Originally published at emogency!. Please leave any comments there. Major Depressive Disorder
Scott Sasaki
Nature of Disorder
Major Depressive Disorder is a very serious and widespread mental illness that affects 10% to 25% for women and from 5% to 12% for men (mentalhealth.com). This is a mental disorder that effects the mood of a person and is nondiscriminatory meaning that it can affect anyone regardless of race, ethnicity, or income. This mental illness is more commonly diagnosed in women than men, especially in adolescent years. Depression in children is relatively balanced.
The cause of major depressive disorder is a combination of brain chemistry, family history, and psychosocial environment. It is not certain which of these factors dominates, but abnormal levels of the neurotransmitters norepinephrine, serotonin, and dopamine are closely linked with depression (mentalhealthchannel). A person has a 27% chance of inheriting a mood disorder from one parent, and this chance doubles if both parents are affected.(mentalhealthchannel).
People that are in an environment that includes abuse, neglect, divorce or addiction are at a higher risk of developing Major Depressive Disorder.
Signs and Symptoms of the Disorder
Major Depressive Disorder is more than a brief feeling of “the blues”, this disorder has specific criteria defined by the Diagnostic and Statistical Manual IV (DSM-IV-TR) as
A minimum of five symptoms from the following list have been present during the same 2-week period and represent a change from previous functioning. One of the symptoms must be #1 or #2, as listed below:
1) Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful)
2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day,nearly every day,as indicated either by subjective account or observation made by others.Do not include symptoms that are clearly due to general medical condition or mood-incongruent delusions or hallucinations
3) Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day
4) Insomnia or hypersomnia nearly every day
5) Psychomotor agitation or retardation nearly every day (observable by others,not merely subjective feelings of restlessness or being slowed down)
6) Fatigue or loss of energy nearly every day
7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)  Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan,or a suicide attempt or specific plan for committing suicide
Persons diagnosed with Major Depressive Disorder may refuse to eat or not feel hunger. On the opposite side of the spectrum they may overeat because they find comfort in foods. It is important to note that some disorders may happen concurrently, such as bulimia and depression but one disorder may be a result of the other disorder leading to tricky diagnosis.
Most people diagnosed with Major Depressive Disorder experience difficulty falling asleep and staying asleep known as insomnia. The opposite, excessive sleeping, which occurs in a minority of depressed patients is known as hypersomnia . It is also common to have profound fatigue and lack of energy (PsychNet-UK). You may notice that people with this disorder walk slower and have late reaction times.
A big giveaway that someone may be at risk for Major Depressive Disorder is a loss of interest or pleasure in activities that were once enjoyed (Medline Plus). You may notice that they no longer have an interest in their favorite hobby and instead choose to do something more passive such as sleeping or watching T.V. Diminished sex drive is also listed under this symptom. Sex may become unenjoyable or so severe that they no longer are able to achieve a climax.
People at risk for suicide give off many warning signs such as giving away close personal belongings, making suicide plans, or writing suicide notes. People contemplate suicide because their pain outweighs their available coping resources (Metanoia). It is important to note that pain in this sense applies to mental pain which may come from internal chemical imbalance in the brain or an outside environmental factor such as losing a loved one.
Treatments for the Disorder
Treatment of Major Depressive Disorder falls into two categories: pharmaceutical treatments and psychotherapy. Pharmaceutical treatments use drugs and Electroconvulsive therapy (ECT) to correct chemical imbalance.
Selective Serotonin Reuptake Inhibitors are known as SSRI’s work by preventing serotonin from becoming reabsorbed back into the sender cell allowing the receptor cell to receive more serotonin. These are the most commonly prescribed drugs to treat depression. Our brain sends messages using these chemicals, if there is a problem with that communication our brain becomes unbalanced. The SSRI theory is that the serotonin that is sent from the first cell doesn’t make it to the receiving cell and essentially is “returned to sender” and becomes reabsorbed. The SSRI binds to the sending cell blocking sent serotonin from reentering the first cell.
Zoloft, Celexa, Lexapro, Prozac and Paxil are trade names of different SSRI’s. Each of these represent a different chemical and each have varying side effects. These are all approved and marketed for treating depression in patients over 18 years old. Many of these drugs are also approved for treating Obsessive Compulsive Disorder and General Anxiety Disorder. Not all of these drugs work for a specific patient, a patient may need to try two or three different SSRI’s before the patient finds one that is suitable. The patient must gradually introduce the drug to the body usually over the course of a week until they reach their effective dose. The effective dose is the amount in milligrams that a person must take to experience the positive effects of the drug while minimizing adverse side effects. The typical testing period of a SSRI is around four weeks. If at that point the psychiatrist or patient sees no influence on their mood, they may switch to a different SSRI. If they see a mild improvement the dosage may be adjusted. If the negative side effects outweigh the benefits then the doctor may switch to a new treatment option.
SSRI’s come with very serious warnings and indications that are mandated by the Federal Drug Administration. SSRI warnings have been changed many times since the first SSRI was introduced to the market. The most notable warning is that Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders (”Zoloft”, Sertraline HCL). This information originally appeared in an informational packet sent along with the SSRI but has since been required by the FDA to be displayed in a “black-box” warning in a prominent location either on the product box or information packet.
Electroconvulsive therapy or ECT is a procedure that dates back to the 1930’s. This treatment works by stimulating the brain with targeted electric current and inducing seizure of the brain. This treatment is used only when a patient hasn’t responded positively to any type of drug. New age ECT has been proven to be effective in patients however this treatment still has the stigma of old ECT where patients were essentially tortured. Today the most prominent side effect is memory loss. (MedHelp)
Psychotherapy is better known as counseling and includes meeting with a psychologist, psychiatrist, or therapist. These specialists will help the patient try to correct their disorder by changing how the patient thinks. Psychotherapists focus on behavioral adjustments such as setting goals and working with patients on how to achieve them. A psychotherapist may coach a patient on how to be successful such as teaching them to stop thinking negatively and how to manage stressful situations that lead them to being depressed. The psychotherapist offers insight to patients that they may not see from close personal friends or family, the psychotherapist is a 3rd and neutral party with strict confidentiality.
References
“All about ECT – Electroconvulsive Therapy.” Medical Information & Answers to Medical Questions – MedHelp. Web. 08 Nov. 2009. <http://www.medhelp.org/lib/ect.htm>.
“Major depression: MedlinePlus Medical Encyclopedia.” National Library of Medicine – National Institutes of Health. Web. 06 Nov. 2009. <http://www.nlm.nih.gov/medlineplus/ency/article/000945.htm>.
“Suicide: Read This First.” Metanoia: online therapy e-therapy mental health education suicide prevention internet counseling help psychotherapy spirituality consumer advocacy Martha Ainsworth. Web. 06 Nov. 2009. <http://www.metanoia.org/suicide/>.
“Major Depressive Disorder – Causes & Risk Factors – mentalhealthchannel.” Mentalhealthchannel, Your Mental Health Community – mentalhealthchannel. Web. 08 Nov. 2009. <http://www.mentalhealthchannel.net/depression/causes.shtml>.
“Major Depressive Episode.” Mental Health – Psychlogy – Psychiatry – PsychNet-UK. Web. 08 Nov. 2009. <http://www.psychnet-uk.com/dsm_iv/major_depression.htm>.
“Major Depressive Disorder Diagnostic Criteria”. The American Psychiatric Association, 2001. Diagnostic and Statistical Manual IV. <http://www.psych.org>
“Zoloft (Sertraline Hcl) Drug Information: Uses, Side Effects, Drug Interactions and Warnings at RxList.” Web. 08 Nov. 2009. <http://www.rxlist.com/zoloft-drug.htm>. | 
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