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Depression: Major Depression
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Depression is a disorder that is defined by certain behaviors and thought patterns. Although the core troubles are the same for children as they are for adults, often the specific behaviors are different, and vary according to the age and developmental level of the child. Importantly, often a child or adolescent is unable to say that they are "depressed" or "sad." Rather, they may say that they are bored, angry, or are just not happy. As examples of how depressive behavior can be somewhat different in adults versus children, below is a list comparing the major symptoms of depression.
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Depression is not the same as being sad or discouraged. These feelings are a normal part of life and qenerally pass on. True depression is severe sadness and hopelessness that does not go away over time and that makes normal activities impossible. The American Psychiatric Association bases its definition of clinical depression or major depression on the following eight primary criteria:
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Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Antidepressants increased the risk of suicidality (suicidal thinking and behavior) in children, adolescents, and young adults in short-term studies in Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of antidepressants in children, adolescents, or young adults must balance the risk to clinical need. Patients of all ages started on antidepressant therapy should be closely monitored and observed for clinical worsening, suicidality, or unusual changes in behavior, especially at the beginning of therapy or at the time of dose changes. This risk may persist until significant remission occurs. Families and caregivers should be advised of the need for close observation and communication with the prescriber.
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Major Depression affects 15% of Americans at some point during their lives, and 100 million people are affected on any given day. The age of onset is fairly evenly spread among people. The mean age is 40, but Depression can onset from childhood to seniors. It can come on suddenly in days, or build over years. Anxiety, phobias, panic and Dysthymia can predate it. On average, the course of Major Depression runs 3 to 9 months if untreated, and 85% cases resolve within 1 year. Over 1/2 of people who experience major depression only have one episode.
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Depression affects different people very differently. As a result many psychiatrists now argue that it is helpful to understand major depression not as whole but as different sub-types. These sub-types can affect not only the symptoms a person has, but the type of treatment that is most likely to be effective. Common sub-types of depression include:
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Depression is by far the most common emotion associated with chronic back pain. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression. This type of depression goes beyond what would be considered normal sadness or feeling "down for a few days". The symptoms of a major depression occur daily for at least two weeks and include at least 5 of the following (DSM-IV, 1994):
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Major Depression