Major Depressive Disorder

Major Depressive Disorder

Major depressive disorder is a common mental illness characterized by a persistent low mood, loss of interest and pleasure, along with other physical, cognitive, and behavioral symptoms.

Characteristics:

• Mood: A pervasive and sustained emotional state that influences worldview and actions.

• Mood disorder: Continuous or disordered mood changes, persistent, causing psychological stress and harmful behavior.

• Major depressive disorder: Sadness, hopelessness, loss of interest in most activities, fatigue, irritability, lasting at least 2 weeks.

Causes:

• Psychological trauma: Conflicts in relationships, work, prolonged chronic illness.

• Genetics: Family history of depression.

• Neurotransmitter abnormalities: Norepinephrine, dopamine, serotonin reuptake inhibitors.

• Endocrine: Increased cortisol, decreased TSH.

Risk factors:

• Previous history of depression: Having a previous episode of depression.

• Family history: Having a family member with depressive disorder.

• Lack of social support: Loss of connection with the community, lack of support from friends and family.

• Stressful events: Having stressful events in life.

• Substance use: Alcohol, drug or stimulant addiction.

• Other medical conditions: Chronic illnesses, endocrine disorders.

Symptoms:

• Main symptoms: Depressed mood, loss of interest, pleasure. In children, irritability, anger.

• Secondary symptoms:

• Eating disorders: Weight loss, weight gain, changes in taste.

• Sleep disturbances: Insomnia (early awakening, difficulty falling asleep), hypersomnia.

• Psychomotor function: Slowed down, agitated (if anxiety disorder is present).

• Fatigue, lack of energy: Feeling exhausted, lack of motivation.

• Decreased ability to think, concentrate: Unable to make decisions, forgetful (in young people).

• Feelings of worthlessness, guilt: Feeling self-blame, unworthy to live, can turn into delusions, hallucinations.

• Thoughts of death, suicide: Having recurring thoughts of death, suicidal ideas, planning suicide.

• Anxiety: Feeling anxious, restless, and jittery.

• Physical symptoms: Headaches, back pain, cramps, nausea, vomiting, constipation, rapid breathing, deep breathing, chest pain.

Masked Depression:

• Not very common.

• No primary or secondary symptoms or only secondary symptoms are prominent.

• Diagnosis of exclusion.

• Monitoring and treatment like depression.

Diagnostic criteria for depression according to DSM-V:

• A: The patient must have at least 5 symptoms lasting at least 2 weeks, including at least 1 main symptom.

• B: Symptoms significantly affect psychology, social, work…

• C: Not due to substances or other medical conditions.

• D: Not explained by other mental disorders.

• E: Never had a manic or hypomanic episode.

Psychological depression tests:

• Hamilton Depression Scale: 17 items.

• Beck Depression Inventory.

Differential diagnosis:

• Depression due to medical condition/substance: Clinical, laboratory tests to find substances in blood and urine.

• Early stage Schizophrenia: More common in patients with paranoid delusions of being harmed, being followed, being controlled; auditory hallucinations of commentary, urging, commanding.

• Post-schizophrenic depression: Depression occurs after schizophrenic disorder has subsided.

• Primary insomnia: No mood symptoms.

Hospital admission indications:

• Severe depression: Severe depressive symptoms affecting the ability to self-care.

• Suicidal thoughts: The patient has suicidal intentions or plans.

Treatment:

• Antidepressants:

• Tricyclic antidepressants (TCAs): Amitriptyline. Has many side effects, used when SSRIs are ineffective.

• SSRIs: Selective serotonin receptor action, first-line, well-tolerated and fewer side effects.

• Fluoxetine (Prozac, Oxeflu, Oxedep)

• Fluvoxamine (Luvox): Less commonly used.

• Paroxetine (Wicky, Xalexa, Pharmapar): Not for pregnant women.

• Sertraline (Zoloft, Serenata, Utralene): Often causes gastrointestinal disturbances.

• Citalopram (Citopam)

• Escitalopram

• SNRIs (Venlafaxine): Also affects the norepinephrine system, second-line, fairly safe.

• 5HT (Mirtazapine): Early effects and causes more sleepiness than SSRIs. Third-line.

• Electroconvulsive therapy:

• Indications: Depression with suicidal intent, depression refusing to eat, depression with psychosis, treatment-resistant depression, antidepressant allergy.

• Contraindications: Combined physical conditions (cardiovascular, respiratory, brain damage due to trauma, encephalitis…), children under 15 years old.

• Psychotherapy: Cognitive therapy, supportive therapy, psychodynamic therapy. Combined with antidepressants, especially effective in mild and moderate depression.

• Social support: Participating in support groups, seeking support from family and friends.

Note:

• Treatment hierarchy is not due to efficacy but because SSRIs are simple, effective, and applicable to most of the general population.

• Patients who are difficult to comply with treatment should use Mirtazapine because it is more potent.

• SSRIs are still recommended first-line.

• Try SSRIs with different doses, different types of drugs, see the reasons why patients are not improving, whether the diagnosis is correct, whether there are other combined therapies to prescribe other drugs.

• Stresam is an antidepressant with fewer side effects, rapid action, used to treat common stress.

Conclusion:

Major depressive disorder is a serious mental illness, but it can be effectively treated. If you or a loved one is experiencing symptoms of depression, seek professional medical help.