Depression as a Major Mood Disorder

A mental health disorder characterised by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life. Possible causes include a combination of biological, psychological and social sources of distress. Increasingly, research suggests that these factors may cause changes in brain function, including altered activity of certain neural circuits in the brain. The persistent feeling of sadness or loss of interest that characterises major depression can lead to a range of behavioural and physical symptoms. It is generally treatable by a medical professional usually by medication, talk therapy, or a combination of the two.

According to the DSM-5 Manual, published in the May of 2013, there are 8 specific disorders described, including Disruptive Mood Dysregulation Disorder (DMDD), Major Depressive Disorder (MDD) - included Major Depressive Episode (MDE), Persistent Depressive Disorder (PDD), Premenstrual Dysphoric Disorder (PMDD), Substance/Medication-Induced Depressive Disorder, Depressive Disorder due to another medical condition, Other Specified Depressive Disorder, and Unspecified Depressive Disorder:

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1. Disruptive Mood Dysregulation Disorder (DMDD). Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18. To be diagnosed with DMDD, a child must have these symptoms steadily for 12 or more months. A child with DMDD experiences: Irritable or angry mood most of the day (nearly every day), Severe temper outbursts (verbal or behavioural) at an average of three or more times per week that are out of keeping with the situation and the child’s developmental level, Trouble functioning due to irritability in more than one place (e.g., home, school, with peers).
2. Major Depressive Disorder (MDD). Clinical depression is marked by a depressed mood most of the day, sometimes particularly in the morning, and a loss of interest in normal activities and relationships -- symptoms that are present every day for at least 2 weeks. In addition, according to the DSM-5 there are other symptoms with major depression. Those symptoms might include: fatigue or loss of energy almost every day, feelings of worthlessness or guilt almost every day, Impaired concentration, indecisiveness, insomnia or hypersomnia (excessive sleeping) almost every day, markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others), restlessness or feeling slowed down, recurring thoughts of death or suicide, significant weight loss or gain (a change of more than 5% of body weight in a month). Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Overall, between 20% and 25% of adults may suffer an episode of major depression at some point during their lifetime. Major depression also affects older adults, teens, and children, but frequently goes undiagnosed and untreated in these populations. Almost twice as many women as men have major or clinical depression; hormonal changes during puberty, menstruation, pregnancy, miscarriage, and menopause, may increase the risk.
3. Persistent Depressive Disorder (PDD). The essential feature of dysthymia is a depressed mood that occurs for most of the day, for more days than not, for at least two years for adults or one year for children and adolescents. Symptoms of dysthymia can come and go over time, and the intensity of the symptoms can change, but symptoms generally don’t disappear for more than two months at a time. Symptoms include: poor appetite or overeating, loss of interest in daily activities, insomnia or hypersomnia, low energy or fatigue, low self-esteem, self-criticism, or feeling incapable, poor concentration or difficulty making decisions, feelings of hopelessness, decreased activity and/or productivity, social isolation, irritability or anger, sadness or feeling down, feelings of guilt. In children, depressed mood and irritability are often primary symptoms.
4. Premenstrual dysphoric disorder (PMDD). Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. It’s a severe and chronic medical condition that needs attention and treatment. Symptoms of PMDD appear during the week before menstruation and end within a few days after your period starts. Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present: depressed mood, anger or irritability, trouble concentrating, lack of interest in activities once enjoyed, moodiness, increased appetite, insomnia or the need for more sleep, feeling overwhelmed or out of control, other physical symptoms, the most common being belly bloating, breast tenderness, and headache.
5. Substance/medication-induced Depressive Disorder. Substance/medication-induced depressive disorder is characterised by a prominent and persistent change in mood, exhibiting clear signs of depression or a marked decrease in interest or pleasure in daily activities and hobbies, and these symptoms start during or soon after a certain substance/medication has been taken, or during withdrawal from the substance/medication. The individual’s mental health history, as well as the nature of the substance/medication taken must be taken into account, to ensure that the depressive symptoms cannot be better explained by a different diagnosis. The symptoms of the depressive disorder must also be severe enough to cause impairment in the day to day functionality of the individual. Withdrawal times for various substances from the body vary, and so the depressive symptoms may continue for some time after the individual has ceased taking the substance/medication.

Symptoms of Depression (DSM-5):

The DSM-5 outlines the following criterion to make 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:

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

Aaron Beck’s Theory of Depression

Different cognitive behavioural theorists have developed their own unique twist on the cognitive way of thinking. According to Dr. Aaron Beck, negative thoughts, generated by dysfunctional beliefs, are typically the primary cause of depressive symptoms. A direct relationship occurs between the amount and severity of someone's negative thoughts and the severity of their depressive symptoms. In other words, the more negative thoughts they experience, the more depressed they will become. Beck also believes that there are three main dysfunctional belief themes (or 'schemas') that dominate a person with depression's thinking: 1) I am defective or inadequate; 2) All of my experiences result in defeats or failures; 3) The future is hopeless. Together, these three themes are described as the negative Cognitive Triad. When these beliefs are present in someone's thoughts, depression is very likely to occur (if it has not already occurred).

An example of the themes will help illustrate how the process of becoming depressed works. For example, a person has just been laid off from their work. If they are not in the grip of the negative cognitive triad, they might think that this event, while unfortunate, has more to do with the economic position of their employer than their own work performance. It might not occur to them at all to doubt themselves, or to think that this event means that they are washed up and might as well throw themselves down a well. But, if the person’s thinking process was dominated by the Negative Cognitive Triad, however, they would very likely conclude that their layoff was due to a personal failure. They would also believe that they will always lose any job they might manage to get and that their situation is hopeless. On the basis of these judgments, they will begin to feel depressed. In contrast, if they were not influenced by negative triad beliefs, they would not question their self-worth too much, and might respond to the lay off by dusting off their resume and starting a job search.

Beyond the negative content of dysfunctional thoughts, these beliefs can also warp and shape the attention a person focuses on certain events or thoughts. Beck stated that people with depression pay selective attention to aspects of their environments that confirm what they already know. They do so even when evidence to the contrary is right in front of them. This failure to pay attention properly is known as Faulty Information Processing.

Particular failures of information processing are very characteristic of the depressed mind. For example, people with depression will tend to pay attention to information which matches their negative expectations and ignore information that goes against those expectations. Faced with a mostly positive performance review, people with depression will manage to find and focus in on the one negative comment that keeps the review from being perfect. They tend to magnify the importance and meaning placed on negative events, and minimize the importance and meaning of positive events. All of these issues, which happen quite unconsciously, function to help maintain core negative themes in the face of evidence that goes against them. This allows them to remain feeling hopeless about the future even when the evidence suggests that things will get better.

Research on Depression

Depression and Sleep

Of all the psychiatric disorders associated with insomnia, depression is the most common. It has been estimated that 90% of patients with depression complain about sleep quality. Since the first reports of short rapid eye movement (REM) latency in depressed patients and of the effect of sleep deprivation on depression in the 1970s, numerous sleep studies have provided extensive observations and theoretical hypotheses concerning the etiology and pathophysiology of depression.

Depression and Type 2 Diabetes Over the Lifespan

A meta-analysis Depression is associated with a 60% increased risk of type 2 diabetes. Type 2 diabetes is associated with only modest increased risk of depression.

Social Media Use and Depression

Social Media use was significantly associated with increased depression among a population of young adults. Given the proliferation of Social Media, identifying the mechanisms and direction of this association is critical for informing interventions that address Social Media use and depression.

Depression and cooking with Biomass:

Cooking with biomass fuel, a common practice in rural India, is associated with a high level of indoor air pollution (IAP). Women who cook with biomass had higher prevalence of depression than users of cleaner fuel LPG. Platelets of biomass users expressed more P-selectin and released more serotonin, implying platelet activation. Depression in biomass users was intimately associated with indoor levels of PM10 and PM2.5 and platelet hyperactivity. Indoor air pollution due to cooking with biomass is a potential risk for depression in women in their child-bearing age.

Depression in Adolescents

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress.

Depression and HIV

Depression is one of the most prevalent psychiatric diagnoses seen in HIV-positive individuals. Women with HIV are about four times more likely to be depressed than those who are not infected. Among 137 HIV-positive women, 51.1% were depressed. Around 16% were having moderate to high risk for isolation. Depression was statistically significant in rural women, widowed women, and lower socioeconomic class women. Conclusion. Depression is highly prevalent among women living with HIV which is still underdiagnosed and undertreated, and there is a need to incorporate mental health services as an integral component of HIV care.

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