MAJOR DEPRESSIVE DISORDER (DEPRESSION) Symptoms, Causes, Complications

---

What is Major Depressive Disorder

Major depressive disorder in basic terms, explains the classic condition among the many listed disorders. The related characteristic features consist of, the occurrence of episodes with a minimum period of 2 weeks’ duration, neuro-vegetative function, cognition, etc.

---

 

Depressive disorder in itself is a wider term, which includes the following terms, dysthymia, substance-induced depressive disorder, major depressive disorder, premenstrual dysphoric disorder, etc.

The commonality among all these disorders is the prevalence of feelings of emptiness, sadness, accompanied by somatic and cognitive symptoms.

The factor which is considered to be related to grief, i.e. dysphoria, is most likely to lessen in intensity with time and occur in waves, also known as pangs of grief.

 

DEFINITION

Major depressive disorder in basic terms, explains the classic condition among the many listed disorders. The related characteristic features consist of, the occurrence of episodes with a minimum period of 2 weeks’ duration, neuro-vegetative function, cognition, etc.

A major depressive episode is differentiated from an episode of grief, by careful consideration of the delineation of the amount of sadness. Chronic depression, dysthymia, following the mood disturbance(s) continues for a minimum of 2 years (in adults) or 1 year (in children). Depression-like phenomena can occur due to the presence of substance-abuse, prescribed medications, and certain medical conditions.

 

PREVALENCE

The prevalence of the major depressive disorder among the people with age group, 18- to 29-year-old individuals is markedly higher than the age group 60 years or older, in the United States. The prevalence is slightly higher in females than males, in their early adolescence.

 

DIAGNOSTIC CRITERIA

• For the diagnosis of MDD, five or more of the mentioned symptoms must be present for a 2-week period and reflect a change from prior functioning: one of the diagnosed symptoms must be either, loss of pleasure or depressed mood.
• Various areas of functioning get affected, in clinical terms such as occupational distress or social impairment.
• Various physiological effects, loss of someone close, feelings of sadness, etc. are not considered under this category.
• No occurrence of either a hypomanic episode or a manic episode.

 

GENDER DIFFERENCES

The major depressive disorder has been found to affect the females subjectively more than males. Although there have been no clear differences in terms of treatment response, or symptoms. In women, it has been found that the risk for suicide attempts is comparatively higher, and the completion rate of a suicide attempt is lower. The suicide rate disparity in the population as a whole is significantly greater, as among the depressed ones.

 

DIAGNOSTIC FEATURES

The mentioned criterion symptoms relating to major depressive disorder must be prevalent nearly daily, to be considered present, except weight gain or loss along with suicidal ideation.

• Persisting depressed mood
• The feeling of fatigue or insomnia
• High sleep disturbance patterns are present; psychomotor disturbances are comparatively a less common symptom
• The essential feature is the prevalence of major depressive symptoms, up to a period of at least 2 weeks
• In the case of children and adolescents, a cranky mood may develop rather than sadness
• Social withdrawal
• Significant levels of reduction in sexual desire(s)
• Mild to severe appetite change(s), eating less food, forced eating, craving for sweet food etc.
• Certain psychomotor disturbances (agitation, inability to sit still, pulling or rubbing of the skin, etc.) or the characteristic of retardation (slowed speech and body movements)

 

SYMPTOMS

The consistent prevalence of at least five among the specified symptoms should be there,

• Irritability or depressed mood
• Decreased interest in most of the activities
• Significant weight gain or loss
• Fatigue
• Guilt/worthlessness
• Diminished ability of concentration
• Suicidal feeling(s)

 

CAUSES

The root cause of the major depressive disorder isn’t known. However, several factors can increase the risk of acquiring the symptoms related to major depressive disorder. Genetics and stress levels can affect brain chemistry. Alterations in the hormones might also contribute to the condition.

The following can also be termed as trigger points:

• Substance-abuse (alcohol or drugs)
• Medical conditions of cancer or hypothyroidism
• Certain medications (including steroids)

 

RISK FACTORS

• Temperament

Neuroticism is one among the well-established risk factors, considered for the onset of major depressive symptoms leading to MDD.

• Environment

Adverse childhood experiences faced by individuals, particularly in case of multiple diverse experiences, stressful life events constitute a set of factors contributing to major depressive disorder.

• Genetic and physiological factors

Immediate family members with the condition of major depressive disorder have a high risk of being prone to major depressive symptoms, than that of the general population.

• Course modifiers

Majority of non-mood disorders pose a high risk to the individuals developing depressive symptoms. Major depressive episode(s) can also be a causal factor due to certain chronic or disabling medical conditions, i.e. cardiovascular disease, diabetes, morbid obesity.

 

COMPLICATIONS

Depression can adversely affect a person physically as well as financially, based on the adversity of the occurrence.

• The economic cost of depression

Depression basically poses a negative impact on youngsters (workforce), which is also considered as one among the leading causes of disability in a wider population.

• Impact of depression on individuals

With the increasing rate of unemployment among the population, the income levels are decreasing rapidly, causing stress in the family.

Low level of confidence and low self-esteem, can adversely impact family relations, followed by isolation by the individual (suffering), increasing the risk of suicide.

 

• Impact of depression on health

Depression impacts the physical as well as psychological aspects of health adversely. It makes persisting pain and distress even more severe. The affected ones are less likely to be in a good state of health, may have a tendency to smoke, along with the intake of certain drugs. There is an increased risk of type-2 diabetes, cardiovascular issues, along with obesity.

 

DIFFERENTIAL DIAGNOSIS

• Manic episodes with irritable mood or mixed episodes

Irritability is one among the common features of major depressive disorder and manic episodes. To make a distinction between the two, a careful clinical evaluation is required.

• Mood disorder due to another medical condition

On the basis of physical examination, individual history, and laboratory findings, if the mood alteration(s) is judged, then it can be a clear indication of an episode of MDD.

• Bipolar disorder or substance-induced depression

Substance-dependence (drug-abuse, medication(s), and toxins) can appear to be, etiologically related to the mood alterations.

• Attention-deficit or hyperactivity disorder

Both ADHD and MDD consist of the symptoms of distractibility and low-frustration tolerance levels. However, it is the duty of the clinician, to be cautious as to not over-diagnose an episode of major depressive disorder in children with attention-deficit-hyperactivity-disorder, characterized by mood disturbances.

 

PREVENTIVE MEASURES

While triggers may vary from person-to-person, certain techniques to prevent depression relapse are as stated.

1. Regularly workout regime

We should try to restore physical fitness in order to be able to stay mentally sound.

Adequate release of chemicals (endorphins), also termed as mood boosters.

• Boosts immunity against depression.

2. Cut down the social media time

Increased social media dependence contributes to depression and lower levels of self-esteem.

We can use website-blocking extensions to enable us access to certain sites for a limited period of time.

3. Strengthening relationships

Indulging in new hobbies, staying connected with peers and family, maintaining a balance of physical activities in everyday life, helps us build new and strong bonds.

4. Getting adequate sleep

Better sleep can be locked with certain small steps:

• Avoiding screens before bedtime
• Assure a good quality mattress
• Avoid caffeine

5. Get off nicotine intake

Any form of nicotine can trigger depression. To stop smoking, we can opt for certain steps:

• The major focus should be on our reason to quit, each time we’re tempted.
• Telling our friends and asking them for their help, holds us accountable.

 

TREATMENT/ THERAPY

• Medication

Primary care providers, first handedly opt for anti-depressants for the treatment of MDD. Selective Serotonin Reuptake Inhibitors (SSRIs) inhibits the breakdown of serotonin (in the brain), resulting in large quantities of neurotransmitters.

Serotonin basically is a brain chemical responsible for mood changes. It helps in improving mood, along with facilitating better sleep patterns. MDD lowers the level of serotonin in people.

• Psychotherapy

Psychotherapy is also known as talk therapy, effective treatment for people with the prevailing condition of MDD. Psychotherapy helps us in various ways:

• increasing our self-esteem
• adjusting to a stressful event
• replacing negative behaviours with healthy ones

• Lifestyle changes

In addition to regular medications and participating in therapies, we can opt for certain lifestyle changes as well:

Eating right– foods rich in vitamin B helps people with MDD symptoms.

Sleeping well- It’s vital to sleep for at least 6 to 8 hours per night.

 

IN CASE OF SUICIDAL THOUGHTS

Suicidal behaviour exists at the majority of the times in case of major depressive episodes. Certain features related to increased risk of suicide include living alone and having prominent feelings of low self-esteem.

 

COPING MECHANISMS

Tips to cope with MDD are as follows:

1. Knowing our worth

Depression may make us feel embarrassed or ashamed. But the reason is not big enough to beat ourselves up. It is a common mental illness affecting many.

2. Simplifying our lives

Anxiety worsens the depressive symptoms. It’s equally difficult and important to remove stressors from our life. So to maintain a healthy balance, we should know our limitations and remove certain obligations.

3. Taking care of ourselves

Simplified lifestyle adjustments help us cope with this illness. Ensuring an adequate amount of sleep helps remove irritability and anxiety.

Regular workout regime along with a healthy diet also helps in many noticeable and unnoticeable ways.