About Depression

Reactive Depression
Endogenous Depression
Major Depressive Episode/Disorder
Dysthymia
Explaining the Different Depressions
Symptoms

Depending on what it is used with, the word 'depression' can cover many different aspects of the illness, including causes and severity. Also see resources for depression specific information.

What is the reason for depression? In the case of workplace bullying, depression is said to be 'reactive' i.e. it is your bodies response to a specific situation. For legal reasons, it is always best to tell the doctor about the stressors that you feel have caused your illness and to ask him to specify the diagnosis of depression as 'reactive depression', if he feels that this is the case. In these circumstances, there is a good chance that you will respond to treatment, whether medication, talking or both and recover - but if the work situation is not changed, then you stand a high chance of relapse.

The other type of depression that can occur is 'endogenous' depression. This is where there appears to be no specific event that triggered the depression and is usually associated with an inherited risk of depression. However, even if there are inherited risks in someone who suffers from workplace bullying, there is no indication that the depression would have been any less severe had there been no apparent genetic risk.

Inherited risks or not, forensic psychiatry should focus on whether you would have suffered at that time without the bullying. If they attempt to apportion cause to predisposing factors without considering this question, they are effectively saying that part of your suffering is nothing to do with the bully. Please, don't try to make excuses for bullies - they have enough of their own.

A Major Depressive Episode is usually part of a Major Depressive Disorder and can be diagnosed when an individual has five or more of these symptoms during the same two-week period. (A major depressive episode may also be part of Bipolar Disorder). Major Depressive Disorder has 3 sub-types, of which the atypical features are most likely in victims. This means that it is an extreme reaction to some stimulant in the environment i.e. the bullying. Some depressing facts about it, pun intended:

• 80 to 90% of individuals with Major Depressive Disorder also have anxiety symptoms, about one third have a full-blown anxiety disorder
• The risk of recurrence is about 70% at 5 year follow up and at least 80% at 8 year follow-up
• After the first episode of Major Depressive Disorder, there is a 50%-60% chance of having a second episode, and a 5-10% chance of having a Manic Episode. After the second episode, the risk increases to 70% and then a 90% chance
• Stress appears to play a prominent role in triggering the first 1-2 episodes of this disorder, but not in subsequent episodes
• Up to 15% of patients with severe Major Depressive Disorder die by suicide. Over age 55, there is a fourfold increase in death rate
• 10-25% of patients with Major Depressive Disorder have pre-existing Dysthymic Disorder. These "double depressions" have a poorer prognosis
  Source www.mentalhealth.com

Criteria for a Major Depressive Disorder (alternative Bipolar Disorder)

Dysthymia is a chronic mild depression. It is experienced for more days than not for at least 2 years and there should be no respite from two or more of these symptoms for more than two months. The symptoms cause significant distress or impairment in social, occupational, educational or other important areas of functioning.

Criteria for Dysthymic Disorder

Explaining the Different Depressions by Dr Sue Collinson

People use the word depression quite loosely, and as a result it has lost any precise meaning. This is particularly so when someone is diagnosed as having depression. In the past, the word 'melancholia' was used, and I think that we need to reclaim the meaning of 'depression', or develop another term, or acronym, to describe the illness. Similarly, the phrase 'mental illness' has very negative associations, but mental simply means 'of the mind', just as cardiac means 'of the heart'. We have constructed an artificial barrier between the mind and the brain, and this badly needs to be dissolved. The brain is an organ, just like the liver or pancreas, but because of its intimate connectedness to the rest of the body, mental illness can also make you feel physically quite unwell.

'Clinical' depression refers to the fact that your doctor was able to make a diagnosis of your illness based on seeing you, talking to you, and listening to your account of how you were feeling. The term 'endogenous' is used to describe an illness or condition that is thought to originate within the individual, for example through a chemical imbalance, while 'exogenous', or 'reactive' depression means that the illness is in response to an external factor. In the case of depression, this could for example be because of a loss or bereavement.

Although you ask 'don't most people get depression', and you could point out that most people will feel very sad at such times, some people's sadness goes beyond the normal parameters, and that is the point at which they may well need professional help. Depression is a very treatable illness, and there are a range of treatment approaches, which include both medication and psychological therapies. Your doctor should be able to help you to choose the one that is best for you.

Written by Dr Sue Collinson, an academic researcher in mental health and a trustee of Depression Alliance. Reproduced with kind permission, it first appeared in Depression Alliances' publication 'A Single Step', they are a UK mental health charity and more details can be found on their website at www.depressionalliance.org

As everyone suffers more, less or differently to others, it would not be appropriate to comment on or infer any particular diagnosis, so individual symptoms caused by bullying will be discussed in isolation from the possible range of diagnoses that may be made by a medical professional.

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