---

Click here: Depresija wiki

---

Nasprotno lahko prihaja do , to je pretiranega spanja. These guidelines include: APA Task Force on ECT 2001 ; Third report of the Royal College of Psychiatrists' Special Committee on ECT 2004 ; National Institute for Health and Clinical Excellence NICE 2003; NICE 2009. ECT is administered under anesthetic with a muscle relaxant.

Weiner chairperson ; et al. Ta težnja je značilno za depresivni , ali pesimistični.

- Tada, umesto izlečenja, dolazi do pogoršanja.

Not to be confused with. It is often accompanied by low , in normally enjoyable activities, low energy, and without a clear cause. People may also occasionally have or. Some people have separated by years in which they are normal, while others nearly always have symptoms present. Major depressive disorder can negatively affect a person's personal, work, or school life as well as sleeping, eating habits, and general health. Between 2—7% of adults with major depression die by , and up to 60% of people who die by suicide had depression or another. The cause is believed to be a combination of , environmental, and psychological factors. Risk factors include a of the condition, major life changes, certain medications, , and. About 40% of the risk appears to be related to genetics. The diagnosis of major depressive disorder is based on the person's reported experiences and a. There is no laboratory test for major depression. Testing, however, may be done to rule out physical conditions that can cause similar symptoms. Major depression should be differentiated from , which is a normal part of life and is less severe. The USPSTF recommends screening for depression among those over the age 12, while a prior found that the routine use of screening questionnaires have little effect on detection or treatment. Typically, people are treated with and. Medication appears to be effective, but the effect may only be significant in the most severely depressed. It is unclear whether medications affect the risk of suicide. Types of counseling used include CBT and. If other measures are not effective ECT may be tried. Hospitalization may be necessary in cases with a risk of harm to self and may occasionally occur against a person's wishes. Major depressive disorder affected approximately 216 million people 3% of the world's population in 2015. The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. Lifetime rates are higher in the 15% compared to the 11%. It causes the second most , after. The most common time of onset is in a person's 20s and 30s. Females are affected about twice as often as males. It was a split of the previous in the DSM-II, which also encompassed the conditions now known as and. Those currently or previously affected may be. An 1892 lithograph of a woman diagnosed with depression Major depression significantly affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health. Its impact on functioning and well-being has been compared to that of other chronic medical conditions such as. A person having a usually exhibits a very low mood, which pervades all aspects of life, and an in activities that were formerly enjoyed. Depressed people may be preoccupied with, or over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred. In severe cases, depressed people may have symptoms of. These symptoms include or, less commonly, , usually unpleasant. Other symptoms of depression include poor concentration and memory especially in those with or psychotic features , withdrawal from social situations and activities, reduced , irritability, and thoughts of death or suicide. In the typical pattern, a person wakes very early and cannot get back to sleep. Some antidepressants may also cause insomnia due to their stimulating effect. A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries, according to the 's criteria for depression. Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. Family and friends may notice that the person's behavior is either or. Older depressed people may have symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements. Depression often coexists with physical disorders common among the elderly, such as , other , , and. Depressed children may often display an irritable mood rather than a depressed mood, and show varying symptoms depending on age and situation. Most lose interest in school and show a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure. Diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness. Associated conditions Major depression frequently with other psychiatric problems. The 1990—92 US reports that half of those with major depression also have lifetime and its associated disorders such as. Anxiety symptoms can have a major impact on the course of a depressive illness, with delayed recovery, increased risk of relapse, greater disability and increased suicide attempts. There are increased rates of alcohol and drug abuse and particularly dependence, and around a third of individuals diagnosed with develop comorbid depression. Depression may also coexist with ADHD , complicating the diagnosis and treatment of both. Depression is also frequently comorbid with and. Depression and often co-occur. One or more pain symptoms are present in 65% of depressed patients, and anywhere from 5 to 85% of patients with pain will be suffering from depression, depending on the setting; there is a lower prevalence in general practice, and higher in specialty clinics. The diagnosis of depression is often delayed or missed, and the outcome can worsen if the depression is noticed but completely misunderstood. Depression is also associated with a 1. People with major depression are less likely to follow medical recommendations for treating and preventing cardiovascular disorders, which further increases their risk of medical complications. In addition, cardiologists may not recognize underlying depression that complicates a cardiovascular problem under their care. The cause of major depressive disorder is unknown. The proposes that biological, psychological, and social factors all play a role in causing depression. The specifies that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either , implying an interaction between , or , resulting from views of the world learned in childhood. Childhood trauma also correlates with severity of depression, lack of response to treatment and length of illness. However, some are more susceptible to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility. Genetics The , or serotonin transporter promoter gene's short allele has been associated with increased risk of depression. However, since the 1990s results have been inconsistent, with three recent reviews finding an effect and two finding none. Other genes that have been linked to a gene-environment interaction include , and , the first two of which are related to the stress reaction of the , and the latter of which is involved in neurogenesis. A 2018 study found 44 that were linked to MDD. It is unknown if the underlying diseases induce depression through effect on quality of life, of through shared etiologies such as degeneration of the in or immune dysregulation in. Depression may also be iatrogenic the result of healthcare , such as drug induced depression. Therapies associated with depression include therapy, , , , cardiac agents, , , , and agents such as. Drug abuse in early age is also associated with increased risk of developing depression later in life. Depression that occurs as a result of pregnancy is called , and is thought to be the result of hormonal changes associated with. Seasonal affective disorder, a type of depression associated with seasonal changes in sunlight, is thought to be the result of decreased sunlight. Further information: The pathophysiology of depression is not yet understood, but the current theories center around systems, the , immunological dysfunction, dysfunction and structural or functional abnormalities of emotional circuits. The monoamine theory, derived from the efficacy of monoaminergic drugs in treating depression, was the dominant theory until recently. The theory postulates that insufficient activity of monoamine neurotransmitters is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas. Firstly, acute depletion of , a necessary precursor of , a monoamine, can cause depression in those in remission or relatives of depressed patients; this suggests that decreased serotonergic neurotransmission is important in depression. Secondly, the correlation between depression risk and polymorphisms in the gene, which codes for serotonin receptors, suggests a link. Third, decreased size of the , decreased activity of , increased density of , and evidence from rat models suggest decreased adrenergic neurotransmission in depression. Furthermore, decreased levels of , altered response to , responses of depressive symptoms to agonists, decreased binding in the , and polymorphism of genes implicate dopamine in depression. Lastly, increased activity of , which degrades monoamines, has been associated with depression. However, this theory is inconsistent with the fact that serotonin depletion does not cause depression in healthy persons, the fact that antidepressants instantly increase levels of monoamines but take weeks to work, and the existence of atypical antidepressants which can be effective despite not targeting this pathway. One proposed explanation for the therapeutic lag, and further support for the deficiency of monoamines, is a desensitization of self-inhibition in by the increased serotonin mediated by antidepressants. However, disinhibition of the dorsal raphe has been proposed to occur as a result of decreased serotonergic activity in tryptophan depletion, resulting in a depressed state mediated by increased serotonin. Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive that controls, the finding of increased jugular 5-HIAA in depressed patients that normalized with SSRI treatment, and the preference for carbohydrates in depressed patients. Already limited, the monoamine hypothesis has been further oversimplified when presented to the general public. Immune system abnormalities have been observed, including increased levels of involved in generating which shares overlap with depression. The effectiveness of NSAIDs and cytokine inhibitors in treating depression, and normalization of cytokine levels after successful treatment further suggest immune system abnormalities in depression. However, this abnormality is not adequate as a diagnosis tool, because its sensitivity is only 44%. These stress-related abnormalities have been hypothesized to be the cause of hippocampal volume reductions seen in depressed patients. Furthermore, a meta-analysis yielded decreased dexamethasone suppression, and increased response to psychological stressors. Further abnormal results have been obscured with the , with increased response being associated with depression. Theories unifying neuroimaging findings have been proposed. Another model proposes hyperactivity of salience structures in identifying negative stimuli, and hypoactivity of cortical regulatory structures resulting in a negative and depression, consistent with emotional bias studies. Further information: A diagnostic assessment may be conducted by a suitably trained , or by a or , who the person's current circumstances, biographical history, current symptoms, and family history. The broad clinical aim is to formulate the relevant biological, psychological, and social factors that may be impacting on the individual's mood. The assessor may also discuss the person's current ways of regulating mood healthy or otherwise such as alcohol and drug use. The assessment also includes a , which is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimism, or suicide, and an absence of positive thoughts or plans. Specialist mental health services are rare in rural areas, and thus diagnosis and management is left largely to clinicians. This issue is even more marked in developing countries. The mental health examination may include the use of a such as the or the or the. The score on a rating scale alone is insufficient to diagnose depression to the satisfaction of the DSM or ICD, but it provides an indication of the severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis. Several rating scales are used for this purpose. A review found that non-psychiatrist physicians miss about two-thirds of cases, though this has improved somewhat in more recent studies. Before diagnosing a major depressive disorder, in general a doctor performs a medical examination and selected investigations to rule out other causes of symptoms. These include blood tests measuring and to exclude ; and serum to rule out a ; and a including to rule out a or chronic disease. Adverse affective reactions to medications or alcohol misuse are often ruled out, as well. Subjective cognitive complaints appear in older depressed people, but they can also be indicative of the onset of a , such as. A can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. In general, investigations are not repeated for a subsequent episode unless there is a medical indication. No biological tests confirm major depression. Biomarkers of depression have been sought to provide an objective method of diagnosis. There are several potential biomarkers, including Brain-Derived Neurotrophic Factor and various functional MRI techniques. One study developed a decision tree model of interpreting a series of fMRI scans taken during various activities. In their subjects, the authors of that study were able to achieve a sensitivity of 80% and a specificity of 87%, corresponding to a negative predictive value of 98% and a positive predictive value of 32% positive and negative likelihood ratios were 6. However, much more research is needed before these tests could be used clinically. DSM-IV-TR and ICD-10 criteria The most widely used criteria for diagnosing depressive conditions are found in the 's revised fourth edition of the DSM-IV-TR , and the 's ICD-10 , which uses the name depressive episode for a single episode and recurrent depressive disorder for repeated episodes. The latter system is typically used in European countries, while the former is used in the US and many other non-European nations, and the authors of both have worked towards conforming one with the other. Both DSM-IV-TR and ICD-10 mark out typical main depressive symptoms. ICD-10 defines three typical depressive symptoms depressed mood, , and reduced energy , two of which should be present to determine depressive disorder diagnosis. According to DSM-IV-TR, there are two main depressive symptoms—depressed mood and anhedonia. At least one of these must be present to make a diagnosis of major depressive episode. Major depressive disorder is classified as a mood disorder in DSM-IV-TR. The diagnosis hinges on the presence of single or recurrent. Further qualifiers are used to classify both the episode itself and the course of the disorder. The category is diagnosed if the depressive episode's manifestation does not meet the criteria for a major depressive episode. The system does not use the term major depressive disorder but lists very similar criteria for the diagnosis of a depressive episode mild, moderate or severe ; the term recurrent may be added if there have been multiple episodes without mania. Major depressive episode Main article: A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks. Episodes may be isolated or recurrent and are categorized as mild few symptoms in excess of minimum criteria , moderate, or severe marked impact on social or occupational functioning. An episode with psychotic features—commonly referred to as —is automatically rated as severe. If the patient has had an episode of or , a diagnosis of is made instead. DSM-IV-TR excludes cases where the symptoms are a result of , although it is possible for normal bereavement to evolve into a depressive episode if the mood persists and the characteristic features of a major depressive episode develop. The criteria have been criticized because they do not take into account any other aspects of the personal and social context in which depression can occur. In addition, some studies have found little empirical support for the DSM-IV cut-off criteria, indicating they are a diagnostic convention imposed on a continuum of depressive symptoms of varying severity and duration: Excluded are a range of related diagnoses, including , which involves a chronic but milder mood disturbance; , consisting of briefer depressive episodes; , whereby only some symptoms of major depression are present; and , which denotes low mood resulting from a psychological response to an identifiable event or. Here, the person is mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms also occur in or in manic episodes, or may be caused by. Postpartum depression has an incidence rate of 10—15% among new mothers. The DSM-IV mandates that, in order to qualify as postpartum depression, onset occur within one month of delivery. It has been said that postpartum depression can last as long as three months. The diagnosis is made if at least two episodes have occurred in colder months with none at other times, over a two-year period or longer. Screening In 2016, the USPSTF recommended screening in the adult populations with evidence that it increases the detection of people with depression and with proper treatment improves outcomes. They recommend screening in those between the age of 12 to 18 as well. A Cochrane review from 2005 found programs do not significantly improve detection rates, treatment, or outcome. Differential diagnoses Main article: To confirm major depressive disorder as the most likely diagnosis, other must be considered, including dysthymia, adjustment disorder with depressed mood, or bipolar disorder. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression sometimes referred to as double depression. Although depression is currently categorized as a separate disorder, there is ongoing debate because individuals diagnosed with major depression often experience some hypomanic symptoms, indicating a mood disorder continuum. Further differential diagnoses involve. Other disorders need to be ruled out before diagnosing major depressive disorder. They include depressions due to physical illness, , and. Depression due to physical illness is diagnosed as a. This condition is determined based on history, laboratory findings, or. When the depression is caused by a medication, drug of abuse, or exposure to a , it is then diagnosed as a specific mood disorder previously called Substance-induced mood disorder in the DSM-IV-TR. Preventative efforts may result in decreases in rates of the condition of between 22 and 38%. Eating large amounts of fish may also reduce the risk. Behavioral interventions, such as and , are effective at preventing new onset depression. Because such interventions appear to be most effective when delivered to individuals or small groups, it has been suggested that they may be able to reach their large target audience most efficiently through the. However, an earlier meta-analysis found preventive programs with a competence-enhancing component to be superior to behavior-oriented programs overall, and found behavioral programs to be particularly unhelpful for older people, for whom social support programs were uniquely beneficial. In addition, the programs that best prevented depression comprised more than eight sessions, each lasting between 60 and 90 minutes, were provided by a combination of lay and professional workers, had a high-quality research design, reported , and had a well-defined intervention. The course is claimed to be the most successful of psychoeducational interventions for the treatment and prevention of depression both for its adaptability to various populations and its results , with a risk reduction of 38% in major depression and an efficacy as a treatment comparing favorably to other psychotherapies. Main article: The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy. Psychotherapy is the treatment of choice over medication for people under 18. The UK NICE 2004 guidelines indicate that antidepressants should not be used for the initial treatment of mild depression, because the risk-benefit ratio is poor. The guidelines further note that antidepressant treatment should be continued for at least six months to reduce the risk of relapse, and that SSRIs are better tolerated than tricyclic antidepressants. Options may include pharmacotherapy, psychotherapy, exercise, electroconvulsive therapy ECT , transcranial magnetic stimulation TMS or light therapy. Antidepressant medication is recommended as an initial treatment choice in people with mild, moderate, or severe major depression, and should be given to all patients with severe depression unless ECT is planned. There is evidence that collaborative care by a team of health care practitioners produces better results than routine single-practitioner care. Treatment options are much more limited in developing countries, where access to mental health staff, medication, and psychotherapy is often difficult. Development of mental health services is minimal in many countries; depression is viewed as a phenomenon of the developed world despite evidence to the contrary, and not as an inherently life-threatening condition. A 2014 Cochrane review found insufficient evidence to determine the effectiveness of psychological versus medical therapy in children. Lifestyle Further information: is recommended for management of mild depression, and has a moderate effect on symptoms. Exercise has also been found to be effective for unipolar major depression. It is equivalent to the use of medications or psychological therapies in most people. In older people it does appear to decrease depression. Exercise may be recommended to people who are willing, motivated, and physically healthy enough to participate in an exercise program as treatment. There is a small amount of evidence that skipping a night's sleep may improve depressive symptoms, with the effects usually showing up within a day. This effect is usually temporary. Besides sleepiness, this method can cause a side effect of or. In observational studies has benefits in depression as large as or larger than those of medications. Besides exercise, sleep and diet may play a role in depression, and interventions in these areas may be an effective add-on to conventional methods. Counseling can be delivered to individuals, groups, or families by mental health professionals. A 2015 review found that appears to be similar to antidepressant medication in terms of effect. A 2012 review found psychotherapy to be better than no treatment but not other treatments. With more complex and chronic forms of depression, a combination of medication and psychotherapy may be used. A 2014 found that work-directed interventions combined with clinical interventions helped to reduce sick days taken by people with depression. There is moderate-quality evidence that psychological therapies are a useful addition to standard antidepressant treatment of in the short term. Psychotherapy has been shown to be effective in older people. Successful psychotherapy appears to reduce the recurrence of depression even after it has been terminated or replaced by occasional booster sessions. Cognitive behavioral therapy See also: CBT currently has the most research evidence for the treatment of depression in children and adolescents, and CBT and interpersonal psychotherapy IPT are preferred therapies for adolescent depression. In people under 18, according to the , medication should be offered only in conjunction with a psychological therapy, such as , , or family therapy. Cognitive behavioral therapy has also been shown to reduce the number of sick days taken by people with depression, when used in conjunction with primary care. The most-studied form of psychotherapy for depression is CBT, which teaches clients to challenge self-defeating, but enduring ways of thinking cognitions and change counter-productive behaviors. Research beginning in the mid-1990s suggested that CBT could perform as well as or better than antidepressants in patients with moderate to severe depression. CBT may be effective in depressed adolescents, although its effects on severe episodes are not definitively known. Several variables predict success for cognitive behavioral therapy in adolescents: higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions. CBT is particularly beneficial in preventing relapse. Cognitive behavioral therapy and occupational programs including modification of work activities and assistance have been shown to be effective in reducing sick days taken by workers with depression. Variants Several variants of cognitive behavior therapy have been used in those with depression, the most notable being , and. Mindfulness based stress reduction programs may reduce depression symptoms. Mindfulness programs also appear to be a promising intervention in youth. Psychoanalysis is a school of thought, founded by , which emphasizes the resolution of mental conflicts. Psychoanalytic techniques are used by some practitioners to treat clients presenting with major depression. A more widely practiced therapy, called , is in the tradition of psychoanalysis but less intensive, meeting once or twice a week. It also tends to focus more on the person's immediate problems, and has an additional social and interpersonal focus. In a meta-analysis of three controlled trials of Short Psychodynamic Supportive Psychotherapy, this modification was found to be as effective as medication for mild to moderate depression. Antidepressants Zoloft is used primarily to treat major depression in adults. Conflicting results have arisen from studies that look at the effectiveness of antidepressants in people with acute, mild to moderate depression. Stronger evidence supports the usefulness of antidepressants in the treatment of depression that is chronic or severe. While small benefits were found, researchers Irving Kirsch and Thomas Moore state they may be due to issues with the trials rather than a true effect of the medication. In a later publication, Kirsch concluded that the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance. Similar results were obtained in a meta analysis by Fornier. A review commissioned by the concluded that there is strong evidence that SSRIs have greater efficacy than placebo on achieving a 50% reduction in depression scores in moderate and severe major depression, and that there is some evidence for a similar effect in mild depression. Similarly, a Cochrane systematic review of clinical trials of the concluded that there is strong evidence that its efficacy is superior to placebo. In 2014 the U. FDA published a systematic review of all antidepressant maintenance trials submitted to the agency between 1985 and 2012. The authors concluded that maintenance treatment reduced the risk of relapse by 52% compared to placebo, and that this effect was primarily due to recurrent depression in the placebo group rather than a drug withdrawal effect. To find the most effective antidepressant medication with minimal side-effects, the dosages can be adjusted, and if necessary, combinations of different classes of antidepressants can be tried. Response rates to the first antidepressant administered range from 50—75%, and it can take at least six to eight weeks from the start of medication to. Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation is recommended. People with chronic depression may need to take medication indefinitely to avoid relapse. SSRIs are the primary medications prescribed, owing to their relatively mild side-effects, and because they are less toxic in overdose than other antidepressants. People who do not respond to one SSRI can be switched to , and this results in improvement in almost 50% of cases. Another option is to switch to the atypical antidepressant. However, venlafaxine is not recommended in the UK as a first-line treatment because of evidence suggesting its risks may outweigh benefits, and it is specifically discouraged in children and adolescents. For child and adolescent depression, is recommended if medication are used. Fluoxetine; however, appears to have only slight benefit in children, while other antidepressants have not been shown to be effective. Medications are not recommended in children with mild disease. There is also insufficient evidence to determine effectiveness in those with depression complicated by. Any antidepressant can cause levels ; nevertheless, it has been reported more often with SSRIs. It is not uncommon for SSRIs to cause or worsen insomnia; the sedating antidepressant can be used in such cases. Irreversible , an older class of antidepressants, have been plagued by potentially life-threatening dietary and drug interactions. They are still used only rarely, although newer and better-tolerated agents of this class have been developed. The safety profile is different with reversible monoamine oxidase inhibitors such as where the risk of serious dietary interactions is negligible and dietary restrictions are less strict. For children, adolescents, and probably young adults between 18 and 24 years old, there is a higher risk of both suicidal ideations and suicidal behavior in those treated with SSRIs. For adults, it is unclear whether SSRIs affect the risk of suicidality. One review found no connection; another an increased risk; and a third no risk in those 25—65 years old and a decrease risk in those more than 65. A was introduced in the United States in 2007 on SSRI and other antidepressant medications due to increased risk of suicide in patients younger than 24 years old. Similar precautionary notice revisions were implemented by the Japanese Ministry of Health. Other medications There is some evidence that fish oil supplements containing high levels of EPA to DHA are effective in the treatment of, but not the prevention of major depression. However, a Cochrane review determined there was insufficient high quality evidence to suggest Omega-3 fatty acids were effective in depression. There is limited evidence that vitamin D supplementation is of value in alleviating the symptoms of depression in individuals who are vitamin D deficient. There is some preliminary evidence that have a beneficial effect on major depression. There is a narrow range of effective and safe dosages of lithium thus close monitoring may be needed. Low-dose may be added to existing antidepressants to treat persistent depression symptoms in people who have tried multiple courses of medication. Limited evidence suggests such as and may be effective in the short term, or as add on therapy. Also, it is suggested that supplement may have a role in depression management. Electroconvulsive therapy ECT is a standard treatment in which are electrically induced in patients to provide relief from psychiatric illnesses. A round of ECT is effective for about 50% of people with treatment-resistant major depressive disorder, whether it is unipolar or. Follow-up treatment is still poorly studied, but about half of people who respond relapse within twelve months. Aside from effects in the brain, the general physical risks of ECT are similar to those of brief. ECT is considered one of the least harmful treatment options available for severely depressed pregnant women. A usual course of ECT involves multiple administrations, typically given two or three times per week until the patient is no longer suffering symptoms. ECT is administered under anesthetic with a muscle relaxant. Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and symptom remission. After treatment, drug therapy is usually continued, and some patients receive maintenance ECT. ECT appears to work in the short term via an effect mostly in the , and longer term via effects primarily in the. Transcranial magnetic stimulation Transcranial magnetic stimulation TMS or is a noninvasive method used to stimulate small regions of the brain. TMS was approved by the FDA for treatment-resistant major depressive disorder in 2008 and as of 2014 evidence supports that it is probably effective. The American Psychiatric Association the Canadian Network for Mood and Anxiety Disorders, and the Royal Australia and New Zealand College of Psychiatrists have endorsed rTMS for trMDD. Other Bright reduces depression symptom severity, with benefit was found for both and for nonseasonal depression, and an effect similar to those for conventional antidepressants. For non-seasonal depression, adding light therapy to the standard antidepressant treatment was not effective. For non-seasonal depression where light was used mostly in combination with antidepressants or a moderate effect was found, with response better than control treatment in high-quality studies, in studies that applied morning light treatment, and with people who respond to total or partial sleep deprivation. Both analyses noted poor quality, short duration, and small size of most of the reviewed studies. There is insufficient evidence for and dance movement therapy in depression. Major depressive episodes often resolve over time whether or not they are treated. Outpatients on a waiting list show a 10—15% reduction in symptoms within a few months, with approximately 20% no longer meeting the full criteria for a depressive disorder. The duration of an episode has been estimated to be 23 weeks, with the highest rate of recovery in the first three months. Studies have shown that 80% of those suffering from their first major depressive episode will suffer from at least 1 more during their life, with a lifetime average of 4 episodes. Other general population studies indicate that around half those who have an episode recover whether treated or not and remain well, while the other half will have at least one more, and around 15% of those experience chronic recurrence. Studies recruiting from selective inpatient sources suggest lower recovery and higher chronicity, while studies of mostly outpatients show that nearly all recover, with a median episode duration of 11 months. Around 90% of those with severe or psychotic depression, most of whom also meet criteria for other mental disorders, experience recurrence. Recurrence is more likely if symptoms have not fully resolved with treatment. Current guidelines recommend continuing antidepressants for four to six months after remission to prevent relapse. Evidence from many indicates continuing antidepressant medications after recovery can reduce the chance of relapse by 70% 41% on placebo vs. The preventive effect probably lasts for at least the first 36 months of use. Those people experiencing repeated episodes of depression require ongoing treatment in order to prevent more severe, long-term depression. In some cases, people must take medications for long periods of time or for the rest of their lives. Cases when outcome is poor are associated with inappropriate treatment, severe initial symptoms that may include psychosis, early age of onset, more previous episodes, incomplete recovery after 1 year, pre-existing severe mental or medical disorder, and as well. Depressed individuals have a shorter than those without depression, in part because depressed patients are at risk of dying by suicide. However, they also have a higher from other causes, being more susceptible to medical conditions such as heart disease. Up to 60% of people who die by suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and. The lifetime risk of suicide associated with a diagnosis of major depression in the US is estimated at 3. The estimate is substantially lower than a previously accepted figure of 15%, which had been derived from older studies of hospitalized patients. Depression is often associated with unemployment and poverty. Major depression is currently the leading cause of in North America and other high-income countries, and the fourth-leading cause worldwide. In the year 2030, it is predicted to be the second-leading cause of disease burden worldwide after , according to the World Health Organization. Delay or failure in seeking treatment after relapse, and the failure of health professionals to provide treatment, are two barriers to reducing disability. The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. In most countries the number of people who have depression during their lives falls within an 8—18% range. In North America, the probability of having a major depressive episode within a year-long period is 3—5% for males and 8—10% for females. Major depression to be about twice as common in women as in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this. The relative increase in occurrence is related to pubertal development rather than chronological age, reaches adult ratios between the ages of 15 and 18, and appears associated with psychosocial more than hormonal factors. Depression is a major cause of worldwide. People are most likely to develop their first depressive episode between the ages of 30 and 40, and there is a second, smaller peak of incidence between ages 50 and 60. The risk of major depression is increased with neurological conditions such as , , or , and during the first year after childbirth. It is also more common after cardiovascular illnesses, and is related more to a poor outcome than to a better one. Studies conflict on the prevalence of depression in the elderly, but most data suggest there is a reduction in this age group. Depressive disorders are more common to observe in urban than in rural population and the prevalence is in groups with stronger socioeconomic factors i. It was a similar but far broader concept than today's depression; prominence was given to a clustering of the symptoms of sadness, dejection, and despondency, and often fear, anger, delusions and obsessions were included. The term also came into use in and. An early usage referring to a psychiatric symptom was by French psychiatrist in 1856, and by the 1860s it was appearing in medical dictionaries to refer to a physiological and metaphorical lowering of emotional function. Since , melancholia had been associated with men of learning and intellectual brilliance, a hazard of contemplation and creativity. The newer concept abandoned these associations and through the 19th century, became more associated with women. A historical caricature of a man with an approaching depression Although melancholia remained the dominant diagnostic term, depression gained increasing currency in medical treatises and was a synonym by the end of the century; German psychiatrist may have been the first to use it as the overarching term, referring to different kinds of melancholia as depressive states. He theorized that loss, such as the loss of a valued relationship through death or a romantic break-up, results in loss as well; the depressed individual has identified with the object of affection through an , process called the libidinal of the. Such loss results in severe melancholic symptoms more profound than mourning; not only is the outside world viewed negatively but the ego itself is compromised. The patient's decline of self-perception is revealed in his belief of his own blame, inferiority, and unworthiness. He also emphasized early life experiences as a predisposing factor. The first version of the DSM DSM-I, 1952 contained depressive reaction and the DSM-II 1968 depressive neurosis, defined as an excessive reaction to internal conflict or an identifiable event, and also included a depressive type of manic-depressive psychosis within Major affective disorders. In the mid-20th century, researchers theorized that depression was caused by a in neurotransmitters in the brain, a theory based on observations made in the 1950s of the effects of and in altering monoamine neurotransmitter levels and affecting depressive symptoms. The chemical imbalance theory has never been proven. To maintain consistency the ICD-10 used the same criteria, with only minor alterations, but using the DSM diagnostic threshold to mark a mild depressive episode, adding higher threshold categories for moderate and severe episodes. The ancient idea of melancholia still survives in the notion of a melancholic subtype. The new definitions of depression were widely accepted, albeit with some conflicting findings and views. There have been some continued empirically based arguments for a return to the diagnosis of melancholia. There has been some criticism of the expansion of coverage of the diagnosis, related to the development and promotion of antidepressants and the biological model since the late 1950s. It is often used to mean this syndrome but may refer to other or simply to a low mood. People's conceptualizations of depression vary widely, both within and among cultures. What we call it—'disease,' 'disorder,' 'state of mind'—affects how we view, diagnose, and treat it. The diagnosis is less common in some countries, such as. It has been argued that the Chinese traditionally deny or emotional depression although since the early 1980s, the Chinese denial of depression may have modified. Alternatively, it may be that Western cultures reframe and elevate some expressions of human distress to disorder status. Similarly, Hungarian-American psychiatrist and others argue that depression is a metaphorical illness that is inappropriately regarded as an actual disease. There has also been concern that the DSM, as well as the field of that employs it, tends to abstract phenomena such as depression, which may in fact be. Stigma Historical figures were often reluctant to discuss or seek treatment for depression due to about the condition, or due to ignorance of diagnosis or treatments. Nevertheless, analysis or interpretation of letters, journals, artwork, writings, or statements of family and friends of some historical personalities has led to the presumption that they may have had some form of depression. People who may have had depression include English author , American-British writer , and American president. Some well-known contemporary people with possible depression include Canadian songwriter and American playwright and novelist. Some pioneering psychologists, such as Americans and , dealt with their own depression. There has been a continuing discussion of whether neurological disorders and mood disorders may be linked to , a discussion that goes back to Aristotelian times. British literature gives many examples of reflections on depression. Social stigma of major depression is widespread, and contact with mental health services reduces this only slightly. Public opinions on treatment differ markedly to those of health professionals; alternative treatments are held to be more helpful than pharmacological ones, which are viewed poorly. In the UK, the and the conducted a joint Five-year Defeat Depression campaign to educate and reduce stigma from 1992 to 1996; a study conducted afterwards showed a small positive change in public attitudes to depression and treatment. Trials are looking at the effects of on depression. The idea is that the drug is used to make the person look less frowning and that this stops the negative from the face. In 2015 it turned out, however, that the partly positive effects that had been observed until then could have been effects. MDD has been studied by taking scans of patients with depression have revealed a number of differences in brain structure compared to those who are not depressed. Meta-analyses of studies in major depression reported that, compared to controls, depressed patients had increased volume of the and and smaller volumes of the , , , and including the and. Hyperintensities have been associated with patients with a late age of onset, and have led to the development of the theory of. See also: Depression is especially common among those over 65 years of age and increases in frequency with age beyond this age. In addition the risk of depression increases in relation to the age and frailty of the individual. Depression is one the most important factors which negatively impact quality of life in adults as well as the elderly. Both symptoms and treatment among the elderly differ from those of the rest of the adult populations. As with many other diseases it is common among the elderly not to present classical depressive symptoms. Diagnosis and treatment is further complicated in that the elderly are often simultaneously treated with a number of other drugs, and often have other concurrent diseases. Treatment differs in that studies of SSRI-drugs have shown lesser and often inadequate effect among the elderly, while other drugs with more clear effects have adverse effects which can be especially difficult to handle among the elderly. However, elderly with depression are seldom offered any psychological treatment, and the evidence surrounding which other treatments are effective is incomplete. ECT or electric-shock therapy has been used as treatment of the elderly, and register-studies suggest it is effective although less so among the elderly than among the rest of the adult population. The risks involved with treatment of depression among the elderly as opposed to benefits is not entirely clear. Awaiting more evidence on how depression-treatment among the elderly is best designed it is important to follow up treatment results, and to reconsider changing treatments if it does not help. Further information: Models of depression in animals for the purpose of study include iatrogenic depression models such as drug induced , forced swim tests, tail suspension test, and learned helplessness models. Criteria frequently used to assess depression in animals include expression of despair, neurovegetative changes, and anhedonia, as many other depressive criteria are untestable in animals such as guilt and suicidality. Retrieved 31 July 2016. Annual Review of Public Health. Annals of Internal Medicine. The Cochrane Database of Systematic Reviews 4 : CD002792. The Psychiatric Clinics of North America. Archived from the original on 27 July 2011. Retrieved 7 September 2008. Archives of General Psychiatry. Retrieved 12 November 2014. American Journal of Surgery. North Sydney, New South Wales: NSW Health Department. PDF from the original on 1 April 2015. The British Journal of Psychiatry. Primary Care Companion to the Journal of Clinical Psychiatry. Journal of Substance Abuse. Delivered from distraction: Getting the most out of life with Attention Deficit Disorder. New York: Ballantine Books. The Journal of Clinical Psychiatry. Archives of Internal Medicine. The Journal of Clinical Psychiatry. Mental Health: A Report of the Surgeon General. PDF from the original on 17 December 2008. Retrieved 11 November 2008. PDF from the original on 17 December 2008. Retrieved 11 November 2008. The Psychiatric Clinics of North America. Archives of General Psychiatry. Archives of General Psychiatry. The Western Journal of Medicine. Journal of Affective Disorders. International Journal of Child Health and Human Development. Archived from on 2010-12-23. Archives of General Psychiatry. Dialogues in Clinical Neuroscience. Depression Research and Treatment. The Journal of Clinical Psychiatry. Archives of General Psychiatry. Archives of General Psychiatry. Neuropsychopharmacology: the fifth generation of progress: an official publication of the American College of Neuropsychopharmacology 5th ed. The Journal of General Physiology. Neuroscience and Biobehavioral Reviews. Journal of Neurology, Neurosurgery, and Psychiatry. Current Opinion in Psychiatry. Archives of General Psychiatry. Archives of General Psychiatry. Primary Care Companion to the Journal of Clinical Psychiatry. Neuropsychiatric Disease and Treatment. The Journal of Neuropsychiatry and Clinical Neurosciences. Journal of Affective Disorders. The American Journal of Psychiatry. Canadian Family Physician Medecin De Famille Canadien. British Broadcasting Corporation BBC. Retrieved 11 October 2008. The Journal of Nervous and Mental Disease. Journal of Psychiatric and Mental Health Nursing. Journal of General Internal Medicine. Journal of Mental Health. Journal of Affective Disorders. Dementia and Geriatric Cognitive Disorders. The Journal of Clinical Psychiatry. Journal of Geriatric Psychiatry and Neurology. Archives of General Psychiatry. Retrieved 8 November 2008. Biology of Depression: From Novel Insights to Therapeutic Strategies eds J. Retrieved 30 October 2008. PDF from the original on 23 March 2014. Retrieved 12 November 2014. Clinical description and diagnostic guideline. Archives of General Psychiatry. The American Journal of Psychiatry. European Archives of Psychiatry and Clinical Neuroscience. The American Journal of Psychiatry. Retrieved 30 October 2008. Journal of Affective Disorders. International Journal of Behavioral Medicine. The American Journal of Psychiatry. Journal of Epidemiology and Community Health. PSYCHOLOGY FOR HEALTH: Contributions to Policy Making, Brussels. PDF from the original on 12 May 2013. Medical Journal of Australia. PDF from the original on 12 November 2014. Retrieved 12 November 2014. British Journal of Psychiatry. PDF from the original on 26 March 2009. Retrieved 2 April 2009. National Institute for Health and Care Excellence. Retrieved 20 March 2013. The American Journal of Psychiatry. The Cochrane Database of Systematic Reviews. The Cochrane Database of Systematic Reviews. National Clinical Practice Guideline Number 23. PDF from the original on 17 December 2008. Retrieved 4 November 2008. The Cochrane Database of Systematic Reviews. The British Journal of Psychiatry. Journal of Affective Disorders. PDF from the original on 9 January 2017. Encyclopedia of Sciences and Religions. The Cochrane Database of Systematic Reviews. The Cochrane Database of Systematic Reviews. The Cochrane Database of Systematic Reviews. International Journal of Geriatric Psychiatry. Retrieved 16 August 2008. Journal of Consulting and Clinical Psychology. What Works for Whom? Second Edition: A Critical Review of Psychotherapy Research. Revista Brasileira De Psiquiatria. The International Journal of Neuropsychopharmacology. Journal of Consulting and Clinical Psychology. Child and Adolescent Psychiatric Clinics of North America. Journal of the American Psychoanalytic Association. Retrieved 12 November 2014. The Cochrane Database of Systematic Reviews. The New England Journal of Medicine. Medicines and Healthcare products Regulatory Agency MHRA. Archived from on 13 November 2008. NHS National Institute for Health and Clinical Excellence. Archived from PDF on 12 November 2014. Retrieved 12 November 2014. The British Journal of Psychiatry. Journal of the American Geriatrics Society. The Annals of Pharmacotherapy. The Cochrane Database of Systematic Reviews. Journal of Affective Disorders. The Journal of Clinical Psychiatry. PDF from the original on 25 June 2008. Retrieved 29 May 2008. The Cochrane Database of Systematic Reviews. Retrieved 29 May 2008. Ministry of Health, Labour and Welfare Japan. PDF from the original on 29 April 2011. The British Journal of Psychiatry. The Cochrane Database of Systematic Reviews 11 : CD004692. Journal of Affective Disorders. American Psychiatric Association APA. Retrieved 3 November 2014. The Journal of Clinical Psychiatry. The Australian and New Zealand Journal of Psychiatry. The Cochrane Database of Systematic Reviews 2 : CD003390. In A Tasman, J Kay, JA Lieberman eds Psychiatry, Second Edition. Current Opinion in Anaesthesiology. Prepared for the 27—28 January 2011 meeting of the Neurological Devices Panel Meeting to Discuss the Classification of Electroconvulsive Therapy Devices ECT. These guidelines include: APA Task Force on ECT 2001 ; Third report of the Royal College of Psychiatrists' Special Committee on ECT 2004 ; National Institute for Health and Clinical Excellence NICE 2003; NICE 2009. There is significant agreement between the three sets of recommendations. Washington, DC: American Psychiatric Publishing. Expert Review of Neurotherapeutics. Journal of Geriatric Psychiatry and Neurology. Archived from on 4 October 2015. PDF from the original on 31 March 2010. Archived from PDF on 23 August 2015. The American Journal of Psychiatry. The Cochrane Database of Systematic Reviews 2 : CD004050. The Cochrane Database of Systematic Reviews 4 : CD006833. The Cochrane Database of Systematic Reviews 2 : CD009895. Journal of Affective Disorders. The Journal of Nervous and Mental Disease. Expert Review of Neurotherapeutics. Archives of General Psychiatry. The Journal of Clinical Psychiatry. Retrieved 16 July 2010. Retrieved 16 July 2010. Journal of Psychosomatic Research. The Journal of Clinical Psychiatry. Journal of Cardiovascular Medicine. Abnormal psychology: An integrative approach 5th ed. Belmont, CA, USA: Thomson Wadsworth. The Australian and New Zealand Journal of Psychiatry. The American Journal of Psychiatry. The American Journal of Psychiatry. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. Retrieved 11 November 2009. Archives of General Psychiatry. Archives of General Psychiatry. Retrieved 19 October 2008. Archives of General Psychiatry. Journal of Neurology, Neurosurgery, and Psychiatry. Retrieved 30 June 2008, from 3 December 2008 at the. The New York Times. Retrieved 30 October 2008. The British Journal of Psychiatry. Annals of General Psychiatry. On Metapsychology: The Theory of Psycholoanalysis. Journal of Mental Science. Washington, DC: American Psychiatric Publishing, Inc. Retrieved 3 August 2008. The American Journal of Psychiatry. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie Review. In: Maj M, Akiskal HS, López-Ibor JJ, Sartorius N eds. PDF from the original on 14 December 2005. Retrieved 8 November 2008. European Archives of Psychiatry and Clinical Neuroscience. Cambridge, MA: Harvard University Press. Retrieved 3 October 2008. The American Journal of Psychiatry. Journal of Mental Health. Retrieved 16 November 2008. New York, NY, USA: Routledge. A blue fire: Selected writings by James Hillman. Archived from on 8 October 2008. Retrieved 19 August 2008. The Inner World of Abraham Lincoln. Urbana: University of Illinois Press. Retrieved 3 October 2008. The American Journal of Geriatric Psychiatry. Letters of William James Vols. Montana USA: Kessinger Publishing Co. Watson: The Founder of Behaviourism. Dialogues in Clinical Neuroscience. The melancholy muse: Chaucer, Shakespeare and early medicine. Pittsburgh, PA, USA: Duquesne University Press. Retrieved 9 August 2008. Retrieved 5 November 2008. Black Dog Institute website. Archived from PDF on 10 September 2008. Retrieved 18 August 2008. In Andrews G, Henderson S. Unmet Need in Psychiatry:Problems, Resources, Responses. The American Journal of Psychiatry. The British Journal of Psychiatry. Archives of General Psychiatry. Journal of Neurology, Neurosurgery, and Psychiatry. Retrieved 16 June 2016. Current Topics in Behavioral Neurosciences. Current Topics in Behavioral Neurosciences. Diagnostic and statistical manual of mental disorders Fourth Edition, Text Revision: DSM-IV-TR ed. Washington, DC: American Psychiatric Publishing, Inc. Abnormal psychology: An integrative approach 5th ed. Belmont, CA, USA: Thomson Wadsworth. Cognitive Therapy of depression. New York, NY, USA: Guilford Press. An Introduction to the History of Psychology 5th ed. Belmont, CA, USA: Thomson Wadsworth. The discovery of being: Writings in existential psychology. New York, NY, USA: W. Melancholia: a disorder of movement and mood: a phenomenological and neurobiological review. Cambridge, UK: Cambridge University Press. UK: BMJ Group and RPS Publishing.

Kad dusa zaboli !
Dialogues in clinical neuroscience 10 2 : 251—5. Druga protiargument temelji na poskusih s farmakološkimi učinkovinami, ki monoamine izčrpajo; namerno zmanjšanje koncentracije centralno razpoložljivih monoaminov lahko nekoliko zniža razpoloženje neterapiranih depresivnih bolnikov,na razpoloženje zdravih ljudi pa to ne vpliva. Bipolinis afektinis sutrikimas maniakin depresija priskiriama nuolatiniams afektiniams nuotaikos sutrikimams. Niekoľko vedeckých štúdií potvrdilo štatistickú koreláciu medzi depresiou a nadmernému vystaveniu niektorým poľnohospodárskym pesticídom. Raven BDNF v krvni plazmi depresivnih oseb je drastično zmanjšana več kot trikrat v primerjavi s kontrolo. Pri starejših ljudeh depresije zgleda ne zmanjšuje.

[Deepak chopra srodna-dusa|Domači pornić|Domaćice : ZIMSKA SALATA OD BELE ROTKVE]