First of all, one should rule out if there are any organic causes, such as neurological disorders or conditions (tumours, cerebrovascular diseases, demyelinating diseases, degenerative diseases of the central nervous system) and endocrine diseases (such as thyroid diseases).
Moreover, iatrogenic causes (induced by therapies) should be excluded, such as therapies with cortisone, interferon, etc.
Mood disorders can be:
- a reaction to painful current events
- represent a current reaction to past painful events
- spontaneously activated, without any apparent reason.
For example, a depressive episode can be caused by bereavement, by relational problems, financial issues or important changes in everyday life (work, love life, family).
Women are more exposed to depression, with an incidence almost double than in men, mainly because of hormonal factors (menstrual cycle, pregnancy, miscarriage, postpartum period, menopause).
Depression may already appear during childhood. A depressive child may present somatic pathologies, such as headaches, stomach-aches, fever, may refuse to go to school, be morbidly attached to a parent, or worry for the possible death of a parent. Older children may be moody, have problems both learning and socializing at school, be confrontational, mournful or feel misunderstood. Since normal behaviour varies from one stage of childhood to another, it may be difficult to understand if the child is simply going through a physiological phase or else is suffering from depression. Parents and teachers may observe sufficient changes in behaviour to cause alarm. Again, here a paediatric evaluation should exclude any other cause for physical symptoms and the child should preferably to seen by a child neuropsychiatrist.
Depression in men is often disguised by alcohol and drug abuse, or hyperactivity in working life (working very late, which is a more socially accepted behaviour). It may happen that depression in men doesn’t manifest as lack of hope, or inability to get help, but rather as irritability and anger. Therefore, this kind of depression may be harder to detect.
Depression in an elderly person is not uncommon. Usually, during medical consultations, elderly people tend to talk more about physical ailments, and are more reluctant to talk about feelings of sadness, such as loss of interest in the activities they used to find pleasant, or a particularly prolonged feeling of pain after a significant emotional loss. Some symptoms could be decoded as a side effect of drugs the patient is already taking for a physical ailment or condition, or as the result of an ongoing illness