Major Depressive Disorder - Types, Causes, Symptoms and Treatments

What Is a Major Depressive Disorder?

Major depressive disorder is a condition that is characterized by long-lived periods of persistent and intense grief. It is also known as clinical depression and has a severe impact on an individual's mood, behaviors, and physical functions like appetite and sleep. It has been reported to be one of the most prevalent health conditions in the United States.

What Is the Cause of Major Depressive Disorder?

Although not clearly known, several factors may contribute to major depressive disorder, which includes the following:

1. Brain Chemistry:

Naturally occurring chemicals in the brain are called neurotransmitters, which affect depression. Any alteration in the effect and function of neurotransmitters and the interaction of these neurotransmitters with the neurocircuits needed for maintaining mood stability result in depression.

2. Physical Changes in Brain:

Though not apparent, physical changes in the brain are known to have an effect on depression.

3. Heredity:

The risk of developing major depressive disorder runs in families. People whose blood relatives have this condition are more likely to get this disease. However, the gene responsible for causing depression is under research.

The following factors trigger the risk of developing major depressive disorder:

• Usage of drugs or alcohol.
• Medications like steroids.
• Chronic medical conditions like hypothyroidism and cancer.
• Childhood abuses.

What Are the Types of Major Depressive Disorder?

Symptoms of depression are not the same for all persons and vary from one individual to another. Type of depression is determined with the help of the following specifiers:

1. Anxious Distress- Restlessness, loss of control, and worrying about possible future events.

2. Melancholic Features- The minimal response to pleasure-seeking activities characterizes it. It is associated with worse morning mood, sluggishness, guilty feeling, appetite changes, waking in the early morning, etc.

3. Seasonal Pattern- Due to changes in the season and decreased sunlight exposure.

4. Catatonia- It is associated with uncontrollable and unnecessary movements.

5. Mixed Features- Concurrent mania and depression characterized by talkativeness, increased self-esteem, and energy.

6. Atypical Features- It involves temporary cheerfulness to happy events, sensitivity to refusal, excessive appetite, sleepfulness, and heavy feeling in the extremities.

7. Postpartum Onset- It occurs during the gestation period or a few weeks after pregnancy.

How Is Major Depressive Disorder Manifested?

Many people are not aware of why they feel depressed. Depression occurs in multiple episodes throughout one's life and can be present throughout the day and almost every day. Also, it can be evident from the day-to-day activities in the household, school, or workplace.

Following are the symptoms of major depressive disorder:

• Hopelessness.
• Emptiness.
• Angry outbursts.
• Fussiness or irritability over silly things.
• Tearfulness.
• Disturbances in the regular sleep cycle either have insomnia or sleeps too much.
• Loss of appetite associated with weight loss.
• Increased food craving associated with weight gain.
• Loss of sexual pleasure.
• Disinterested in activities like sports or some hobby.
• Anxiety.
• Energy loss.
• Feeling fatigued.
• Agitation.
• Decreased thinking.
• Slow speaking and body movements.
• Unexplained headaches and back pain.
• Frequents thoughts about death.
• Suicidal thoughts.
• Difficulty in concentrating and decision-making.
• Self-blaming.
• Guilty feeling.
• Trouble remembering.

How Is Major Depressive Disorder Manifested in Children and Young Adults?

In addition to the above signs and symptoms, children and teens exhibit a few other symptoms like:

1. In children, underweight, clinginess, refusing school, grief, fussiness, aches, etc., are seen.

2. In teenagers, depression manifests as poor performance in school, poor attendance, feeling worthless, using recreational drugs or alcohol, harming oneself, bypassing social interaction, being disinterested in daily activities, sadness, excessive eating, and sleeping, feeling misapprehended, feeling very sensitive, etc.

How Is Major Depressive Disorder Manifested in Older Adults?

Depression should not be considered a normal phenomenon of aging. Instead, medical help should be sought. Although many older adults are reluctant to speak about this, we must look for the following signs in them:

• Changes in personality.
• Memory loss.
• Appetite loss.
• Fatigue.
• Not interested in socializing.
• Suicidal thoughts.
• Aches or pain in the body.
• Reduced interest in sexual activities that are not associated with any medications.

What Increases the Risk of Developing Depression?

Depression can occur in any stage but is probably thought to start in the teens, 20s, or 30s. The below factors increases the risk of developing or triggering an existing depression:

• Low self-esteem.
• Too much dependency on others.
• Pessimistic approach.
• Self-blaming.
• Chronic medical conditions like stroke, cancer, cardiac diseases, or experiencing chronic pain.
• Inherited traits of depression, bipolar disorder, suicide, or alcoholism in the family.
• Transgender, lesbian, gay, bisexual, or have a condition where there is improper development of the genitals, making it challenging to identify the sex of the individual.
• Alcohol abuse.
• Drug abuse.
• Physical abuse or sexual abuse in the past.
• Loss or death of a dear one.
• Relationship difficulties.
• Financial instability.
• Medications like sleeping pills and anti-hypertensive tablets.
• History of mental disorders like post-traumatic stress disorder, anxiety disorder, or eating disorder.

How Is a Major Depressive Disorder Diagnosed?

1. Physical Examination:

In order to determine if depression is associated with an underlying medical condition, a complete medical history and physical examination are made by the physician.

2. Blood Tests:

Blood tests like complete blood count and thyroid function tests are done to determine abnormalities in blood cell count and proper functioning of the thyroid, respectively.

3. Psychiatric Evaluation:

Symptoms, behavior patterns, feelings, and thoughts are analyzed by the mental health professional. In some cases, the patient might be asked to fill a questionnaire.

4. DSM-5:

The American Psychiatric Association has listed criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), using which the mental health professional diagnoses and categorizes depression.

What Disorders Result in Depression?

• Bipolar disorders.
• Persistent depressive disorder.
• Cyclothymic disorder.
• Premenstrual dysphoric disorder.
• Disruptive mood dysregulation disorder.

How Is a Major Depressive Disorder Treated?

A major depressive disorder primarily improves with psychotherapy and medications. In some cases, treatment might require a stay in the hospital followed by outpatient treatment.

The following are the treatment modalities available for the treatment of depression:

A. Medications:

1. Selective Serotonin Reuptake Inhibitors- Escitalopram, Sertraline, Fluoxetine, Citalopram, Vilazodone, and Paroxetine are the SSRIs used. These are recommended because they are safe and have comparatively fewer side effects than other antidepressants.

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)- Duloxetine, Levomilnacipran, Venlafaxine, Desvenlafaxine, etc., are used.

3. Atypical Antidepressants- Bupropion, Nefazodone, Vortioxetine, Mirtazapine, and Trazodone, are the atypical antidepressants that do not typically belong to any other group of antidepressants.

4. Tricyclic Antidepressants- These are prescribed only after trying SSRIs because they have more adverse effects. However, they are very effective.

5. Monoamine Oxidase Inhibitors (MAOIs)- Isocarboxazid, Phenelzine, and Tranylcypromine are the MAOIs that are used for treating depression, but they are recommended only if other medications are not effective. They have serious side effects, and strict diet restrictions must be followed while taking these drugs as they have severe food interactions with cheese, wine, and pickles. They also interact with certain medications and herbal supplements. Selegiline is a newer medicine of this group that has fewer side effects and can be worn as a skin patch.

6. Other Medicines- Some other medications can be taken with the above drugs to supplement the antidepressant effects. Anti-psychotics, anti-anxiety drugs, and sometimes another antidepressant can be given to improve the effects of the drug.

B. Psychotherapy:

It is a treatment procedure that involves talking about the mental health condition and other related issues with a therapist. It is also known as psychological therapy or talk therapy. Different types of psychotherapy can effectively treat depression, including cognitive-behavioral therapy, interpersonal therapy, or group therapy.

Psychotherapy can help you in the following ways:

• Replace negative thoughts and behaviors with positive and healthy thoughts.
• Calibrate realistic life goals.
• Gives a sense of satisfaction and control.
• Tolerance to distress.
• Tune oneself to face the crisis and help solve it.
• Develop good interactions with others and explore relationships.

Additional Forms of Psychotherapy- in addition to face-to-face interaction, psychotherapy can also be carried out in the form of online sessions, computer programs, workbooks, or videos. These can be guided fully or partially by a therapist or can sometimes be totally independent.

In-Patient Treatment:

In severe cases where there is an increased risk of harming oneself or others, psychiatric treatment is done in the hospital. Stay in the hospital is recommended until the condition improves. In case of partial hospitalization or day treatment programs, counseling and outpatient support help people by bringing the symptoms under control.

C. Brain Stimulation Therapies:

Electroconvulsive therapy and transcranial magnetic stimulation are the therapies that help in treating depression by causing brain stimulation. These are used when antidepressants medications and psychotherapy are not effective.

1. Electroconvulsive Therapy- In electroconvulsive therapy, an electric current passed through the brain influences the neurotransmitters in the brain, thereby relieving depression.

2. Transcranial Magnetic Stimulation- In the case of transcranial magnetic stimulation, nerve cells responsible for mood stabilization and regulation are stimulated by brief electrical impulses which arise from the electric coil placed on the scalp.

What Are the Complications of Major Depressive Disorder?

Depression affects not only the individual but also the family as a whole. If left untreated, it can cause severe emotional, physical, and behavioral adverse effects involving all spheres of life.

The following are the complications of depression:

• Misusing drugs or alcohol.
• Physical aches or pain.
• Suicidal thoughts, suicidal attempts, or sometimes suicide.
• Social phobia.
• Self-harming.
• Premature death.
• Obesity that may lead to diabetes and cardiac diseases.
• Anxiety.
• Panic disorder.
• Difficulty in maintaining relationships.
• Problems with work or school.
• Conflicts between family members.

Conclusion:

Do not feel hopeless about having depression because it is undoubtedly a treatable entity with adequate treatment measures. Follow the treatment protocol suggested by your mental health professional strictly, as this helps in overcoming depression. Do not skip follow-up appointments or stop your medicines without the advice of the doctor. Enjoy a stress-free life!