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Svoju ispovijest o tome kako se već na prvoj godni studija doslovce prodala za zelenu majicu a potom našla u grotlu prostitucije, ispričala nam je 35-godišnja Istrijanka, nekadašnja studentica. Da sam bio iskusniji, ja bi uzeo u obzir njezine emocionalne prtljage i njezine izbjegavati poput kuge, ali sam bio mlad, neiskusan i na večeru je razgovarao sa mnom. Sve je krenulo od majice, pa trenirke, tenisica, štiklica...
Ispovijest prostitutke s fakulteta: Zaradila sam dovoljno za idućih deset godina zaradila sam dovoljno da idućih deset godina ne moram ništa raditi. Mi smo ubrzo su krenuli na naš izabrani zanimanja i naš zajednički život bio savršen kao što smo kupili naš san doma i namještena zajedno. Svi mi imamo fantazije, ali samo se neki odvaže i realizirati ih.
Gole 50-godišnjakinje: Žene u godinama, u tajicama i uskim majicama - Zbog njegova učestalog žicanja novca, sve mi je to nekako bilo čudno i počela sam sumnjati da ga troši na neke druge stvari, kazuje nam majka maloljetnog Kaštelanina. Ipak, imao sam razvio duboke osjećaje za nju.
Svaka žena se jebe je misterija, jedan se pažljivo promatraju i dive. Svaka žena je različita, a druga tajna da se dive. Većina mog života, pokušao sam ih razumjeti, ali bez uspjeha! Ja sam zaključio da ne postoji razumijevanje njima. Kao i većina dječaka počeo sam stekao svoje znanje o seksu i žena u ranoj dobi. Možda devet ili deset godina. Znanje je često netočne i obmanjujuće, ali to je sve što sam imao. Kad sam postao tinejdžer sam naučio moje znanje o seksu s ulice. To sve se činilo tako jednostavno na prvi, a ja jednostavno mora naći djevojku koja će pristati, a mi bismo ići u neke privatne mjesto i sam stavio moj penis u njezinu ans nešto divno će se dogoditi kao što sam napredni u muškosti. Možda je to bio razlog zbog kojeg sam završio srednju školu, djevica. Tada, otprilike na polovici puta kroz srednju školu, zena za jebanje počeo sam se pitati što je nestalo iz mog znanja. Mnogi su dečki tvrdili da su 'zabio' s djevojkama i očito neke priče bile točne. Zatim, u nadi da će poboljšati svoje vlastite tehnike, JA ček vanjska strana oni dečki koji su bili čineći ga s djevojkama da vidim što oni posjeduju da nisam. Oni su različitih etničkih pozadina. Neki su bili fini primjeri muževnosti, ali kao i mnogi, čini se, wimps. Neki su bili čvrst i vjeran, dok drugi nisu. Dakle, pitao sam se. U mom vlastitom samo-analiza, ja broje moje imovine. Bio sam sportaš, dobro izgleda, živjela je dobar ustajanje života, odjevena dobro i napravio dobre ocjene. Moji roditelji i moja nastavnici stalno me je ohrabrio - mi reći što je dobro mladić bio sam postaje Ja se činilo da znam drugačije. Imao sam nekoliko prijatelja, svi dečki! Djevojke činilo mi se izbjeći! Osjećao sam se prljavo i nemoralno kao što sam često mislio posteljine jednom od djevojaka u mom razredu. Naravno, ovo je bio strani moje osobe da roditelji i nastavnici nisu vidjeli. Zatim, kao što sam je služio moj službu u vojsci, vidio sam ljude uzimajući položi redovito. Muškarci koji su jedva iznad životinjske razine! Drugi, činilo se da pronalaženje prikladne ženke kako bi ih zadovoljni! Samo mi se da leži oko vojarne! Bio sam pola svijeta daleko od kuće i nobody'd mene znati. Kurva kuće su pravne oko baze, a žene samo mogu držati odgovor. Možda ako JA mogao dobiti neki doživljaj. Tada je plan počeo da se formira. Ja utvrditi pogodan datum i vrijeme. Zatim, u petak navečer, sam išao dolje Reeperbahn prema dobro označen crveno svjetlo distrikt duboko u misli. Kao što sam prišao ulazu u okrugu, osjećao sam se suho, kiselog okusa u ustima i moje tijelo drhti. Tada sam ih vidio - žene u svojim krevetićima, osvijetljeni i sebe nudi kao što sam ja prošao. Mnogi su azijski, mala i nestrpljiv. Drugi su veličanstven i lijep. Svi došao s cijenom. Ipak, to nije 'činiti se pravo! Ja lutala oko za neko vrijeme snimanja robe i pokušava izabrati. Zatim, nakon sati gledanja, baš kao što sam bio s obzirom odustaje cijela ideja, dječji krevetić popped otvoren i njezin zavjese bile prostrane širok. Mladi, tamne kose, žena u krevetiću možda su djevojke iz susjedstva kod kuće ili srednju školu razreda. Odjednom, osjetio sam sokovi poteći i moje tijelo reagirati - okrenuo sam se prema njoj jasle. Kao što sam prišao, žene su se oči susrele moje u pozivu samo za jebanje na taljige bliže. Razgovarali smo za samo trenutak kao ona anketiranih moje psihičko i fizičko stanje. Ona me rukom za vrata po strani krevetića. Kao što sam ušao u vrata, kako bi se pozdravio moj uskoro biti ljubavnik, osjećao sam se mojih usta pržena i suha kao moje tijelo zadrhta u očekivanju uzbuđen. Odjednom sam imao potrebu da pee i zamoli za toiletien kao moj kurva, Nicky, nasmijala se i ukazuje na još jedan vrata. Kada sam se vratio, u nijansama su izvučeni i zavjese zatvoreno kao malo električni grijač širenje topline oko maloj sobi. Nicky sub odjeven sada u teškim ogrtačem nad njom više otkriva haljinu kao i ona objasnila da je ona samo bih stigla i soba je previše hladno za naše potrebe kako bismo mogli razgovarati za vrijeme. U samo nekoliko minuta, Nicky bio u potpunosti svjestan svoga djevičanskog stanja i obećao da će mi pomoći. Kao što smo razgovarali, počeo sam da se opustite i preselila se na to sjesti pokraj mene na krevetu. Ja gurnula natrag teško kao svoje vlastite emocije činilo da diktiraju i ona prestala. Budite osjetljivi,,, Let's to probati opet! Tada, osjetio sam njezin jezik u usta i reagirala pažljivo da se osjećaju zadovoljstvo. U nekoliko minuta soba je bila topla i Nicky prolio joj ogrtač dok je plesala na show off joj dovoljno grudi i lijepo dupe kao ona prolio joj slab kostim. Zatim, ona mi je pomogao u dobivanju svoju odjeću off. Zatim gol zajedno ona me grli i osjećao sam žena meso iznad mene za prvi put. Opet, preselio sam joj držati u snažan stisak i osjetio sam joj pojačati i zamrznuti. Konačno, ja bih pronašao ženu koja je bila spremna i sve sam morao učiniti je staviti moj penis u njoj osjećati da slavne osjećaj su bili muškarci pričaju zauvijek. Ubrzo je u njoj i toplo, vlage osjećaj svakako je zadovoljstvo popunjena. Zatim, možda minutu kasnije i to je bio preko. Gdje je to slavna osjećaj? Osjećao sam se samo tužno i varao. Naravno, u potrazi leđa, ja sam naučiti mnogo te noći. Nicky je učio me poljubiti i da mi savjetovali kako bih milovala joj grudi i trbuh, itd. Našao sam ju dvaput više u Reeperbahn i ja iskoristio svoje usluge. To je bio treći posjet koji je učio mene osnove kunilingus i zadovoljstvo felacio. Rekla je jednostavno, bilo je kasno i ona je bila umorna i htjela spavati s nekim. Čudno smo spavali zajedno tu noć i iskusni, dok niz novih iskustava, ali ona ne dopušta mi da joj vijak. Nikad vidio Nicky opet nakon te noći. Nedugo nakon toga, moj regrutacija je bila i sam se vratio kući na faksu. Tamo živi u koledžu spavaonica, našla sam billeted u istoj zgradi kao i prije dvadeset, ili tako ženski mornari iz obližnje baze koji nisu imali tromjesečja na bazi. Naravno, bio sam još uvijek sramežljiva, nespretan klinac koji još nije pristupio žena u bilo kojoj, ali profesionalan način i tih žena su bili popularni sa starijim studentima. Kao što je prošli tjedan, JA je napravio moj jadni pokušaji da se sastanu i zavesti više od tih žena. Zapravo, nikada nisam dobio puno mimo njih sastanku. Zatim, s odbacivanjem moja jedina očekivanja, ja jednostavno ih ignorirati - to je do Winona došle! Winona, ili Winnie kao što ju je pozvao, držao prilično mnogo do sebe i je očito nosi opterećenje od emocionalne prtljage. Iako nije lijepo u smislu piste modela, ona je više zaobljena i mekša. Njezina druga fizikalna svojstva su lijepe oči i kremast complection okružen mornarice propisom styled smeđu kosu. Ona je uvijek obučen konzervativno - dok druge žene nosile kratke hlače i štedljiv bluze da se okrene muške glave je nosila traperice. Najistaknutija značajka njezina bića joj je stanje kod depresije. Da sam bio iskusniji, ja bi uzeo u obzir njezine emocionalne prtljage i njezine izbjegavati poput kuge, ali sam bio mlad, neiskusan i na večeru je razgovarao sa mnom. Nespretno govorio o svjetovnim stvarima, ali kao što sam napravio napor to držati njoj sudjelovali u razgovoru, našao sam joj radiš isto. Unutar tjedan dana smo imali u razvoju prijateljstva. Uskoro smo bili u posjetu natrag i naprijed između naše sobe. Još jedan tjedan i bili smo razmjene intimne misli i ideje. Ipak, ona nikad nije rekla mi ništa o velikom boli osjećala. Pitala sam se, ali nije rekao ništa. Zatim, jedan dan, sam upoznao jedan od njenih prijatelja koji me je zaustavio i mi sudjelovali u razgovoru. Ona je izvijestila da je Winnie je ozlijeđen loše u neugodne afere s pravim kreten. Ona se nadao nisam bio joj pritiskom za seks ili ništa. Ti dečki su puno podjednako. Ona smatra me bezopasno! Zatim, duboko u mom srcu sam znala da je bio u pravu. Dakle, ja se opredijelili za prijateljstvo, iako sam htjela da se pritisak za više sa svakim vlakana moga bića. Winnie i ja smo ubrzo bliski prijatelji, prijatelji rade stvari zajedno. Znajući joj delikatna emocionalnu ravnotežu, pokušao sam biti osjetljivi na njenim potrebama i željama. Zatim, dati joj zadovoljstvo, pokušao sam biti galantni. Otvaranje vrata, nju za sjedenje na večeru, itd. Izgledalo je više osjetljiva sam postao, što je više nasmiješio i dao mi je zadovoljstvo. Nekoliko mjeseci prošlo, a ja bih bio sretan da tu provede ostatak svoga života pod tim okolnostima. U međuvremenu, oko kampusa, ljudi su brzo skočiti na zaključke na nas vide zajedno, a bilo je uobičajeno trač da smo spavali zajedno. Bilo je malo trač da je Winnie radije bi se omogućilo što je zadržao bi se Lotharios daleko od nje i to mi je dao određeni status. Bilo je nedjeljno poslijepodne, a bili smo leži na mom krevetu čitajući. Vi znate da sam nesposoban da počine bilo kakvu vezu sada, pa ipak, vi se uvijek rado vraćaju, nikada mi pritiskom i mi klanjaju. Zatim, ona mi je rekla da želi spavati sa mnom više nego što sam ikada znati. Rekla mi je htjela da me voliš i da me sretnim, ali nije mogla učiniti. Ja prosvjedovali i ostala poduzeća. Winnie je za oko još par tjedana, ali naš odnos je bio preko. S me izbjegavati, a zatim je premješten. Konačno, ja bih zaveo ženu i prije nego što smo mogli savršen odnos je bila nestala. Život je bacio mi još krive. Nekako, nisam bio ozlijeđen kao duboko kao možda sam po Winnie ide. Imao sam volio nju znajući da je to beznadno i ona me je ostavio s puno uvid. Ipak, imao sam razvio duboke osjećaje za nju. U roku od dva tjedna Winnie odlaska, koledž djevojke su stvaranje prijateljske geste i mornarice djevojke Izgledalo je da traži van mjesta pokraj mene na večeru. Očigledno, moj odnos s Winnie nije otišao nezapažen. Rekla mi je da Winnie je smještena na novu baznu i činilo sretnim, rekla je ona još čudna stvar. Jednom sam vam uzeo za papak i sad se pitam kako sam mogla biti tako loše! Hajdemo u grad, a ja ću kupiti piće. Nakon toga, bilo je slijed žena. Sam koketirao s gotovo svaka žena sam upoznala. Stari ili mladi, lijepim ili ne tako, zanimljivo ili dosadno. Sve žene dobio moju pozornost. Kod većine slučajeva to počelo kada sam postao svjestan žena u mojoj prisutnosti. Možda ću se diviti joj fizičke značajke iz cijele sobi ili negdje drugdje iz daljine. Na kraju, ona će postati svjesni svojih pogleda i odgovoriti. U većini slučajeva ona će privući bliže, a mi bi se govoriti. U sekundi sam znao da li sam htjela nastaviti dalje odnos ili ne. Ako ne, ili ako dama izabrao da ga ispusti, naš susret bio je više i nema zla učinio. S druge strane, ako se činilo zanima i ja bio zainteresiran, možemo nastaviti razgovarati ili nositi odnos dalje. Opet, bilo je granica. Žene, kao i muškarci koketiraju za nekoliko razloga. Na kraju, sam upoznao Sandy. Lijepo izgleda, inteligentna dama s spreman osmijeh i pokušava završiti fakultet kao što sam bio. Na vrlo malo novca! Sandy mogao imati datumi s puno dečki, ali sam primjetio da ona kao da više vole aktivnosti u domu. Na prvom sastanku joj počeo sam promatrajući joj tajno, a ona odgovorila dolaskom na mene. Više razgovor i bio sam zainteresiran. Njezine oči i govor tijela, rekao mi je također bio zainteresiran. Sandy je ubrzo blizak prijatelj. Kao što smo postali bliže počeo sam osjećati potrebu da joj dodir. Da miluju njezine ruke ili ruku, ili možda njen vrat. Zatim sam osjetio potrebu da joj poljubac. Bio je to drugi tjedan za naš odnos kad je predložio da joj sobni drug bi otišao za vikend, a ja bi trebao doći do nje. Sandy nije bio djevica, iako je možda prošlo za jedan. Ona je stručnjak u ljubavi odluka - najbolji koje sam ikad doživio. Mi završio koledž kao ljubavnici, a onda udala ubrzo nakon stjecanja diplome. Mi smo ubrzo su krenuli na naš izabrani zanimanja i naš zajednički život bio savršen kao što smo kupili naš san doma i namještena zajedno. Moglo bi se reći da smo imali samo jednu epizodu na našu ljubav čineći kao što smo stalno bili titillating i klanjaju jedni druge i jedna sjednica je počela prije nego prethodna bio okončan. Sandy je bilo vruće. Zatim, to se dogodilo. Iznenada, neobjašnjive gubitak apetita, vrtoglavica, smanjenje tjelesne izdržljivosti i rezultat od doličan nepovezanih stvari koje liječnici nisu mogli objasniti. Nakon dugotrajnih testiranja i ispitivanja su određeni uzrok njezina bolest, ali do tada je bilo prekasno! Kao što je ona umrla u moje ruke, ja proklet Bogu da će učiniti tako okrutna stvar. Htio sam ga angažirati i učiniti nasilje na njega. Htio sam dovesti natrag Sandy. Ostao sam samo svoje depresije. Naravno, kao mladi, ubrzo sam se našao otpornost u borbi protiv natrag - da biste dobili moj život natrag i našla sam nešto preko trideset godina i pun snage. Tu su i druge žene i našla sam u potrazi. To je bio unosan polje žena, mnogi novo razveli, i broj profesionalnih žena koji je iznenada shvatio da je njihov biološki sat je trčanje dolje. Očaj je bio očit u mnogim. Monica je bio jedan od polja, ali još nije toliko očajan kao što je prišao trideset. Sam je upoznao sasvim slučajno, kada sam pokucao hrane off joj stola kao što sam prošao trotoar kafića. To je bio potpuno nenamjerno, nesreće i okrenuo se ispraviti nered bih napravio. Kao što sam očistiti i prerasporediti joj hranu, primijetio sam joj i pronašla zanimljiv, ali ona kao da ne nude kamate na njezinu dijelu. Platio sam račun i lijevo. Nekoliko dana kasnije, sam sjedio u istoj trotoar kafića, kada sam primijetio ruku doprijeti do pladanj hrane i premjestiti ga na samom rubu stola. Pogledao sam gore i Monica je bio nasmijan. Sada, pedeset četiri godine kasnije, ja sam sama opet. Monica i ja udala čim joj razvod od nasilnog muža je postala pravomoćna i bila je slobodan to učiniti. Monica je strpljiv, vrsta, osjetljiva ljubavnik, nedostaje samopouzdanje i duboko ožiljcima od destruktivnih događaja sa svojim prvim mužem. U našim tridesetim godinama, kada smo započeli naše obitelji, naše strasti bila prigušen je ranije događaje u našim životima. Ipak, Monica bila dobra za mene. Obožavala sam ju u svakoj prilici. Mi smo bili prijatelji i intimni prijatelji kao što smo suočeni tjeskobama našeg života zajedno. Imali smo napravili fizičku ljubav u svakoj prilici tijekom tih godina i uvijek sam uživao u gledanju i dira svoje tijelo. Mi doista obožavao jedni druge. Mi smo uspješno podigli petero djece i posla ih na njihovom putu. Život je bio dobar. Nažalost, Monica je prošao na aukciji. To je bio njezin srce, kazali su liječnici. Zahvaljujem se svaki od njih. Mislim da često zadovoljstvo su mi dali, i po tome što pacijenta sa mnom. Ja sam uistinu bio blagoslovljen.
Hrvatice
Zahvaljujem se svaki od njih. Zna da nikad ne smije voljeti. A i oni su upravo to plaćali. Winnie i ja smo ubrzo bliski prijatelji, prijatelji rade stvari zajedno. Oni su različitih etničkih pozadina. Oni uvijek traže nešto novo.
Ulaskom na sajt preuzimam svu odgovornost za svoje postupke. U njega možete lako ući, samo ako poželite da se družite s Bosancima jer su oni otvoreni za svako novo prijateljstvo. To su ljudi koji žive jednostavno, skromno i nadasve pošteno. Uđite, dopisujte se, slamajte srca i smejte se.
Odbacite predrasude, ne obazirite se na mišljenja ljudi oko sebe i doživećete užitak bez premca! Zato smo hteli da Vam pružimo bar nešto besplatno.
Dijaspora klub: sajt za upoznavanje, druženje, ljubav ili posao u dijaspori - Šta više možete da poželite u vreme krize?
Družite se s merakom uz sajt Upoznavanje BiH Ajmo curice, ajmo dječaci, studenti, đaci, milicajci... Hajdemo na sajt Upoznavanje BiH. Baš kao što pesma kaže — hajdemo u planine jer tamo nema zime. Kod prijatelja iz BiH je uvek toplo i srdačno. Družite se sa veselim ljudima koji žive na prelepim planinama i u bogatim ravnicama ove zemlje koja ima dušu. Neka Vas oraspolože svojim izvanrednim smislom za humor i neka Vam prenesu svoj optimizam. To su ljudi koji žive jednostavno, skromno i nadasve pošteno. Kod njih je upoznavanje srdačno i iskreno, bez foliranja i lažnih obećanja. Nisu uštogljeni i zato je lako biti njihov prijatelj. Upoznavanje BiH Vam donosi spontane bosance koji će Vam najpre ispričati vic o Muji i Hasi, a zatim Vam se nenametljivo predstaviti. Ne pate od kompleksa više vrednosti, pa očekujte jedno pravo druženje na ovom — pravom sajtu. Družite se uz sevdalinke ili poznate rok grupe iz ovih krajeva BiH. Svako od njih je preneo deo predela Bosne u svoje poznate pesme. Zavoleli ste njihove pesme, a upoznavanjem ćete zavoleti i ljude iz BiH. Sigurni smo u to! Definitivno ste pronašli mesto na kome se iznose istinske emocije i živi pravi život. Život uz divne prijatelje i čašicu razgovora. Pa posle zanimljivog druženja, sledi odmaranje na divanu... Ima li šta lepše? Bosna Vam se nudi na dlanu, a Vi je zgrabite i ne puštajte. Nadamo se da smo Vam zagolicali maštu i da ste poželeli da se upoznate sa prijateljima iz BiH. Velika je čast i privilegija družiti se s njima, a Vama se uz naš sajt Upoznavanje BiH pruža ta šansa. Nemojte da je izgubite jer se ona dobija samo jednom u životu. A Vi je imate! Zato upoznaje bosansku raju i smejte se zajedno...
Našao novu ribu na badoo sajtu za upoznavanje uzivo- Top devojka HD
Tragajte i upoznajte se. O njenoj prelepoj reci Drini koja je opevana u mnogim pesmama pitajte svoje nove prijatelje. Mi vam pružamo najbolju uslugu, kroz brzo i lako oglašavanje kao i pretragu više desetina hiljada oglasa. Zato otvorite širom oči pa ih zatim protrljajte, jer dobro ste videli... Velika je čast i privilegija družiti se s njima, a Vama se uz naš sajt Upoznavanje BiH pruža ta šansa. Prvi korak: pošaljite seksi flert ili simpatičnu poruku. I Vama se nešto nudi besplatno.
Nasprotno lahko prihaja do , to je pretiranega spanja. These guidelines include: APA Task Force on ECT 2001 ; Third report of the Royal College of Psychiatrists' Special Committee on ECT 2004 ; National Institute for Health and Clinical Excellence NICE 2003; NICE 2009. ECT is administered under anesthetic with a muscle relaxant.
Weiner chairperson ; et al. Ta težnja je značilno za depresivni , ali pesimistični.
- Tada, umesto izlečenja, dolazi do pogoršanja.
Not to be confused with. It is often accompanied by low , in normally enjoyable activities, low energy, and without a clear cause. People may also occasionally have or. Some people have separated by years in which they are normal, while others nearly always have symptoms present. Major depressive disorder can negatively affect a person's personal, work, or school life as well as sleeping, eating habits, and general health. Between 2—7% of adults with major depression die by , and up to 60% of people who die by suicide had depression or another. The cause is believed to be a combination of , environmental, and psychological factors. Risk factors include a of the condition, major life changes, certain medications, , and. About 40% of the risk appears to be related to genetics. The diagnosis of major depressive disorder is based on the person's reported experiences and a. There is no laboratory test for major depression. Testing, however, may be done to rule out physical conditions that can cause similar symptoms. Major depression should be differentiated from , which is a normal part of life and is less severe. The USPSTF recommends screening for depression among those over the age 12, while a prior found that the routine use of screening questionnaires have little effect on detection or treatment. Typically, people are treated with and. Medication appears to be effective, but the effect may only be significant in the most severely depressed. It is unclear whether medications affect the risk of suicide. Types of counseling used include CBT and. If other measures are not effective ECT may be tried. Hospitalization may be necessary in cases with a risk of harm to self and may occasionally occur against a person's wishes. Major depressive disorder affected approximately 216 million people 3% of the world's population in 2015. The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. Lifetime rates are higher in the 15% compared to the 11%. It causes the second most , after. The most common time of onset is in a person's 20s and 30s. Females are affected about twice as often as males. It was a split of the previous in the DSM-II, which also encompassed the conditions now known as and. Those currently or previously affected may be. An 1892 lithograph of a woman diagnosed with depression Major depression significantly affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health. Its impact on functioning and well-being has been compared to that of other chronic medical conditions such as. A person having a usually exhibits a very low mood, which pervades all aspects of life, and an in activities that were formerly enjoyed. Depressed people may be preoccupied with, or over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred. In severe cases, depressed people may have symptoms of. These symptoms include or, less commonly, , usually unpleasant. Other symptoms of depression include poor concentration and memory especially in those with or psychotic features , withdrawal from social situations and activities, reduced , irritability, and thoughts of death or suicide. In the typical pattern, a person wakes very early and cannot get back to sleep. Some antidepressants may also cause insomnia due to their stimulating effect. A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries, according to the 's criteria for depression. Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. Family and friends may notice that the person's behavior is either or. Older depressed people may have symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements. Depression often coexists with physical disorders common among the elderly, such as , other , , and. Depressed children may often display an irritable mood rather than a depressed mood, and show varying symptoms depending on age and situation. Most lose interest in school and show a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure. Diagnosis may be delayed or missed when symptoms are interpreted as normal moodiness. Associated conditions Major depression frequently with other psychiatric problems. The 1990—92 US reports that half of those with major depression also have lifetime and its associated disorders such as. Anxiety symptoms can have a major impact on the course of a depressive illness, with delayed recovery, increased risk of relapse, greater disability and increased suicide attempts. There are increased rates of alcohol and drug abuse and particularly dependence, and around a third of individuals diagnosed with develop comorbid depression. Depression may also coexist with ADHD , complicating the diagnosis and treatment of both. Depression is also frequently comorbid with and. Depression and often co-occur. One or more pain symptoms are present in 65% of depressed patients, and anywhere from 5 to 85% of patients with pain will be suffering from depression, depending on the setting; there is a lower prevalence in general practice, and higher in specialty clinics. The diagnosis of depression is often delayed or missed, and the outcome can worsen if the depression is noticed but completely misunderstood. Depression is also associated with a 1. People with major depression are less likely to follow medical recommendations for treating and preventing cardiovascular disorders, which further increases their risk of medical complications. In addition, cardiologists may not recognize underlying depression that complicates a cardiovascular problem under their care. The cause of major depressive disorder is unknown. The proposes that biological, psychological, and social factors all play a role in causing depression. The specifies that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either , implying an interaction between , or , resulting from views of the world learned in childhood. Childhood trauma also correlates with severity of depression, lack of response to treatment and length of illness. However, some are more susceptible to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility. Genetics The , or serotonin transporter promoter gene's short allele has been associated with increased risk of depression. However, since the 1990s results have been inconsistent, with three recent reviews finding an effect and two finding none. Other genes that have been linked to a gene-environment interaction include , and , the first two of which are related to the stress reaction of the , and the latter of which is involved in neurogenesis. A 2018 study found 44 that were linked to MDD. It is unknown if the underlying diseases induce depression through effect on quality of life, of through shared etiologies such as degeneration of the in or immune dysregulation in. Depression may also be iatrogenic the result of healthcare , such as drug induced depression. Therapies associated with depression include therapy, , , , cardiac agents, , , , and agents such as. Drug abuse in early age is also associated with increased risk of developing depression later in life. Depression that occurs as a result of pregnancy is called , and is thought to be the result of hormonal changes associated with. Seasonal affective disorder, a type of depression associated with seasonal changes in sunlight, is thought to be the result of decreased sunlight. Further information: The pathophysiology of depression is not yet understood, but the current theories center around systems, the , immunological dysfunction, dysfunction and structural or functional abnormalities of emotional circuits. The monoamine theory, derived from the efficacy of monoaminergic drugs in treating depression, was the dominant theory until recently. The theory postulates that insufficient activity of monoamine neurotransmitters is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas. Firstly, acute depletion of , a necessary precursor of , a monoamine, can cause depression in those in remission or relatives of depressed patients; this suggests that decreased serotonergic neurotransmission is important in depression. Secondly, the correlation between depression risk and polymorphisms in the gene, which codes for serotonin receptors, suggests a link. Third, decreased size of the , decreased activity of , increased density of , and evidence from rat models suggest decreased adrenergic neurotransmission in depression. Furthermore, decreased levels of , altered response to , responses of depressive symptoms to agonists, decreased binding in the , and polymorphism of genes implicate dopamine in depression. Lastly, increased activity of , which degrades monoamines, has been associated with depression. However, this theory is inconsistent with the fact that serotonin depletion does not cause depression in healthy persons, the fact that antidepressants instantly increase levels of monoamines but take weeks to work, and the existence of atypical antidepressants which can be effective despite not targeting this pathway. One proposed explanation for the therapeutic lag, and further support for the deficiency of monoamines, is a desensitization of self-inhibition in by the increased serotonin mediated by antidepressants. However, disinhibition of the dorsal raphe has been proposed to occur as a result of decreased serotonergic activity in tryptophan depletion, resulting in a depressed state mediated by increased serotonin. Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive that controls, the finding of increased jugular 5-HIAA in depressed patients that normalized with SSRI treatment, and the preference for carbohydrates in depressed patients. Already limited, the monoamine hypothesis has been further oversimplified when presented to the general public. Immune system abnormalities have been observed, including increased levels of involved in generating which shares overlap with depression. The effectiveness of NSAIDs and cytokine inhibitors in treating depression, and normalization of cytokine levels after successful treatment further suggest immune system abnormalities in depression. However, this abnormality is not adequate as a diagnosis tool, because its sensitivity is only 44%. These stress-related abnormalities have been hypothesized to be the cause of hippocampal volume reductions seen in depressed patients. Furthermore, a meta-analysis yielded decreased dexamethasone suppression, and increased response to psychological stressors. Further abnormal results have been obscured with the , with increased response being associated with depression. Theories unifying neuroimaging findings have been proposed. Another model proposes hyperactivity of salience structures in identifying negative stimuli, and hypoactivity of cortical regulatory structures resulting in a negative and depression, consistent with emotional bias studies. Further information: A diagnostic assessment may be conducted by a suitably trained , or by a or , who the person's current circumstances, biographical history, current symptoms, and family history. The broad clinical aim is to formulate the relevant biological, psychological, and social factors that may be impacting on the individual's mood. The assessor may also discuss the person's current ways of regulating mood healthy or otherwise such as alcohol and drug use. The assessment also includes a , which is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimism, or suicide, and an absence of positive thoughts or plans. Specialist mental health services are rare in rural areas, and thus diagnosis and management is left largely to clinicians. This issue is even more marked in developing countries. The mental health examination may include the use of a such as the or the or the. The score on a rating scale alone is insufficient to diagnose depression to the satisfaction of the DSM or ICD, but it provides an indication of the severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis. Several rating scales are used for this purpose. A review found that non-psychiatrist physicians miss about two-thirds of cases, though this has improved somewhat in more recent studies. Before diagnosing a major depressive disorder, in general a doctor performs a medical examination and selected investigations to rule out other causes of symptoms. These include blood tests measuring and to exclude ; and serum to rule out a ; and a including to rule out a or chronic disease. Adverse affective reactions to medications or alcohol misuse are often ruled out, as well. Subjective cognitive complaints appear in older depressed people, but they can also be indicative of the onset of a , such as. A can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. In general, investigations are not repeated for a subsequent episode unless there is a medical indication. No biological tests confirm major depression. Biomarkers of depression have been sought to provide an objective method of diagnosis. There are several potential biomarkers, including Brain-Derived Neurotrophic Factor and various functional MRI techniques. One study developed a decision tree model of interpreting a series of fMRI scans taken during various activities. In their subjects, the authors of that study were able to achieve a sensitivity of 80% and a specificity of 87%, corresponding to a negative predictive value of 98% and a positive predictive value of 32% positive and negative likelihood ratios were 6. However, much more research is needed before these tests could be used clinically. DSM-IV-TR and ICD-10 criteria The most widely used criteria for diagnosing depressive conditions are found in the 's revised fourth edition of the DSM-IV-TR , and the 's ICD-10 , which uses the name depressive episode for a single episode and recurrent depressive disorder for repeated episodes. The latter system is typically used in European countries, while the former is used in the US and many other non-European nations, and the authors of both have worked towards conforming one with the other. Both DSM-IV-TR and ICD-10 mark out typical main depressive symptoms. ICD-10 defines three typical depressive symptoms depressed mood, , and reduced energy , two of which should be present to determine depressive disorder diagnosis. According to DSM-IV-TR, there are two main depressive symptoms—depressed mood and anhedonia. At least one of these must be present to make a diagnosis of major depressive episode. Major depressive disorder is classified as a mood disorder in DSM-IV-TR. The diagnosis hinges on the presence of single or recurrent. Further qualifiers are used to classify both the episode itself and the course of the disorder. The category is diagnosed if the depressive episode's manifestation does not meet the criteria for a major depressive episode. The system does not use the term major depressive disorder but lists very similar criteria for the diagnosis of a depressive episode mild, moderate or severe ; the term recurrent may be added if there have been multiple episodes without mania. Major depressive episode Main article: A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks. Episodes may be isolated or recurrent and are categorized as mild few symptoms in excess of minimum criteria , moderate, or severe marked impact on social or occupational functioning. An episode with psychotic features—commonly referred to as —is automatically rated as severe. If the patient has had an episode of or , a diagnosis of is made instead. DSM-IV-TR excludes cases where the symptoms are a result of , although it is possible for normal bereavement to evolve into a depressive episode if the mood persists and the characteristic features of a major depressive episode develop. The criteria have been criticized because they do not take into account any other aspects of the personal and social context in which depression can occur. In addition, some studies have found little empirical support for the DSM-IV cut-off criteria, indicating they are a diagnostic convention imposed on a continuum of depressive symptoms of varying severity and duration: Excluded are a range of related diagnoses, including , which involves a chronic but milder mood disturbance; , consisting of briefer depressive episodes; , whereby only some symptoms of major depression are present; and , which denotes low mood resulting from a psychological response to an identifiable event or. Here, the person is mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms also occur in or in manic episodes, or may be caused by. Postpartum depression has an incidence rate of 10—15% among new mothers. The DSM-IV mandates that, in order to qualify as postpartum depression, onset occur within one month of delivery. It has been said that postpartum depression can last as long as three months. The diagnosis is made if at least two episodes have occurred in colder months with none at other times, over a two-year period or longer. Screening In 2016, the USPSTF recommended screening in the adult populations with evidence that it increases the detection of people with depression and with proper treatment improves outcomes. They recommend screening in those between the age of 12 to 18 as well. A Cochrane review from 2005 found programs do not significantly improve detection rates, treatment, or outcome. Differential diagnoses Main article: To confirm major depressive disorder as the most likely diagnosis, other must be considered, including dysthymia, adjustment disorder with depressed mood, or bipolar disorder. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression sometimes referred to as double depression. Although depression is currently categorized as a separate disorder, there is ongoing debate because individuals diagnosed with major depression often experience some hypomanic symptoms, indicating a mood disorder continuum. Further differential diagnoses involve. Other disorders need to be ruled out before diagnosing major depressive disorder. They include depressions due to physical illness, , and. Depression due to physical illness is diagnosed as a. This condition is determined based on history, laboratory findings, or. When the depression is caused by a medication, drug of abuse, or exposure to a , it is then diagnosed as a specific mood disorder previously called Substance-induced mood disorder in the DSM-IV-TR. Preventative efforts may result in decreases in rates of the condition of between 22 and 38%. Eating large amounts of fish may also reduce the risk. Behavioral interventions, such as and , are effective at preventing new onset depression. Because such interventions appear to be most effective when delivered to individuals or small groups, it has been suggested that they may be able to reach their large target audience most efficiently through the. However, an earlier meta-analysis found preventive programs with a competence-enhancing component to be superior to behavior-oriented programs overall, and found behavioral programs to be particularly unhelpful for older people, for whom social support programs were uniquely beneficial. In addition, the programs that best prevented depression comprised more than eight sessions, each lasting between 60 and 90 minutes, were provided by a combination of lay and professional workers, had a high-quality research design, reported , and had a well-defined intervention. The course is claimed to be the most successful of psychoeducational interventions for the treatment and prevention of depression both for its adaptability to various populations and its results , with a risk reduction of 38% in major depression and an efficacy as a treatment comparing favorably to other psychotherapies. Main article: The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy. Psychotherapy is the treatment of choice over medication for people under 18. The UK NICE 2004 guidelines indicate that antidepressants should not be used for the initial treatment of mild depression, because the risk-benefit ratio is poor. The guidelines further note that antidepressant treatment should be continued for at least six months to reduce the risk of relapse, and that SSRIs are better tolerated than tricyclic antidepressants. Options may include pharmacotherapy, psychotherapy, exercise, electroconvulsive therapy ECT , transcranial magnetic stimulation TMS or light therapy. Antidepressant medication is recommended as an initial treatment choice in people with mild, moderate, or severe major depression, and should be given to all patients with severe depression unless ECT is planned. There is evidence that collaborative care by a team of health care practitioners produces better results than routine single-practitioner care. Treatment options are much more limited in developing countries, where access to mental health staff, medication, and psychotherapy is often difficult. Development of mental health services is minimal in many countries; depression is viewed as a phenomenon of the developed world despite evidence to the contrary, and not as an inherently life-threatening condition. A 2014 Cochrane review found insufficient evidence to determine the effectiveness of psychological versus medical therapy in children. Lifestyle Further information: is recommended for management of mild depression, and has a moderate effect on symptoms. Exercise has also been found to be effective for unipolar major depression. It is equivalent to the use of medications or psychological therapies in most people. In older people it does appear to decrease depression. Exercise may be recommended to people who are willing, motivated, and physically healthy enough to participate in an exercise program as treatment. There is a small amount of evidence that skipping a night's sleep may improve depressive symptoms, with the effects usually showing up within a day. This effect is usually temporary. Besides sleepiness, this method can cause a side effect of or. In observational studies has benefits in depression as large as or larger than those of medications. Besides exercise, sleep and diet may play a role in depression, and interventions in these areas may be an effective add-on to conventional methods. Counseling can be delivered to individuals, groups, or families by mental health professionals. A 2015 review found that appears to be similar to antidepressant medication in terms of effect. A 2012 review found psychotherapy to be better than no treatment but not other treatments. With more complex and chronic forms of depression, a combination of medication and psychotherapy may be used. A 2014 found that work-directed interventions combined with clinical interventions helped to reduce sick days taken by people with depression. There is moderate-quality evidence that psychological therapies are a useful addition to standard antidepressant treatment of in the short term. Psychotherapy has been shown to be effective in older people. Successful psychotherapy appears to reduce the recurrence of depression even after it has been terminated or replaced by occasional booster sessions. Cognitive behavioral therapy See also: CBT currently has the most research evidence for the treatment of depression in children and adolescents, and CBT and interpersonal psychotherapy IPT are preferred therapies for adolescent depression. In people under 18, according to the , medication should be offered only in conjunction with a psychological therapy, such as , , or family therapy. Cognitive behavioral therapy has also been shown to reduce the number of sick days taken by people with depression, when used in conjunction with primary care. The most-studied form of psychotherapy for depression is CBT, which teaches clients to challenge self-defeating, but enduring ways of thinking cognitions and change counter-productive behaviors. Research beginning in the mid-1990s suggested that CBT could perform as well as or better than antidepressants in patients with moderate to severe depression. CBT may be effective in depressed adolescents, although its effects on severe episodes are not definitively known. Several variables predict success for cognitive behavioral therapy in adolescents: higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions. CBT is particularly beneficial in preventing relapse. Cognitive behavioral therapy and occupational programs including modification of work activities and assistance have been shown to be effective in reducing sick days taken by workers with depression. Variants Several variants of cognitive behavior therapy have been used in those with depression, the most notable being , and. Mindfulness based stress reduction programs may reduce depression symptoms. Mindfulness programs also appear to be a promising intervention in youth. Psychoanalysis is a school of thought, founded by , which emphasizes the resolution of mental conflicts. Psychoanalytic techniques are used by some practitioners to treat clients presenting with major depression. A more widely practiced therapy, called , is in the tradition of psychoanalysis but less intensive, meeting once or twice a week. It also tends to focus more on the person's immediate problems, and has an additional social and interpersonal focus. In a meta-analysis of three controlled trials of Short Psychodynamic Supportive Psychotherapy, this modification was found to be as effective as medication for mild to moderate depression. Antidepressants Zoloft is used primarily to treat major depression in adults. Conflicting results have arisen from studies that look at the effectiveness of antidepressants in people with acute, mild to moderate depression. Stronger evidence supports the usefulness of antidepressants in the treatment of depression that is chronic or severe. While small benefits were found, researchers Irving Kirsch and Thomas Moore state they may be due to issues with the trials rather than a true effect of the medication. In a later publication, Kirsch concluded that the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance. Similar results were obtained in a meta analysis by Fornier. A review commissioned by the concluded that there is strong evidence that SSRIs have greater efficacy than placebo on achieving a 50% reduction in depression scores in moderate and severe major depression, and that there is some evidence for a similar effect in mild depression. Similarly, a Cochrane systematic review of clinical trials of the generic concluded that there is strong evidence that its efficacy is superior to placebo. In 2014 the U. FDA published a systematic review of all antidepressant maintenance trials submitted to the agency between 1985 and 2012. The authors concluded that maintenance treatment reduced the risk of relapse by 52% compared to placebo, and that this effect was primarily due to recurrent depression in the placebo group rather than a drug withdrawal effect. To find the most effective antidepressant medication with minimal side-effects, the dosages can be adjusted, and if necessary, combinations of different classes of antidepressants can be tried. Response rates to the first antidepressant administered range from 50—75%, and it can take at least six to eight weeks from the start of medication to. Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation is recommended. People with chronic depression may need to take medication indefinitely to avoid relapse. SSRIs are the primary medications prescribed, owing to their relatively mild side-effects, and because they are less toxic in overdose than other antidepressants. People who do not respond to one SSRI can be switched to , and this results in improvement in almost 50% of cases. Another option is to switch to the atypical antidepressant. However, venlafaxine is not recommended in the UK as a first-line treatment because of evidence suggesting its risks may outweigh benefits, and it is specifically discouraged in children and adolescents. For child and adolescent depression, is recommended if medication are used. Fluoxetine; however, appears to have only slight benefit in children, while other antidepressants have not been shown to be effective. Medications are not recommended in children with mild disease. There is also insufficient evidence to determine effectiveness in those with depression complicated by. Any antidepressant can cause levels ; nevertheless, it has been reported more often with SSRIs. It is not uncommon for SSRIs to cause or worsen insomnia; the sedating antidepressant can be used in such cases. Irreversible , an older class of antidepressants, have been plagued by potentially life-threatening dietary and drug interactions. They are still used only rarely, although newer and better-tolerated agents of this class have been developed. The safety profile is different with reversible monoamine oxidase inhibitors such as where the risk of serious dietary interactions is negligible and dietary restrictions are less strict. For children, adolescents, and probably young adults between 18 and 24 years old, there is a higher risk of both suicidal ideations and suicidal behavior in those treated with SSRIs. For adults, it is unclear whether SSRIs affect the risk of suicidality. One review found no connection; another an increased risk; and a third no risk in those 25—65 years old and a decrease risk in those more than 65. A was introduced in the United States in 2007 on SSRI and other antidepressant medications due to increased risk of suicide in patients younger than 24 years old. Similar precautionary notice revisions were implemented by the Japanese Ministry of Health. Other medications There is some evidence that fish oil supplements containing high levels of EPA to DHA are effective in the treatment of, but not the prevention of major depression. However, a Cochrane review determined there was insufficient high quality evidence to suggest Omega-3 fatty acids were effective in depression. There is limited evidence that vitamin D supplementation is of value in alleviating the symptoms of depression in individuals who are vitamin D deficient. There is some preliminary evidence that have a beneficial effect on major depression. There is a narrow range of effective and safe dosages of lithium thus close monitoring may be needed. Low-dose may be added to existing antidepressants to treat persistent depression symptoms in people who have tried multiple courses of medication. Limited evidence suggests such as and may be effective in the short term, or as add on therapy. Also, it is suggested that supplement may have a role in depression management. Electroconvulsive therapy ECT is a standard treatment in which are electrically induced in patients to provide relief from psychiatric illnesses. A round of ECT is effective for about 50% of people with treatment-resistant major depressive disorder, whether it is unipolar or. Follow-up treatment is still poorly studied, but about half of people who respond relapse within twelve months. Aside from effects in the brain, the general physical risks of ECT are similar to those of brief. ECT is considered one of the least harmful treatment options available for severely depressed pregnant women. A usual course of ECT involves multiple administrations, typically given two or three times per week until the patient is no longer suffering symptoms. ECT is administered under anesthetic with a muscle relaxant. Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and symptom remission. After treatment, drug therapy is usually continued, and some patients receive maintenance ECT. ECT appears to work in the short term via an effect mostly in the , and longer term via effects primarily in the. Transcranial magnetic stimulation Transcranial magnetic stimulation TMS or is a noninvasive method used to stimulate small regions of the brain. TMS was approved by the FDA for treatment-resistant major depressive disorder in 2008 and as of 2014 evidence supports that it is probably effective. The American Psychiatric Association the Canadian Network for Mood and Anxiety Disorders, and the Royal Australia and New Zealand College of Psychiatrists have endorsed rTMS for trMDD. Other Bright reduces depression symptom severity, with benefit was found for both and for nonseasonal depression, and an effect similar to those for conventional antidepressants. For non-seasonal depression, adding light therapy to the standard antidepressant treatment was not effective. For non-seasonal depression where light was used mostly in combination with antidepressants or a moderate effect was found, with response better than control treatment in high-quality studies, in studies that applied morning light treatment, and with people who respond to total or partial sleep deprivation. Both analyses noted poor quality, short duration, and small size of most of the reviewed studies. There is insufficient evidence for and dance movement therapy in depression. Major depressive episodes often resolve over time whether or not they are treated. Outpatients on a waiting list show a 10—15% reduction in symptoms within a few months, with approximately 20% no longer meeting the full criteria for a depressive disorder. The duration of an episode has been estimated to be 23 weeks, with the highest rate of recovery in the first three months. Studies have shown that 80% of those suffering from their first major depressive episode will suffer from at least 1 more during their life, with a lifetime average of 4 episodes. Other general population studies indicate that around half those who have an episode recover whether treated or not and remain well, while the other half will have at least one more, and around 15% of those experience chronic recurrence. Studies recruiting from selective inpatient sources suggest lower recovery and higher chronicity, while studies of mostly outpatients show that nearly all recover, with a median episode duration of 11 months. Around 90% of those with severe or psychotic depression, most of whom also meet criteria for other mental disorders, experience recurrence. Recurrence is more likely if symptoms have not fully resolved with treatment. Current guidelines recommend continuing antidepressants for four to six months after remission to prevent relapse. Evidence from many indicates continuing antidepressant medications after recovery can reduce the chance of relapse by 70% 41% on placebo vs. The preventive effect probably lasts for at least the first 36 months of use. Those people experiencing repeated episodes of depression require ongoing treatment in order to prevent more severe, long-term depression. In some cases, people must take medications for long periods of time or for the rest of their lives. Cases when outcome is poor are associated with inappropriate treatment, severe initial symptoms that may include psychosis, early age of onset, more previous episodes, incomplete recovery after 1 year, pre-existing severe mental or medical disorder, and as well. Depressed individuals have a shorter than those without depression, in part because depressed patients are at risk of dying by suicide. However, they also have a higher from other causes, being more susceptible to medical conditions such as heart disease. Up to 60% of people who die by suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and. The lifetime risk of suicide associated with a diagnosis of major depression in the US is estimated at 3. The estimate is substantially lower than a previously accepted figure of 15%, which had been derived from older studies of hospitalized patients. Depression is often associated with unemployment and poverty. Major depression is currently the leading cause of in North America and other high-income countries, and the fourth-leading cause worldwide. In the year 2030, it is predicted to be the second-leading cause of disease burden worldwide after , according to the World Health Organization. Delay or failure in seeking treatment after relapse, and the failure of health professionals to provide treatment, are two barriers to reducing disability. The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. In most countries the number of people who have depression during their lives falls within an 8—18% range. In North America, the probability of having a major depressive episode within a year-long period is 3—5% for males and 8—10% for females. Major depression to be about twice as common in women as in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this. The relative increase in occurrence is related to pubertal development rather than chronological age, reaches adult ratios between the ages of 15 and 18, and appears associated with psychosocial more than hormonal factors. Depression is a major cause of worldwide. People are most likely to develop their first depressive episode between the ages of 30 and 40, and there is a second, smaller peak of incidence between ages 50 and 60. The risk of major depression is increased with neurological conditions such as , , or , and during the first year after childbirth. It is also more common after cardiovascular illnesses, and is related more to a poor outcome than to a better one. Studies conflict on the prevalence of depression in the elderly, but most data suggest there is a reduction in this age group. Depressive disorders are more common to observe in urban than in rural population and the prevalence is in groups with stronger socioeconomic factors i. It was a similar but far broader concept than today's depression; prominence was given to a clustering of the symptoms of sadness, dejection, and despondency, and often fear, anger, delusions and obsessions were included. The term also came into use in and. An early usage referring to a psychiatric symptom was by French psychiatrist in 1856, and by the 1860s it was appearing in medical dictionaries to refer to a physiological and metaphorical lowering of emotional function. Since , melancholia had been associated with men of learning and intellectual brilliance, a hazard of contemplation and creativity. The newer concept abandoned these associations and through the 19th century, became more associated with women. A historical caricature of a man with an approaching depression Although melancholia remained the dominant diagnostic term, depression gained increasing currency in medical treatises and was a synonym by the end of the century; German psychiatrist may have been the first to use it as the overarching term, referring to different kinds of melancholia as depressive states. He theorized that loss, such as the loss of a valued relationship through death or a romantic break-up, results in loss as well; the depressed individual has identified with the object of affection through an , process called the libidinal of the. Such loss results in severe melancholic symptoms more profound than mourning; not only is the outside world viewed negatively but the ego itself is compromised. The patient's decline of self-perception is revealed in his belief of his own blame, inferiority, and unworthiness. He also emphasized early life experiences as a predisposing factor. The first version of the DSM DSM-I, 1952 contained depressive reaction and the DSM-II 1968 depressive neurosis, defined as an excessive reaction to internal conflict or an identifiable event, and also included a depressive type of manic-depressive psychosis within Major affective disorders. In the mid-20th century, researchers theorized that depression was caused by a in neurotransmitters in the brain, a theory based on observations made in the 1950s of the effects of and in altering monoamine neurotransmitter levels and affecting depressive symptoms. The chemical imbalance theory has never been proven. To maintain consistency the ICD-10 used the same criteria, with only minor alterations, but using the DSM diagnostic threshold to mark a mild depressive episode, adding higher threshold categories for moderate and severe episodes. The ancient idea of melancholia still survives in the notion of a melancholic subtype. The new definitions of depression were widely accepted, albeit with some conflicting findings and views. There have been some continued empirically based arguments for a return to the diagnosis of melancholia. There has been some criticism of the expansion of coverage of the diagnosis, related to the development and promotion of antidepressants and the biological model since the late 1950s. It is often used to mean this syndrome but may refer to other or simply to a low mood. People's conceptualizations of depression vary widely, both within and among cultures. What we call it—'disease,' 'disorder,' 'state of mind'—affects how we view, diagnose, and treat it. The diagnosis is less common in some countries, such as. It has been argued that the Chinese traditionally deny or emotional depression although since the early 1980s, the Chinese denial of depression may have modified. Alternatively, it may be that Western cultures reframe and elevate some expressions of human distress to disorder status. Similarly, Hungarian-American psychiatrist and others argue that depression is a metaphorical illness that is inappropriately regarded as an actual disease. There has also been concern that the DSM, as well as the field of that employs it, tends to abstract phenomena such as depression, which may in fact be. Stigma Historical figures were often reluctant to discuss or seek treatment for depression due to about the condition, or due to ignorance of diagnosis or treatments. Nevertheless, analysis or interpretation of letters, journals, artwork, writings, or statements of family and friends of some historical personalities has led to the presumption that they may have had some form of depression. People who may have had depression include English author , American-British writer , and American president. Some well-known contemporary people with possible depression include Canadian songwriter and American playwright and novelist. Some pioneering psychologists, such as Americans and , dealt with their own depression. There has been a continuing discussion of whether neurological disorders and mood disorders may be linked to , a discussion that goes back to Aristotelian times. British literature gives many examples of reflections on depression. Social stigma of major depression is widespread, and contact with mental health services reduces this only slightly. Public opinions on treatment differ markedly to those of health professionals; alternative treatments are held to be more helpful than pharmacological ones, which are viewed poorly. In the UK, the and the conducted a joint Five-year Defeat Depression campaign to educate and reduce stigma from 1992 to 1996; a study conducted afterwards showed a small positive change in public attitudes to depression and treatment. Trials are looking at the effects of on depression. The idea is that the drug is used to make the person look less frowning and that this stops the negative from the face. In 2015 it turned out, however, that the partly positive effects that had been observed until then could have been effects. MDD has been studied by taking scans of patients with depression have revealed a number of differences in brain structure compared to those who are not depressed. Meta-analyses of studies in major depression reported that, compared to controls, depressed patients had increased volume of the and and smaller volumes of the , , , and including the and. Hyperintensities have been associated with patients with a late age of onset, and have led to the development of the theory of. See also: Depression is especially common among those over 65 years of age and increases in frequency with age beyond this age. In addition the risk of depression increases in relation to the age and frailty of the individual. Depression is one the most important factors which negatively impact quality of life in adults as well as the elderly. Both symptoms and treatment among the elderly differ from those of the rest of the adult populations. As with many other diseases it is common among the elderly not to present classical depressive symptoms. Diagnosis and treatment is further complicated in that the elderly are often simultaneously treated with a number of other drugs, and often have other concurrent diseases. Treatment differs in that studies of SSRI-drugs have shown lesser and often inadequate effect among the elderly, while other drugs with more clear effects have adverse effects which can be especially difficult to handle among the elderly. However, elderly with depression are seldom offered any psychological treatment, and the evidence surrounding which other treatments are effective is incomplete. ECT or electric-shock therapy has been used as treatment of the elderly, and register-studies suggest it is effective although less so among the elderly than among the rest of the adult population. 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Dialogues in clinical neuroscience 10 2 : 251—5. Druga protiargument temelji na poskusih s farmakološkimi učinkovinami, ki monoamine izčrpajo; namerno zmanjšanje koncentracije centralno razpoložljivih monoaminov lahko nekoliko zniža razpoloženje neterapiranih depresivnih bolnikov,na razpoloženje zdravih ljudi pa to ne vpliva. Bipolinis afektinis sutrikimas maniakinė depresija priskiriama nuolatiniams afektiniams nuotaikos sutrikimams. Niekoľko vedeckých štúdií potvrdilo štatistickú koreláciu medzi depresiou a nadmernému vystaveniu niektorým poľnohospodárskym pesticídom. Raven BDNF v krvni plazmi depresivnih oseb je drastično zmanjšana več kot trikrat v primerjavi s kontrolo. Pri starejših ljudeh depresije zgleda ne zmanjšuje.
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