Depressive disorders


The term depression is often used to describe a low or discouraged mood that results from disappointment (eg, financial crisis, natural disaster, serious illness) or loss (eg, the death of a person). Dear). However, the most appropriate terms for these moods are demoralization and grief.

Demoralization and grief

Negative feelings of demoralization and pain, unlike those of depression, do the following:

Occur in waves that tend to be tied to thoughts or reminders of the inciting event

They are resolved when circumstances or events improve

They can be interspersed with periods of positive emotion and humor

They are not accompanied by pervasive feelings of worthlessness and self-loathing

Depressed mood typically lasts for days rather than weeks or months, and suicidal thoughts and prolonged loss of function are much less likely.

However, events and stressors that induce demoralization and grief can also precipitate a major depressive episode, particularly in vulnerable individuals (eg, those with a history or family history of major depression).


The exact cause of depressive disorders is unknown, but genetic and environmental factors contribute.

Heredity accounts for 50% of the etiology (less in the so-called late-onset depression). Therefore, depression is more common among first-degree relatives of patients with this condition; concordance between identical twins is high. Furthermore, genetic factors probably influence the development of depressive responses to adverse events.

Other theories focus on changes in neurotransmitter concentrations, including abnormal regulation of cholinergic, catecholaminergic (noradrenergic or dopaminergic), glutamatergic, and serotonergic (5-hydroxytryptamine) neurotransmission (1). Neuroendocrine dysregulation may be a factor, and 3 axes in particular stand out: hypothalamus-pituitary-adrenal, hypothalamic-pituitary-thyroid, and growth hormone.

Psychosocial factors may also be involved. The major stressful situations of daily life, especially separations and losses, usually precede episodes of major depression; however, these events do not usually cause severe, long-lasting depression, except in people predisposed to a mood disorder.

People who have had an episode of major depression are at higher risk of having other episodes in the future. People who are less flexible and / or prone to anxiety show a greater propensity to develop a depressive disorder. These people generally lack the social skills necessary to adjust to the pressures of life. Depression can also appear in people who have other mental illnesses.

Signs and symptoms

Depression causes cognitive, psychomotor, and other dysfunction (eg, poor concentration, tiredness, loss of sexual desire, loss of interest or pleasure in almost all previously enjoyed activities, sleep disturbances) as well as depressed mood. People with a depressive disorder often have suicidal thoughts and may attempt suicide. Other symptoms or mental disorders (eg, anxiety or panic attack) frequently coexist and sometimes complicate diagnosis and treatment.

Major depression (unipolar disorder)

Patients appear sad, with watery eyes, frowning, downward corners of the mouth, drooping posture, poor eye contact, no facial expression, few body movements, and changes in speech (eg, low voice, lack of prosody, use of monosyllables). The appearance can be confused with that of Parkinson’s disease. In some patients, the depressed mood is so deep that the tears stop; they say that they are incapable of suffering the usual emotions and feel that the world has become dull and dull.


Depressive disorders must be distinguished from demoralization and grief. Other mental disorders (eg, anxiety disorder) can mimic or obscure the diagnosis of depression. Sometimes various disorders appear. Major depression (unipolar disorder) must be differentiated from bipolar disorder.

In elderly patients, depression can manifest as depressive dementia (previously called pseudodementia), which produces many of the signs and symptoms of dementia, such as psychomotor retardation and decreased concentration. However, early dementia can lead to depression. In general, when the diagnosis is in doubt, treatment of a depressive disorder should be attempted.

It can be difficult to differentiate chronic depressive disorders, such as dysthymia, from substance use disorders, especially since they can coexist and contribute to each other.


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