The major depression, Also called major depressive disorder or clinical depression, it is a mental illness characterized by an extremely depressed mood and decreased interest in experiencing any pleasure in life.
In addition, it includes cognitive symptoms (indecision, feelings of little worth) and altered physical functions (changes in appetite, weight changes, disturbed sleep, loss of energy). Although all the symptoms are important, the physical changes are remarkable in this disorder and signal its appearance.
People with this disorder are also said to have "unipolar depression," because the mood remains at one pole. It is currently known that it is rare that there is a single episode of Major Depressive Disorder (MDD).
If there are two or more episodes separated by a period of at least two months without depression, it is called "recurrent major depressive disorder." The diagnosis of MDD is based on the experiences reported by the person, on the behavior reported by friends or family, and on the evaluation of the mental state.
There is no laboratory test for major depression, although tests are usually done to rule out the possibility that symptoms are caused by physical illness..
The most common time of appearance is between 20 and 40 years, with a peak between 30 and 40 years. Patients are usually treated with antidepressants, supplemented with cognitive-behavioral therapy.
The more severe the depression, the greater the effect of antidepressants. On the other hand, hospitalization may be necessary in the most serious cases or in risk of suicide or harm to others.
Proposed causes are psychological, psychosocial, hereditary, evolutionary, and biological.
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Although depression can occur only once in a lifetime, several depressive episodes usually occur..
During these episodes, symptoms occur most of the day and can be:
The symptoms of MDD in children and adolescents are common to those in adults, although there may be some differences:
MDD is not a normal part of older people and must be treated. Depression in older people is often poorly diagnosed and treated, and they may refuse to seek help.
Symptoms of depression in older people may be different or less obvious and may include:
The biopsychosocial model proposes that the factors that intervene in depression are biological, psychological and social.
Most antidepressants have an influence on the balance of three neurotransmitters: dopamine, noreprinephrine and serotonin.
Most antidepressant medications increase the levels of one or more monoamines (neurotransmitters serotonin, noreprinephrine, and dopamine) in the synaptic space between brain neurons. Some medications directly affect monoaminergic receptors.
It is hypothesized that serotonin regulates other neurotransmitter systems; reduced serotonergic activity could allow these systems to malfunction.
According to this hypothesis, depression arises when low levels of serotonin promote low levels of noreprinephrine (a monoaminergic neurotransmitter). Some antidepressants directly improve levels of noreprinephrine, while others increase levels of dopamine, another monoaminergic neurotransmitter.
Currently, the monomaminergic hypothesis states that the deficiency of certain neurotransmitters is responsible for the symptoms of depression.
1-Magnetic resonance images of patients with depression have shown certain differences in brain structure.
People with depression have a larger volume of the lateral ventricles and adrenal gland, and a smaller volume of the basal ganglia, thalamus, hypothalamus, and frontal lobe.
On the other hand, there could be a relationship between depression and hippocampal neurogenesis.
2-The loss of neurons in the hippocampus (involved in memory and humor) occurs in some people with depression and correlates with lower memory and dysthymic mood. Certain drugs can stimulate the level of serotonin in the brain, stimulating neurogenesis and increasing the mass of the hippocampus. 3-A similar relationship has been observed between depression and the anterior cingulate cortex (involved in the modulation of emotional behavior).4-There is some evidence that major depression could be caused in part by overactivation of the hypothalamic-pituitary-adrenal axis, which results in an effect similar to the stress response.
5-Estrogen has been related to depressive disorders due to their increase after puberty, prenatal period and postmenopause.
6-The responsibility of a molecule called cytokines has also been studied.
There are several aspects of the personality and its development that appear to be integral to the occurrence and persistence of MDD, with the tendency to negative emotions being the primary precursor.
Depressive episodes are correlated with negative life events, although their coping characteristics indirectly influence. On the other hand, low self-esteem or the tendency to have irrational thoughts are also related to depression.
The psychologist Aaron T. Beck developed a known model of depression in the early 1960s. This model proposes that there are three concepts that create depression:
From these principles, Beck developed cognitive behavioral therapy.
Another psychologist, Martin Seligman, proposed that depression is similar to learned helplessness; learn that you have no control over situations.
In the 1960s, John Bowlby developed another theory; attachment theory, which proposes a relationship between depression in adulthood and the type of relationship between the child and the parent or caregiver in childhood.
It is believed that experiences of loss of family, rejection or separation can cause the person to consider themselves of little value and be insecure.
There is another personality trait that depressed people often have; They often blame themselves for the occurrence of negative events and accept that they are the ones that create the positive results. This is the so-called pessimistic explanatory style.
Albert Bandura proposes that depression is associated with a negative self-concept and lack of self-efficacy (they believe that they cannot achieve personal goals or influence what they do).
In women there are a series of factors that make the onset of depression more likely: loss of a mother, being responsible for several children, lack of trustworthy relationships, unemployment.
Older people also have some risk factors: going from "giving care" to "needing care", death of someone close, change in personal relationships with wife or other relatives, changes in health.
Finally, existential therapists relate depression to a lack of meaning in the present and a lack of vision for the future..
Poverty and social isolation are related to an increased risk of developing mental disorders. Sexual, physical or emotional abuse in childhood is also related to developing depressive disorders in adulthood.
Other risk factors in family functioning are: depression in parents, conflicts between parents, deaths or divorces. In adulthood, stressful events and events related to social rejection are related to depression.
Lack of social support and adverse conditions at work - poor decision-making capacity, bad work climate, poor general conditions - are also related to depression.
Finally, prejudice can lead to depression. For example, if in childhood the belief develops that working in a certain profession is immoral and in adulthood working in that profession, the adult may blame and direct the prejudice to himself.
Evolutionary psychology proposes that depression may have been incorporated into human genes, due to its high heritability and prevalence. Current behaviors would be adaptations to regulate personal relationships or resources, although in the modern environment they are maladaptations.
From another point of view, depression could be seen as an emotional program of a kind activated by the perception of personal worthlessness, which may be related to guilt, perceived rejection and shame.
This trend could have appeared in hunters thousands of years ago who were marginalized by declining skills, something that could continue to appear today.
In the psychiatric population there is a high level of substance use, especially sedatives, alcohol and cannabis. According to DSM-IV, a diagnosis of mood disorder cannot be made if the direct cause is the effect produced by substance use..
Excessive alcohol consumption significantly increases the risk of developing depression, as do benzodiazepines (central nervous system depressants).
A) Presence of a single major depressive episode.
B) Major depressive episode is not better explained by the presence of schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or unspecified psychotic disorder.
C) There has never been a manic episode, a mixed episode or a hypomanic episode.
Specify:
A) Presence of five or more of the following symptoms during a period of 2 weeks, representing a change from previous activity; one of the symptoms must be 1. depressed mood, or 2. loss of interest or capacity for pleasure:
B) Symptoms do not meet criteria for a mixed episode.
C) Symptoms cause clinically significant distress or impairment of the individual's social, occupational, or other important areas of activity.
D) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
E) Symptoms are not better explained by the presence of grief, symptoms persist for more than two months or are characterized by marked functional disability, morbid worries of worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
DSM IV recognizes 5 subtypes of TDM:
Major depressive disorder often co-occurs with other mental disorders and physical illnesses:
When diagnosing MDD, other mental disorders that share some characteristics should be considered:
The three main treatments for depression are cognitive-behavioral therapy, medication, and electroconvulsive therapy..
The American Psychiatric Association recommends that initial treatment be tailored based on the severity of symptoms, co-occurring disorders, patient preferences, and response to previous treatments. Antidepressants are recommended as initial treatment in people with moderate or severe symptoms..
It is currently the therapy that has the most evidence of its effectiveness in children, adolescents, adults and the elderly.
In people with moderate or severe depression, they can work the same or better than antidepressants. It is about teaching people to challenge irrational thoughts and change negative behaviors..
Variants that have been used in depression are rational emotional behavioral therapy and mindulness. Specifically, minfulness appears to be a promising technique for adults and adolescents..
Sertraline (SSRI) has been the most prescribed compound in the world, with more than 29 million prescriptions in 2007. Although more results are needed in people with moderate or acute depression, there is evidence of its usefulness in people with dysthymia.
Research conducted by the National Institute for Health and Care Excellence found that there is strong evidence that selective serotonin reuptake inhibitors (SSRIs) are more effective than placebo in reducing moderate and severe depression by 50%.
To find the right drug treatment, you can readjust the doses and even combine different classes of antidepressants.
Typically, it takes 6-8 weeks to see results and is usually continued for 16-20 weeks after remission to minimize the chance of recurrence. In some cases it is recommended to keep the medication for a year and people with recurrent depression may need to take it indefinitely..
SSRIs are currently the most effective compound or drug. They are less toxic than other antidepressants and have fewer side effects.
Monoamine oxidase inhibitors (MAOIs) are another class of antidepressants, although they have been found to have interactions with drugs and foods. They are rarely used today.
There is some evidence that selective COX-2 inhibitors have positive effects for major depression.
Lithium appears effective in reducing suicide risk in people with bipolar disorder and depression.
Electroconvulsive therapy is a treatment that induces electrical seizures in patients to reduce psychiatric illnesses. It is used as a last option and always with the consent of the patient.
One session is effective for approximately 50% of people resistant to other treatments and half of those who respond relapse at 12 months.
The most common adverse effects are confusion and memory loss. It is administered under anesthesia with a muscle relaxant and is usually administered two or three times per week..
Bright light or light therapy reduces symptoms of depression and seasonal affective disorder, with effects similar to those of conventional antidepressants.
For non-seasonal depressions, adding light therapy to normal antidepressants is not effective. Physical exercise is recommended for mild and moderate depression. According to some research it is equivalent to the use of antidepressants or psychological therapies.
The average duration of a depressive episode is 23 weeks, being the third month in which there are more recoveries.
Research has found that 80% of people who experience their first episode of major depression will experience at least one more in their lifetime, with an average of 4 episodes in their lifetime..
Recurrence is more likely if symptoms have not completely resolved with treatment. To avoid it, current indications recommend continuing with the medication for 4-6 months after remission..
People who suffer from recurrent depression require continuous treatment to prevent long-term depression and in some cases it is necessary to continue the medication indefinitely..
People with depression are more susceptible to heart attacks and suicide. Up to 60% of people who commit suicide suffer from mood disorders.
Once an episode of major depression occurs, you are at risk for another. The best way to prevent is to be aware of what triggers the episode and the causes of major depression.
It is important to know what the symptoms of major depression are in order to act soon or receive treatment. These are some tips for its prevention:
More women are diagnosed than men, although this trend may be due to the fact that women are more willing to seek treatment.
There are several risk factors that seem to increase your chances of developing major depression:
According to World Health Organization, depression affects more than 350 million worldwide, being the leading cause of disability and contributing significantly to morbidity.
The first depressive episode is more likely to develop between the ages of 30 and 40 and there is a second peak in incidence between the ages of 50 and 60.
It is more common after cardiovascular diseases, parkinson's, stroke, multiple sclerosis and after the first child.
Untreated depression can lead to health, emotional, and behavioral problems that affect all areas of life. Complications can be:
If you have a family member or friend who is affected by depression, the most important thing is to help diagnose the disease and start treatment.
You could make an appointment and accompany your family member, encourage them to continue the treatment later or to seek a different treatment if there is no improvement after 6-8 weeks.
You can follow the following tips:
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If you have depression you can feel hopeless, without energy and without wanting to do anything. It can be very difficult for you to act to help yourself, although you need to recognize the need for help and treatment.
Some advices:
And what experiences do you have with depression? I am interested in your opinion. Thanks!
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