Depression (mood)

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Depression
A man diagnosed as suffering from melancholia with strong su Wellcome L0026693.jpg
Lithograph of a person diagnosed with melancholia and strong suicidal tendency in 1892
Specialty Psychiatry, psychology
Symptoms Low mood, aversion to activity, loss of interest, loss of feeling pleasure
CausesBrain chemistry, genetics, life events, medical conditions, personality [1]
Risk factors Stigma of mental health disorder [2]
Diagnostic method Patient Health Questionnaire, Beck Depression Inventory
Differential diagnosis Anxiety, bipolar disorder, borderline personality disorder
PreventionSocial connections, physical activity
Treatment Psychotherapy, psychopharmacology

Depression is a mental state of low mood and aversion to activity. [3] It affects about 3.5% of the global population, or about 280 million people worldwide, as of 2020. [4] Depression affects a person's thoughts, behavior, feelings, and sense of well-being. [5] The pleasure or joy that a person gets from certain experiences is reduced, and the afflicted person often experiences a loss of motivation or interest in those activities. [6] People with depression may experience sadness, feelings of dejection or hopelessness, difficulty in thinking and concentration, or a significant change in appetite or time spent sleeping; suicidal thoughts can also be experienced.

Contents

Depression can have multiple, sometimes overlapping, origins. Depression can be a symptom of some mood disorders, some of which are also commonly called depression, such as major depressive disorder, bipolar disorder and dysthymia. [7] Additionally, depression can be a normal temporary reaction to life events, such as the loss of a loved one. Depression is also a symptom of some physical diseases and a side effect of some drugs and medical treatments.

Contributing factors

Allegory on melancholy, from c. 1729-1740, etching and engraving, in the Metropolitan Museum of Art (New York City) Allegory on Melancholy Met DP885774.jpg
Allegory on melancholy, from c. 1729–1740, etching and engraving, in the Metropolitan Museum of Art (New York City)

Life events

Adversity in childhood, such as bereavement, neglect, mental abuse, physical abuse, sexual abuse, or unequal parental treatment of siblings, can contribute to depression in adulthood. [8] [9] Childhood physical or sexual abuse in particular significantly correlates with the likelihood of experiencing depression over the survivor's lifetime. [10] People who have experienced four or more adverse childhood experiences are 3.2 to 4.0 times more likely to suffer from depression. [11] Poor housing quality, non-functionality, lack of green spaces, and exposure to noise and air pollution are linked to depressive moods, emphasizing the need for consideration in planning to prevent such outcomes. [12] Locality has also been linked to depression and other negative moods. The rate of depression among those who reside in large urban areas is shown to be lower than those who do not. [13] Likewise, those from smaller towns and rural areas tend to have higher rates of depression, anxiety, and psychological unwellness. [14]

Studies have consistently shown that physicians have had the highest depression and suicide rates compared to people in many other lines of work—for suicide, 40% higher for male physicians and 130% higher for female physicians. [15] [16] [17]

Life events and changes that may cause depressed mood includes, but are not limited to, childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education, military service, family, living conditions, marriage, etc.), a medical diagnosis (cancer, HIV, diabetes, etc.), bullying, loss of a loved one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation, or catastrophic injury. [18] [19] [20] [21] [22] Similar depressive symptoms are associated with survivor's guilt. [23] Adolescents may be especially prone to experiencing a depressed mood following social rejection, peer pressure, or bullying. [24]

Childhood and adolescence

Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or behavioral dyscontrol instead of the more common sad, empty, or hopeless feelings seen with adults. [25] Children who are under stress, experiencing loss, or have other underlying disorders are at a higher risk for depression. Childhood depression is often comorbid with mental disorders outside of other mood disorders; most commonly anxiety disorder and conduct disorder. Depression also tends to run in families. [26]

Personality

Depression is associated with low extraversion, [27] and people who have high levels of neuroticism are more likely to experience depressive symptoms and are more likely to receive a diagnosis of a depressive disorder. [28] Additionally, depression is associated with low conscientiousness. Some factors that may arise from low conscientiousness include disorganization and dissatisfaction with life. Individuals may be more exposed to stress and depression as a result of these factors. [29]

Side effect of medical treatment

It is possible that some early generation beta-blockers induce depression in some patients, though the evidence for this is weak and conflicting. There is strong evidence for a link between alpha interferon therapy and depression. One study found that a third of alpha interferon-treated patients had developed depression after three months of treatment. (Beta interferon therapy appears to have no effect on rates of depression.) There is moderately strong evidence that finasteride when used in the treatment of alopecia increases depressive symptoms in some patients. Evidence linking isotretinoin, an acne treatment, to depression is strong. [30] Other medicines that seem to increase the risk of depression include anticonvulsants, antimigraine drugs, antipsychotics and hormonal agents such as gonadotropin-releasing hormone agonist. [31]

Substance-induced

Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from chronic use. These include alcohol, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs such as heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants. [32]

Non-psychiatric illnesses

Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions, and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, pernicious anemia, hypothyroidism, hyperparathyroidism, Lyme disease, multiple sclerosis, Parkinson's disease, celiac disease, [33] chronic pain, stroke, diabetes, cancer, and HIV. [34] [35] [36]

Studies have found that anywhere from 30 to 85 percent of patients suffering from chronic pain are also clinically depressed. [37] [38] [39] A 2014 study by Hooley et al. concluded that chronic pain increased the chance of death by suicide by two to three times. [40] In 2017, the British Medical Association found that 49% of UK chronic pain patients also had depression. [41]

As many as 1/3 of stroke survivors will later develop post-stroke depression. Because strokes may cause damage to the parts of the brain involved in processing emotions, reward, and cognition, stroke may be considered a direct cause of depression. [42]

Psychiatric syndromes

A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (commonly called major depression or clinical depression) where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic depressed mood, the symptoms of which do not meet the severity of a major depressive episode. Another mood disorder, bipolar disorder, features one or more episodes of abnormally elevated mood, cognition, and energy levels, but may also involve one or more episodes of depression. [43] Individuals with bipolar depression are often misdiagnosed with unipolar depression. [44] When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as a seasonal affective disorder.

Outside the mood disorders: borderline personality disorder often features an extremely intense depressive mood; adjustment disorder with depressed mood is a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode; [45] and posttraumatic stress disorder, a mental disorder that sometimes follows trauma, is commonly accompanied by depressed mood. [46]

Inflammation

This section is an excerpt from Inflammation § Connection to depression.[ edit ]
Inflammatory processes can be triggered by negative cognition or their consequences, such as stress, violence, or deprivation. Negative cognition may therefore contribute to inflammation, which in turn can lead to depression. A 2019 meta-analysis found that chronic inflammation is associated with a 30% increased risk of developing major depressive disorder, supporting the link between inflammation and mental health. [47]

Historical legacy

Research suggests possible associations between Neanderthal genetics and some forms of depression. [48]

Authors and researchers have begun to conceptualize ways in which the historical legacies of racism and colonialism may create depressive conditions. [49] [50] Given the lived experiences of marginalized peoples, ranging from conditions of migration, class stratification, cultural genocide, labor exploitation, and social immobility, depression can be seen as a "rational response to global conditions", according to Ann Cvetkovich. [51]

Psychogeographical depression overlaps somewhat with the theory of "deprejudice", a portmanteau of "depression" and "prejudice" proposed by Cox, Abramson, Devine, and Hollon in 2012, [52] who argue for an integrative approach to studying the often comorbid experiences. Cox, Abramson, Devine, and Hollon are concerned with the ways in which social stereotypes are often internalized, creating negative self-stereotypes that then produce depressive symptoms.

Unlike the theory of "deprejudice", a psychogeographical theory of depression attempts to broaden study of the subject beyond an individual experience to one produced on a societal scale, seeing particular manifestations of depression as rooted in dispossession; historical legacies of genocide, slavery, and colonialism are productive of segregation, both material and psychic material deprivation, [53] and concomitant circumstances of violence, systemic exclusion, and lack of access to legal protections. The demands of navigating these circumstances compromise the resources available to a population to seek comfort, health, stability, and sense of security. The historical memory of this trauma conditions the psychological health of future generations, making psychogeographical depression an intergenerational experience as well.[ citation needed ]

This work is supported by recent studies in genetic science which has demonstrated an epigenetic link between the trauma suffered by Holocaust survivors and genetic reverberations in subsequent generations. [54] [ non-primary source needed ]

Measures

Measures of depression include, but are not limited to: Beck Depression Inventory-11 and the 9-item depression scale in the Patient Health Questionnaire (PHQ-9). [55] Both of these measures are psychological tests that ask personal questions of the participant, and have mostly been used to measure the severity of depression. The Beck Depression Inventory is a self-report scale that helps a therapist identify the patterns of depression symptoms and monitor recovery. The responses on this scale can be discussed in therapy to devise interventions for the most distressing symptoms of depression. [6]

Theories

There are multiple schools of depression theory. Beck's cognitive triad theorizes that an individual with depression has "automatic, spontaneous, and seemingly uncontrollable negative thoughts" [56] about the self, the world or environment, and the future. The Tripartite Model of Anxiety and Depression helps to explain the common comorbidity of anxiety and depression by separating symptoms into three groups: negative affect, positive affect, and physiological hyperarousal. [57] The epigenetics of depression is the study of how epigenetics (heritable characteristics that do not involve changes in DNA sequence) contribute to depression. Behavioral theories of depression explain the etiology of depression with behavioral science; adherents promote the use of behavioral therapies for treatment. Evolutionary approaches to depression are attempts by evolutionary psychologists and evolutionary psychiatrists to use the theory of evolution to further understand mood disorders. The biology of depression is the attempt to identify a biochemical origin of depression, as opposed to theories that emphasize psychological or situational causes.

Management

Depressed mood may not require professional treatment, and may be a normal temporary reaction to life events, a symptom of some medical condition, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition which may benefit from treatment.

The UK National Institute for Health and Care Excellence (NICE) 2009 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, because the risk-benefit ratio is poor. [58]

Physical activity has a protective effect against the emergence of depression in some people. [59] Increased daily step counts have been associated with lower depressive symptoms. [60]

There is limited evidence suggesting yoga may help some people with depressive disorders or elevated levels of depression, but more research is needed. [61] [62]

Reminiscence of old and fond memories is another alternative form of treatment, especially for the elderly who have lived longer and have more experiences in life. [63] It is a method that causes a person to recollect memories of their own life, leading to a process of self-recognition and identifying familiar stimuli. By maintaining one's personal past and identity, it is a technique that stimulates people to view their lives in a more objective and balanced way, causing them to pay attention to positive information in their life stories, which would successfully reduce depressive mood levels. [64]

There is limited evidence that continuing antidepressant medication for one year reduces the risk of depression recurrence with no additional harm. [65] Recommendations for psychological treatments or combination treatments in preventing recurrence are not clear. [65]

Epidemiology

Depression is the leading cause of disability worldwide, the United Nations (UN) health agency reported, estimating that it affects more than 300 million people worldwide – the majority of them women, young people and the elderly. An estimated 4.4 percent of the global population has depression, according to a report released by the UN World Health Organization (WHO), which shows an 18 percent increase in the number of people living with depression between 2005 and 2015. [66] [67] [68]

Depression is a major mental-health cause of disease burden. Its consequences further lead to significant burden in public health, including a higher risk of dementia, premature mortality arising from physical disorders, and maternal depression impacts on child growth and development. [69] Approximately 76% to 85% of depressed people in low- and middle-income countries do not receive treatment; [70] barriers to treatment include: inaccurate assessment, lack of trained health-care providers, social stigma and lack of resources. [4]

The stigma comes from misguided societal views that people with mental illness are different from everyone else, and they can choose to get better only if they wanted to. [71] Due to this more than half of the people with depression do not receive help with their disorders. The stigma leads to a strong preference for privacy. An analysis of 40,350 undergraduates from 70 institutions by Posselt and Lipson found that undergraduates who perceived their classroom environments as highly competitive had a 37% higher chance of developing depression and a 69% higher chance of developing anxiety. [72] Several studies have suggested that unemployment roughly doubles the risk of developing depression. [73] [74] [75] [76] [77]

The World Health Organization has constructed guidelines – known as The Mental Health Gap Action Programme (mhGAP) – aiming to increase services for people with mental, neurological and substance-use disorders. [4] Depression is listed as one of conditions prioritized by the programme. Trials conducted show possibilities for the implementation of the programme in low-resource primary-care settings dependent on primary-care practitioners and lay health-workers. [78] Examples of mhGAP-endorsed therapies targeting depression include Group Interpersonal Therapy as group treatment for depression and "Thinking Health", which utilizes cognitive behavioral therapy to tackle perinatal depression. [4] Furthermore, effective screening in primary care is crucial for the access of treatments. The mhGAP adopted its approach of improving detection rates of depression by training general practitioners. However, there is still weak evidence supporting this training. [69]

According to 2011 study, people who are high in hypercompetitive traits are also likely to measure higher for depression and anxiety. [79]

History

The term depression was derived from the Latin verb deprimere, "to press down". [80] From the 14th century, "to depress" meant to subjugate or to bring down in spirits. It was used in 1665 in English author Richard Baker's Chronicle to refer to someone having "a great depression of spirit", and by English author Samuel Johnson in a similar sense in 1753. [81]

In Ancient Greece, disease was thought due to an imbalance in the four basic bodily fluids, or humors . Personality types were similarly thought to be determined by the dominant humor in a particular person. Derived from the Ancient Greek melas, "black", and kholé, "bile", [82] melancholia was described as a distinct disease with particular mental and physical symptoms by Hippocrates in his Aphorisms, where he characterized all "fears and despondencies, if they last a long time" as being symptomatic of the ailment. [83]

During the 18th century, the humoral theory of melancholia was increasingly being challenged by mechanical and electrical explanations; references to dark and gloomy states gave way to ideas of slowed circulation and depleted energy. [84] German physician Johann Christian Heinroth, however, argued melancholia was a disturbance of the soul due to moral conflict within the patient.

In the 20th century, the German psychiatrist Emil Kraepelin distinguished manic depression. The influential system put forward by Kraepelin unified nearly all types of mood disorder into manic–depressive insanity. Kraepelin worked from an assumption of underlying brain pathology, but also promoted a distinction between endogenous (internally caused) and exogenous (externally caused) types. [85]

Other psycho-dynamic theories were proposed. Existential and humanistic theories represented a forceful affirmation of individualism. [86] Austrian existential psychiatrist Viktor Frankl connected depression to feelings of futility and meaninglessness. [87] Frankl's logotherapy addressed the filling of an "existential vacuum" associated with such feelings, and may be particularly useful for depressed adolescents. [88] [89]

Researchers theorized that depression was caused by a chemical imbalance in neurotransmitters in the brain, a theory based on observations made in the 1950s of the effects of reserpine and isoniazid in altering monoamine neurotransmitter levels and affecting depressive symptoms. [90] During the 1960s and 70s, manic-depression came to refer to just one type of mood disorder (now most commonly known as bipolar disorder) which was distinguished from (unipolar) depression. The terms unipolar and bipolar had been coined by German psychiatrist Karl Kleist. [85]

In July 2022, British psychiatrist Joanna Moncrieff, also psychiatrist Mark Horowtiz and others proposed in a study on academic journal Molecular Psychiatry that depression is not caused by a serotonin imbalance in the human body, unlike what most of the psychiatry community points to, and that therefore anti-depressants do not work against the illness. [91] [92] However, such study was met with criticism from some psychiatrists, who argued the study's methodology used an indirect trace of serotonin, instead of taking direct measurements of the molecule. [93] Moncrieff said that, despite her study's conclusions, no one should interrupt their treatment if they are taking any anti-depressant. [93]

See also

Related Research Articles

<span class="mw-page-title-main">Antidepressant</span> Class of medication used to treat depression and other conditions

Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction.

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed as an approach to treat depression, CBT is often prescribed for the evidence-informed treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

<span class="mw-page-title-main">Major depressive disorder</span> Mood disorder

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability, after lower back pain.

<span class="mw-page-title-main">Mood disorder</span> Mental disorder affecting the mood of an individual, over a long period of time

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called perinataldepression, is a mood disorder which may be experienced by pregnant or postpartum individuals. Symptoms include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.

Adjustment disorder is a mental and behavioral disorder defined by a maladaptive response to a psychosocial stressor. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

Dysthymia, also known as persistent depressive disorder (PDD), is a mental and behavioral disorder, specifically a disorder primarily of mood, consisting of similar cognitive and physical problems as major depressive disorder, but with longer-lasting symptoms. The concept was used by Robert Spitzer as a replacement for the term "depressive personality" in the late 1970s.

Atypical depression is defined in the DSM-IV as depression that shares many of the typical symptoms of major depressive disorder or dysthymia, but is characterized by improved mood in response to positive events. In contrast to those with atypical depression, people with melancholic depression generally do not experience an improved mood in response to normally pleasurable events. Atypical depression also often features significant weight gain or an increased appetite, hypersomnia, a heavy sensation in the limbs, and interpersonal rejection sensitivity that results in significant social or occupational impairment.

<span class="mw-page-title-main">Psychotic depression</span> Medical condition

Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms. It can occur in the context of bipolar disorder or major depressive disorder. Psychotic depression can be difficult to distinguish from schizoaffective disorder, a diagnosis that requires the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Unipolar psychotic depression requires that psychotic symptoms occur during severe depressive episodes, although residual psychotic symptoms may also be present in between episodes. Diagnosis using the DSM-5 involves meeting the criteria for a major depressive episode, along with the criteria for "mood-congruent or mood-incongruent psychotic features" specifier.

Treatment-resistant depression (TRD) is major depressive disorder in which an affected person does not respond adequately to at least two different antidepressant medications at an adequate dose and for an adequate duration. Inadequate response has most commonly been defined as less than 25% reduction in depressive symptoms following treatment with an antidepressant. Many clinicians and researchers question the construct validity and clinical utility of treatment-resistant depression as currently conceptualized.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

Minor depressive disorder, also known as minor depression, is a mood disorder that does not meet the full criteria for major depressive disorder but at least two depressive symptoms are present for a long time. These symptoms can be seen in many different psychiatric and mental disorders, which can lead to more specific diagnoses of an individual's condition. However, some of the situations might not fall under specific categories listed in the Diagnostic and Statistical Manual of Mental Disorders. Minor depressive disorder is an example of one of these nonspecific diagnoses, as it is a disorder classified in the DSM-IV-TR under the category Depressive Disorder Not Otherwise Specified (DD-NOS). The classification of NOS depressive disorders is up for debate. Minor depressive disorder as a term was never an officially accepted term, but was listed in Appendix B of the DSM-IV-TR. This is the only version of the DSM that contains the term, as the prior versions and the most recent edition, DSM-5, do not mention it.

<span class="mw-page-title-main">Rumination (psychology)</span> Focused attention on ones mental distress

Rumination is the focused attention on the symptoms of one's mental distress. In 1998, Nolen-Hoeksema proposed the Response Styles Theory, which is the most widely used conceptualization model of rumination. However, other theories have proposed different definitions for rumination. For example, in the Goal Progress Theory, rumination is conceptualized not as a reaction to a mood state, but as a "response to failure to progress satisfactorily towards a goal". According to multiple studies, rumination is a mechanism that develops and sustains psychopathology conditions such as anxiety, depression, and other negative mental disorders. There are some defined models of rumination, mostly interpreted by the measurement tools. Multiple tools exist to measure ruminative thoughts. Treatments specifically addressing ruminative thought patterns are still in the early stages of development.

Management of depression is the treatment of depression that may involve a number of different therapies: medications, behavior therapy, psychotherapy, and medical devices.

The biology of depression is the attempt to identify a biochemical origin of depression, as opposed to theories that emphasize psychological or situational causes.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

<span class="mw-page-title-main">Differential diagnoses of depression</span> Differential diagnoses

Depression, one of the most commonly diagnosed psychiatric disorders, is being diagnosed in increasing numbers in various segments of the population worldwide. Depression in the United States alone affects 17.6 million Americans each year or 1 in 6 people. Depressed patients are at increased risk of type 2 diabetes, cardiovascular disease and suicide. Within the next twenty years depression is expected to become the second leading cause of disability worldwide and the leading cause in high-income nations, including the United States. In approximately 75% of suicides, the individuals had seen a physician within the prior year before their death, 45–66% within the prior month. About a third of those who died by suicide had contact with mental health services in the prior year, a fifth within the preceding month.

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