Depressive Disorders
Depressive Disorders
Authored by: Christiana Louisa Ticoalu, M.A., Psychology & Management
Language Editor: Alda Belinda
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog
Welcome
Dear Reader,
IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions.
Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.
Definition
Depressive Disorders vs. Sadness
The unfortunate reality is that everyone feels sadness and dejection from time to time, oftentimes due to the pressures of life in general. People from all walks of life are frequently exposed to extremely difficult or unpleasant experiences beyond their control that trigger adverse emotions. Indeed, to a certain extent, a depressed mood may be an expected response to detrimental life experiences and adversities. Furthermore, sadness in itself may be considered a normal part of the spectrum of human emotion.
To provide an example, many individuals endure deep sadness or grief upon losing a loved one: due to a conscious choice to end a relationship or bereavement. Whilst sadness is a hallmark of depression, it in itself is not considered a sufficient indicator of an underlying depressive disorder. Individuals experiencing depressive disorders differ from those experiencing sadness or grief with regard to the range, severity, and duration of their symptoms. Further, their symptoms go above and beyond what is expected relative to their situational and sociocultural context.
What is Depressive Disorders?
Though the symptoms of depressive disorders are heterogeneous, the conditions share several commonalities. Firstly, depressive disorders are characterized by a loss of pleasure or a depressed mood (including sadness, irritability and emptiness). Secondly, individuals who are experiencing depressive disorders usually endure a combination of cognitive, behavioural and neuro-vegetative symptoms, the latter of which may include a lack of appetite, weight fluctuations and insomnia. These symptoms are experienced for the larger part of almost every day, for a period of at least two weeks. Collectively, these symptoms greatly undermine an individual’s ability to function across important life domains.
Symptoms
For a comprehensive list of depressive disorders symptomatology, we recommend you visit the ICD-11 webpage.
Comorbidities
Comorbidities are co-occurring conditions that lead to a greater symptom burden, and may in some cases predict poorer course and outcome. Common conditions that appear alongside depressive episodes include but are not limited to:
- Obsessive-Compulsive Disorder
- Anxiety disorders including generalized anxiety disorder, social anxiety disorder, panic disorder and agoraphobia
- Post-traumatic stress disorder
- Personality disorders
Development and Course
We would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.
- Rarely appearing in childhood, the condition increases in prevalence after puberty.
- Depressive disorders typically appear during an individual’s mid-20s.
- There is considerable variation in the course of depressive disorders. Whilst some individuals experience chronic, relentless and unremitting depressive episodes, others experience a shorter course and less-detrimental outcomes.
- In the absence of evidence-based treatment, many individuals experience partial remission and continue to experience residual symptoms.
Variability
There are variations in the way this condition presents. Below, we present findings reported within the ICD-11.
Age-Related Differences
- Amongst young children, the depressed mood often manifests as somatic symptoms including headaches and stomach aches and separation anxiety
- A deficit in concentration often leads to reduced academic performance, an increase in the amount of time required to finish school assignments, or struggles to complete assigned work
- Compared to adults, children are more likely to demonstrate symptoms of hypersomnia (excessive sleepiness throughout the day, even after getting a good night’s rest)
- Children and adolescents are more likely to endure hyperphagia (extreme and abnormal increases in appetite); as such, appetite disturbances in children often materialize as weight gain. Conversely, adults often have trouble eating, consequently leading to weight loss.
- Intentional self-injuries may begin in childhood
- Individuals of all age-groups are at risk of contemplating, and committing, suicide.
Gender and Sex-Related Differences
- Prior to puberty, the condition appears with similar prevalence between boys and girls.
- Following puberty, girls are approximately twice as likely as boys to experience a depressive episode.
Etiological Risk Factors
The factors contributing to the onset and maintenance of this condition are heterogeneous and multifactorial in nature. In most cases, the condition is a result of several precipitating factors interacting together in concert. For instance, dispositional factors typically interact with the environment in which the condition develops.
Nevertheless, we remind you that whilst a correlation exists between these variables and the manifestation of the condition, its onset, prognosis, and outcome are not definitively based upon the presence of one, or even several, of the variables.
Temperamental or personality factors
- Low self-esteem
- The tendency to engage in self-criticism
- The tendency to adopt pessimistic views of the world and future
Heritability
- The condition is more common amongst those who have a close family member with a history of mood disorders (including but not limited to depression) and/or substance use
The presence of other mental health conditions
- Simultaneously enduring other mental health conditions including anxiety disorders, eating disorders, or PTSD
- Enduring, or having previously endured, chronic physiological illnesses including cancer, heart conditions or strokes
Neurobiological factors
- The under reactivation of the prefrontal cortex areas has been observed amongst individuals with depressive disorders. This includes both the lateral and anterior cingulate cortex which have been implicated in cognitive control.
- The condition is associated with the over-activation of the amygdala, the area of the brain that plays a central role in threat response, including anxiety and negative emotions.
- This dysregulation is accompanied by alterations in neurotransmitter systems, including noradrenergic, cholinergic, serotonergic, and dopaminergic pathways
Environmental factors
- Being raised by parents with depression or symptoms of serious psychiatric conditions
- A childhood in which one was subjected to such a stressful, unpredictable environment
- Adverse or traumatic life events
- A history of abuse (emotional, physical, sexual or otherwise)
Consequences
The symptoms of depressive disorders have widespread consequences across social, economic, academic, occupational domains and otherwise. These consequences may have detrimental effects on one’s quality of life. Whilst not everyone experiencing this condition will experience these disruptions, studies have highlighted various associated correlating consequences. Individuals with the condition have been observed to be at heightened risk for:
- Low energy
- Social isolation
- Strained social relationships
- Strained familial relationships
- Compromised health
- Difficulty maintaining employment
- Lower academic attainment
- Suicide ideations and suicide
A Gentle Reminder
We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help.
Sources and Readings
Disclaimer
We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading.
World Health Organization. (2019). ICD-11: International Classification of Diseases (11th revision). Retrieved from https://icd.who.int/
Code for Single Depressive Disorder: 6A70
Fried, E., & Nesse, R. (2014). The Impact of Individual Depressive Symptoms on Impairment of Psychosocial Functioning. Plos ONE, 9(2), e90311. doi: 10.1371/journal.pone.0090311
Monroe, S., & Harkness, K. (2022). Major Depression and Its Recurrences: Life Course Matters. Annual Review Of Clinical Psychology, 18(1), 329-357. doi: 10.1146/annurev-clinpsy-072220-021440