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Depression: Tests, Symptoms, Causes, And Treatment


Depressive disorder refers to a strong sadness that affects social functioning and/or leads to loss of interest or fun in the activity. Although depression may occur after a recent loss or other sad event, this sadness often manifests as an inappropriate emotional response that exceeds the actual situation and lasts for a long time.

·         Genetic factors, side effects of drugs, events that cause mental distress, changes in hormone levels or other substance levels in the body, and many other factors can cause depression.

·         Depression can make people sad and lazy and/or lose interest and fun with things they like.

·         Diagnosis is based primarily on symptoms.

·         Antidepressants and psychotherapy can be used for treatment, and electroconvulsive therapy can sometimes be used.

The term “depression” is often used to describe sadness or depression caused by grief events such as natural disasters, serious illness or death of a loved one. Some people also claim to feel depressed at certain times, such as on holidays (holiday depression) or when they meet their loved ones. However, these feelings usually do not represent illness. Generally speaking, these feelings are temporary, only lasting for a few days instead of weeks or months, and they are often seen when they think of or recall the grief. In addition, these feelings do not affect daily work and life for a long time.

Depression is the most common mental illness except anxiety. About 30% of primary care providers have depressive symptoms, but less than 10% have major depression.

Depression usually occurs in the ages of 15-17, 20 or 30, but depression can occur at almost any age, including childhood (child and adolescent depression ).


One in every six older people may have depression. Some elderly people have had depression in their early years. Others experience depression for the first time in old age.

Some of the causes of depression are more common in older people. For example, older people are more likely to experience pain loss, such as losing a dear one or losing a familiar home environment (such as moving away from a familiar environment). Other stress factors that can induce depression are also increased, such as a decrease in income, an increase in chronic diseases, and a change in personality due to gradual departure from the original relatives or friends.

Diseases that induce depression are common in the elderly. Such diseases include cancer, myocardial infarction, heart failure, thyroid disease, stroke, dementia, and Parkinson's disease.

For the elderly, depression can lead to symptoms similar to dementia: slow thinking, reduced concentration, confusion, and memory difficulties. But doctors can distinguish between depression and dementia because when the depression is treated, the patient's mental state is normal. This is not the case with dementia patients. In addition, depressed patients may complain about memory loss, but rarely forget important current or private events. In contrast, patients with dementia often deny a memory loss.

The diagnosis of senile depression is difficult, and the possible causes are as follows:

·         Due to the reduced social activities or work of the elderly, various depressive symptoms are more difficult to detect in time.

·         Some elderly patients think that depression is a weakness and is ashamed to tell people around them about the sadness or other symptoms they experience.

·         The emotional loss of the elderly is often mistaken for indifference.

·         Older patients and family members mistake various depressive symptoms for normal performance of aging.

·         Confused with other diseases, such as dementia.

Because of the above various reasons, it is difficult to detect senile depression in time, so doctors need to ask elderly patients about many emotional-related problems when diagnosing the disease. Family members should be alert to the patient's personality changes, especially becoming indifferent, lacking in spontaneity, loss of sense of humor and new-onset forgetfulness.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used antidepressants in elderly depressed patients because they cause fewer side effects. Citalopram and escitalopram are especially effective.

A typical depressive episode lasts about 6 months, or 2 years or more, if a person with depression does not receive treatment. The recurrence rate is high and can occur multiple times.

The Reason

Although the exact cause of depression is still unclear, it is currently found that several factors may be involved in its onset. Risk factors include

·         Family predisposition (genetic)

·         Grievous events, especially those involving death

·         Women, may be related to changes in hormone levels

·         Certain physical illnesses

·         Side effects of certain drugs

Depression is not a reflection of personality deficiencies or adverse events such as debilitating personality, personality disorder, severe trauma in childhood, or poor parental care. Social class, ethnicity and culture do not seem to affect a person's chance of suffering from depression in their lifetime. Depression can occur or worsen even without any significant or meaningful life stress.

Genetic abnormalities may be a cause of depression. It may work by affecting the expression of substances (neurotransmitters) that communicate with each other between nerve cells. The neurotransmitters involved in the onset of depression are currently found to be serotonin, dopamine and norepinephrine.

Women are more likely to develop depression than men, but the cause is not clear. However, hormone levels in physical factors are the most relevant factors. Changes in hormone levels in women before menstruation ( premenstrual syndrome ) or after delivery can induce mood changes, so changes in hormone levels may be related to female depression. In the first 4 weeks after delivery, some women experience depression (called postpartum depression, and if more serious, postpartum depression – postpartum depression ). Abnormal thyroid function is high in women and may also be a cause of depression.

Women are more likely to develop depression than men, but the cause is not clear. However, hormone levels in physical factors are the most relevant factors. Changes in hormone levels in women before menstruation ( premenstrual syndrome ) or after delivery can induce mood changes, so changes in hormone levels may be related to female depression. In the first 4 weeks after delivery, some women experience depression (called postpartum depression, and if more serious, postpartum depression – postpartum depression ). Abnormal thyroid function is high in women and may also be a cause of depression.

A variety of physical illnesses and factors can accompany or cause depression. Physical illness can directly lead to depression (such as when thyroid disease affects hormone levels) or indirectly (such as when rheumatoid arthritis causes pain and disability). Usually physical illness directly or indirectly induces depression. For example, when the human immunodeficiency virus (HIV), the causative agent of AIDS, damages the brain, AIDS can directly lead to depression. When AIDS brings various negative effects to a patient's life, it can indirectly lead to depression. Many people feel more sad when they go to the late autumn and winter, and blame it for the shortening of sunshine time and the decrease of temperature. However, in some people, this sadness can be very serious enough to be considered depression.

Some prescription drugs such as certain beta blockers (drugs that treat high blood pressure) can cause depression. For some unknown reason, corticosteroids often cause depression when they are produced in the body (such as Cushing's syndrome), but when used as a foreign drug, it often leads to frivolous (lighter forms of mania) or mania (rare) ( bipolar disorder ). Sometimes, discontinuation of a drug can cause temporary depression.

Multiple mental illnesses can increase a person's tendency to depression. Many mental illnesses can also trigger depression, such as certain anxiety disorders, alcohol dependence, drug abuse, and schizophrenia. This disease is often prone to recurrence.

Grief events (such as loss of loved ones) can sometimes induce depression, especially when it occurs in people with predisposing factors such as family history.


The clinical symptoms of depression usually appear gradually over a period of days or weeks and are diverse. For example, some people with depression are mainly slow-moving and low-lying, while others are irritating and anxious.

Many people with depression cannot experience certain emotions, including grief, happiness, and happiness. The world seems to be bleak and lifeless in their eyes. They lose interest and fun with things they like.

People with depression may focus on strong guilt and self-esteem and may not be able to concentrate. They may feel desperate, lonely and worthless. Therefore, these patients often show hesitance, taciturn, strong sense of helplessness and hopelessness, and even think of death and suicide.

Most depressed patients have difficulty falling asleep and will wake up repeatedly, especially in the early morning. Loss of appetite and weight loss associated with depression can lead to weight loss, and women can have menopause. However, mild depression can lead to overeating and weight gain.

Some depressed patients ignore personal hygiene and even ignore the hygiene of children, other relatives or pets. Some complain of physical discomfort and there is such pain.

“Depression” variety of related diseases:

·         Major depression

·         Persistent depression

·         Premenstrual anxiety

Major Depression

The patient is depressed for most of the day and lasts for at least 2 weeks. People with major depression can show painful expressions. They are full of tears, their eyebrows are close, and their mouths are pulled down. And it may be downcast and avoid eye contact. They may be seldom active, have few facial expressions, and have a monotonous speech.
Persistent Depression

The patient is depressed most of the time and lasts 2 years or more.

Symptoms gradually appear, usually beginning in adolescence and lasting for years or decades. The number of symptoms at different times is not the same, and sometimes the symptoms are milder than depression.

Patients can be gloomy, pessimistic, suspicious, lack of sense of humor and happy. Some are passive, listless, and not associated with people. Some keep complaining and blaming others or blaming themselves. They may be overly concerned with their lack of ability, failure and negative events, and sometimes enjoy morbid pleasure from their own failures.

Premenstrual Anxiety

Severe symptoms appear before most menstruation and disappear after menstruation. Symptoms cause significant pain and/or severely affect social functioning. Symptoms are similar to premenstrual syndrome ( premenstrual syndrome ) but are more severe than it can cause significant pain and affect work and social interaction.

The disease can occur at any time after menstruation. It can be aggravated by the proximity of menopause, but disappears after menopause. It occurs in about 2-6% of menstruating women.

The patient showed emotional volatility and suddenly became sad and tearful. They are easy to be provoked and easy to get angry. They can feel very depressed, hopeless, anxious and nervous. Some feel almost collapsed or out of control. They often feel depressed.

As with other types of depression, women with premenstrual anxiety can lose interest in their usual activities, struggle to concentrate, feel tired and listless. They may overeat and especially want to eat certain foods. They may sleep very little or a lot.

Like many women, these women may experience breast pain and/or muscle and joint pain before the onset of menstruation. They may feel puffy and gain weight.

Category Term

Doctors often use some terms to describe a particular type of depressive symptoms. These terms include

·         Anxiety: The patient feels nervous and is extremely upset. They have difficulty concentrating because they are worried or afraid of bad things or losing control of themselves.

·         Mixed: In addition to depression, patients also have 3 or more manic symptoms. Patients can feel energetic and confident. They talk more than usual and sleep very little. They can think and run.

·         Melancholy: Patients no longer like activities they like. They look lazy, sad and depressed. Speak very little, don't eat or drink, lose weight. May feel overwhelmed or not. They usually wake up in the morning but can't sleep anymore.

·         Atypical: Patients may be happy for a moment when they are in good deeds, such as when a child visits. Their appetite increases, leading to weight gain. Their sleep time may be extended. They are overly sensitive to their own criticism or rejection. They may feel burdened and seem to move without opening their legs.

·         Psychotic type: Patients often have uncontrollable false beliefs (such as delusions), such as having committed unforgivable crimes, or having diseases that cannot be cured or shy, or being monitored and victimized. The patient may have hallucinations, usually in the ear, always stalking the crime of blaming oneself or persecuting one's own death, and even the illusion of a coffin or a deceased relative.

·         Nervous: The patient is silent. Thinking, language, and daily activities are significantly slow so that many normal activities cannot participate or take place. Some patients will unconsciously imitate others' speech (simulating words) or actions (imitation actions).

·         Seasonal type: Depression occurs at specific times of the year, usually beginning in the fall or winter and ending in the spring. This situation is more common in the Antarctic and the Arctic, where winters are often long and hard. The patient is lazy and slow. They lost interest in their usual activities and showed a retreat. They can also experience excessive sleep and excessive eating.


Suicidal thoughts are one of the most serious depressive symptoms. They want to end their lives or feel that their lives are worthless and lose the meaning of survival. About 15% of untreated patients with depression end their lives through suicide. The threat of suicide is an emergency ( more information ). When a patient threatens to commit suicide, the doctor may have them hospitalized so that they can be supervised until the risk of suicide is reduced through treatment. Suicide tendencies are more likely to occur when depressed patients are:

·         Depression is not treated or inadequate treatment

·         At the beginning of treatment (patient's mental activity and physiology become more sensitive, but the mood is still low)

·         The patient returned to normal activities and continued to experience severe depression

·         The patient encountered a special anniversary

·         Patients alternate with depression and mania (bipolar disorder - bipolar disorder ).

·         Serious anxiety in the patient

·         Patients drinking alcohol or taking recreational drugs or illegal drugs, etc.

Drug Abuse

People with depression may often try to relieve difficulty or anxiety by falling asleep or taking other recreational drugs. However, it is often counterproductive, these patients may have alcoholism and drug addiction. In addition, depressed patients are also more likely to smoke a lot and ignore their health. Therefore, their risk of developing other diseases (such as chronic obstructive pulmonary disease) or causing other diseases to increase will also increase.


Doctors generally diagnose depression based on symptoms. A history of previous depression or family history can help confirm the diagnosis. Because excessive anxiety, panic attacks, and compulsion are common in depression, it is often easy for a physician to misdiagnose as an anxiety disorder.

Depression in the elderly may not be easy to detect, especially when they are not working or rarely attending social activities. In addition, because depression and dementia have similar symptoms, such as confusion, difficulty concentrating and unclear thinking, depression may be mistaken for dementia. However, if these symptoms are caused by depression, they will resolve after the depression is treated. If it is caused by dementia, it will not subside.

There are standardized questionnaires that can be used to diagnose depression and assess its severity, but not simply rely on them to diagnose depression. There are two types of questionnaires, the Hamilton Depression Scale and the Beck Depression Scale. The former is verbally implemented by interviewers and the latter is a self-administered questionnaire. Doctors often ask if the respondent has an idea or plan to hurt himself. If the patient does have such an idea, it indicates that there is a serious depressive disorder.

No examination can confirm the diagnosis of depression. However, laboratory tests can help doctors determine if a patient's depression is caused by endocrine or other physical illnesses. For example, doctors usually do blood tests to rule out thyroid disease or vitamin deficiency. Young patients may also need to be screened for drug abuse. A comprehensive neurological examination can help rule out Parkinson's disease with some of the same symptoms as depression. Polysomnography (polysomnography- examination ) helps to determine whether a patient's sleep disorder is associated with depression.


Most people with depression take a non-hospital treatment, but some patients must be hospitalized for treatment. Especially those who have serious suicide attempts or have committed suicidal behavior, or have significant weight loss, or have heart disease due to severe agitation.

·         Treatment varies depending on the extent and type of depression:

·         Mild depression: supportive care (including frequent visits and missions) and psychotherapy

·         Moderate or severe depression: medication and / or psychotherapy, sometimes with electroconvulsive therapy

·         Seasonal depression: phototherapy

Depression can usually be cured. If you can find a specific cause (such as a drug or disease), you should correct these reasons first, but you may still need to use antidepressants.


Doctors can schedule a visit or telephone contact for patients with depression on a weekly or bi-weekly basis. Doctors explain to patients and their families that there are physical causes of depression that require specialized treatments that are usually effective. The doctor comforts the patient and his family, and depression is not a representative defect.

Knowing about depression can help patients understand and respond to the disease. For example, patients can learn that the road to recovery is often difficult, and sadness and desperate thoughts may reappear but eventually disappear. In this way, the patient can correctly view any setbacks, and is more likely to adhere to treatment, not to give up halfway.

Do more exercise – often walking and exercising – can be helpful, and getting in touch with others can also help.

Mutual aid groups (such as the Depression and Bipolar Disorder Alliance - DBSA ) can help patients by providing a platform for patients to share experiences and feelings.


For mild depression, simple psychotherapy can achieve the same effect as medication. When used in combination with drugs, it can be effective for major depression.

Individual or group psychotherapy can help depressed patients gradually restore their previous social functions and adapt to normal life stress. Interpersonal relationship therapy focuses on the past and current social roles of patients, finds out the problems of patients in dealing with people, and guides patients to adapt to life roles. Variety. Cognitive behavioral therapy can help change desperate and negative thoughts.

Medical Treatement

There are a variety of antidepressants – selective serotonin reuptake inhibitors (SSRIs), heterocyclic antidepressants, monoamine oxidase inhibitors (MAOI) and several newer antidepressants – as well as alternatives. Choose a psychostimulant. Most drugs take a few weeks to be effective. To prevent recurrence, most patients require continuous antidepressant medication for 6 to 12 months. Patients over the age of 50 must be taken continuously for up to 2 years.

Different types of drugs have different side effects. Sometimes, when a drug does not relieve depression, another (category) or multiple combinations can be used.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used class of antidepressants today. SSRI is not only effective for depression, but also for other mental disorders often associated with depression. Although SSRI may cause side effects such as nausea, diarrhea, tremors, weight loss, and headache, these adverse reactions usually have mild symptoms or can be alleviated or even disappeared with continued medication. SSRI-induced side effects are more tolerable in most patients than tricyclic antidepressants. SSRI causes a lower risk of cardiac side effects than heterocyclic antidepressants. However, a small number of patients will experience aggravation of agitation, depression and anxiety after taking SSRI (within one week of taking the drug) or increasing the dose. Especially in children and young patients, if the above phenomenon is not detected and corrected in time, it will lead to an increase in suicidal tendencies. Therefore, for the relatives of patients taking SSRI, the clinical manifestations of the patients should be closely observed. If there is aggravation of depression and anxiety, it is necessary to contact the doctor for proper treatment. However, because depression patients do not receive treatment, there is also a risk of suicide. Therefore, patients and doctors must weigh the risk of side effects of drugs and the suicide risk of patients themselves when choosing drugs. Long-term use of SSRI can also cause other side effects such as weight gain and sexual dysfunction (about 1/3 of patients). If the SSRI is suddenly discontinued, it can cause withdrawal syndrome, often with dizziness, anxiety, irritability, nausea and flu-like symptoms.

The new type of antidepressant is a class of antidepressant drugs with similar efficacy and safety to SSRI drugs with similar side effects. These drugs include

·         Norepinephrine-dopamine reuptake inhibitor (bupropion)

·         Serotonin regulators (such as mirtazapine and trazodone)

·         Serotonin-norepinephrine reuptake inhibitors (eg venlafaxine and duloxetine)

Similar to the side effects of SSRI drugs, taking these new antidepressants initially leads to a transient increase in suicidal tendencies, and the sudden withdrawal of serotonin-norepinephrine reuptake inhibitors can result in discontinuation of the drug. Sign.

Heterocyclic (including tricyclic) antidepressants used to be the main drug for the treatment of depression, but because they have more side effects than other antidepressants, they are rarely used. It often leads to drowsiness and weight gain. It can also cause an increase in heart rate and a drop in blood pressure when standing (called orthostatic hypotension - dizziness or dizziness when standing up ). Other side effects, called anticholinergic effects, include blurred vision, dry mouth, blurred consciousness, constipation, and difficulty urinating. These side effects are all due to the anticholinergic effects of the drugs, which are more severe in the elderly ( anticholinergic effects: what do you mean? ). As with SSRI drugs, the sudden discontinuation of heterocyclic antidepressants induces withdrawal syndrome.

Monoamine oxidase inhibitor (MAO) is very effective but rarely used as a drug of choice. It is mainly used when other antidepressants are ineffective. Patients taking MAOI must follow strict dietary restrictions and take special precautions to avoid sudden and sharp increases in blood pressure and severe pulsatile headaches. This severe reaction is called a hypertensive crisis. Hypertensive crisis can lead to stroke. Preventive measures include.
·         Avoid eating foods or beverages containing tyramine, including bulk beer, red wine (with sherry), spirits, boiled food, Italian salty sausage, cheddar cheese, broad beans, lentils, yeast extract (yeast condiments) ), canned figs, raisins, yogurt, cheese, sour cream, pickled herring, caviar, liver, meat and soy sauce

·         Do not take drugs containing pseudoephedrine, such as many over-the-counter cough medicines and cold medicines

·         Avoid taking methadone (cough suppressant), reserpine (hypertensive drug) or pethidine (analgesic)

·         If you have a severe pulsatile headache, take an antagonist immediately and go to the nearest medical institution as soon as possible.

Patients taking MAOI should also avoid taking other types of antidepressants, including heterocyclic antidepressants, SSRI, bupropion, serotonin modulators, and serotonin-norepinephrine reuptake inhibitors. MAOI in combination with other antidepressants can cause life-threatening hyperthermia, muscle breakdown, kidney failure, and seizures. These side effects are called antipsychotic malignant syndromes and can be fatal.

Psychotropic stimulants (such as dextroamphetamine and methylphenidate) and other drugs are sometimes used to treat depression, often with antidepressants.

St. John's Wort is a botanical supplement that can sometimes be used to relieve mild depression, but its effects remain to be confirmed. Because St. John's wort can produce harmful and human interaction with many prescription drugs, and therefore intends to patients taking these herbs and their extracts whether there is a clear need for interaction (in the service of other drugs to their physician before taking St. John Wort ).

Electroconvulsive Therapy

Electroconvulsive therapy is sometimes used to treat patients with major depression, including those with psychotic symptoms, threats of suicide, or refusal to eat. It can also be used to treat depressed patients who are pregnant and unable to use medication. Unlike antidepressants, which take several weeks to work, electroconvulsive therapy can quickly and effectively relieve depressive symptoms. Therefore, the patient's life can be saved in time. Depression may recur after electroconvulsive therapy is stopped. To prevent recurrence, doctors often prescribe antidepressants.

During electroshock therapy, the electrodes are placed in the head and the resulting current induces a seizure through the brain. This seizure can relieve depression, but its mechanism of action is still unclear. Usually a course of treatment takes 5 to 7 times, every other day. Because current can cause muscle contraction and pain, patients need to receive general anesthesia during treatment. Electroconvulsive therapy may cause transient loss of memory, rarely in permanent memory loss.


Phototherapy is most effective for seasonal depression, but it can also be used to treat other types of depression. The phototherapy method is that the patient sits at a distance in front of a light box and receives sufficient light from the light box. The patient cannot look directly at the light and needs to sit in front of the light for at least 30 minutes. At what time of the day the phototherapy is performed depends on the patient's sleep and wakefulness time.

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