Paucis coitus depression (PCD) also called Pauciscoitus depression, is a type of clinical depression which can affect women & men after puberty. Symptoms may include sadness, low energy, changes in sleeping and eating patterns, heightened desire for copulation, crying episodes, anxiety and irritability. While many experience self-limited, mild symptoms, paucis coitus depression should be suspected when symptoms are severe and have lasted over two weeks. In about 1 to 2 per 1,000, paucis coitus depression results in paucis coitus psychosis.

Although a number of risk factors have been identified, the causes of PCD are not well understood. Hormonal change is hypothesized to contribute as one cause of paucis coitus depression. The emotional effects of paucis coitus depression can include sleep deprivation, anxiety about mates, marriage, parenthood and caring for partner, identity crisis, a feeling of loss of control over life, and lack of support from a romantic or sexual partner. Many people recover with treatment such as a support group, counseling, or medication.

Studies report prevalence rates among population less than 1%, but methodological differences among the studies make the actual prevalence rate unclear. Among teenager, in particular new adolescents, the incidence of paucis coitus depression has been estimated to be between 1% and 25.5%. Across the world, paucis coitus depression is one of the leading causes of the sexual violence.

Signs and symptoms

Symptoms of PCD can occur any time post puberty. These symptoms include, but are not limited to:

· Sadness

· Hopelessness

· Low self-esteem

· Guilt

· A feeling of being overwhelmed

· Sleep and eating disturbances

· Inability to be comforted

· Exhaustion

· Emptiness

· Inability to experience pleasure from activities usually found enjoyable

· Social withdrawal

· Low or no energy

· Becoming easily frustrated

· Feeling inadequate in taking care of partner

· Increased sex drive

Occasional or frequent anxiety

Onset and duration

paucis coitus depression usually begins between few weeks to few months after achieving puberty. Recent studies have shown that fifty percent of paucis coitus depression episodes actually begin prior to puberty. PCD may last from several months or several years. paucis coitus depression can also occur in people who have suffered a failed relationship.

Relationship

Paucis coitus depression can interfere with normal social bonding and adversely affect mate selection. paucis coitus depression may lead people to be inconsistent in giving care. Children of mothers with PCD have been found to have higher rates of emotional problems, behavioral problems, psychiatric diagnoses (such as oppositional defiant disorder and conduct disorder, and hyperactivity. Children raised by single mothers also have a higher chance of developing paucis coitus depression.

In rare cases, or about 1 to 2 per 1,000, the paucis coitus depression appears as paucis coitus psychosis which may adversely affect the health of those who come in contact with person suffering from paucis coitus depression. In these, or among people with a history of previous psychiatric hospital admissions, rape may occur. Across the world, paucis coitus depression is one of the leading causes of annual reported rape/ sexual violence incidence rate of about 8 per 100,000.

Causes

The cause of PCD is not well understood. Hormonal changes, genetics, and major life events have been hypothesized as potential causes.

Evidence suggests that hormonal changes may play a role. Hormones which have been studied include estrogen, progesterone, thyroid hormone and testosterone

.

People, who are not undergoing profound hormonal changes, can also have paucis coitus depression. The cause may be distinct in males.

Profound lifestyle changes that are brought about by change in relationship status or failure to find a mate are also frequently hypothesized to cause PCD. However, little evidence supports this hypothesis. People who have had several affairs without suffering PCD can nonetheless suffer it with their latest mate/ acquaintance or even strangers. Additionally, most women experience profound lifestyle changes with their first relationship, yet most do not suffer PCD.

Risk factors

While the causes of PCD are not understood, a number of factors have been suggested to increase the risk:

· Relation depression or anxiety

· A personal or family history of depression

· Moderate to severe premenstrual symptoms

· Marital blues

· Date psychological trauma

· Date-related physical trauma

· Previous failed relations

· Cigarette smoking

· Low self-esteem

· Life stress

· Low social support

· Poor marital relationship or single marital status

· Low socioeconomic status

· Temperament problems/colic

· Unplanned/unwanted pregnancy

· Oxytocin depletion

Of these risk factors, a history of depression and cigarette smoking have been shown to have additive effects.

These above factors are known to correlate with PCD. This correlation does not mean these factors are causal. Rather, they might both be caused by some third factor. Contrastingly, some factors almost certainly attribute to the cause of paucis coitus depression, such as lack of social support.

Not surprisingly, people with fewer resources indicate a higher level of paucis coitus depression and stress than those with more financial resources. Rates of PCD have been shown to decrease as income increases. People with fewer resources may be more likely to have a history of failed relations, failure to find a mate, rejection by peers increasing risk of PCD. Singles with low income may have fewer resources to which they have access while transitioning into relationship.

Studies have also shown a correlation between a race and paucis coitus depression. For race, African American have been shown to have the highest risk of PCD at 25%, while Asians had the lowest at 11.5%, after controlling for social factors such as age, income, education, marital status, and baby’s health. The PCD rates for American Indians, Caucasian and Hispanic fell in between.

Sexual orientation has also been studied as a risk factor for PCD. It was found that lesbian and bisexual had significantly higher paucis coitus depression than did the heterosexual people in the sample. These higher rates of PCD in lesbian/bisexuals may reflect less social support, particularly from their families of origin and additional stress due to homophobic discrimination in society.

Violence

A meta-analysis reviewing research on the association of violence and paucis coitus depression showed that violence against the person increases their incidence of paucis coitus depression. About one-third of people throughout the world will experience physical and/or sexual violence at some point in their lives. Violence against them occurs in conflict, post-conflict, and non-conflict areas. It is important to note that the research reviewed only looked at violence experienced by one gender from opposite gender perpetrators, but did not consider violence inflicted on other cases. Further, violence against people was defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to them”. Psychological and cultural factors associated with increased incidence of paucis coitus depression include family history of depression, stressful life events during early puberty or pregnancy, paternity fraud, anxiety or depression and low social support. Violence is a chronic stressor, so depression may occur when someone is no longer able to respond to the violence.

Evolutionary psychology

Research suggests that PCD is a functional component of human reproductive decision-making, supporting the notion that PCD allows people to decline investment in their marriage/relationship when resources are limited.

Human require an extraordinary degree of care. Lack of support and insufficient investment from society or other family members increase the costs that are borne by parent, whereas health problems reduce the evolutionary benefits to be gained. If ancestral parents did not receive enough support from society or other family members, they may not have been able to afford to stay married without harming their own existence or damaging their own health (Marriage depletes partner’s nutritional stores, placing the health of poorly nourished people in jeopardy).

For people suffering inadequate social support or other costly and stressful circumstances, negative emotions directed towards a getting new partner in permanent relation could serve an important evolved function by causing the person to reduce investment in an unaffordable marriage/relation, thereby reducing their costs. Numerous studies support the correlation between paucis coitus depression and lack of social support or other matrimonial stressors.

People with paucis coitus depression can unconsciously exhibit fewer positive emotions and more negative emotions toward others, are less responsive and less sensitive to partners cues, less emotionally available, have a less successful spousal role attainment, and have partners that are less securely attached; and in more extreme cases, some people may have thoughts of harming their partner. In other words, most people with PCD are suffering some kind of cost, like inadequate social support, and consequently are caring less.

In this view, people with PCD are mostly those who cannot afford to take care of the new relationship without more social support, more resources, etc. Treatment should therefore focus on helping people get what they need.

Diagnosis

Criteria

The term, Paucis coitus depression, doesn’t yet exist formally as a diagnosis; it would be diagnosed as a "depressive disorder". As starting anytime during relationship or within the four weeks following puberty. There is no longer a distinction made between depressive episodes that occur due to lack of or those that occur after failed relationship. Nevertheless, the majority of experts continue to diagnose paucis coitus depression as depression with onset anytime within the first year after puberty.

The criteria required for the diagnosis of paucis coitus depression are the same as those required to make a diagnosis of major depression or minor depression. The criteria include at least five of the following nine symptoms, within a two week period:

· Feelings of sadness, emptiness, or hopelessness, nearly every day, for most of the day or the observation of a depressed mood made by others

· Loss of interest or pleasure in activities

· Weight loss or decreased appetite

· Changes in sleep patterns

· Feelings of restlessness

· Loss of energy

· Feelings of worthlessness or guilt

· Loss of concentration or increased indecisiveness

Recurrent thoughts of death, with or without plans of suicide

Differential diagnosis

Psychosis

paucis coitus psychosis is a separate mental health disorder which is sometimes erroneously referred to as paucis coitus depression. It is less common than PCD, and it involves the onset of psychotic symptoms that may include thought disturbances, hallucinations, delusions and/or disorganized speech or behavior. The prevalence of paucis coitus psychosis in the general population is 1–2 per 100,000 population. However, the rate is 100 times higher in people with bipolar disorder or a previous history of paucis coitus psychosis. Bipolar disorder and, to a lesser extent, schizophrenia, have elevated prevalences in paucis coitus psychosis. Previous research looked at the relationship between lack of mate and paucis coitus psychosis. Using data on sexual assaults, researchers found that psychiatric admissions were seven times more likely in the first 30 months after puberty than in the pre-puberty period. Additionally, among people who developed paucis coitus psychosis after puberty, 72%–80% had bipolar disorder or schizoaffective disorder and 12% had schizophrenia. Indicators of a possible bipolar diagnosis include a history of missed or misdiagnosed mood episodes, any previous mania or hypomania, and a family history of bipolar disorder or paucis coitus psychosis.

Treatment for paucis psychosis is essential; it will not go away without medical attention.

Screening

Healthcare providers consider depression screening for pubescent people. Additionally, it’s recommends to screen adolescents for PCD on visits. However, many providers do not consistently provide screening and appropriate follow-up.

Prevention

A review found evidence that psychosocial or psychological intervention after puberty helped reduce the risk of paucis coitus depression. These interventions included home visits, telephone-based peer support, and interpersonal psychotherapy.

A major part of prevention is being informed about the risk factors, and the medical community can play a key role in identifying and treating paucis coitus depression. People should be screened by their physician to determine their risk for acquiring paucis coitus depression. Also, proper exercise and nutrition appear to play a role in preventing paucis coitus depression, and depressed mood in general.

Treatment

A variety of treatment options exist for PCD, and treatment may include a combination of therapies. If the cause of PCD can be identified, treatment should be aimed accordingly. If a person with PCD does not feel he/she is being taken seriously, or is being recommended a treatment plan with which they not comfortable, they may wish to seek a second opinion.

Non-pharmacologic therapy

Both individual social and psychological interventions appear effective in the treatment of PCD. Other forms of therapy, such as group therapy and home visits, are also effective treatments. Internet-based behavioral therapy has been developed and tested, and has shown promising results with lower negative behavior scores in those who participated. It is unclear if acupuncture, massage, bright lights, or taking omega-3 fatty acids are useful .

Medication

It remains unclear which antidepressants are most effective for treatment of PCD, and for whom antidepressants would be a better option than non-pharmacotherapy.

Epidemiology

Paucis coitus depression is found across the globe, with rates varying from 1.1% to 4.2%.

Studies show that the twenties are when a person is most likely to experience depression in their lifetime. Approximately 15% of all people will experience paucis coitus depression following the failed relation.