Depressive Disorders - Unipolar Depression
Major depressive episode
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), in order to diagnose a major depressive episode it is necessary that the symptoms last for at least two weeks and that they are at least 5 of a list of 9. Furthermore, it is mandatory, must include at least one of the first 2. These symptoms are:
- depressed mood;
- loss of interest;
- loss or increase in weight or reduction or increase in appetite;
- insomnia or hypersomnia (sleeping many hours);
- agitation or slowing of psychic and motor skills;
- easy fatigue or lack of energy;
- feeling of self-depreciation or guilt;
- reduced ability to think or concentrate or indecision;
- recurrent thoughts of death or suicide.
The major depressive episode is characterized by a persistently and severely depressed mood for most of the day, almost every day. The duration varies from 6 to 12 months, but can also exceed 2 years; in this case, we speak of chronicization.
Symptoms related to mood
The lowering of mood is characterized by sadness, moral pain, despair. It is not influenced by external encouragement or attempts at consolation, and is often accompanied by the loss of interests and pleasures ( anhedonia ), with feelings of indifference, inadequacy, dryness and emptiness, sometimes with the feeling of loss and lack of feelings ( affective depersonalization ) . The patient often has a tendency to cry, but the lowering of the mood can also be seen in the look, in the tone of the voice, in the shortness of the responses, in the mimicry, in the gestures and movements (generally slowed down). He presents a reduction in concentration and memory, psychic and motor impairments (slowing down but also, in some cases, agitation), insomnia or drowsiness, decreased or increased appetite and / or weight. Anxiety and worry can also coexist, especially when negative events occur. Feelings of sadness are sometimes not understood or undervalued, as well as by family members and friends, even by the patient himself. For example, depressive feelings are not perceived but feelings of almost physical weight, listlessness, tiredness and reduced initiative.
Another fundamental symptom is the reduction or loss of pleasure and interest in work, recreational activities and visits with friends and favorite pastimes, which are replaced by a feeling of indifference and detachment.
To learn more: Symptoms Major Depression
Cognitive symptoms
The patient reports a diminished capacity to think and concentrate, to make decisions and to memorize. The psycho-motor slowing down, the loss of interest and initiative, the difficulty in diverting oneself from frequent painful brooding over one's past with self-deprecating and guilt feelings ( painful retrospection ), can interfere with the performance of normal activities. Even the simple preparation of the shopping list, for example, may seem superior to one's own strength for the housewife; the most basic activities, as well as entertainment (reading the newspaper for example, or watching television), may be impossible due to the lack of concentration, the loss of interest and the feeling of lack of the necessary energy. Even the experience of time is altered, with the sensation of its arrest, of a dilated and immutable present, a past marked by unrepairable errors or faults and a non-existent or in any case hopeless future with the fall of all projects. Basic trust, self-esteem and the ability to feel hope, which provide meaning and value to existence, are seriously compromised. There is also an impoverishment of mental contents, and often the patient repeatedly proposes the same painful themes, and tends to feel responsible for his own problems and their persistence despite the treatments. He may have economic worries, hypochondriacal concerns and incurability, thoughts of self-accusation and death. In two thirds of patients there is a desire to die and a suicidal ideation. In the most serious cases, this is experienced as the only possible release from suffering, as an expiation of faults or in response to the belief that it is not possible to be helped.
Sometimes, the major depressive episode manifests itself with delusions (disturbances of the form and content of thoughts) and hallucinations (disturbances of the perception of thoughts). The delusions can be:
- of guilt: the patient has the conviction of being responsible, with his own behaviors, for any misfortunes that have occurred to his family, to faults never committed and often absurd, such as natural disasters, or wars;
- of unworthiness: he does not feel worthy of being in the world;
- of ruin: he is convinced that he no longer has any means of support for himself and his family;
- hypochondriacs and incurability: he is convinced that he has a serious or incurable illness, or that he cannot recover from the current depression;
- of bodily denial: the patient denies the existence of himself, of his physical integrity, of the internal organs of his body, of the world and of time;
- of reference and persecution: he is convinced that he is on the verge of being arrested for alleged faults or crimes committed.
Hallucinations can be auditory (for example voices that blame the patient or command him to commit suicide), taste or smell.
Psychic and motor symptoms
In the depressed one can observe a marked psychic and motor slowing down, with slow gait and difficulty in performing the movements, which are carried out with an evident effort. The patient remains motionless for a long time, or in bed all day, neglecting food, clothing and hygiene. The slowdown is also evident in the reduced production of ideas, which are all centered on themes of guilt and self-accusation, poverty and ruin, in the poverty of words that are stunted, slow, emitted in a low voice, in the monotonous and poor language of contents, which can be reduced to monosyllables. Also the aspect changes its appearance, with a mimic based on pain and suffering, in which the corners of the mouth are bent downwards, the forehead is corrugated, the look is sad, dull and desolate. In some cases, on the contrary, anxiety and agitation can prevail (in this case we speak of agitated depression): the patient is unable to sit still, is restless, suffering, irritable, can ceaselessly torment his hands, arriving in some In case of injury to the skin without realizing it or feeling pain, it can cry or perform self-injurious or suicidal gestures.
Somatic and vegetative symptoms
The decrease in appetite and weight are frequent, while the increase in appetite and food intake, especially carbohydrates ( craving for carbohydrates ) and the consequent increase in weight, are less common. The patient reports feeling very tired and weak, of having sleep disorders (feeling that they have been restful or early awakening, multiple awakenings, difficulty in falling asleep), drop in sexual desire with difficulty in erection for man or frigidity in woman, constipation, sense of chest tightness and heart that "beats strong in the chest".
