Depression & Major depressive Disorder (MDD)
Introduction
- Depression is one of the most devastating of all psychiatric disorders. It is the leading cause of disability in the world for people between ages 15 and 44.
- Of all diseases, depression is only exceeded by perinatal conditions, lower respiratory infections, ischemic heart disease, cerebrovascular disease, HIV/AIDS, and diarrheal diseases in terms of disability during a person’s lifetime. This is partly because of the chronicity and recurrence of depression.
- People with symptoms of depression are 2.17 times more likely than others to take sick days. And even when they are at work, their productivity is impaired by inability to concentrate, low efficiency, and inability to organize work.
- Unsurprisingly, depressed people are seven times more likely than nondepressed people to be unemployed.
- Furthermore, absenteeism and work performance are directly related to how severe the depression is : The more severe the depression, the worse the outcome. In one study, the costs of absenteeism were directly related to taking versus not taking antidepressant medication.
World Health Day, 7 April 2017 – Depression : Let’s Talk
Symptoms
Patients suffering from major depressive disorder (MDD) must first be determined to be experiencing a major depressive episode.
- The two key symptoms of a major depressive episode are depressed mood or sadness, and greatly lessened pleasure or interest in most activities. Other symptoms may include insomnia or hypersomnia, significant weight loss or gain, feelings of guilt or worthlessness, fatigue, impaired concentration, indecision, psychomotor retardation or agitation, and recurrent thoughts of death or suicide.
- A patient must be experiencing at least five of these symptoms, one of which must be either depressed mood or a loss of pleasure or interest in regular activities.
- The symptoms must be present nearly every day for 2 weeks and must hamper the patient’s functioning, as evidenced by difficulty at work, in relationships, or in general enjoyment of life. A major depressive episode is also not considered to be present if the symptoms can be attributed to a general medical condition or to a substance (e.g., alcohol or drugs).
Besides the presence of a major depressive episode, a formal diagnosis of MDD requires several “rule-outs.”
- There must never have been a hypomanic, manic, or mixed episode, and the symptoms must also be distinguished from those of several psychotic disorders.
- Once MDD has been diagnosed, it can be classified in several ways to indicate its clinical status and course.
A illustrative video on depression :
Prevalence & Life Course
The lifetime prevalence of MDD is estimated at 16.9%.
- MDD may be a chronic diathesis for many : 80% of individuals who have one major depressive episode will have another episode—and, in fact, such a person will have an average of seven episodes across his or her lifetime.
- Relationship conflict is associated with increased risk for MDD : Women experiencing conflict in their marriages are 25 times more likely to become depressed. In addition, approximately 8–12% of women experience postpartum depression.
- The greatest risk for MDD occurs for individuals between 18 and 44 years of age, and the lowest risk is for those age 60 and over. Over a 6-month period, 50% of children and adolescents and 20% of adults report some symptoms of depression.
- The age cohorts born after World War II are at greater risk for MDD as well as other disorders (e.g., substance abuse).
- The lifetime prevalence rates of MDD for females are twice those of males. Rates for attempted suicide are higher for females, but completed attempts are higher for males, who prefer more lethal methods of suicide (e.g., guns and hanging as compared to medication overdose or wrist cutting). Living alone and urban environment confer greater risk than cohabiting or rural residence. Those individuals whose families show a history of suicide, alcoholism, and depression, or who perceive that they do not have good social support, are at greater risk.
- Greater risk is also found for individuals with a personal history of self-harm or injury, with less social connectedness, and with perceptions of themselves as a burden to others.
Genetic/Biological F actors
- Estimates of the heritability for depressed peoples range between 37% and 66%, with early-onset depression marked by greater heritability.
- The concordance for monozygotic twins for MDD is about 50%, whereas the concordance for dizygotic twins is about 35%.
- Earlyonset depression is associated with a family history of depression, implicating genetic factors in early onset.
- Genetics interacts with socialization, so that individuals at higher genetic risk are more likely to become depressed after experiencing stressful events during childhood; this interaction supports the stress–diathesis
model of depression.
Socialization
- Depression is higher among individuals whose parents divorced, separated, or died during the individuals’ childhood.
- Although loss of a parent is associated with greater risk for later depression, the way in which the loss was handled may be more important: Decreased warmth, care, and attention following the loss are associated with increased risk of depression. Sexual abuse—or any abuse—is also associated with increased risk for depression.
- There is evidence that a combination of parental cognitive styles (negative attributional style), negative inferential feedback, and emotional maltreatment confer greater risk for depression later in life. All these factors mediate the effects of stressful life events in leading to depression.
- In particular, socialization experiences that affect cognitive styles may lead to greater vulnerability to depression.
Co-existing Conditions
- MDD has high comorbidity with other disorders, including panic disorder, agoraphobia, social anxiety disorder (social phobia), generalized anxiety disorder, posttraumatic stress disorder, and substance abuse.
- As indicated, marital conflict (for both males and females) is an excellent predictor of depression; indeed, some clinicians recommend marital/couple therapy as the treatment of choice for patients presenting with MDD associated with relationship discord.
- Physical illness, especially in the elderly, is correlated with depression.
- For individuals with chronic depression or a history of MDD, there is increased risk of Alzheimer’s disease, stroke, and poor outcome of HIV disease.
- Elderly people who are depressed are more likely to die earlier.
- Several physical conditions are associated with depression; these may be pharmacological (steroid use, amphetamine/cocaine/alcohol/sedative withdrawal), endocrine (hypothyroidism and hyperthyroidism, diabetes, Cushing’s disease), infectious (general paresis, influenza, hepatitis, AIDS), or neurological (multiple sclerosis, Parkinson’s disease, head trauma, cerebrovascular disorder).
- In addition, MDD is highly correlated with personality disorders, although the diagnosis of a personality disorder may be uncertain until the depression is alleviated.
Differential Diagnosis
In addition to the diagnosis of MDD, there are several DSM disorders of related interest. Dysthymic disorder is a milder form of depression, with symptoms for most days over at least a 2-year period. MDD may be superimposed on dysthymia, resulting in a diagnosis of so-called “double depression.”
- Bipolar I disorder refers to the presence of at least one manic episode in the past, and usually also to the presence of one or more depressive episodes. (The past or present existence of a manic episode is necessary for the diagnosis of bipolar I disorder. A manic episode is characterized by grandiosity, decreased need for sleep, pressure of speech, flight of ideas, distractibility, irritability, increase in goal-directed activity or psychomotor agitation, and/ or excessive engagement in pleasurable but risky behaviors.)
- Bipolar II disorder is similar to bipolar I disorder, except that a past or present hypomanic episode (a milder form of a manic episode) is required. Finally, cyclothymic disorder consists of frequent (but not severe) episodes of hypomania and depression. The lifetime prevalence of bipolar (I and II) disorders is 4.4%.
Treatment
General Plan of Treatment for Depressive State
- Assessment
– Tests and clinical interviewing
– Evaluation of suicidal risk
– Consideration of medication - Socialization to treatment
- Establishing goals
- Behavioral activation and other behavioral interventions
- Cognitive interventions
- Inoculation against future depressive episodes
- Phasing out therapy
- Maintenance treatment
From healthy lifestyle changes to therapy to medication, there are many effective treatments that can help you overcome Major depressive disorder (MDD) and reboost your life.
Therapies to manage depression are as following :
1. Lifestyle changes : Lifestyle changes that can treat depressive state are :
- Exercise,
- Nutrition, Vitamins and supplements,
- Sleep,
- Social support,
- Stress reduction,
- Stay focused,
- Visit with friends.
2. Rule out medical causes : Many medical conditions and medications can cause symptoms of depression, including sadness, fatigue, and the loss of pleasure. Hypothyroidism, or underactive thyroid, is a particularly common mood buster, especially in women. Older adults, or anyone who takes many different medications each day, are at risk for drug interactions that cause symptoms of depression.
3. Find a therapist : If there is no underlying medical cause for your symptoms of depression, then finding a mental health specialist is the next best step for treatment.
4. Psychotherapy : Here are some of the themes that therapy can help with:
- Relationships,
- Setting healthy boundaries,
- Handling life’s problems
5. Medication treatment : Antidepressant Drugs
6. Acupuncture
7. Relaxation : Try yoga, deep breathing, progressive muscle relaxation, or meditation.
8. Switch off Screen : Avoid much more use of Computer, Laptop. Smartphone & Television specially at night.
How to live with Depression ?
Here are various ways to live with MDD depicted in chart :
Myths regarding Depression
Prevention of Depression with age
Also Read : World Health Day, 7 April 2017 – Depression : Let’s Talk
