Major depression is another term for clinical depression and is characterized by mood changes. It is a serious mental disorder that may be a single episode or a chronic condition affecting the lifestyle of the individual by taking away his interest in pleasurable activities. People who suffer from this condition have a sense of hopelessness and despair. According to the National Institute of Mental Health, about 6.7% of the U.S. population aged over 18 are affected by major depression and approximately 20% to 25% of adults may have suffered an episode of major depression in their lifetime .
Three types of causes have been identified as possible reasons of major depressive disorder, namely, intrapsychic, environmental, and biological. Intrapsychic causes may be conflicts that occur during childhood or patterns of thinking that individuals get from their family members. Another intrapsychic cause is that of learned helplessness, when people feel that their lives are not within their control and they cannot do anything to improve its quality. Examples of environmental causes of major depressive disorder are environmental disasters, death of a loved one, an unsuccessful relationship or some major life changes such as divorce. The biological causes are those which are related to genetics, the level of neurotransmitters and the level of cortisol secretions.
Almost every day, a person with major depression feels fatigue or loss of energy; worthlessness or guilt; insomnia or hypersomia (excessive sleeping); and anhedonia, which is a noticeable loss of interest or delight in almost all activities. Other symptoms include indecisiveness; impaired concentration; restlessness or feeling slowed down; repeated contemplation of death or suicide; considerable weight loss or gain of more than five per cent within a period of one month.
Major depression may affect older adults, teens and even children. Both men and women are at risk of major depression. For women, the risks increase during puberty, menstruation, pregnancy, miscarriage, and menopause, when hormonal changes occur. In men, the signs of depression include irritability, anger, drug or alcohol abuse and violent behavior.
Major depressive disorder can lead to other complications if left untreated. These complications include heart disease, pain perception, sexual and sleep problems and increased risk of suicide. For patients who have serious suicidal tendencies, hospitalization may be required.
The treatment options available for patients with major depression disorder are medication, psychotherapy and Electroconvulsive Therapy (ECT) and Repetitive Transcranial Magnetic Stimulation (rTMS). Several types of antidepressant medications may be given to the patient to control the symptoms. The first type is the Selective serotonin reuptake inhibitors (SSRIs). SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). SSRIs are known to be safer than other antidepressants and it has less bothersome side effects. Most common side effects are headaches, nausea, jitters, decreased sexual desire or insomnia. This can be addressed by adjusting the dosage of the medication, although most side effects go away as the body learns to adjust to it.
Another type of antidepressant is the Serotonin and norepinephrine reuptake inhibitors (SNRIs). These include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq). In addition to the similar side effects as that of SSRIs, these medications may also cause intense perspiration, dry mouth, fast heart beat and difficulty in bowel movement.
Other types of antidepressants are Norepinephrine and dopamine reuptake inhibitors (NDRIs), Atypical antidepressants, Tricyclic antidepressants, Monoamine oxidase inhibitors (MAOIs). These medications exhibit different side effects such as seizures, weight gain, diarrhea or insomnia. Aside from anti depressants, some doctors also recommend stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications for some patients. Other doctors may suggest the augmentation strategy which is the use of a combination of these medicines.
Just recently, the U.S. Food and Drug Administration approved Brintellix (vortioxetine), a new medication for treating major depressive disorder. The side effects noted for this drug are nausea, constipation and vomiting.
Aside from medication, psychotherapy may also be used to cure major depression. Psychotherapy may be cognitive behavioral therapy, behavioral therapy, interpersonal therapy, rational emotive therapy and family and psychodynamic approaches. For psychotherapy to be effective, both the therapist and patient should be willing to work with each other. The aim of this type of treatment is for the patient to develop his relationship skills and to be able to communicate more effectively by freely expressing appropriate emotions in various occasions. For cognitive behavioral therapy, the focus is not on the cause of the depression, rather, it is more concerned with changing the way the person feels. On the other hand, interpersonal therapy is more directed at improving the patient’s social relationships helping him in his communication skills and in the appropriate expression of his emotions.
If medication and psychotherapy fails or when the symptoms are too severe, the Electroconvulsive therapy and other brain stimulation therapies may be done. Electroconvulsive treatment is only the last resort for patients with depression because of the questionable effects on one’s memory. Another method is the Repetitive transcranial magnetic stimulation (rTMS) where an electromagnet is placed on the scalp, thereby stimulating the cerebral cortex. This treatment can sometimes result in contractions in the scalp and facial muscles or may lead to seizures.
The treatment for depression is not instant. Patience is required for both the therapist and the individual. The effects of medications are usually felt within six to eight weeks. For psychotherapy, 50 minute sessions, once a week might extend anywhere from six months to one year to make it effective.
Major depressive disorder is a serious mental condition. There are however several treatment options available. What is important is that the individual has the support of his family and is willing to undergo treatment.
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