Mood disorders have been described since ancient times. There are many examples in the literature describing states of sadness, depression and mania. Depression causes disturbances in social and occupational functioning and radically changes the life of the person affected and members of her family. Sometimes it occurs as a disproportionate reaction to a tragic event, sometimes it is difficult to associate it with a specific unpleasant event. Mourning is a dramatic event that is approaching depression because of the strong and disconsolate sadness that accompanies it.
Mania is a state characterized by euphoria, hyperactivity, openness to the environment, extreme sense of bliss and unlimited faith in oneself. People affected by mania are constantly talking, gnawing nails, immoderately drinking, smoking tobacco, chewing gum, biting the inside of the mouth. They feel happy, but barely reach peace. There is also a type of depression associated with certain moments in life, such as climacteric depression, which may occur in menopausal women, or postpartum depression.
During our lives, each of us experiences feelings of sadness, discouragement or guilt. This can happen as a result of a specific event, such as the death of a loved one, loss of job or love, failure at school or simply because of the gray sky. These are normal reactions that testify to our rich emotionality. Ordinary sadness can be overcome – sometimes you just have to forgive, give a second chance or receive some support from loved ones. Depression is something else. It causes disturbances in social and professional functioning. The life of a person affected by depression and her family changes. Sometimes it occurs as a disproportionate reaction to a tragic event, sometimes it is difficult to associate it with a specific unpleasant event.
Types of depression
The main types of depression are severe depressive disorders and dysthymic disorders.
Depending on whether one or more of her episodes have occurred, severe depression is divided into:
- severe depressive disorder, a single episode;
- severe depressive disorder, recurring.
A severe depressive episode is a condition in which almost every day, within two weeks, there are at least five of the following symptoms:
- depressed mood: is a state that differs qualitatively and quantitatively from sadness. A person can not be comforted, feels deep despair and hopelessness that does not seem comparable to other reactions to sadness, normally felt by everyone;
- loss of pleasure or interest in ordinary activities: a person affected by depression is no longer able to feel the emotions associated with those things that have aroused her interest in the past, such as work, hobbies, social contacts;
- increase or loss of weight or appetite: this can be a very significant symptom, usually affecting the change by 5% during the month compared to the initial body weight;
- insomnia or excessive drowsiness: basically there is no difficulty in initiating sleep, but there are often awakenings in the second half of the night and premature waking up in the morning in a depressive mood. It was also noted that these patients show reduced delta sleep (phase 3 and 4 sleep).
- psychomotor changes (slowdown or agitation): slower movement, verbal expression is more often observed, which gradually decreases and slows down. Less often there is arousal and a multitude of thoughts;
- energy loss and fatigue: people affected by depression are not able to perform even the simplest activities, they feel weak and tired;
- guilt, being unnecessary and low self-esteem: the patient is constantly accused of something he did not do, is burdensome to others and thinks that his life does not make sense and that he has no prospects;
- difficulties with concentration and thinking: there is a slowdown in thought activity, perhaps related to an attempt to reduce suffering;
- thinking about death, suicidal thoughts and / or suicide attempts: it is often the case that such patients are able to plan and / or commit suicide.
There must be at least a depressed mood or loss of interest in pleasures.
These symptoms cause embarrassment and cause failures in the social and professional sphere or in other important areas of life. In addition, this condition is a change from the previous course of action of the person and is not medically justified by the use of other drugs or mourning.
Dysthymia is characterized by a long period (2 years) and symptoms that are not severe enough to classify them as an episode of depression. However, for most of the day, almost every day, there is a lowered mood, a loss of interest in almost all ordinary activities. In addition, during the two years of the disease, its symptoms may not occur for a period not longer than 2 months.
To talk about depression, at least two of the following must appear:
- lack of appetite or overeating;
- insomnia or excessive drowsiness;
- lack of energy or asthenia;
- low self-esteem;
- difficulty in concentrating and making decisions;
- feeling of despair.
There is an early episode of depression if the first symptoms occur before the age of 21 and a late episode if it occurs after the age of 21.
We are talking about double depression when depressive disorders are observed in patients with dysthymia.
Frequency of appearance
Depression occurs relatively frequently, affects 4.5% of the population and affects twice as much women than men. The course of the disease varies depending on the type of depression (severe depressive episode, dysthymia, double depression). Very often, there are relapses: more often in patients who have previously had three episodes of major depression, and even more often in those who have been diagnosed with dysthymia.
The tests comparing the effectiveness of pharmacological treatment and psychotherapy showed the equivalence of both methods. Although there is no evidence to support the thesis that better results are provided by combination therapy (pharmacological and psychotherapy), it is important that patients have access to both methods.
In 50% of cases, the therapy leads to remission (resolution) of symptoms, but within a year half of these patients have a relapse. Therefore, only a quarter of patients feel good after a short therapy.
Patients should be examined carefully during treatment. In cases in which no therapy is carried out, in the event of an acute phase of depression (eg life-threatening), pharmacological treatment with psychotherapeutic support is usually recommended. After overcoming the crisis, psychotherapy becomes more and more important. There is a wide range of prescription drugs that should be carefully analyzed for both their therapeutic effect and side effects that may limit the patient’s cooperation.
Depression caused by life situations
Some types of depression are associated with specific moments in a person’s life. One of them is climacteric depression, which may occur in women during menopause. There is also depression caused by exhaustion, which occurs after a long period of emotional overload, and depression associated with the cut off from the roots, affecting people who had to leave the place where they lived (eg because of moving house). Depression in the elderly does not have specific characteristics, because the loss of hope and fear for one’s own health as well as other fears are reflected in the external reality. Let’s look at these types of depression in more detail.
Menopause is the end of the menstrual cycle. With the cessation of the cycle, ovarian activity ceases and metabolic, psycho- and neurohormonal changes take place in the body. In most cases, this process is not rapid. Often, however, a phase called premenopause occurs when the cycle becomes irregular and menstruation differs in intensity and duration.
Extending life, changing the role of women and other factors meant that women after the end of the reproductive period did not necessarily lose “everything.” However, it is also a fact that at every stage of life, serious changes and the same menopause can be treated as a physiological crisis.
Probably the way a woman experiences menopause reflects her usual way of dealing with life situations. In addition to cultural, social and personal factors, biological and genetic conditions also play a role here. Menopause can occur when a woman suffers from various psychosomatic illnesses. On the mental level, there are many different symptoms, such as anxiety, aggression, excessive emotions, malaise, insomnia or excessive lethargy, phobias, difficulty concentrating and sexual dysfunction. Undoubtedly one of the most common disorders is depression. In this case too, depression is associated with the woman’s personality and can take various forms: from mild to intense and short-term or long-term. In some cases, when depression is accompanied by symptoms such as anxiety, phobia, general lack of satisfaction and sexual satisfaction, we are talking about the existential climacteric syndrome.
Depression caused by exhaustion
In this way, a special form of the reactive form of depression, which is revealed after a long period of emotional overload, is defined.
This type of depression most often affects men burdened with high responsibility.
Depression occurs when a person ceases to cope and / or tolerate overload.
Symptoms such as anxiety, uncontrolled outbursts of emotions and states of exhaustion arise.
Depression caused by cutting off the roots
This type of depression affects people who had to leave their current place of residence, e.g. as a result of emigration or moving house. The loss consists in leaving the place, people and customs with which the person had strong ties.
Depression in the elderly
Depression in the elderly has special features because the feeling of vanity, loss of hope, the feeling of being unnecessary, fear for one’s own health and other fears are reflected in the external reality. Depression in the elderly often takes the form of regression or paranoia. Elderly people often show anxiety, irritability, delusions, hallucinations and psychomotor agitation.
It is important to consider depression with an organic or symptomatic basis, caused by metabolic imbalance (hyperthyroidism or hypothyroidism, overactivity or underactivity of the adrenal cortex), infectious or toxic factors.