depression

depression, clinical depression

Mental states characterized by feelings of sadness, hopelessness, and loss of interest, experienced by most individuals. They are deemed clinical (that is a mental illness ) if they are persistent, severe, and out of proportion to any identifiable precipitant. The term depression entered psychiatric classification primarily as a symptom of melancholia (the predecessor to depression) and has only featured as a diagnostic label since the end of the nineteenth century (initially in the term manic depression).

The precise differentiation of types of depression varies. In the post-war period it has been common to distinguish reactive and endogenous depression. With reactive depression-a neurosis -there is an identifiable precipitant, but the response is exaggerated. With endogenous depression-a psychosis -there is not; instead the illness appears to arise from within. However, the DSM-III , under the heading of ‘Affective Disorders’, distinguishes bi-polar (manic depression) and unipolar disorders (depression).

The various types of depression are now the most frequently diagnosed mental illnesses, and are more common in women than men (with a usual ratio of two to one). There are undoubtedly biochemical changes associated with depressive states (though work on the biochemistry of depression has not been very successful) and the most widely used treatments are physical-drugs or ECT (electro-convulsive therapy). However, the case for the importance of social factors in the aetiology of depression is strong. George Brown and Tirril Harris's study of the Social Origins of Depression (1978) demonstrated very clearly that adverse life-events and other stress-inducing occurrences, when combined with situationally generated vulnerability, increased the chances of clinical depression (both reactive and endogenous).