Mood of extreme gloom not associated with any particular cause or stimulus, or blackness of mood out of proportion to its cause. It can be a phase of manic-depressive psychosis, but is also a clinical picture in its own right. It can be a reaction to a shocking event (’reaction’ depression), or the result of neurotic problems (’psychogenic’ or ‘neurotic’ depression). The cause can be brain disorder (atherosclerosis, Parkinson’s disease), a general physical illness (hypothyroidism, Addison’s disease, myasthenia gravis) or poisoning (corticosteroids, some drugs to lower blood pressure). Sometimes there is no demonstrable cause (’endogenous’ depression). The latter case is often hereditary. Any form of depression, but particularly endogenous depression, can be associated with physical symptoms, such as marked slowness of thinking, inhibition of movement, and mimicry. The patient may complain of loss of appetite and constipation, wake earlier without being rested, and not look forward to the day. He often feels better in the evening (’day fluctuation’). If depression is serious it can lead to all sorts of delusions. The condition is then known as melancholia. Endogenous depression is usually treated with anti-depressant drugs. In neurotic or reactive depression antidepressants work above all on the physical symptoms. Psychotherapy can help the patient to solve his problems;

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