Major Depressive episodes are characterized by the classic symptoms Inflated self-esteem or grandiosity; Decreased need for sleep (e.g., feels rested after. Some people also have episodes of major depression before or while they decreased activity; loss of interest in formerly enjoyable activities. Depression has been linked to reduced oxygen in the body. and emotional regulation does exist after bouts of longer-lasting depression.
Depression Decreases Bouts Of
The other mood disorders tend to be variations on the theme of bipolar disorder and are discussed in our Bipolar Disorders Topic Center.
Throughout our discussion it is important to keep in mind that the term "depression" is not particularly specific. There are multiple kinds of depression; and the diagnosis of a particular disorder varies depending on the severity, duration, and persistence of symptoms.
For those seeking addiction treatment for themselves or a loved one, the MentalHelp. Our helpline is offered at no cost to you and with no obligation to enter into treatment. With that in mind, would you like to learn about some of the best options for treatment in the country? In addition, three or more of the following symptoms must be present four symptoms must be present if the person's mood is only irritable: Inflated self-esteem or grandiosity Decreased need for sleep e.
Introduction And Types Of Depression. Historical And Current Understandings. Biology, Psychology And Sociology. Treatment - Medication And Psychotherapy. Depression is a very common mental illness that is highly recurrent in individuals.
In addition, it is a disorder with substantial personal and public health consequences. Thus, there is great interest in the development of strategies that might reduce the recurrence of depression.
Important to the development of preventive interventions is a basic understanding of the factors that predict and contribute to recurrence. However, research in this area is rife with methodological variability. However, these differences do not seem to have an impact on study findings because study results do not appear to vary according to the method used to identify depressed people.
Second, there have been differing definitions of recurrence, although this is less of a problem since the publication of proposed consensus terms by Frank and colleagues , and now most recent research employs these standard definitions.
In addition, there has also been confusion about whether recurrence refers to a recurrent episode or whether it refers to a recurrent subtype of depression. Third, studies have varied in whether they include only individuals with unipolar depression, or whether they also include those with bipolar disorder who have experienced recurrent depressive episodes; this difference may account for some of the divergent findings reviewed in this paper, especially in studies using clinical samples where rates of bipolar disorder are often higher.
Alternatively, some studies only examine hospital readmission rates, which may represent only unusually severe cases of depression and may be missing the presence of less severe recurrent episodes which do not lead to re-hospitalization. Both of these factors may play a role in some of the divergent findings across studies. Fifth, investigations have varied in the extent to which they address the potential influence of maintenance therapy, psychotherapy or antidepressants, on recurrence.
Finally, many studies note the high attrition rates that occur in research on depression, which might be influencing all of the reviewed research. Despite these methodological differences, some variables have consistently been found to relate to recurrence of depression, while for other variables the evidence is more mixed.
There is considerable evidence that demographic variables are related to first-onset of depression. However, this is not the case for recurrence.
Instead, from the studies reviewed, it appears that sex, SES, and marital status are not risk factors for depression recurrence. Several clinical and family history variables do appear to be related to increased risk for recurrence, however.
For example, there is evidence that both age at onset and number of prior episodes are related to recurrence, although their importance relative to one another has been difficult to determine due to their moderate intercorrelation. In addition, the severity of the first or index episode as measured by number of symptoms or presence of suicidal thinking, but not duration has been linked to increased risk for recurrence in adults but not in children.
The presence of comorbid psychopathology, especially other affective disorders, also is related to recurrence risk in adults but not children. However, more research is necessary to determine which specific non-affective disorders confer increased risk for depression recurrence. Family history of psychopathology, particularly depression or other affective disorders, is also associated with increased risk for recurrence in those of all ages, although again more research is necessary regarding the role of non-affective disorders in increasing risk for recurrence of depression.
In addition, several psychological and psychosocial variables have been proposed as risk factors for recurrent depression, including negative cognitions, high neuroticism, poor social support, and stressful life events.
There appears to be ample evidence from the studies reviewed that each of these variables is related not only to risk for first onset of depression, but also for recurrent depression. However, it is important to note that there is recent evidence supporting common genetic vulnerability to both recurrent depression and neuroticism or social support, and thus this might not be a directly causal relationship.
Thus, many variables appear to be related to risk for recurrence of depression. Many researchers, it seems, interpret these findings to mean that these risk factors are causally related to depression recurrence, and that if they could be somehow ameliorated, then recurrent episodes could potentially be avoided. Research has also shown that depression liability may be better conceptualized as an underlying liability to internalizing disorders in general e.
It is possible that those individuals who have inherited a greater risk for depression are at risk not only for an early age at first onset and for comorbid psychopathology, particularly other internalizing disorders, but also for a family history of depression, increased neuroticism, more stressful life events, and for greater numbers of episodes in their lifetime.
On the other hand, individuals with a small inherited risk for depression would have later ages at first onset, fewer numbers of lifetime episodes, less neuroticism, fewer stressful life events, and less comorbid psychopathology in themselves and in their family members. Analyses on genetically informative samples will be necessary to determine if these clinical variables are indeed good candidate targets for preventative interventions, or if they might be better conceptualized as markers of the severity of the underlying liability to depression in general.
Finally, several scar theories were also reviewed. They are all similar in that they propose that something, presumably encoded at the biological level, changes during an episode of depression, which then makes future episodes more likely. There was virtually no evidence to support the existence of a psychosocial scar, but there was slight evidence in favor of the occurrence of a scar on cognitions, although only in children and adolescents, but not adults.
Regarding stressful life events, there was considerable research to support SLEs as a risk factor for recurrent depression. In addition, there was some evidence to support the idea that sensitization to SLEs occurs, although it was not definitive. There was also some evidence of stress generation occurring. A direct comparison of these two hypotheses regarding SLEs would make an interesting future study.
For example, individuals with high levels of neuroticism are already at increased risk for a first-onset of depression. Just because one episode of depression increases their neuroticism scores, on average, this does not mean that their subsequent risk for depression is automatically increased; instead, it could be that they are at the same risk for recurrence because they already had sufficient levels of neuroticism in order to lead to depression in the first place.
This is relevant for the other scar theories as well. Furthermore, it is important to note that the scar theories suppose that due to the greater rates of depression in those who have a history of depression compared to those who have no such history, it must be the case that depression itself somehow increases the vulnerability to becoming depressed again.
However, a more parsimonious explanation may instead be that individuals at high risk for multiple episodes already possessed the necessary characteristics to make them prone to recurrent depression, and that these necessary characteristics existed even before their first episode. For example, individuals at high risk for a recurrent subtype of depression may already have higher levels of neuroticism or SLEs, even before their first episode; any changes in these domains that occur after a depressive episode may simply be reflecting a sequela of depression rather than a scar per se.
Given the largely null findings in the area of scar theories, this is a highly plausible alternative. More specifically, the mechanism conferring premorbid risk for recurrent depression could involve an underlying genetic liability.
In conclusion, the prevention of recurrence is a daunting but important task. Finally, it should be noted that there is little evidence to support the idea that any of these risk factors operate through scarring.
It is also important to note that the literature has yielded somewhat different results for children and adolescents. While age at onset, family history of psychopathology, personality, and SLEs appear to act as risk factors for recurrence in both children and adults, severity of the first episode and comorbidity of other forms of psychopathology do not appear to be related to increased risk for recurrence in children and adolescents.
Furthermore, there is some evidence to suggest that there is scarring on cognitions in children and adolescents with depression, whereas in adults cognitions are more likely risk factors rather than scars. Thus, these different findings regarding risk for recurrence of depression in children versus adults certainly deserves further exploration from researchers. Another important issue, however, is the question of why this pattern of risk factors has emerged.
The putative risk factors for recurrence may simply be reflecting an underlying vulnerability to a recurrent subtype of depression. That is, those at underlying risk for recurrent depression may also, even before their first episode onset, be at risk for the risk factors reviewed herein.
More specifically, it is hypothesized that individuals inherit a level of risk for recurrent depression. If they are high in this underlying genetic vulnerability, they are also likely to have an earlier age at onset, greater numbers of depressive episodes, more severe episodes, greater comorbidity, a stronger family history of depression, higher neuroticism scores, more SLEs, a depressogenic cognitive style, and less social support.
While this is not to say that there is genetic predeterminism and that this genetic risk for recurrence and its associated risk factors cannot be modified through environmental mechanisms in order to alter the course of recurrences, it is likely that genetic factors may be strongly at play in the recurrent subtype of depression.
It is this hypothesis regarding the underlying genetic vulnerability for recurrence and the putative risk factors reviewed herein that is most in need of further testing. There is a dearth of research on recurrence of depression using genetically informative samples, but it is with such samples that the most information can be obtained. Further research on the genetic underpinnings of recurrent depression, as well as how this relates to the putative risk factors reviewed earlier, is the most promising line of research for us to learn more about the etiology of recurrent depression.
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See other articles in PMC that cite the published article. Abstract Depression is a highly recurrent disorder with significant personal and public health consequences. Table 1 Methodological differences in the reviewed studies. Open in a separate window. Demographics Considerable research on risk factors for recurrent depression has focused on demographic variables. Gender The influence of gender on depression has been a major topic of study.
Socio-Economic Status and Marital Status Socio-economic status SES and marital status have also been studied to determine if they play a role in the risk for recurrence in depression. Clinical Picture and Family History Several clinical features of depression have been investigated to see if they explain risk for recurrence.
Age at Onset of First Episode and Number of Depressive Episodes There have been several studies that have examined the role of age at onset of the first episode as it relates to later recurrence of depression. Comorbid Psychopathology Many researchers have examined the impact of comorbid psychopathology on risk for recurrence of depression.
Family History of Psychopathology Recurrence of depression has been linked to a family history of various types of psychopathology, including any mental illness, affective disorders in general, and major depression in particular.
Psychological and Psychosocial Risk Factors for Recurrence Cognitions Negative cognitive styles have long been implicated as a risk factor for the onset of depression.
Personality Many studies have documented the relationship between high levels of neuroticism and risk for depression e. Social Support Presence of adequate social support has been implicated as a protective factor for depression e.
An Explanatory Mechanism for Elevated Recurrence Risk Due to the greater rates of depression in those who have a history of depression compared to those who have no such history, it must be the case that either the depression itself somehow increases the vulnerability to becoming depressed again, or that individuals at high risk for multiple episodes already possessed the necessary characteristics to make them prone to depression even before their first episode.
Psychosocial Scar Zeiss and Lewinsohn investigated the possibility that depression leaves a psychosocial scar. Cognition Scar Given the strong relationship between cognition and depression e. Personality Scar Another area in which a scar from depression has been hypothesized to occur has been in personality, particularly neuroticism.
Sensitization Sensitization has been investigated in several samples, with mixed results. Stress Generation Hammen proposed the hypothesis of stress generation; she examined SLEs over the course of one year in 14 women with unipolar depression, 11 with bipolar disorder, 13 with chronic medical illnesses, and 22 with no illness physical or psychological. Summary and Conclusions Depression is a very common mental illness that is highly recurrent in individuals. Learned helplessness in humans: Journal of Abnormal Psychology.
Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression. New concepts, strategies and technologies.
Childhood psychopathology retrospectively assessed among adults with early onset major depression. Journal of Affective Disorders. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association; Text Revision - Fourth. Risk factors for depression at month follow-up in adult primary health care patients with major depression: Cognitive Therapy of Depression.
The Guilford Press; Beck Depression Inventory - II. The Psychological Corporation; Belsher G, Costello CG. Relapse after recovery from unipolar depression: Genetic mediation of the relationship between social support and psychological well-being. Personality and clinical predictors of recurrence of depression.
Course and outcome of child and adolescent major depressive disorder. Clinical presentation and course of depression in youth: Does onset in childhood differ from onset in adolescence?
Recurrent and nonrecurrent depression. Archives of General Psychiatry. A randomized controlled trial. Journal of Consulting and Clinical Psychology. Cognitive, physiological, and personality correlates of recurrence of depression. Predicting the short-term outcome of first episodes and recurrences of clinical depression: A prospective study of life events, difficulties, and social support networks. Journal of Clinical Psychiatry. Adolescent twins discordant for major depressive disorder: Shared familial liability to externalizing and other internalizing disorders.
Journal of Child Psychology and Psychiatry. Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Predictors of relapse into major depressive disorder in a nonclinical population. American Journal of Psychiatry. Predicting the long-term outcome of affective disorders. Neurobehavioral aspects of affective disorders.
Annual Review of Psychology. The psychometric characteristics of the Hamilton Depression Inventory. Journal of Personality Assessment. A vulnerability marker for depression evidence from a family study.
Personality dimensions and depression: Canadian Journal of Psychiatry. Neuroticism, major depression and gender: Diagnostic criteria for use in psychiatric research. The Maudsley long-term follow-up of child and adolescent depression: Psychiatric outcomes in adulthood.
British Journal of Psychiatry. Suicidality, criminality, and social dysfunction in adulthood. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Clinical predictors of recurrence in depression. Socio-economic status, family disruption and residential stability in childhood: Relation to onset, recurrent, and remission of major depression.
Longitudinal follow-up of unipolar depressives: An investigation of predictors to relapse. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry. Generation of stress in the course of unipolar depression. Arch Womens Ment Health. The generation of life events in recurrent and non-recurrent depression.
Suicide as an outcome for mental disorders: Epidemiology of major depressive disorder. Control groups in schizophrenia research: A neglected source of variability. Cicchetti D, Grove WM, editors. Thinking clearly about psychology: Essays in honor of Paul E Meehl. University of Minnesota Press; The course of depression in individuals at high and low cognitive risk for depression: Number of episodes and antidepressant response in major depression.
International Journal of Neuropsychopharmacology. Depressive spectrum disorders in high-risk adolescents: Episode duration and predictors of time to recovery. Causal relationship between stressful life events and the onset of major depression. Familial influences on the clinical characteristics of major depression: A longitudinal twin study of personality and major depression in women.
The structure of the genetic and environmental risk factors for six major psychiatric disorders in women: Phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Recurrence in affective disorder: Effect of age and gender. Severity of depressive episodes according to ICD Prediction of risk of relapse and suicide. Predictors of recurrence in affective disorder - Analyses accounting for individual heterogeneity.
Gender differences in major depression: Gender and its effects on psychopathology. American Psychiatric Press; Childhood adversities and adult depression: Basic patterns of association in a US national survey. Childhood family violence and adult recurrent depression. Journal of Health and Social Behavior. Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity, and recurrence.
Results from the US comorbidity survey. Prevalence, correlates and course of minor depression and major depression in the national comorbidity survey.
Clinical features of major depressive disorder in adolescents and their relatives: Impact on familial aggregation, implications for phenotype definition, and specificity of transmission.
Age of onset in chronic major depression: Relations to demographic and clinical variables, family history, and treatment response. The course, morbidity, and costs of depression. Gender and the course of major depressive disorder through adolescence in clinically referred youngsters.
Depressive disorders in childhood: A longitudinal study of the risk for subsequent major depression. Developmental changes in the phenomenology of depression in girls compared to boys from childhood onward. The structure of common mental disorders.
Gender differences in unipolar depression: An update of epidemiological findings and possible explanations. The interaction of drug- and psycho-therapy in the long-term treatment of depression. Update on prevention of recurrence. Mundt C, Goldstein MJ, editors. Interpersonal factors in the origin and course of affective disorders. The association between social support and course of depression: Is it confounded with personality? First onset versus recurrence of depression: Differential processes of psychosocial risk.
Major depression in community adolescents: Age at onset, episode duration, and time to recurrence. Journal of the Academy of Child and Adolescent Psychiatry. A prospective study of risk factors for unipolar depression. Try to find other ways to relieve stress and lift your mood — you can find some useful tips and advice here.
Try the DrinkCompare Calculator to see benefits of cutting down. He or she may also prescribe you antidepressant medication. Our trained advisors are on hand to give you some confidential advice. Chat with an advisor. Alcohol and depression Read our guide about how alcohol can worsen symptoms of depression and in some cases cause them, and learn how changing your drinking can help: How alcohol can affect your mood? The vicious cycle of drinking and depression Relieving depression Getting help Drinkchat.
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In major depression, mood and/or interest (pleasure) are decreased for most of may be suggested to decrease the risk of future episodes for certain people at. For example, in both depression and anxiety, irritability, decreased Rare bouts of depression that last only a few days are usually not a. Response, Remission, Recovery, Relapse, and Recurrence of Depression . the duration of subsequent depressive episodes was greatly reduced because of.