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Major Depressive Disorder

Depression is commonly defined as a mental disorder characterized by very low moods and low levels of self-esteem (Crane and Hannibal 149). Major Depressive Disorder is one of the most common forms of depression, and is explicitly defined as a mood disorder where the affected person has had two or more major depressive episodes during which he/she has exhibited:

Symptoms

Several symptoms for MDD have been agreed upon, as per the DSM-IV-TR (Diagnostic Statistical Manual). MDD is characterized by a depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day:

  • depressed mood most of the day
  • diminished interest or pleasure in all or most activities
  • significant unintentional weight loss or gain
  • insomnia or sleeping too much
  • agitation or psychomotor retardation noticed by others
  • fatigue or loss of energy
  • feelings of worthlessness or excessive guilt
  • diminished ability to think or concentrate, or indecisiveness
  • recurrent thoughts of death

(DSM-IV-TR 356)

Abnormality

Major Depressive Disorder falls under the study of abnormal psychology; MDD is definitely considered abnormal by at least three of the seven criteria of gauging abnormality proposed by Rosenhan and Seligman in 1984 (Crane and Hannibal 137). One who has major depressive disorder is indeed suffering distress and discomfort, and as such is exhibiting maladaptive cognitions (which would lead to maladaptive behaviors). Sufferers of MDD also have an aspect of unconventionality to their illness, as they perceive the world about them with a much more depressed state of consciousness, contrary to what most of the population experiences. This classification of MDD as an abnormal behavior bears great significance as it implies that those with MDD do not function normally in society, and thus are affectively disadvantaged to other ‘normal’ people.

Brief History

Depression has had a long history, dating as far back as at least the time of Hippocrates, in the fifth century BCE. Hippocrates referred to depression as ‘melancholia’, stating that it exists “if fear and distress last for a long time” (Horwitz 41). However, the form of depression known as Major Depressive Disorder has not been around for very long, relatively speaking. It was first proposed in the 1970’s by US clinicians who were trying to make more explicit diagnostic criteria for identifying various forms of depression. Later this was published in the DSM III in 1980 (Horwitz 44-6). In order to remove ambiguity, vagueness, and conflicting theories from a manual meant for diagnosis, this inclusion of MDD was, as with all other publications in the DSM III, strictly descriptive and thus did not focus on the etiology of Major Depressive Disorder. However, this symptom-based nature of the DSM III had a problem of its own; because the manual was strictly symptom based, it did not allow diagnoses to take contextual, patient-specific factors into consideration. The DSM IV, published in 1994, considered MDD as more of a social fact, and does take into consideration more contextual information about patients (Horwitz 47).

Epidemiology

Epidemiological studies of the prevalence of MDD have shown that measures of the adult population with MDD have great variability. “The point prevalence of Major Depressive Disorder in adults in community samples has varied from 5% to 9% for women and from 2% to 3% for men” (DSM-IV-TR 372). Thus, MDD affects about 14.8 million US adults (age 18 or older). Depression affects women more so than men (The Numbers). Worldwide, about 350 million people suffer from depression in general (Marcus 6). Prevalence of MDD does not seem to be related with ethnicity, education, income, or marital status (DSM-IV-TR 372)

Etiology

The symptoms of Major Depressive Disorder used for diagnosis are as aforementioned in the definition of MDD. Other symptoms of depression in general include: overeating, appetite loss, loss of interest in sex, aches, pains, headaches, cramps and digestive problems that do not ease even with treatment (Depression). In terms of the etiology of MDD, several levels of analyses can be used to theorize and define possible correlations and causes. From the neurobiological standpoint, those expressing Psychotic Features, more severe episodes of depression and Melancholic Features exhibit heightened levels of glucocorticoids in certain neurological pathways and altered brainwaves during sleep (as recorded by EEG sleep measurements). 20%-25% of people with “chronic or severe general medical condition” will develop MDD while they have said medical condition (DSM-IV-TR 371). Specific serotonin, dopamine, and norepinephrine pathways in the brain do not function properly when one becomes depressed. Higher levels and more frequent release of the hormone cortisol is a contributing factor to development of more severe MDD. From an intrapsychic point of view, scientists have analogized learned helplessness to apply to humans, seeing it as a probable cause of depression. Individuals who go through distress during times of helplessness are likely to become passive in times of future distress (e.g. individuals who have suffered a history of child abuse). Interestingly, there also seem to be genetic influences on the propensity of developing depression; the 5-HTT gene and several different loci on chromosomes 18, 21 and 22 correlate with certain aspects of depression. Other possible causes of depression include: alcohol and drug abuse, personal loss, and low socioeconomic status (Fitzgerald, Sadock et al. 529-30).

The direct effects of MDD can be seen in the symptoms that an individual might have had to be diagnosed with Major Depressive Disorder in the first place. These include a lowered mood most of the time, reduced interest or pleasure in all or most activities, significant unintentional weight loss or gain, insomnia or hypersomnia, agitation or psychomotor retardation, fatigue, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, or indecisiveness, and thoughts of death. Any of these symptoms will cause unnecessary distress to whoever has them, and might even lead to an individual’s suicide. The presence MDD might be traumatic not only for the individual with MDD, but also for those in close social proximity to said individual; loved ones may also be placed under unnecessary distress.

Treatment

Several treatment methods are usually implemented for a patient with MDD; many times multiple methods are used in unison in order to provide a holistic treatment, accounting for biological, cognitive, and social factors. Modern psychiatrists are advised to utilize pharmacotherapy, depression-focused psychotherapy, and electroconvulsive therapy, with a primary goal of remission of MDD. Pharmacotherapy of depression mainly includes the prescription of SSRIs (Serotonin Selective Reuptake Inhibitors), SNRIs (Serotonin-norepinephrine reuptake inhibitors), MAOIs (monoamine oxidase inhibitors) and TCAs (tricyclic antidepressants). Some examples of prescribed antidepressants are Zoloft (sertraline), Paxil (paroxetine) and Prozac (fluoxetine). It is recommended that patients showing more of a prominence of irritability or anxiousness should take SSRIs or SNRIs, while those suffering more of a prominence in fatigue or a loss of enjoyment in life should be prescribed dopamine or norepinephrine enhancers (Brown).

Though pharmacotherapy might be sufficient for many cases of MDD, it is recommended that psychotherapy and, in some cases, electroconvulsive therapy also be utilized in order to prevent relapse of MDD in a patient (Sadock et al. 554). Forms of psychotherapy include cognitive, interpersonal, psychoanalytic, family and behavioral therapies. The cognitive approach allows patients to understand negative thought processes and develop more positive cognitions. Interpersonal therapy focuses more on problems between the patient and another person or other people. Behavioral therapy teaches patients about their maladaptive behaviors so that they may understand and receive positive reinforcement in their daily lives. Psychoanalytic therapy attempts to change the structure of an individual’s personality (e.g. by introducing new coping mechanisms, teaching interpersonal trust, etc). The familial approach to therapy is used in cases where MDD might threaten the structure of said individual’s family (Sadock et al. 553-5).

Conclusion

Major Depressive Disorder is a serious but treatable mental disorder. It has a high prevalence in the United States and contributes to many suicides each year. However, great strides have been made in diagnosing and treating the disorder with considerable reliability and efficacy. Research and development of many forms of antidepressants have created a wide range pharmacotherapeutic treatments for a population with nuanced physiological differences. Various forms of psychotherapy have also been documented and tested in order to optimize treatment on the individual level. Even though a ‘cure’ for Major Depressive Disorder has not been discovered, at least there are treatments with considerable levels of potency to alleviate those affected.

Resources

Belmaker, R. H., and Galila Agam. “Major Depressive Disorder.” New England Journal of Medicine 358.1 (2008): 55-68. Print.

Brown, Charles H. “Pharmacotherapy of Major Depressive Disorder.” USPharmacist.com. N.p., 16 Nov. 2011. Web. 02 Sept. 2013. <http://www.uspharmacist.com/content/d/feature/c/31081/>.

Crane, John, and Jette Hannibal. IB Diploma Programme: Psychology Course Companion. Oxford: Oxford UP, 2009. Print.

“Depression.” National Institute of Mental Health. National Institute of Mental Health, n.d. Web. 02 Sept. 2013. <http://www.nimh.nih.gov/health/topics/depression/index.shtml>. Diagnostic and Statistical Manual of Mental Disorders: DSM III. Washington: American Psychiatric Association, 1980. Print.

Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000. Print.

Fitzgerald, Jane A. “Major Depressive Disorder.” Encyclopedia of Mental Disorders. Advameg, n.d. Web. 02 Sept. 2013. <http://www.minddisorders.com/Kau-Nu/Major-depressive-disorder.html>.

Horwitz, Allan V., and Jerome C. Wakefield. “The Age of Depression.” The Public Interest(2005): 39-58. Print.

Marcus, Marina et al. Depression: A Global Public Health Concern. N.p.: World Health Organization, n.d. PDF.

“The Numbers Count: Mental Disorders in America.” National Institute of Mental Health. National Institute of Mental Health, n.d. Web. 02 Sept. 2013. <http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml>.

Sadock, Benjamin J., Harold I. Kaplan, and Virginia A. Sadock. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. 20th ed. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins, 2007. Print.

Spaner, D., R.C. Bland, and S.C. Newman. “Major Depressive Disorder.” Acta Psychiatrica Scandinavica 89.S376 (1994): 7-15. Print.


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