Depression (mood)

Depression is a state of low mood and aversion to activity. Depressed persons may feel sad, anxious, empty,
hopeless, helpless, worthless, guilty, irritable or restless. They may lose interest in activities that once were
pleasurable, experience loss of appetite or overeating, or problems concentrating, remembering details or making
decisions; and may contemplate or attempt suicide. Insomnia, waking early, excessive sleeping, fatigue, loss of
energy, or aches, pains or digestive problems that are resistant to treatment may be present.

Illnesses featuring depression

A number of psychiatric syndromes feature depressed mood as a main symptom. Mood disorders are a group of
disorders considered to be primary disturbances of mood. Within them, major depressive disorder (MDD),
commonly called major depression, or clinical depression, is a condition where a person has two or more discrete
major depressive episodes. Dysthymia is a condition of chronic depressed mood, the symptoms of which do not
meet the severity of a major depressive episode. People suffering bipolar disorder may also experience major
depressive episodes.

Outside the mood disorders, chronic dysthymia is also commonly a feature of borderline personality disorder.
Adjustment disorder with depressed mood is a mood disturbance appearing as 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.

For a discussion of non-psychiatric medical illnesses that cause depression see Depression (differential diagnoses).

Physiology or mechanism

Depression is associated with changes in substances in the brain (neurotransmitters) that help nerve cells
communicate, such as serotonin, dopamine and norepinephrine. The levels of these neurotransmitters can be
influenced by genetics, hormonal changes, responses to medications, aging, brain injuries, seasonal/light cycle
changes, and other medical conditions.

Assessment

A full patient medical history, physical assessment, and thorough evaluation of symptoms helps determine the cause
of the depression. Standardized questionnaires can be helpful such as the Hamilton Rating Scale for Depression, and
the Beck Depression Inventory.

A doctor generally performs a medical examination and selected investigations to rule out other causes of
symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism; basic electrolytes
and serum calcium to rule out a metabolic disturbance; and a full blood count including ESR to rule out a systemic
infection or chronic disease. Adverse affective reactions to medications or alcohol misuse are often ruled out, as
well. Testosterone levels may be evaluated to diagnose hypogonadism, a cause of depression in men.

Subjective cognitive complaints appear in older depressed people, but they can also be indicative of the onset of a
dementing disorder, such as Alzheimer's disease. Cognitive testing and brain imaging can help distinguish
depression from dementia. A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise
unusual symptoms. Investigations are not generally repeated for a subsequent episode unless there is a medical
indication.