clinical depression

Depression (major depressive disorder) MDD

Depression is a mood disorder that causes persistant feeling of sadness and loss of interest.

Depression is common and serious medical illness that negatively affects how you feel the way you think and how you act.

Classification of Depression Disorders

1. Major depressive Disorder (MDD)

a. Atypical depression

b. Melancholic depression

c. Psychotic major depression (PMD)

d. Catatonic depression

e. Post partum depression (PPD)

f. Seasonal affective disorder (SAD)

2. Manic Depression (Bipolar disorder)

1. Depressive episodes

2. Manic episodes

3. Hypomanic episodes

4. Mixed-mood state

3. Dysthymic Depression

( depressive disorder, PPD) (double depression), (Chronic depression)

A mild but long-term form of depression.

Dysthymia is defined as a low mood occurring for at least two year, along with at least two other symptoms of depression.

4.  Depression Disorder not otherwise specified (DD-NOS)

1. Recurrent brief depression (RBD)

2. Minor depressive Disorder or simply minor depression

5. Situational depression (reactive depression)

Adjustment disorder with depressed mood.

Symptoms of depression related to stressor.

Etiology of Depression

1. Genetics

Predisposition factor

2. Neurotransmitters

3. Neurodegenerative diseases

Alzheimer's disease

Parkinson's disease

Multiple sclerosis

Seizure disorders

Macular degeneration

Chronic pain

4. Personality

High level of anxiety

Social avoidance 


Interpersonal sensitivity


5. Stress

Chronic pain

Medical illness

Psychosocial stress

Impaired social support


Negative life events


6. Hormones

Causing and triggering depression can be result of thyroid problem, menopause.

7. Life Events

Death or loss of loved one, financial problem, high stress triggered depression.

8. Early childhood trauma

Traumatic events during childhood/abuse or loss of parents cause permanent changes in brain. More susceptible to depression.

Sign and symptoms of depression

1. General symptoms

1. Loss in interest in pleasurable activities.

2. Dissatisfaction with life

3. Withdrawal from social activities

4. Loss of energy

5. Feeling useless or hopeless

6. Irritability

7. Great concern with health problem

8. Sadness or crying

9. Worry and/or self- critism/ worthless

10. Difficulty concentrating and or making decision

11. Loss of appetite and weight

12. Feeling excessive guilty

13. Aches and pains

14. Thoughts of death or suicide

2. Psychological symptoms

1. Feeling sad, depressed or hopeless most of day.

2. Feeling of excessive guilt or worthless

3. Reduce interest/pleasure

4. Slowed or agitated movement

5. Recurrent thoughts of dying or ending own life.

6. Anger and irritability

3. Physical or somatic symptoms

1. Unintentional weight loss and decrease in appetite

2. Weight gain and increase in appetite

3. Insomnia or excessive sleeping

4. Fatigue and loss of energy

5. Diminished ability to think, concentrate or make decisions

6. Physical symptoms of Anxiety including;

Dry mouth




Suicidal ideation

Suicide attempt or plan

Diagnostic criteria (major depressive episodes criteria)

1. At least five or more of 9 symptoms (including at least 1 of depressed mood and loss of interest or pleasure) in same 2 week period. Each of these symptoms represents a change from previous functioning.

a. Depressed mood (subjective or obserbed)

b. Loss of interest or pleasure

c. Change in weight or appetite

d. Insomnia or hypersomnia

e.  Psychomotor agitation or retardation (observed)

f. Fatigue or loss of energy

h. Excessive feeling of worthlessness or guilt

i.  Impaired concentration or indecisiveness

j. Thoughts of death or suicidal ideation or suicide attempt

k. Diminished ability to think or concentrate (subjective or observed)

2. Symptoms cause distress or impairment social, occupational/ areas of functioning

4. The symptoms are not due to direct physiological effects of substance (eg; drug of abuse, medication) are general medication condition (eg; Hypothyroidism).

5. The symptoms are not better accounted for bereavement i.e after loss of loved one. Symptoms persist of longer than 2 months and are characterized by marked functional, impairment, suicidal ideation, psychotic symptoms or psychomotor retardation.

 Psychodynamics of depression

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