Depression

Depression can be classified in various ways and can take many forms, including bipolar or manic depression (Akiskal & Pinto, 1999; Goodwin & Jamison, 1990), major depression (Beckham et al., 1995), and dysthymia (Griffiths et al., 2000). The symptoms of major depression include loss of pleasure (anhedonia) (Clark, 2000; Willner, 1993); loss of motivation/interest (Klinger, 1975; 1993; Watson & Clark, 1988); negative thinking about the self, world and future (Beck et al., 1979); increased negative emotions (such as anxiety and anger) (van Praag, 1998); problems in cognitive functions such as memory, attention, and concentration (Gotlib et al., 2000; Watts, 1993); dysfunctional changes in sleep and restorative processes (Moldofsky & Dickstein, 1999); and a host of biological changes in various neurotransmitter and hormonal systems (McGuade & Young, 2000; Thase & Howland, 1995), and various brain areas such as the frontal cortex (Davidson, 2000). Major depression, although highly heterogeneous, is a common disorder with a point prevalence of around 5% (Kaelber et al., 1995), and a 12-month prevalence twice this — 7.7% for men and 12.9% for women (Kessler et al., 1994)—although both point and yearly prevalence can be much higher in some disadvantaged and traumatised communities (Bebbington et al., 1989). One in 4-5 women and one in 7-10 men will have an episode at some time in their lives (Bebbington, 1998). At least 50% of people with major depression will have more than one episode, with early-onset depression (on or before 20 years) being particularly vulnerable to relapse (Giles et al., 1989). Indeed, major depression is often a relapsing condition, and in about 20% of cases it can become chronic (McCullough, 2000; Scott, 1988). The World Heath Organisation has pointed out that depression constitutes one of the most common mental health problems; is a major personal, social, and economic burden; and is increasing (Murray & Lopez, 1996; Fombonne, 1994, 1999).

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