terest or pleasure in activities; the person is described as depressed, sad, hopeless, or discouraged. Depressed mood can be inferred from facial expressions and demeanor. Somatic complaints may be emphasized rather than feelings of sadness. Increased irritability may be present. Many people feel they have to force themselves to eat or they may crave specific foods; weight gains or losses may be noted. Insomnia or hypersomnia may occur. The inability to sit still or the opposite, slowed speech, thinking, and body movements may be found. A lack of energy without physical exertion are reported; usual activities such as washing and dressing are exhausting. Negative evaluations of worth, quilt feelings, self-blame or ruminations over past failings may include delusional proportions. Depression may impair abilities to think or make decisions; intellectually demanding occupations may be unmanageable. Thoughts of suicide may be present. Degree of symptoms varies from mild to severe, interfering with social, occupational, and other areas of functioning (DSM-IV, 1994).
Major Depressive Disorder can begin at any age, the average age for onset is in the mid-20s. The course of the disorder varies; some have isolated episodes separated by many years, others have clusters of episodes, and others experience more frequent episodes with age. The number of prior episodes predicts likelihood of a subsequent episode: 50 to 60 percent with a single episode, are expected to have a second episode; two episodes have a 70 percent chance of a third; and three episodes have a 90 percent chance of a fourth. Episodes may end completely, partially, or not at all. Partial remission results in a greater likelihood of additional episodes and continuing patterns of partial recovery, therefore previous recovery may have prognostic value (DSM-IV, 1994).
Attempts have been made to categorize depressive illness according to symptoms. Distinctions be...