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Depressive Disorder: Symptoms
Last reviewed: 17.10.2021
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Depression is characterized not only by a depressed mood, but also leads to cognitive, psychomotor and other impairments (eg, poor concentration, fatigue, loss of sexual desire, disruption of the menstrual cycle).
Other mental symptoms or disorders (eg, anxiety or panic attacks) often occur simultaneously with depression, which sometimes makes diagnosis and treatment difficult. Patients with all forms of depression are prone to abuse of alcohol and other psychoactive substances in order to cure sleep disorders or anxiety symptoms; However, depression is less likely to cause alcoholism and substance abuse than is considered. Patients with depression also smoke a lot and neglect their own health, which increases their risk of developing and progressing other diseases (for example, chronic obstructive pulmonary disease). Depression can reduce immune defense. With depression, the risk of myocardial infarction and stroke increases, as cytokines and factors that increase blood clotting are released.
Major depression (unipolar disorder)
Periods (episodes) that include 5 or more mental or physical symptoms and last 2 weeks or more can be defined as major depression. Obligatory symptoms are reduced mood to the level of despair and despair (often called depressive mood) or loss of interest or pleasure from daily activities (anhedonia). Other mental symptoms include a sense of uselessness or guilt, repetitive thoughts about death or suicide, a decrease in the ability to concentrate and sometimes agitation. Somatic symptoms include changes in body weight and appetite, loss of energy, fatigue, psychomotor retardation or agitation, sleep disturbances (insomnia, hypersomnia, early morning awakenings). The patient may look unhappy, with tears in his eyes, with withered eyebrows, lowered corners of the mouth, in a hunched posture, with poor visual contact, inadequate facial expression, slow body movements, speech changes (eg, a low voice, use of monosyllabic answers). This appearance is also characteristic of Parkinson's disease. In some patients, mood reduction is so deep that they can not cry; they say that they are not able to experience ordinary emotions, they think that the world around has become colorless and lifeless. The patient's diet can be significantly affected, which requires urgent intervention. Some depressed patients neglect personal hygiene or even their children, close and domestic animals.
Major depression is often divided into subgroups. A psychotic subgroup is characterized by delusions, conviction of unpardonable sins or crimes, the presence of hidden, incurable or shameful diseases or ideas of persecution. Patients may have auditory or visual hallucinations (eg, accusing and judgmental voices). The catatonic subgroup is characterized by severe psychomotor inhibition or excessive aimless activity, segregation and in some patients grimacing and repetition of someone else's speech (echolalia) or movements (echopraxia). The melancholic subgroup is characterized by loss of pleasure from almost any activity, inability to respond to positive stimuli, unchanged emotional manifestations, excessive or inadequate guilt, early morning awakenings, marked psychomotor inhibition or agitation, expressed by loss of appetite or body weight. An atypical subgroup is characterized by an improvement in mood in response to positive stimuli and increased sensitivity, which manifests itself in a pronounced depressive response to criticism or rejection, a feeling of painful helplessness or anergy, a set of body weight or increased appetite, hypersomnia.
Dysthymia
Slightly expressed or subthreshold depressive symptoms are considered dysthymia. Symptoms usually start discreetly during adolescence and persist for many years or decades, not reaching a pronounced degree (for a diagnosis> 2 years); Dysthymia can be periodically complicated by episodes of major depression. Patients with this disorder are usually gloomy, pessimistic, joyless, passive, apathetic, introverted, overly critical of themselves and others and complaining.
[6], [7], [8], [9], [10], [11], [12], [13], [14]
Depression, nowhere else classified
Clusters of symptoms that do not meet the criteria of other depressive disorders are related to depression, nowhere else classified. For example, mild depressive disorder may include some of the symptoms of major depression lasting 2 weeks or more, but less than 5 needed to diagnose major depression. A short depressive disorder includes the necessary symptoms for the diagnosis of major depression, but lasts only 2 days to 2 weeks. Premenstrual dysphoric syndrome includes depressed mood, anxiety, decreased interest in activity, but only at certain periods of menstrual cycles, beginning with the luteal phase and ending a few days after the onset of menstruation.
[15], [16], [17], [18], [19], [20]
Mixed anxiety and depression
Although this condition, also called anxious depression, is not regarded in DSM-IV as a variant of depression, it is manifested by simultaneous mild symptoms of both anxiety and depression. The course is usually chronic intermittent. Since depressive disorder is more serious, patients with a mixed anxiety-depressive condition should be treated for depression. Obtrusiveness, panic, social phobia in combination with hypersomnia depression testify to the bipolar disorder of type II.