Running head: DEPRESSION 1
Depression
Name
Institution
Instructor
Date
DEPRESSION 2
Abstract
Major depressive disorder or depression is a global scourge and a big problem in the
United States. It is considered an immobilizing condition that has led to high-level public health
concerns, affecting one in every 15 adults in the country. There have been great advances in the
treatment and interventions that have been targeted towards high-risk groups; however, there is
still a large part of the population that still requires help. More intervention by various
stakeholders, collaborations between different disciplines is needed to bring down the levels of
depression within the country.
DEPRESSION 3
Depression
Introduction
Depression or major depressive disorder as it is also known is a mood disorder that
causes one to avoid doing any activities (APA, 2017). It can lead to even more severe symptoms
which affect how an individual thinks and does their day-to-day operations. An individual who is
experiencing a depressed mood is usually sad, feel dejected, helpless, and they feel they are
worthless. They also tend to display feelings of irritability, guilt, all the time they are angry, or
feel ashamed and always restless (APA, 2017). There is also the loss of interest, suicidal
thoughts, feeling aches and pains, cramps, or having digestion problems. The primary risk
factors for depression include genetics, the personality, some physical illness, significant changes
in someone's life, stress and trauma.
There are different types of depression and can be displayed differently depending on the
circumstances. Dysthymia or persistent depressive disorder is a prolonged type that can go up to
two years; the patient will experience fluctuations where they have severe symptoms to reduced
cases (NIH, n.d). Perinatal is a type of mild disorder and may clear within a fortnight; this kind is
common with pregnant women and may become full blown during or after delivery. Psychotic
depression combines severe depression and psychotic behavior (NIH, n.d). Seasonal affective
disorder is one that is triggered by seasonal changes mostly when there is reduced sunlight like in
winter times (NIH, n.d). However, it disappears as soon as the more favorable weather is
restored. Finally, bipolar disorder is also ranked under disorder because of the extreme periods of
low moods. Other types of disorders include the disruptive mood dysregulation disorder and
premenstrual dysphoric disorder (PMDD) (NIH, n.d).
The impact of depression
DEPRESSION 4
Major depression is still a prevalent and an immobilizing condition that makes up for a
vital public health problem in the United States. Many organizations have pointed out to its
impact, and it is seen as one of the leading health care priorities (Health People 2020, 2014).
According to statistics from the National Survey on Drug Use and Health, depression affects one
in every 15 adults each year which translates to approximately 16 million U.S adult populations
(National Institute of Mental Health, n.d). The World Health Organization report showed that
the major cases of depression are also the same ones that have the most burden when it comes to
disability in mental and behavioral disorders. Major depression leads to 3.7% of all the U.S
disability-adjusted life years (DALY) and 8.3% of the U.S years lived with disability (YLDs)
(National Institute of Mental Health, n.d).
Mental disorders still cause the most common disabilities, and the disease burden from it
is among the top most. Annually approximately 18.1% of U.S adults which is over 40 million
have mental illness and 4.2% which is 9.8 million suffer from incapacitating mental illness
(CBHSQ, 2015). Additionally, Neuropsychiatric disorders are ranked the highest as the leading
causative agent for disabilities in the U.S, and it accounts for 18.7% of all the years that are lost
to disability and premature mortality (US Burden of Disease Collaborators, 2013). Suicide is
ranked the 10th overall cause of death in the country that led to the death of over 40,000
Americans in the year 2014 (CDC, 2014).
The World Health Organization indicated that by the year 2030 depression will account
for the leading cause of disability than any other physical disorder or mental disorder that has
ever been given (Manicavasagar, 2012). Despite the great advances in medicine, treatment of
depression remains to be challenging with 30-40% of the cases being diagnosed as being
DEPRESSION 5
resistant to treatment. The treatment resistant types of depression do not respond to trials set and
other psychopharmacological treatments (Rongrong et al. 2015).
The importance of depression cannot be overestimated, and it has been seen as a global
burden by the World Health Organization, the body has even ranked unipolar affective disorder
as one of the leading medical causative agent of disability coming only second to ischemic
disease of the heart (Palazidou, 2012). The prevalence of the disorder is also high and leads to
lifetime risks of nearly 20% according to some study, and it is linked to mortality and morbidity
challenges (Kessler et al. 2005). The patients that are depressed are quite prone to physical
health problems such as coronary artery complications ailments and diabetes also resulting in
severe medical conditions (Palazidou, 2012).
Depression and effects on diverse populations
Depression cases in adult populations have been linked to exposure to sexual and
physical abuse of the individuals during their childhood years. A study by Lindert et al. (2014)
assembled data and made comparisons of ill-treatment against no-abuse exposure before the
people had reached their 16 years of age, and it was then compared to anxiety concerns after the
age 16 (Lindert et al. 2014). It was found that the anxiety, depression, and distress were reported
in adults that had experienced childhood sexual and physical abuse (Lindert et al. 2014). Another
group that has been significantly affected by depression are the physicians more especially those
that are in training. Studies have indicated that the resident physicians encounter higher levels of
depression as compared to the members of the public (Joules et al. 2014; Kessler et al. 2005).
A study by Mata et al. (2015) collected data from a pool of 31 cross-sectional studies
making up a total of 9447 individuals and an additional 23 longitudinal studies encompassing
8113 people. The studies utilized clinical interviews and also self-reporting instruments. The
DEPRESSION 6
results showed that there was a prevalence of depression or symptoms related to depressive
tendencies among the resident physicians giving an average result of 28% across different
instruments of analysis. The value also went to increase with the instrument tool and also with
the year’s progression.
Depression crisis and areas under investigation
Ongoing studies have indicated that depression is a long term, and at the same time has
relapsing conditions that result in morbidity and mortality and with high chances of ending with
chronic conditions (Palazidou, 2012). Approximately three-quarter of the patients go through
more than one episode of depression and also have a higher chance of recurrence once the first
episode has occurred in their younger years of growth and if there is a history of depression in
the family (Palazidou, 2012). There is a higher increase in recurrence as every new episode
comes by and also with the growing frequency of episodes of depression.
Another factor besides the depressive episodes is the duration of illness that remains
untreated (Palazidou, 2012). When there is a longer period the poorer the response will be the
treatment, and it, therefore, lowers the chances of remission. It has been seen that most of the
patients are not able to achieve full remission due to some factors such as the irregularity of
accessing treatment, there is also poor compliance, prematurely ending the treatment among
other factors (Palazidou, 2012). The long duration of depressions which occur over two years
are quite common, and they are considered to be acuter when compared with the episodic types
of depression and are linked with greater effects on cardiac and respiratory challenges. In such
situations, the patients tend to go through greater social fears and go abuse benzodiazepine
leading to impairment of their psychological well-being and somatic impairment (Palazidou,
2012).
DEPRESSION 7
There have been great strides made in the study of depression and how it is linked to
neurobiology. However, there are still areas that require further studies, and one example is an
investigation of the molecular functions that link the gene and the environment by which they
interact. By learning how the two link can go a long way in developing remediating solutions for
depression (Palazidou, 2012). Also, there is more exposition of the neuroanatomical and other
physiological connection linking the limbic parts and the prefrontal cortex (PFC) that may prove
useful when identifying the regions that can be targeted during treatment (Palazidou, 2012).
There is also the field of dysregulation of the HPA axis and other known stressors that have been
looked at in the near and distant past and may not be present at all times in depression but will
require further studying to be fully understood (Palazidou, 2012).
Depression and resiliency
Some of the psychosocial factors that are linked with the resilience of depression or stress
in general consist of emotions of optimism, happiness, and humor, flexible cognitive abilities,
and style, acceptance by the individual, spirituality (Southwick et al. 2005). Additionally, there is
altruistic behavior, social support, having a model of coping, the ability to recover from any
negative episodes, having role models, just to mention but a few. Besides those, there is the
ability of an individual to lower the likelihood of them developing stress triggered depression or
anxiety (Southwick et al. 2005). They are also in a position to treat any stress-triggered
psychopathological situations (Southwick et al. 2005).
To be able to achieve the above, there are activities that persons affected should cultivate;
they should find ways of making their days meaningful. They should remain optimistic, learn
from their experiences, and get to take care of themselves. When one encounters a difficult
period, they should learn to refer back to their past experiences to times when they overcame
DEPRESSION 8
similar challenges. Finally, a social connection is also helpful in nurturing resilience to
depression.
Depression and neurobiology
Studies have indicated that depressive disorder to be a long term condition that leads to
further relapse and that it is linked to greater levels of disability and even mortality (Palazidou,
2012). Depression has been linked to neurobiological concerns and related to the how the brain
is structured and how it functions and associated abnormalities (Palazidou, 2012). Studies have
indicated the genetic vulnerability and stress as the key triggers to aetiopathogenesis. (Palazidou,
2012). The dysregulation of the hypothalamo-pituitary adrenal (HPA) lowers the hippocampal
levels and also the activities of the prefrontal cortex (PFC) in individuals that are depressed
(Palazidou, 2012). Additionally, it interferes with the homeostasis that is within the neuro circuit
that links with depression.
Depression has been seen to have a multifactorial aetiopathogenesis and also a genetic
diathesis, coupled with both physical and psychological stress they play a major role and work
through several pathophysiological methods (Palazidou, 2012). Some of the symptoms include
reduced activity in neurotransmissions, lowered brain neurotrophins and hyperactivity at the
hypothalamo-pituitary adrenal (HPA) axis and also the inflammatory response channels
(Palazidou, 2012). The interference is linked to the functional defects of the neurocircuits that
end up affecting its balance. The prefrontal cortex (PFC) which is also affected and impaired in
will not be in a position to regulate the higher activities in the cortical or limbic areas and so lead
to the clinical appearance of depression (Palazidou, 2012). The correction of such cases is
achieved by use of antidepressants that function by raising the monoaminergic
neurotransmissions and the concentrations of BDNF and reverse the changes leading to
DEPRESSION 9
modulation at the cortico-limbic neuro-circuit functions that had been disrupted (Palazidou,
2012).
Depression and developmental theory
Many theories have been developed on depression. Behaviorism theory emphasizes the
environment as influencing one's behavioral patterns. Observable behaviors and the way by
which people learn such as operant conditioning, classical, and social learning theories link
depression to individuals' interaction with the environment (McLeod, 2015). Classical
conditioning asserts that depression is gained through learning by linking certain stimuli with
negative emotional scenarios. Operant conditioning is associated with the removal of positive
reinforcement from an environment (McLeod, 2015). For depression, it may be caused by one
losing their job or a loved one and so lowering the positive reinforcements from others who may
have been around an individual. The depressed people would then become reclusive and less
active socially. Additionally, it may be brought about by unintentional reinforcement of
depression from other people such as a loss of a loved one who may have been a pillar of
strength and real help (McLeod, 2015).
Psychodynamic theory is also used to explain depression. Freud's psychoanalytic theory
is an example which links biological triggers to depression (McLeod, 2015). Additionally, Freud
also related to the rejection by a loved one or loss suffered. He argued that the loss of a loved or
a job can work to trigger certain historical episodes that someone went through during their
childhood years. Cognitive theory has also been utilized in analyzing depression which asserts
that emotional and other behavioral symptoms are brought about by challenges in one's cognitive
challenges. Depression is a product of a negative and skewed thinking process (McLeod, 2015).
The theory also asserts that thinking comes before depressed mood starts, it the thought process
DEPRESSION 10
that triggers the depression. Humanist theory affirms that there are human needs such as self-
actualization are required for one's wellbeing (McLeod, 2015). The one that has it ends up
having a meaningful life as opposed to the one that does not (McLeod, 2015).
Conclusion
There is no doubt that depression is the global scourge that affects a big number of people
of varied ages all through the world. The economic effect of the disorder is also unmatched.
Mental disorders are amongst the leading causes of most common disabilities, and the disease
burden from it is among highest. On an annual basis, approximately 18.1% of U.S adults and
4.2% suffer from incapacitating mental illness (CBHSQ, 2015). Neuropsychiatric disorders are
also ranked the highest leading causative agent for disabilities in the U.S, accounting for 18.7%
of all the years that are lost to disability and premature mortality (US Burden of Disease
Collaborators, 2013). The prevalence of the disorder is also high and leads to lifetime risks of
nearly 20% according to some study, and it is linked to mortality and morbidity challenges
(Kessler et al. 2005). The patients that are depressed are also prone to other physical health
problems such as coronary artery complications ailments and diabetes also resulting in severe
medical conditions (Palazidou, 2012).
For an extended period, the effects of depression on disability have been acknowledged
and have been seen as a health concern but have been overlooked when it comes to public health
interventions. However, in recent years there has been great progress in the development of
preventative measures and interventions. It cannot be stressed more on the importance of
collaboration between different disciplines in both the public health and mental health in
developing multilevel approaches that will help in controlling and at best-preventing depression.
DEPRESSION 11
References
APA (2017). What is Depression? American Psychiatric Association. Retrieved August 23,
2017, https://www.psychiatry.org/patients-families/depression/what-is-depression
CBHSQ (2015). Behavioral health trends in the United States: Results from the 2014 National
Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality.
HHS Publication No. SMA 15-4927, NSDUH Series H-50. Retrieved August 23, 2017,
http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-
2014.htm
CDC (2014). Web-based injury statistics query and reporting system (WISQARS). Centers for
Disease Control and Prevention (CDC), National Center for Injury Prevention and
Control (NCIPC). Retrieved August 23, 2017, http://www.cdc.gov/ncipc/wisqars.
Health People 2020 (2014). Mental Health and Mental Disorders. Office of Disease Prevention
and Health Promotion. Retrieved August 23, 2017, from
https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-
disorders
Joules, N., Williams, D.M and Thompson, A.W (2014). Depression in resident physicians: a
systematic review. Open Journal of Depression;03(03):89–100.
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R and Walters, E.E (2005).
‘Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National
Comorbidity Survey Replication.’ Archives of General Psychiatry;62(6):593–602.
Lindert, J., vonJEhrenstein, S.O., Grashow, R., Gal, G., Braehler, E and Weisskopf, G.M (2014).
Sexual and physical abuse in childhood is associated with depression and anxiety over
DEPRESSION 12
the life course: systematic review and meta-analysis. International Journal of Public
Health Volume 59, Issue
J
2
, pp 359–372
Manicavasagar, V (2012). A review of Depression Diagnosis and Management. Australian
Psychological Society (APS). Retrieved August 23, 2017, from
https://www.psychology.org.au/publications/inpsych/2012/february/manicavasagar/
Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Angelantonio, E. D., and Sen, S.
(2015). Prevalence of Depression and Depressive Symptoms Among Resident Physicians
A Systematic Review and Meta-analysis. JAMA, 314(22), 2373–2383.
http://doi.org/10.1001/jama.2015.15845
McLeod, S (2015) Psychological Theories of Depression. Simply Psychology. Retrieved August
23, 2017, https://www.simplypsychology.org/depression.html
Murray C.J.L and Lopez A.D (2002). The World Health Report, 2002: Reducing Risks,
Promoting Health Life. World Health Organization.
National Institute of Mental Health. Data from 2013 National Survey on Drug Use and Health.
Retrieved August 23, 2017, from www.nimh.nih.gov/health/statistics/prevalence/major-
depression-among-adults.shtml
NIH (n.d). Depression. National Institute of Mental Health. Retrieved August 23, 2017, from
https://www.nimh.nih.gov/health/topics/depression/index.shtml
Palazidou, E (2012). “The neurobiology of depression.” British Medical Bulletin, Volume 101,
Issue 1, 1. 127–145, Retrieved August 23, 2017, from https://doi.org/10.1093/bmb/lds004
Rongrong, N., Wei, J., Zuoxing, L and Prakash, R (2015). “P300 for Depression: An
Underestimated Neurophysiological Tool” Journal of Depression and Anxiety,
5:1000212 http://dx.doi.org/10.4172/2167-1044.1000212
DEPRESSION 13
Southwick S.M., Vythilingam, M and Charney, D. S (2005). The psychobiology of depression
and resilience to stress implications for prevention and treatment. Annual Review of
Clinical Psychology. 2005;1:255-91.
US Burden of Disease Collaborators (2013). "The state of US health, 1990-2010: the burden of
diseases, injuries, and risk factors." JAMA, 310(6): 591-608
