Sorrow .

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Misery. Despondency. "I'll change my state with any lowlife, Thou canst from prison or dunghill bring. My agony's past cure, another Damnation, I may not in this torment stay, Now frantic I loathe my life, Loan me a bridle or a blade.
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Depression "I\'ll change my state with any bastard, Thou canst from prison or dunghill get. My agony\'s past cure, another Hell, I may not in this torment abide, Now frantic I detest my life, Lend me a strap or a blade. Every one of my griefs to this are carefree, Naught so damn\'d as Melancholy." Robert Burton , The Anatomy of Melancholy ( 1621 ) "Sadness is a turmoil of state of mind, so strangely difficult and slippery in the way it gets to be distinctly known to the self—to the interceding insightfulness—as to skirt near being past portrayal. It in this manner remains about limitless to the individuals who have not experienced it in its outrageous temperament, in spite of the fact that the misery, "the blues" which individuals experience sporadically and connect with the general bother of regular presence are of such pervasiveness that they do give numerous people a HINT of the disease in its cataclysmic shape." William Styron , Darkness Visible: A Memoir of Madness ( 1990 )

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Causes of Disability in the United States, Canada, and Western Europe in 2000 Iglehart, J. K. N Engl J Med 2004;350:507-514

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The Birth & Growth of " Major Depression " Statistics for "Significant Depressive" Disorder (DSM-IV): - direct to serious sorrow: 6.5% group commonness rate - lifetime recurrence approaches 20% - 22% of more established grown-ups report "feeling dismal" a large portion of the day/consistently We live in a "time of despairing ". " bread and spread " of psychiatry, similarly as "despondency" was pre-DSM III: 54% of psychiatric visits and treatment are for gloom 15% are for schizophrenia 9% are for nervousness issue 22% are for all else joined

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Diagnostic Algorithm for Major Depression Whooley, M. A. et al. N Engl J Med 2000;343:1942-1950

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Diagnostic Categories for Depression

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The Birth & Growth of " Major Depression " Pre-DSM III term: " sadness " – moderately uncommon and restricted to mental refuges 1917 - 8% of therapists in private/outpatient hone 1941 - 38% " " " " " 1970 - 66% " " " " " 1920s-1970s : psychiatry moved its concentration to psychopathology of day by day life/ordinary concerns (sex, marriage, common disappointment) Depression in U.S. dichotomized: " endogenous " or " receptive " In Europe: " endogenous-crazy " or " psychotic responsive "

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The Birth & Growth of " Major Depression " Q: Why did this twofold perspective of wretchedness gradually cease to exist in the 1970s ? - clear, unmistakable limits between the 2 classes hard to discover -John Feighner at Washington University (" Feighner criteria " 1972) 3 criteria - dysphoric temperament set apart by indications of being depressed, tragic, down and out, sad - 5 of 7 side effects from: loss of hunger, sleep trouble, loss of vitality, disturbance, loss of enthusiasm for normal exercises, blame feelings, moderate considering, or repetitive suicidal musings must be available - more likely than not kept going no less than 1 month and not be because of another prior mental issue Feighner criteria = remarkably high unwavering quality rating scores

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The Birth & Growth of " Major Depression " Other central point in destruction of "responsive melancholy": - psychiatric meds got to be distinctly symptomatic "splitters" - present day living versus innate inclination: drugs treat both the same Peter Kramer\'s Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self (1993) - changed what constituted "finish treatment" -agreed with ascent of oversaw care/HMOs -changed treatment of "sub-limit" cases -"benchmark" change: treatment versus upgrade - - - - Conflating minor despondency/dysthymia with significant depression prompts to two troublesome results: (1) social powers are not considered or considered important (2) limits the scan for all encompassing treatment and avoidance

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" Major Depression " and Environmental Stress

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" Major Depression " and Environmental Stress

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The Futile Pursuit of Happiness: Environmental Stress Gilbert, Wilson, Loewenstein, & Kahneman : "We reliably misestimate the force and term of something\'s utility; this is known as the " affect inclination \'." Our capacity to foresee the enthusiastic outcomes of a choice, buy, or occasion is short of what we think. Our oversights of desire can lead specifically to botches in picking what we think will give us delight. We regularly " miswant ." Key part of " adjustment " to great things and " flexibility " to awful things. our "mental resistant framework" (a kind of passionate "indoor regulator") e.g., recollect when you got your first dial-up 14,400 baud modem?

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The Tyranny of Choice " Starter Marriages" wonder Census Bureau: 3 million separated 18-29 year-olds (1999) 253,000 separated 25-29 year-olds (1962) Atul Gawande, M.D. & malignancy study -65% of individuals studied say that if they somehow managed to get disease, they would need to pick their own treatment; of the individuals who do get growth, however, just 12% really need to pick Steven Venti, Dartmouth financial expert & Employer 401k arrangements The more subsidizes businesses offer their workers in 401k arrangements, the more outlandish the representatives are to put resources into any of them. " Wine Warehouse" versus "Service station" encounters

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Depression and the Tyranny of Choice Excessive decision is frequently mentally and candidly troublesome. Why ? I ncreases weight of data social occasion to settle on an insightful choice Doing all the "money saving advantage/expected utility" figurings is depleting I ncreases assumptions about how great the choice will be People frequently gather an optimistic composite of the considerable number of choices inescapable Which improves the probability that they will lament the choice they make And expands the possibility that they will censure themselves when a choice neglects to satisfy desires (more lament and second-speculating). Schwartz: Perhaps schools/colleges offer excessively numerous decisions now, which may help clarify twofold , triple-majoring, and so on (e.g., Spiderbytes)

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Combating the "Loss of motion of Choice" Helpful countermeasures : (1) Pro-Actively Limit Choices to "1 st arrange," "2 nd arrange," "3 rd arrange" (2) Counterfactual Downward (3) Make Some Decisions Nonreversible (e.g., Harvard photography class) (4) Anticipate Adaptation (5) Learn to Love Constraints (Say "No")

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Teens and the Antidepressant Dilemma Young individuals\' utilization of the antidepressants known as specific serotonin reuptake inhibitors seems to have dramatically increased between 1995-96 and 2001-02. That depends on a database of visits related with a SSRI solution. While just a single SSRI medication, fluoxetine, has FDA endorsement for use in young people, the information recommends that by 2002 different SSRIs had taken a bigger share of these medicines. Diary of Adolescent Health (2005)

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Teens and the Antidepressant Dilemma: "Rollback" Dilemma

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Treating the Environment & Dangers of Under-Diagnosing general wellbeing basic: aversion ! ecological stressors & commonness Maria Shin, right, and her significant other moved to Great Neck from Seoul, looking for a less forced scholastic life for their two high school youngsters

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Dangers of Over-and Under-Diagnosing Hans Eysenck\'s identity hypothesis (1947)

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