Depression

Depression, emotional state characterized by sadness, despondency, apathy, and sometimes a deep sense of loss; in psychiatry, clinical depressive illness is more intense and lasts longer than common depressed feelings. Seriously depressed people feel isolated and hopeless and often reproach or blame themselves for exaggerated faults and shortcomings. Fatigue and disturbed sleep are common, while some depressed people sleep more than usual. Crying spells, whether or not there is something to cry about, are also characteristic. Some depressive illness masks itself in physical discomfort or by contributing to alcoholism or drug addiction. Chronic fatigue and boredom, as well as habitual underachievement, may be unrecognized forms of depression. The hyperkinetic (overly active) child, conversely, may be compensating for an underlying depression; drugs that relieve depression in adults seem to help hyperactive children. Not all those suffering from depressive illness attempt suicide, nor are all those who attempt suicide necessarily suffering from depressive illness, but the relationship is striking. It is estimated that as many as 75% of those who attempt suicide are seriously depressed, and other studies indicate that people hospitalized for depression at some time in their lives are about 36 times more likely to commit suicide than are nondepressed people, with the greatest risk being during or immediately following hospitalization. After the age of 40, the possibility of suicide increases in severely depressed persons. Almost twice as many women as men suffer from depressive illness and almost twice as many women attempt suicide, but 3 times more men than women succeed.

Psychogenic (or reactive) depression, the most common form of depressive illness, is brought on by a stressful situation. Even in this milder form of depressive illness, suicide is a serious possibility. Often the person can be helped by the comforting of family or friends. Many who suffer the illness, however, require professional assistance. Endogenous depression is far more serious. Unipolar depression may show itself in severely withdrawn and uncommunicative behavior or agitated activity, such as pacing the floor, wringing the hands, and a rapid stream of talk about feelings and fear. Bipolar (or manic-depressive) illness shows itself in up-down swings. The manic-depressive is the victim of a cycle of moods, with a phase lasting from several days up to several years. Unlike the psychogenic depressive, these more severely afflicted persons have delusions about being unworthy, condemned, and criticized and often think they are physically altered. The very real danger of suicidal outcome makes hospitalization a usual requirement in treatment. Involutional depression describes a category of mental illness found in persons in their middle years, due to disturbances of metabolism, growth, nutrition, or endocrine (hormone) function. Recent evidence, however, has cast strong doubts as to whether a special kind of depression actually affects this age group. There is wide agreement that both heredity and environmental factors play an important part in depressive illness. Depression is more likely to occur in a person with a family history of depressive illness. Some investigators have found that nearly 25% of patients had mentally ill mothers and more than 15% had depressed fathers.