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An introduction to depression, the human fear factor

Depression (mood)
Depression, or, more properly, a depressed mood, may in everyday English refer to a state of melancholia, unhappiness or sadness, or to a relatively minor downturn in mood that may last only a few hours or days. This is quite distinct from the medical diagnosis of clinical depression. However, if depressed mood lasts at least two weeks, and is accompanied by other symptoms that interfere with daily living, it may be seen as a symptom of clinical depression, dysthymia or some other diagnosable mental illness, or alternatively as sub-syndromal depression. In the field of psychiatry, the word depression can also have this meaning of low mood but more specifically refers to a mental illness when it has reached a severity and duration to warrant a diagnosis; see Clinical depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that a depressed mood is often reported as being: "... depressed, sad, hopeless, discouraged, or 'down in the dumps'." In a clinical setting, a depressed mood can be something a patient reports (a symptom), or something a clinician observes (a sign), or both. A depressed mood is generally situational and reactive, and associated with grief, loss, or a major social transition. A change of residence, marriage, divorce, the break-up of a significant relationship, graduation, or job loss are all examples of instances that might trigger a depressed mood.

Subjective experience of being depressed
The feeling of depression is one of emotional suffering, sometimes seen as a mental analogue of physical pain. Someone who is depressed may be said to have a 'heavy heart', or if more seriously depressed be 'broken-hearted', because of a common sensation of the emotion in the chest. Other somatic expressions can be a sense of 'low spirits', a 'drag' or being weighed down, and a heaviness in breathing, expressed as despondent or dejected sighing. It may also be associated with apathy, boredom, emptiness and lack of any positive source of interest or joy. Depression - in this non-medical sense - may be caused by a loss or personal failure (as in sadness), personal rejection, or indeed by any undesired outcome or situation, particularly if the situation happens or continues despite the efforts of the subject. In addition to sadness, there can in a depressed mood be a conscious resignation that the unpleasant situation is difficult to change. Usually whatever causes the state of depression is consciously recognised as the cause, which is not necessarily the case with longer-term clinical depression. Other conscious factors in maintaining depression may be loneliness and long-term stress. External affective signs of depressed mood also include a physical hunching or stooping, or putting the head in the hands, and an appearance of being physically subdued, and flatness of speech.

Sadness
Sadness and sorrow tend to refer to a feeling about specific events, whereas 'depression' can be a state of more generalised, and possibly chronic, gloom and despondency that is not relieved by companionship or hope. Sadness is more likely to involve weeping as an external sign, and the corresponding subjective experience of tension in the throat.

Determinants of mood
Depression can be the result of many factors, individually and acting in concert.

Environment
Reactions to events, often a loss in some form, are perhaps the most obvious causes. This loss may be obvious, such as the death of a loved one, or having moved from one house to another (mainly with children), or less obvious, such as disillusionment about one's career prospects. Monotonous environments can be depressing. A lack of control over one's environment can lead to feelings of helplessness. Domestic disputes and financial difficulties are common causes of a depressed mood. Love, or lack of being able to express your feelings can lead to a feeling of unexplainable sadness or grief.

Psychological Factors
Sometimes the depressed mood may relate more to internal processes or even be triggered by them. Pessimistic views of life or a lack of self-esteem can lead to depression. Illnesses and changes in cognition that occur in psychosis and dementias, to name but two, can lead to depression. Depression may also be comorbid with cardiovascular disorders.

Physiological Considerations
A diathesis-stress model of depression (including clinical depression) is now widely accepted. This implies that underlying personality has some degree of influence over how the mood of individuals is affected by life events. The social, psychological and biological etiology of depression is still being actively investigated. The causal relationship with biological variables is unknown and so it is difficult to pinpoint the condition's roots. Some general physiological considerations include genetics (i.e. a hypothesised innate disposition to depression), neurochemistry (e.g. high levels of stress hormones such as cortisol, low dopamine activity), sleep patterns, female hormone imbalance (e.g. PMS in women), male hormone imbalance (testosterone) in men, use of medication (e.g. corticosteroids), chronic illness (e.g. diabetes or hypothyroidism), and seasonal factors (e.g. seasonal affective disorder related to hormones and sunlight).

Adaptive benefits of depression
While a depressed mood is usually seen as deleterious, it may have adaptive benefits. The loss of a loved spouse, child, friend or relation, a physical illness or loss of lifestyle, tends to lead to feelings of depression. Freud noted the similarities between mourning and depression (then called melancholia) in a now famous paper entitled, "Mourning and Melancholia". The depressed mood is adaptive in that it leads the person towards altering their thought patterns and behavior or way of living or else continues until such a time as they do so. It can be argued that depression and clinical depression is in fact the refusal of a person to heed the call to change from within their own mind. For example, in mourning it is essential that one must eventually let go of the dead person and return to the world and other relationships. Depression appears to have the effect of stopping a person in their tracks and forcing them to turn inwards and engage in a period of self reflection; it is a deeply introspective state. During this period, which can last anything from days to years, the individual must find a new way to interpret their thoughts and feelings and reassess the extent to which their appraisal of their reality is a valid one. Seasonal affective disorder may point to an atavistic link with behaviour in hibernation.

Depressed mood in literature and culture
Unlike jealousy or anger, a mild depressed state is not intimately associated with a motive for action, and this is a likely reason for it being under-represented in drama. The journey of King Lear could be seen as a state of depression seeking forgiveness and redemption, although it is arguably pathological. Many of the works of Anton Chekhov, such as Uncle Vanya, involve either depressed mood or clinical depression. On the other hand, sorrow and regret perhaps occur much more commonly in literature, and tragedy, where the audience or readers may share to sadness or despair of the characters, is seen as one of the greatest of art forms and perhaps the most profound. The films and plays of Ingmar Bergman cover both bereavement (as in Virgin Spring) and depressed mood (Wild Strawberries).