Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer . A medical professional who practices oncology is an oncologist . The name's etymological origin is the Greek word ὄγκος ( ónkos ), meaning "tumor", "volume" or "mass". Oncology is concerned with:
106-534: Medical histories remain an important screening tool: the character of the complaints and nonspecific symptoms (such as fatigue , weight loss , unexplained anemia , fever of unknown origin , paraneoplastic phenomena and other signs) may warrant further investigation for malignancy. Occasionally, a physical examination may find the location of a malignancy . Diagnostic methods include: Apart from diagnoses, these modalities (especially imaging by CT scanning ) are often used to determine operability , i.e. whether it
212-532: A metabolic disturbance ; and a full blood count including ESR to rule out a systemic infection or chronic disease. Adverse affective reactions to medications or alcohol misuse may be ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism , a cause of depression in men. Vitamin D levels might be evaluated, as low levels of vitamin D have been associated with greater risk for depression. Subjective cognitive complaints appear in older depressed people, but they can also be indicative of
318-490: A 2019 review was inconclusive as to whether cytokines play any definitive role in ME/CFS . Fatigue has been correlated with reductions in structural and functional connectivity in the brain. This has included in post-stroke, MS, NMOSD and MOG, and ME/CFS. This was also found for fatigue after brain injury, including a significant linear correlation between self-reported fatigue and brain functional connectivity. Areas of
424-442: A 2019 study found 102 variants in the genome linked to depression. However, it appears that major depression is less heritable compared to bipolar disorder and schizophrenia. Research focusing on specific candidate genes has been criticized for its tendency to generate false positive findings. There are also other efforts to examine interactions between life stress and polygenic risk for depression. Depression can also arise after
530-451: A broad range of brain networks, and has been linked to many types of fatigue. Findings implicate neuroinflammation in the etiology of fatigue in autoimmune and related disorders. Low-grade inflammation may cause an imbalance between energy availability and expenditure. Cytokines are small protein molecules that modulate immune responses and inflammation (as well as other functions) and may have causal roles in fatigue. However
636-733: A car crash, and being awake over 20 hours is the equivalent of driving with a blood-alcohol concentration level of 0.08%. People with multiple sclerosis experience a form of overwhelming tiredness that can occur at any time of the day, for any duration, and that does not necessarily recur in a recognizable pattern for any given patient, referred to as "neurological fatigue", and often as "multiple sclerosis fatigue" or "lassitude". People with autoimmune diseases including inflammatory rheumatic diseases such as rheumatoid arthritis , psoriatic arthritis and primary Sjögren's syndrome , experience similar fatigue. Attempts have been made to isolate causes of central nervous system fatigue . Acute fatigue
742-796: A chronic or terminal medical condition, such as HIV/AIDS or asthma , and may be labeled "secondary depression". It is unknown whether the underlying diseases induce depression through effect on quality of life, or through shared etiologies (such as degeneration of the basal ganglia in Parkinson's disease or immune dysregulation in asthma). Depression may also be iatrogenic (the result of healthcare), such as drug-induced depression. Therapies associated with depression include interferons , beta-blockers , isotretinoin , contraceptives , cardiac agents, anticonvulsants , antimigraine drugs , antipsychotics , and hormonal agents such as gonadotropin-releasing hormone agonist (GnRH agonist). Celiac disease
848-506: A combination of medication and psychotherapy may be used. There is moderate-quality evidence that psychological therapies are a useful addition to standard antidepressant treatment of treatment-resistant depression in the short term. Psychotherapy has been shown to be effective in older people. Successful psychotherapy appears to reduce the recurrence of depression even after it has been stopped or replaced by occasional booster sessions. The most-studied form of psychotherapy for depression
954-424: A depressed state mediated by increased serotonin. Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive than controls, the finding of increased jugular 5-HIAA in people who are depressed that normalized with selective serotonin reuptake inhibitor (SSRI) treatment, and the preference for carbohydrates in people who are depressed. Already limited,
1060-439: A diagnosis that could explain the fatigue after a year with the condition. In those people who had a possible diagnosis, musculoskeletal (19.4%) and psychological problems (16.5%) were the most common. Definitive physical conditions were only found in 8.2% of cases. Fatigue can be seen as a uni-dimensional phenomenon that influences different aspects of human life. It can be multi-faceted and broadly defined, making understanding
1166-474: A higher chance of developing depression, which shows the two are connected. There is even evidence suggesting that altering the microbes in the gut can have regulatory effects on developing depression. Theories unifying neuroimaging findings have been proposed. The first model proposed is the limbic-cortical model, which involves hyperactivity of the ventral paralimbic regions and hypoactivity of frontal regulatory regions in emotional processing. Another model,
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#17327730257451272-411: A higher risk of developing clinical depression. There appears to be a link between air pollution and depression and suicide. There may be an association between long-term PM2.5 exposure and depression, and a possible association between short-term PM10 exposure and suicide. The pathophysiology of depression is not completely understood, but current theories center around monoaminergic systems,
1378-476: A lack of energy in the muscle, by a decrease of the efficiency of the neuromuscular junction or by a reduction of the drive originating from the central nervous system , and can be reversed by rest. The central component of fatigue is triggered by an increase of the level of serotonin in the central nervous system. During motor activity, serotonin released in synapses that contact motor neurons promotes muscle contraction . During high level of motor activity,
1484-557: A lifelong disorder with recurrent major depressive episodes . Those with major depressive disorder are typically treated with psychotherapy and antidepressant medication . Medication appears to be effective, but the effect may be significant only in the most severely depressed. Hospitalization (which may be involuntary ) may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. Electroconvulsive therapy (ECT) may be considered if other measures are not effective. Major depressive disorder
1590-426: A major role in the development of depression. Family and twin studies find that nearly 40% of individual differences in risk for major depressive disorder can be explained by genetic factors . Like most psychiatric disorders, major depressive disorder is likely influenced by many individual genetic changes. In 2018, a genome-wide association study discovered 44 genetic variants linked to risk for major depression;
1696-442: A medical context is used to cover experiences of low energy that are not caused by normal life. A 2021 review proposed a definition for fatigue as a starting point for discussion: "A multi-dimensional phenomenon in which the biophysiological, cognitive, motivational and emotional state of the body is affected resulting in significant impairment of the individual's ability to function in their normal capacity" . Another definition
1802-676: A metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor cannot be found. However, immunohistochemical markers often give a strong indication of the primary malignancy. This situation is referred to as " malignancy of unknown primary ", and again, treatment is empirically based on past experience of the most likely origin. Depending upon the cancer identified, follow-up and palliative care will be administered at that time. Certain disorders (such as ALL or AML ) will require immediate admission and chemotherapy , while others will be followed up with regular physical examination and blood tests . Often, surgery
1908-771: A monoamine—can cause depression in those in remission or relatives of people who are depressed, suggesting that decreased serotonergic neurotransmission is important in depression. Second, the correlation between depression risk and polymorphisms in the 5-HTTLPR gene, which codes for serotonin receptors, suggests a link. Third, decreased size of the locus coeruleus , decreased activity of tyrosine hydroxylase , increased density of alpha-2 adrenergic receptor , and evidence from rat models suggest decreased adrenergic neurotransmission in depression. Furthermore, decreased levels of homovanillic acid , altered response to dextroamphetamine , responses of depressive symptoms to dopamine receptor agonists, decreased dopamine receptor D1 binding in
2014-415: A more noticeable slowing of movements. Depressed children may often display an irritable rather than a depressed mood; most lose interest in school and show a steep decline in academic performance. Diagnosis may be delayed or missed when symptoms are interpreted as "normal moodiness". Elderly people may not present with classical depressive symptoms. Diagnosis and treatment is further complicated in that
2120-507: A patient, with the relative contribution of each mechanism differing over time. Proposed fatigue explanations due to permanent changes in the brain may have difficulty in explaining the "unpredictability" and "variability" (i.e. appearing intermittently during the day, and not on all days) of the fatigue associated with inflammatory rheumatic diseases and autoimmune diseases (such as multiple sclerosis ). Inflammation distorts neural chemistry, brain function and functional connectivity across
2226-500: A person who is sufficiently somnolent may experience microsleep . However, objective cognitive testing can be used to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness. The perception of mental fatigue is believed to be modulated by the brain's reticular activating system (RAS). Fatigue impacts a driver's reaction time, awareness of hazards around them and their attention. Drowsy drivers are three times more likely to be involved in
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#17327730257452332-616: A person's sleeping habits, eating habits, and general health. A person having a major depressive episode usually exhibits a low mood, which pervades all aspects of life, and an inability to experience pleasure in previously enjoyable activities. Depressed people may be preoccupied with or ruminate over thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness or hopelessness. Other symptoms of depression include poor concentration and memory, withdrawal from social situations and activities, reduced sex drive , irritability, and thoughts of death or suicide. Insomnia
2438-482: A promising intervention in youth. Problem solving therapy , cognitive behavioral therapy, and interpersonal therapy are effective interventions in the elderly. Psychoanalysis is a school of thought, founded by Sigmund Freud , which emphasizes the resolution of unconscious mental conflicts. Psychoanalytic techniques are used by some practitioners to treat clients presenting with major depression. A more widely practiced therapy, called psychodynamic psychotherapy ,
2544-518: A range of related diagnoses, including dysthymia , which involves a chronic but milder mood disturbance; recurrent brief depression , consisting of briefer depressive episodes; minor depressive disorder , whereby only some symptoms of major depression are present; and adjustment disorder with depressed mood , which denotes low mood resulting from a psychological response to an identifiable event or stressor . The DSM-5 recognizes six further subtypes of MDD, called specifiers , in addition to noting
2650-458: A side effect of certain medications (e.g., lithium salts , ciprofloxacin ); beta blockers , which can induce exercise intolerance , medicines used to treat allergies or coughs, and many cancer treatments, particularly chemotherapy and radiotherapy . Use of benzodiazepines has been found to correlate with higher fatigue. Fatigue is often associated with diseases and conditions. Some major categories of conditions that often list fatigue as
2756-520: A symptom include physical diseases, substance use illness, mental illnesses, and other diseases and conditions. In some areas, it has been proposed that fatigue be separated into primary fatigue, caused directly by a disease process, and ordinary or secondary fatigue, caused by a range of causes including exertion and also secondary impacts on a person of having a disease (such as disrupted sleep). The ICD-11 MG22 definition of fatigue captures both types of fatigue; it includes fatigue that "occur[s] in
2862-469: A tendency to fall asleep, whereas fatigue refers to an overwhelming sense of tiredness, lack of energy, and a feeling of exhaustion. Sleepiness and fatigue often coexist as a consequence of sleep deprivation. However sleepiness and fatigue may not correlate. Fatigue is generally considered a longer-term condition than sleepiness (somnolence). Distinguishing features of medical fatigue include Differentiating characteristics of fatigue that may help identify
2968-464: A tendency to higher concentrations of HSP72. A small 2020 study of Crohn's disease patients found that higher fatigue visual analogue scale (fVAS) scores correlated with hgher HSP90α levels. A related small 2012 trial investigating if application of an IL-1 receptor antagonist ( anakinra ) would reduce fatigue in primary Sjögren's syndrome patients was inconclusive. Fatigue is currently measured by many different self-measurement surveys. Examples are
3074-401: A third of fatigue primary care cases, no medical or psychiatric diagnosis is found. Tiredness is a common medically unexplained symptom. Fatigue can often be traced to poor sleep habits. Sleep deprivation and disruption is associated with subsequent fatigue. Sleep disturbances due to disease may impact fatigue. Caffeine and alcohol can disrupt sleep, causing fatigue. Fatigue may be
3180-691: A treatment comparing favorably to other psychotherapies. The most common and effective treatments for depression are psychotherapy, medication, and electroconvulsive therapy (ECT); a combination of treatments is the most effective approach when depression is resistant to treatment. American Psychiatric Association treatment guidelines recommend that initial treatment should be individually tailored based on factors including severity of symptoms, co-existing disorders, prior treatment experience, and personal preference. Options may include pharmacotherapy, psychotherapy, exercise, ECT, transcranial magnetic stimulation (TMS) or light therapy . Antidepressant medication
3286-437: Is surgically possible to remove a tumor in its entirety. Currently, a tissue diagnosis (from a biopsy ) by a pathologist is essential for the proper classification of cancer and to guide the next step of treatment. On extremely rare instances when this is not possible, "empirical therapy" (without an exact diagnosis) may be considered, based on the available evidence (e.g. history, x-rays and scans.) On very rare occasions,
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3392-446: Is CBT, which teaches clients to challenge self-defeating, but enduring ways of thinking (cognitions) and change counter-productive behaviors. CBT can perform as well as antidepressants in people with major depression. CBT has the most research evidence for the treatment of depression in children and adolescents, and CBT and interpersonal psychotherapy (IPT) are preferred therapies for adolescent depression. In people under 18, according to
3498-558: Is a history of prior episodes, with no history of mania). ICD-11 symptoms, present nearly every day for at least two weeks, are a depressed mood or anhedonia , accompanied by other symptoms such as "difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue." These symptoms must affect work, social, or domestic activities. The ICD-11 system allows further specifiers for
3604-446: Is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode. Other disorders need to be ruled out before diagnosing major depressive disorder. They include depressions due to physical illness, medications , and substance use disorders . Depression due to physical illness
3710-402: Is a self-reported, persistent (constant) fatigue lasting at least one month. Clinical depression Major depressive disorder ( MDD ), also known as clinical depression , is a mental disorder characterized by at least two weeks of pervasive low mood , low self-esteem , and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in
3816-454: Is activated by stressful life events. The preexisting vulnerability can be either genetic , implying an interaction between nature and nurture , or schematic , resulting from views of the world learned in childhood. American psychiatrist Aaron Beck suggested that a triad of automatic and spontaneous negative thoughts about the self , the world or environment , and the future may lead to other depressive signs and symptoms. Genes play
3922-680: Is also a connection between the gut microbiome and the central nervous system, otherwise known as the Gut-Brain axis , which is a two-way communication system between the brain and the gut. Experiments have shown that microbiota in the gut can play an important role in depression as people with MDD often have gut-brain dysfunction. One analysis showed that those with MDD have different bacteria living in their guts. Bacteria Bacteroidetes and Firmicutes were most affected in people with MDD, and they are also impacted in people with irritable bowel syndrome . Another study showed that people with IBS have
4028-490: Is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimism , self-harm or suicide, and an absence of positive thoughts or plans. Specialist mental health services are rare in rural areas, and thus diagnosis and management is left largely to primary-care clinicians. This issue is even more marked in developing countries. Rating scales are not used to diagnose depression, but they provide an indication of
4134-399: Is another possible contributing factor. Substance use in early age is associated with increased risk of developing depression later in life. Depression occurring after giving birth is called postpartum depression and is thought to be the result of hormonal changes associated with pregnancy . Seasonal affective disorder , a type of depression associated with seasonal changes in sunlight,
4240-454: Is attempted to remove a tumor entirely. This is only feasible when there is some degree of certainty that the tumor can in fact be removed. When it is certain that parts will remain, curative surgery is often impossible, e.g. when there are metastases , or when the tumor has invaded a structure that cannot be operated upon without risking the patient's life. Occasionally surgery can improve survival even if not all tumour tissue has been removed;
4346-417: Is believed to be caused by a combination of genetic , environmental, and psychological factors, with about 40% of the risk being genetic. Risk factors include a family history of the condition, major life changes, childhood traumas, certain medications, chronic health problems , and substance use disorders . It can negatively affect a person's personal life, work life, or education, and cause issues with
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4452-527: Is closely linked to the concept of ego depletion , though the validity of the concept is disputed. For example, one pre-registered study of 686 participants found that after exerting mental effort, people are likely to disengage and become less interested in exerting further effort. Decreased attention can also be described as a more or less decreased level of consciousness . In any case, this can be dangerous when performing tasks that require constant concentration, such as operating large vehicles. For instance,
4558-705: Is common; in the typical pattern, a person wakes very early and cannot get back to sleep. Hypersomnia , or oversleeping, can also happen, as well as day-night rhythm disturbances, such as diurnal mood variation . Some antidepressants may also cause insomnia due to their stimulating effect. In severe cases, depressed people may have psychotic symptoms. These symptoms include delusions or, less commonly, hallucinations , usually unpleasant. People who have had previous episodes with psychotic symptoms are more likely to have them with future episodes. A depressed person may report multiple physical symptoms such as fatigue , headaches, or digestive problems; physical complaints are
4664-545: Is complex and in up to a third of primary care cases no medical or psychiatric diagnosis is found. Fatigue (in the general usage sense of normal tiredness) often follows prolonged physical or mental activity. Physical fatigue results from muscle fatigue brought about by intense physical activity . Mental fatigue results from prolonged periods of cognitive activity which impairs cognitive ability, can manifest as sleepiness , lethargy , or directed attention fatigue , and can also impair physical performance. Fatigue in
4770-502: Is currently a rapid expansion in the use of monoclonal antibody treatments, notably for lymphoma ( Rituximab ) and breast cancer ( Trastuzumab ). Vaccines and other immunotherapies are the subject of intensive research. Approximately 50% of all cancer cases in the Western world can be treated to remission with radical treatment. For pediatric patients, that number is much higher. A large number of cancer patients will die from
4876-444: Is diagnosed as a mood disorder due to a general medical condition . This condition is determined based on history, laboratory findings, or physical examination . When the depression is caused by a medication, non-medical use of a psychoactive substance, or exposure to a toxin , it is then diagnosed as a specific mood disorder (previously called substance-induced mood disorder ). Preventive efforts may result in decreases in rates of
4982-444: Is either depressed mood or loss of interest or pleasure. Depressed mood occurs nearly every day as subjective feelings like sadness, emptiness, and hopelessness or observations made by others (e.g. appears tearful). Loss of interest or pleasure occurs in all, or almost all activities of the day, nearly every day. These symptoms, as well as five out of the nine more specific symptoms listed, must frequently occur for more than two weeks (to
5088-784: Is equivalent to the use of medications or psychological therapies in most people. In older people it does appear to decrease depression. Sleep and diet may also play a role in depression, and interventions in these areas may be an effective add-on to conventional methods. In observational studies, smoking cessation has benefits in depression as large as or larger than those of medications. Talking therapy (psychotherapy) can be delivered to individuals, groups, or families by mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers , counselors, and psychiatric nurses. A 2012 review found psychotherapy to be better than no treatment but not other treatments. With more complex and chronic forms of depression,
5194-456: Is in the tradition of psychoanalysis but less intensive, meeting once or twice a week. It also tends to focus more on the person's immediate problems, and has an additional social and interpersonal focus. In a meta-analysis of three controlled trials of Short Psychodynamic Supportive Psychotherapy, this modification was found to be as effective as medication for mild to moderate depression. Conflicting results have arisen from studies that look at
5300-484: Is not adequate as a diagnosis tool, because its sensitivity is only 44%. These stress-related abnormalities are thought to be the cause of hippocampal volume reductions seen in people who are depressed. Furthermore, a meta-analysis yielded decreased dexamethasone suppression, and increased response to psychological stressors. Further abnormal results have been obscured with the cortisol awakening response , with increased response being associated with depression. There
5406-546: Is not enough to diagnose most neuromuscular disorders. Mental fatigue is a temporary inability to maintain optimal cognitive performance. The onset of mental fatigue during any cognitive activity is gradual, and depends upon an individual's cognitive ability, and also upon other factors, such as sleep deprivation and overall health. Mental fatigue has also been shown to decrease physical performance. It can manifest as somnolence , lethargy , directed attention fatigue , or disengagement. Research also suggests that mental fatigue
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#17327730257455512-562: Is often difficult. Development of mental health services is minimal in many countries; depression is viewed as a phenomenon of the developed world despite evidence to the contrary, and not as an inherently life-threatening condition. There is insufficient evidence to determine the effectiveness of psychological versus medical therapy in children. Physical exercise has been found to be effective for major depression, and may be recommended to people who are willing, motivated, and healthy enough to participate in an exercise program as treatment. It
5618-564: Is particularly beneficial in preventing relapse. Cognitive behavioral therapy and occupational programs (including modification of work activities and assistance) have been shown to be effective in reducing sick days taken by workers with depression. Several variants of cognitive behavior therapy have been used in those with depression, the most notable being rational emotive behavior therapy , and mindfulness-based cognitive therapy . Mindfulness-based stress reduction programs may reduce depression symptoms. Mindfulness programs also appear to be
5724-663: Is recommended as an initial treatment choice in people with mild, moderate, or severe major depression, and should be given to all people with severe depression unless ECT is planned. There is evidence that collaborative care by a team of health care practitioners produces better results than routine single-practitioner care. Psychotherapy is the treatment of choice (over medication) for people under 18, and cognitive behavioral therapy (CBT), third wave CBT and interpersonal therapy may help prevent depression. The UK National Institute for Health and Care Excellence (NICE) 2004 guidelines indicate that antidepressants should not be used for
5830-430: Is recommended. People with chronic depression may need to take medication indefinitely to avoid relapse. SSRIs are the primary medications prescribed, owing to their relatively mild side-effects, and because they are less toxic in overdose than other antidepressants. People who do not respond to one SSRI can be switched to another antidepressant , and this results in improvement in almost 50% of cases. Another option
5936-434: Is some evidence for a similar effect in mild depression. Similarly, a Cochrane systematic review of clinical trials of the generic tricyclic antidepressant amitriptyline concluded that there is strong evidence that its efficacy is superior to placebo. Antidepressants work less well for the elderly than for younger individuals with depression. To find the most effective antidepressant medication with minimal side-effects,
6042-402: Is that fatigue is "a significant subjective sensation of weariness, increasing sense of effort, mismatch between effort expended and actual performance, or exhaustion independent from medications, chronic pain, physical deconditioning, anaemia , respiratory dysfunction, depression , and sleep disorders" . The use of the term "fatigue" in medical contexts may carry inaccurate connotations from
6148-444: Is that which is temporary and self-limited. Acute fatigue is most often caused by an infection such as the common cold and can be cognized as one part of the sickness behavior response occurring when the immune system fights an infection . Other common causes of acute fatigue include depression and chemical causes, such as dehydration , poisoning , low blood sugar , or mineral or vitamin deficiencies. Prolonged fatigue
6254-634: Is thought to be triggered by decreased sunlight. Vitamin B 2 , B 6 and B 12 deficiency may cause depression in females. Adverse childhood experiences (incorporating childhood abuse , neglect and family dysfunction ) markedly increase the risk of major depression, especially if more than one type. Childhood trauma also correlates with severity of depression, poor responsiveness to treatment and length of illness. Some are more susceptible than others to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility. Couples in unhappy marriages have
6360-528: Is to augment the atypical antidepressant bupropion to the SSRI as an adjunctive treatment. Venlafaxine , an antidepressant with a different mechanism of action, may be modestly more effective than SSRIs. However, venlafaxine is not recommended in the UK as a first-line treatment because of evidence suggesting its risks may outweigh benefits, and it is specifically discouraged in children and adolescents as it increases
6466-699: The American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization 's International Statistical Classification of Diseases and Related Health Problems (ICD). The latter system is typically used in European countries, while the former is used in the US and many other non-European nations, and the authors of both have worked towards conforming one with
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#17327730257456572-614: The European Organisation for Research and Treatment of Cancer (EORTC) or the National Cancer Research Network (NCRN). The most valued companies worldwide whose leading products are in Oncology include Pfizer (United States), Roche (Switzerland), Merck (United States), AstraZeneca (United Kingdom), Novartis (Switzerland) and Bristol-Myers Squibb (United States) who are active in
6678-508: The Internet . The Netherlands mental health care system provides preventive interventions, such as the "Coping with Depression" course (CWD) for people with sub-threshold depression. The course is claimed to be the most successful of psychoeducational interventions for the treatment and prevention of depression (both for its adaptability to various populations and its results), with a risk reduction of 38% in major depression and an efficacy as
6784-470: The National Institute for Health and Clinical Excellence , medication should be offered only in conjunction with a psychological therapy, such as CBT , interpersonal therapy , or family therapy . Several variables predict success for cognitive behavioral therapy in adolescents: higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions. CBT
6890-484: The circadian rhythm , immunological dysfunction, HPA-axis dysfunction and structural or functional abnormalities of emotional circuits. Derived from the effectiveness of monoaminergic drugs in treating depression, the monoamine theory posits that insufficient activity of monoamine neurotransmitters is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas. First, acute depletion of tryptophan —a necessary precursor of serotonin and
6996-462: The striatum , and polymorphism of dopamine receptor genes implicate dopamine , another monoamine, in depression. Lastly, increased activity of monoamine oxidase , which degrades monoamines, has been associated with depression. However, the monoamine theory is inconsistent with observations that serotonin depletion does not cause depression in healthy persons, that antidepressants instantly increase levels of monoamines but take weeks to work, and
7102-636: The Fatigue Symptom Inventory (FSI) and the Fatigue Severity Scale. There is no consensus on best practice, and the existing surveys do not capture the intermittent nature of some forms of fatigue. A 2023 guidance indicates the following A 2016 German review found that A 2014 Australian review recommended that a period of watchful waiting may be appropriate if there are no major warning signs. A 2009 study found that about 50% of people who had fatigue received
7208-568: The absence of... exertion... as a symptom of health conditions." Obesity correlates with higher fatigue levels and incidence. In somatic symptom disorder the patient is overfocused on a physical symptom, such as fatigue, that may or may not be explained by a medical condition. Adverse life events have been associated with fatigue. The concept of adrenal fatigue is often raised in media but no scientific basis has been found for it. The mechanisms that cause fatigue are not well understood. Several mechanisms may be in operation within
7314-529: The amount of serotonin released increases and a spillover occurs. Serotonin binds to extrasynaptic receptors located on the axonal initial segment of motor neurons with the result that nerve impulse initiation and thereby muscle contraction are inhibited. Muscle strength testing can be used to determine the presence of a neuromuscular disease , but cannot determine its cause. Additional testing, such as electromyography , can provide diagnostic information, but information gained from muscle strength testing alone
7420-520: The brain for which there is evidence of relation to fatigue are the thalamus and middle frontal cortex, fronto-parietal and cingulo-opercular, and default mode network, salience network, and thalamocortical loop areas. A 2024 review found that structural connectivity changes may underlie fatigue in pwRRMS but that the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies. A small 2023 study found that infratentorial lesion volume (cerebellar and brainstem)
7526-421: The causes of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases. A 2021 review considered that different "types/subsets" of fatigue may exist and that patients normally present with more than one such "type/subset". These different "types/subsets" of fatigue may be different dimensions of the same symptom, and the relative manifestations of each may depend on
7632-417: The concentration of quinolinic acid correlates to the severity of depressive symptoms. A diagnostic assessment may be conducted by a suitably trained general practitioner , or by a psychiatrist or psychologist , who records the person's current circumstances, biographical history, current symptoms, family history, and alcohol and drug use. The assessment also includes a mental state examination , which
7738-863: The condition of between 22 and 38%. Since 2016, the United States Preventive Services Task Force (USPSTF) has recommended screening for depression among those over the age 12; though a 2005 Cochrane review found that the routine use of screening questionnaires has little effect on detection or treatment. Screening the general population is not recommended by authorities in the UK or Canada. Behavioral interventions, such as interpersonal therapy and cognitive-behavioral therapy , are effective at preventing new onset depression. Because such interventions appear to be most effective when delivered to individuals or small groups, it has been suggested that they may be able to reach their large target audience most efficiently through
7844-445: The cortico-striatal model, suggests that abnormalities of the prefrontal cortex in regulating striatal and subcortical structures result in depression. Another model proposes hyperactivity of salience structures in identifying negative stimuli, and hypoactivity of cortical regulatory structures resulting in a negative emotional bias and depression, consistent with emotional bias studies. The newer field of psychoneuroimmunology ,
7950-484: The criteria for a major depressive episode. A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks. Episodes may be isolated or recurrent and are categorized as mild (few symptoms in excess of minimum criteria), moderate, or severe (marked impact on social or occupational functioning). An episode with psychotic features—commonly referred to as psychotic depression —is automatically rated as severe. If
8056-411: The current depressive episode: the severity (mild, moderate, severe, unspecified); the presence of psychotic symptoms (with or without psychotic symptoms); and the degree of remission if relevant (currently in partial remission, currently in full remission). These two disorders are classified as "Depressive disorders", in the category of "Mood disorders". According to DSM-5, at least one of the symptoms
8162-490: The disease, and a significant proportion of patients with incurable cancer will die of other causes. There may be ongoing issues with symptom control associated with progressive cancer, and also with the treatment of the disease. These problems may include pain , nausea , anorexia , fatigue , immobility, and depression . Not all issues are strictly physical: personal dignity may be affected. Moral and spiritual issues are also important. While many of these problems fall within
8268-454: The dosages can be adjusted, and if necessary, combinations of different classes of antidepressants can be tried. Response rates to the first antidepressant administered range from 50 to 75%, and it can take at least six to eight weeks from the start of medication to improvement. Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation
8374-427: The effectiveness of antidepressants in people with acute, mild to moderate depression. A review commissioned by the National Institute for Health and Care Excellence (UK) concluded that there is strong evidence that SSRIs , such as escitalopram , paroxetine , and sertraline , have greater efficacy than placebo on achieving a 50% reduction in depression scores in moderate and severe major depression, and that there
8480-421: The elderly are often simultaneously treated with a number of other drugs, and often have other concurrent diseases. The etiology of depression is not yet fully understood. The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression. The diathesis–stress model specifies that depression results when a preexisting vulnerability, or diathesis ,
8586-479: The existence of atypical antidepressants which can be effective despite not targeting this pathway. One proposed explanation for the therapeutic lag, and further support for the deficiency of monoamines, is a desensitization of self-inhibition in raphe nuclei by the increased serotonin mediated by antidepressants. However, disinhibition of the dorsal raphe has been proposed to occur as a result of decreased serotonergic activity in tryptophan depletion, resulting in
8692-659: The experimental treatment of ketamine with treatment-resistant depression. With this, in MDD, people will more likely have a Th-1 dominant immune profile, which is a pro-inflammatory profile. This suggests that there are components of the immune system affecting the pathology of MDD. Another way cytokines can affect depression is in the kynurenine pathway , and when this is overactivated, it can cause depression. This can be due to too much microglial activation and too little astrocytic activity. When microglia get activated, they release pro-inflammatory cytokines that cause an increase in
8798-493: The extent in which it impairs functioning) for the diagnosis. Major depressive disorder is classified as a mood disorder in the DSM-5. The diagnosis hinges on the presence of single or recurrent major depressive episodes . Further qualifiers are used to classify both the episode itself and the course of the disorder. The category Unspecified Depressive Disorder is diagnosed if the depressive episode's manifestation does not meet
8904-553: The initial treatment of mild depression because the risk-benefit ratio is poor. The guidelines recommend that antidepressants treatment in combination with psychosocial interventions should be considered for: The guidelines further note that antidepressant treatment should be continued for at least six months to reduce the risk of relapse , and that SSRIs are better tolerated than tricyclic antidepressants . Treatment options are more limited in developing countries, where access to mental health staff, medication, and psychotherapy
9010-637: The length, severity and presence of psychotic features: To confirm major depressive disorder as the most likely diagnosis, other potential diagnoses must be considered, including dysthymia , adjustment disorder with depressed mood, or bipolar disorder . Dysthymia is a chronic, milder mood disturbance in which a person reports a low mood almost daily over a span of at least two years. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression (sometimes referred to as double depression ). Adjustment disorder with depressed mood
9116-425: The macroscopic tumor has already been completely removed surgically but there is a reasonable statistical risk that it will recur. Chemotherapy and radiotherapy are commonly used for palliation, where disease is clearly incurable: in this situation the aim is to improve the quality of life and to prolong it. Hormone manipulation is well established, particularly in the treatment of breast and prostate cancer. There
9222-466: The mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability , after lower back pain . The diagnosis of major depressive disorder is based on
9328-450: The monoamine hypothesis has been further oversimplified when presented to the general public. A 2022 review found no consistent evidence supporting the serotonin hypothesis, linking serotonin levels and depression. HPA-axis abnormalities have been suggested in depression given the association of CRHR1 with depression and the increased frequency of dexamethasone test non-suppression in people who are depressed. However, this abnormality
9434-500: The more general usage of the same word. More accurate terminology may also be needed for variants within the umbrella term of fatigue. Tiredness which is a normal result of work , mental stress , anxiety , overstimulation and understimulation, jet lag , active recreation , boredom , or lack of sleep is not considered medical fatigue. This is the tiredness described in MeSH Descriptor Data. Sleepiness refers to
9540-566: The most common presenting problem in developing countries, according to the World Health Organization 's criteria for depression. Appetite often decreases, resulting in weight loss, although increased appetite and weight gain occasionally occur. Major depression significantly affects a person's family and personal relationships , work or school life, sleeping and eating habits, and general health. Family and friends may notice agitation or lethargy . Older depressed people may have cognitive symptoms of recent onset, such as forgetfulness, and
9646-502: The onset of a dementing disorder , such as Alzheimer's disease . Cognitive testing and brain imaging can help distinguish depression from dementia. A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. No biological tests confirm major depression. In general, investigations are not repeated for a subsequent episode unless there is a medical indication . The most widely used criteria for diagnosing depressive conditions are found in
9752-689: The other. Both DSM and ICD mark out typical (main) depressive symptoms. The most recent edition of the DSM is the Fifth Edition, Text Revision (DSM-5-TR), and the most recent edition of the ICD is the Eleventh Edition (ICD-11). Under mood disorders, ICD-11 classifies major depressive disorder as either single episode depressive disorder (where there is no history of depressive episodes, or of mania ) or recurrent depressive disorder (where there
9858-662: The patient's personality, religion, culture, and family life. Though these issues are complex and emotional, the answers are often achieved by the patient seeking counsel from trusted personal friends and advisors. It requires a degree of sensitivity and very good communication on the part of the oncology team to address these problems properly. There is a tremendous amount of research being conducted on all frontiers of oncology, ranging from cancer cell biology, and radiation therapy to chemotherapy treatment regimens and optimal palliative care and pain relief . Next-generation sequencing and whole-genome sequencing have completely changed
9964-406: The person has had an episode of mania or markedly elevated mood , a diagnosis of bipolar disorder is made instead. Depression without mania is sometimes referred to as unipolar because the mood remains at one emotional state or "pole". Bereavement is not an exclusion criterion in the DSM-5, and it is up to the clinician to distinguish between normal reactions to a loss and MDD. Excluded are
10070-434: The person's reported experiences, behavior reported by relatives or friends, and a mental status examination . There is no laboratory test for the disorder, but testing may be done to rule out physical conditions that can cause similar symptoms. The most common time of onset is in a person's 20s, with females affected about twice as often as males. The course of the disorder varies widely, from one episode lasting months to
10176-475: The person, provider, and/or the medical system. Non-psychiatrist physicians have been shown to miss about two-thirds of cases, although there is some evidence of improvement in the number of missed cases. A doctor generally performs a medical examination and selected investigations to rule out other causes of depressive symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism ; basic electrolytes and serum calcium to rule out
10282-465: The possible cause of fatigue include Some people may have multiple causes of fatigue. A 2021 study in a Korean city found that alcohol consumption was the variable with the most correlation with overall fatigue. A 2020 Norway study found that 69% of substance use disorder patients had severe fatigue symptoms, and particularly those with extensive use of benzodiazepines . Causality, as opposed to correlation, were not proven in these studies. In up to
10388-481: The procedure is referred to as "debulking" (i.e. reducing the overall amount of tumour tissue). Surgery is also used for the palliative treatment of some cancers, e.g. to relieve biliary obstruction, or to relieve the problems associated with some cerebral tumors. The risks of surgery must be weighed against the benefits. Chemotherapy and radiotherapy are used as a first-line radical therapy in several malignancies. They are also used for adjuvant therapy, i.e. when
10494-531: The production of COX 2 . This, in turn, causes the production of PGE 2 , which is a prostaglandin , and this catalyzes the production of indolamine , IDO. IDO causes tryptophan to get converted into kynurenine and kynurenine becomes quinolinic acid . Quinolinic acid is an agonist for NMDA receptors, so it activates the pathway. Studies have shown that the post-mortem brains of patients with MDD have higher levels of quinolinic acid than people who did not have MDD. With this, researchers have also seen that
10600-450: The relative contribution of different mechanisms. Inflammation may be the root causal mechanism in many cases. Physical fatigue, or muscle fatigue , is the temporary physical inability of muscles to perform optimally. The onset of muscle fatigue during physical activity is gradual, and depends upon an individual's level of physical fitness – other factors include sleep deprivation and overall health. Physical fatigue can be caused by
10706-517: The remit of the oncologist, palliative care has matured into a separate, closely allied specialty to address the problems associated with advanced disease. Palliative care is an essential part of the multidisciplinary cancer care team. Palliative care services may be less hospital-based than oncology, with nurses and doctors who are able to visit the patient at home. There are a number of recurring ethical questions and dilemmas in oncological practice. These include: These issues are closely related to
10812-900: The severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis. Several rating scales are used for this purpose; these include the Hamilton Rating Scale for Depression , the Beck Depression Inventory or the Suicide Behaviors Questionnaire-Revised . Primary-care physicians have more difficulty with underrecognition and undertreatment of depression compared to psychiatrists. These cases may be missed because for some people with depression, physical symptoms often accompany depression. In addition, there may also be barriers related to
10918-597: The study between the immune system and the nervous system and emotional state, suggests that cytokines may impact depression. Immune system abnormalities have been observed, including increased levels of cytokines -cells produced by immune cells that affect inflammation- involved in generating sickness behavior , creating a pro-inflammatory profile in MDD. Some people with depression have increased levels of pro-inflammatory cytokines and some have decreased levels of anti-inflammatory cytokines. Research suggests that treatments can reduce pro-inflammatory cell production, like
11024-506: The treatment areas Kinase inhibitors, Antibodies , Immuno-oncology and Radiopharmaceuticals . Fatigue (physical) Fatigue describes a state of tiredness (which is not sleepiness), exhaustion or loss of energy. Fatigue (in the medical sense) is sometimes associated with medical conditions including autoimmune disease , organ failure , chronic pain conditions, mood disorders , heart disease , infectious diseases , and post-infectious-disease states. However, fatigue
11130-405: The understanding of cancers. Identification of novel genetic/molecular markers will change the methods of diagnosis and treatment, paving the way for personalized medicine. Therapeutic trials often involve patients from many different hospitals in a particular region. In the UK, patients are often enrolled in large studies coordinated by Cancer Research UK (CRUK), Medical Research Council (MRC),
11236-538: Was a relatively good predictor of RRMS fatigue severity. Studies have found MS fatigue correlates with damage to NAWM (normal appearing white matter ) (which will not show on normal MRI but will show on DTI (diffusion tensor imaging) ). The correlation becomes unreliable in patients aged over 65 due to damage due to ageing. A small 2016 study found that primary Sjögren's syndrome patients with high fatigue, when compared with those with low fatigue, had significantly higher plasma concentrations of HSP90α , and
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