, the inability to experience pleasure in activities that were formerly enjoyed. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred.  In severe cases, depressed people may have symptoms of psychosis. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant.
Other symptoms of depression include
- poor concentration and memory
- withdrawal from social situations and activities
- reduced sex drive, irritability,
- and thoughts of death or suicide (which requires immediate professional help).
Insomnia is a common symptom. In the typical pattern, a person wakes very early and cannot get back to sleep. Hypersomnia, or oversleeping, can also happen. Some antidepressants may also cause insomnia due to their stimulating effect.
A depressed person may report multiple physical symptoms such as
- headaches, or
- digestive problems.
Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. Family and friends may notice that the person’s behavior is either agitated or lethargic.
The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression.
On the biological side, the monoamine hypothesis is still the predominant biological explanation of depression. The monoamines are serotonine, norepinephrine, and dopamine. The antidepressants act on the neurotransmitter levels or on the receptors.
Serotonin is hypothesized to regulate other neurotransmitter systems; decreased serotonin activity may allow these systems to act in unusual and erratic ways. According to this “permissive hypothesis”, depression arises when low serotonin levels promote low levels of norepinephrine, another monoamine neurotransmitter. Some antidepressants enhance the levels of norepinephrine directly, whereas others raise the levels of dopamine, a third monoamine neurotransmitter. These observations gave rise to the monoamine hypothesis of depression. In its contemporary formulation, the monoamine hypothesis postulates that a deficiency of certain neurotransmitters is responsible for the corresponding features of depression.
For further articles on depression on this site:
How Are People in Ukraine Coping Six Months into the War? A Study on Stress, Anxiety, and Depression.
Discovering What Works: The Science of Youth Psychotherapy and Four Decades of Meta-Analysis
Discover How Anxiety and Depression Affect Long COVID
Discover How Interactive Art Exhibitions Can Boost Your Mood and Reduce Anxiety
How Our Self-Concept Affects Our Mood: An Insightful Look at Adolescent Depression and Brain Functions
Can Insulin Affect Depression by Affecting Dopamine and Reward Processing in the Brain?
Understanding Depression and Apathy in Huntington’s Disease: A Comprehensive Review
Discovering the link between depression and memory recall: a meta-analysis on over-general autobiographical memory.
An Overview of Substance Use, Mood, and Anxiety Disorders in ADHD and Non-ADHD Adults
Get ready for the future of mental health research: Center for Global Mental Health Research Webinar Series 2023 – Finding the perfect treatment for the right people at the right time. Let’s promote stratification to boost Global Mental Health!
Discover How Ultraprocessed Foods Can Affect Your Mental Health!
Meta-Analysis Shows Effective Psychological Treatment for Perinatal Depression
The effect of anxiety and depression on the health-related quality of life of severe acute pancreatitis survivors: structural equation modeling approach
Discovering the Positive Impact of Counselling: A Community Study on Anxiety and Depression
Anxiety, depressive symptoms, and distress over the course of the war in Ukraine in three federal states in Germany
Relationship between depression, anxiety, stress, and SARS-CoV-2 infection: a longitudinal study
Brief self-affirmation intervention for adults with psoriasis for reducing anxiety and depression and boosting well-being: Evidence from a randomized controlled trial
Condition openness is associated with better mental health in individuals with an intersex/differences of sex development condition: structural equation modeling of European multicenter data
Prenatal maternal stress, child internalizing and externalizing symptoms, and the moderating role of parenting: findings from the Norwegian mother, father, and child cohort study
Accelerated biological aging and risk of depression and anxiety: evidence from 424,299 UK Biobank participants
Study: ADHD Increases Risk for Postpartum Depression, Anxiety
Tracking perceived stress, anxiety, and depression in daily life: a double-downward spiral process
Postpartum people’s experiences of and responses to the COVID-19 pandemic during the first year of the pandemic: A descriptive qualitative study
A systematic review of fear, stigma, and mental health outcomes of pandemics
Exposure to COVID-19 news and its relation to stress, depression, and anxiety in the context of difficulty in accessing social support
Network analysis of the relationships between problematic smartphone use and anxiety, and depression in a sample of Chinese college students
[Correspondence] A fundamental change is needed for appraising placebo responses in psychiatry
A New Model Predicts Depression and Anxiety Using Artificial Intelligence and Social Media
The fNIRS evaluation of frontal and temporal lobe cortical activation in Chinese first-episode medication-naïve and recurrent depression during a verbal fluency task
Rick Hanson: Compassion is a kind of superpower. Here’s what research says it can do.
Classic Psychedelic Use and Mechanisms of Mental Health: Exploring the Mediating Roles of Spirituality and Emotion Processing on Symptoms of Anxiety, Depressed Mood, and Disordered Eating in a Community Sample
Social media use and adolescents’ well-being: A note on flourishing
Long-term Exposure to Multiple Ambient Air Pollutants and Association With Incident Depression and Anxiety
Differential relationship of observer-rated and self-rated depression and anxiety scales with heart rate variability features
The contribution of transdiagnostic vulnerability factors in patients with chronic insomnia
Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial
The risk factors of progestational anxiety, depression, and sleep disturbance in women with recurrent pregnancy loss: A cross-sectional study in China
Self perceived health and stress in the pregnancy during the COVID-19 pandemic
Newly Discovered Trigger for Major Depression Opens New Possibilities for Treatments
An exploration of happiness, anxiety symptoms, and depressive symptoms among older adults during the coronavirus pandemic.
Mindfulness-informed (ACT) and Mindfulness-based Programs (MBSR/MBCT) applied for college students to reduce symptoms of depression and anxiety
Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta‐analysis including 409 trials with 52,702 patients
Depression and brain fog as long-COVID mental health consequences: Difficult, complex and partially successful treatment of a 72-year-old patient—A case report
Pilot Testing C-STRESS: A Mental Health App for College Students With Depression
Chatbot Intervention for Anxiety and Depressive Symptoms in Young Adults
Effectiveness of yoga for major depressive disorder: A systematic review and meta-analysis
A cross-sectional study of sleep, mood, well-being, motivations, and perceived support in Ukrainian veterans and active-duty military personnel with disability, and their supporters, preparing for a sporting event
Somatic symptom profiles are associated with pre-treatment depression and anxiety symptom severity but not inpatient therapy outcomes
Sustained increase in depression and anxiety among psychiatrically healthy adolescents during late stage COVID-19 pandemic
Relationship of insight to neurocognitive function and risk of recurrence in depression: A naturalistic follow-up study
Prevalence of depression and its association with quality of life in patients after pacemaker implantation during the COVID-19 pandemic: A network analysis
Communication and Connectedness against Depression and Anxiety
Seasonal Affective Disorder (SAD): the link between sunlight and health
Psychotherapy to Treat and Manage Depression
Building on the Basic Parameters (1)
Communication-Focused Therapy® (CFT) for Depression
Communication-Focused Therapy® (CFT) for Depression
Haverkampf CJ Atypical Depression J Psychiatry Psychotherapy Communication 2018 Dec 31 9(4) 91-97
Body Work and Exercise for Anxiety Panic Attacks Depression and OCD
Psychopharmacological Frontiers (1)
Tell me about Your Life – Narrative Communication and Change
Communication-Focused Therapy (CFT) for Depression
Depression and Psychotherapy (6)
Depression in pregnancy needs to be treated
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 Lynch, Virginia A.; Duval, Janet Barber (2010). Forensic Nursing Science. Elsevier Health Sciences. p. 453. ISBN 0323066380.
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 American Psychiatric Association 2000a, p. 349
 American Psychiatric Association 2000a, p. 412
© 2012, 2016 Dr Christian Jonathan Haverkampf. All rights reserved.
Psychotherapy & Counselling, Communication, Medicine (Psychiatry); Dublin, Ireland
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