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General overview

Major depression is a mental disorder which is characterized by a persistent and pervasive low mood. This illness is accompanied by a loss of interest or pleasure of previously enjoyable activities and low self-esteem of the affected individual.

Depression is a disabling condition which can negatively affect an individual's quality of life. An important issue to take note of is that major depression isn't a weakness that one can just shake off. This condition is like any other illness and it requires appropriate treatment for it to improve or resolve completely.

Symptoms

In episodes of depression, symptoms can develop most of the day, nearly every day. These symptoms can include the following:

  • Feelings of tearfulness, hopelessness, sadness or emptiness.
  • Agitation and anxiety.
  • Restlessness.
  • Sleep disturbances - insomnia or oversleeping.
  • Aggressive outbursts or irritability or frustration over small matters.
  • Feelings of guilt or worthlessness over previous failures and blaming oneself for things that they weren't responsible for.
  • Changes in appetite - usually a decreased appetite resulting in weight loss. In some cases, patients experience cravings for refined and high fat foods which results in weight gain.
  • Unexplained physical issues such as chest pain, back pains and headaches.
  • There's issues with concentrating and focusing and having problems with decision making and remembering things.
  • Frequent or recurrent suicidal thoughts, thoughts of death or suicide attempts.

The difference between tearfulness in pseudobulbar affect (PBA) and major depression

PBA is characterized by involuntary crying or uncontrollable episodes of crying. Other synonyms for this condition are emotional lability, labile effect or emotional incontinence.

This affect occurs secondary to brain injury and neurological disorders such as strokes or multiple sclerosis. PBA is often misdiagnosed as major depression, but there are clear distinctions between the two conditions. They are as follows:

  • The duration of crying during PBA is seconds to minutes, whereas in depression it can last intermittently for weeks to months.
  • The affect of crying in PBA is unrelated to the patient's mood, whereas in depression it's associated with sadness, guilt, etc and is associated with the patient's mood.
  • During crying episodes the patient's behaviour doesn't change in PBA, but in depression the patient can be fatigued or agitated.
  • In PBA there are no misperceptions regarding the patient, whereas in depression patient's have negative views of themselves.
  • Regarding the patient's insight, in PBA it isn't impaired whereas in depression it it.
  • The stimulus of crying in PBA is not specific or not appropriate to the situation, whereas in depression there is a specific mood-related situation.

Management

Patients that are experiencing suicidal thoughts or are attempting to commit suicide should seek immediate medical attention. If they are not willing to present themselves to an emergency room, then the police can be contacted to escort the patient to such a facility.

Psychotherapy in terms of cognitive-behaviour therapy (CBT) may be useful. Here, patients can learn to swap negative thoughts with positive ones, and also develop coping skills to help manage the stimulus which is causing the excessive crying spells which are associated with depression.

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