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Synonyms . Depressive Disorder, Deep Depression, Melancholy

Definition of depression. Reduced mood, accompanied by a loss of pleasure and interests, changes in psychomotor skills and functional physical disorders 

The clinical syndrome of (deep) depression / depressive episode is a heterogeneous group of different types of depression (see. Classification)

Epidemiology of Depression

• Depressions are among the most frequent in the structure of mental illness
• Prevalence is 17% (women – 23%, men – 17%)
• In Germany, direct costs for treating depression are about 4 billion euros

Depression is recorded in the following categories of patients :
– 10% among patients observed by family doctors (depressive syndromes manifest in 25%)
– 15-25% among people living in nursing homes and boarding schools
– 15% among people over 65 years old
– 50% among people with Parkinson’s disease
– 25% among patients with Alzheimer’s disease
– 50% of people who have suffered an apoplexy stroke develop depression over the course of a year

Etiopathogenesis of depression

• Multifactorial conditionality (concept of vulnerability):
– interaction “neurobiology-stressors”
– the degree of depressive effect of life events on a person is determined primarily by individual predisposition

• Genetic factors / heredity:
– special family studies, studies of twins and adoptions confirm a hereditary predisposition. The risk of developing depression in children, one of whose parents suffers from this disease, is up to 20%, a similar indicator in identical twins is up to 65%

• Neurobiological factors:
– decrease in the volume of the hippocampus, neurodegenerative hypothesis
– neurobiochemistry:
hypothesis of a deficiency of endogenous amines (noradrenaline / serotonin deficiency)
concept of neurotransmitter imbalance

– hypothesis of the influence of stress hormone (confirmed by neuroendocrinological studies)
dysregulation of the hypothalamus, pituitary, adrenal cortex and thyroid gland, as well as an increase in plasma cortisol

– chronobiological factors seasonal rhythm the
so-called daytime fluctuations shortening the phase of REM sleep

– pharmacogenic and somatogenic reasons (see. Differential diagnosis)

• Psychosocial factors / stressors – often have a psychoreactive expression (stressors, a difficult life situation, such as the loss of loved ones or other hardships) – psychodynamic and psychoanalytic models – cognitive and educational-theoretical models – cognitive triad: negative perception of self, environment and of the future – dysfunctional cognitive abilities – “forced helplessness” – the extinction of drives and needs – lack of ability to overcome – impaired self-perception and low self-esteem 
• Personal factors – “melancholic type” (accuracy, excessive correctness, sacrifice, accuracy down to pedantry) – “oral character structure” (low frustration tolerance, strong dependence on others, “dependent personality”) – “anal character structure”: obsessive traits 

Risk factors for developing depression :
• Female gender
• Presence of family history of
depression • Early history of depression
• Early loss of parents • History of
experienced violence
• Personality traits
• Stressors (separation, guilt)
• Alcohol / drug addiction
• Neurological diseases (Parkinson’s disease, apoplexy)