Major Depressive Disorder

Major depressive disorder is a mental health condition that results in debilitating and intense sadness. The illness may last for months or years, and patients may have to take time off work or school while they recover. While some patients may only experience a single episode of major depressive disorder in their lifetime, others will have multiple episodes. Experts believe that this condition may be genetic.

What Are the Risk Factors for This Condition?

In the United States, this health condition is one of the most commonly diagnosed mental disorders. Researchers believe that genetics, biology, environment, and psychological factors may all contribute to the development of this condition. Having a personal or family history of this illness elevates a person’s risk of developing it, and some medical conditions and medications can also cause this condition. The disorder may be triggered by life stressors such as traumatic events or major life changes. For example, individuals who experience the loss of a family member, friend, or pet may become depressed, and the illness often develops following a divorce or the loss of a job.

Who Is Typically Affected by This Condition?

Major depressive disorder, or MDD, is usually diagnosed in adulthood. Many adults in midlife or later life experience this illness along with physical conditions. For example, patients with diabetes, cancer, cardiovascular disease, Parkinson’s disease, or dementia may also be depressed. In these cases, the mental health condition may be caused due to the trauma of being diagnosed with a serious illness; it may also be caused or exacerbated by the potential side effects of the medications used to manage these physical conditions.

This illness occurs in individuals of all ages, and it manifests differently in children. While depressed adults often present with a low mood, children who are depressed tend to exhibit stronger signs of irritability than sadness.

Women have double the risk of contracting this disorder as compared to men. Experts believe that the hormonal changes that occur with puberty, pregnancy, and menopause may potentially increase a woman’s risk of the illness. Studies suggest that women may also experience a greater number of stressful or traumatic life events, and gender differences in coping styles and stress sensitivity may further elevate the risk for females. Differences in socialization and societal and cultural roles may also influence a woman’s risk of developing this condition.

What Are the Symptoms of This Condition?

The symptoms of a major depressive disorder vary greatly from person to person, but they are all significant enough to disrupt daily functioning. People with this disorder typically experience major changes in appetite. For some patients, this manifests as loss of appetite and causes weight loss. Other patients may have an increased appetite that can lead to weight gain.  Major depressive disorder causes disruption to normal sleep patterns. Some individuals may find that they sleep too much, known as hypersomnia, and others may have difficulty falling or staying asleep, which is insomnia. Patients typically experience either an inability to sit still, which is restlessness, or a slowing down of their movements, also known as psychomotor retardation. Fatigue is common with this condition, and some patients may feel so tired that bathing and dressing are difficult or neglected.

Emotionally, MDD patients experience persistent sadness or a sense of emptiness, and this is accompanied by a loss of interest in activities that the person once enjoyed, including a loss of interest in working, eating, or seeing friends. Patients may also feel guilty, worthless, or hopeless, and they may constantly ruminate about mistakes or events from the past. These symptoms might be accompanied by suicidal thoughts, and some depressed patients may attempt to commit suicide.

To be diagnosed with this disease, patients must experience sadness, loss of interest in favorite activities, and at least three of the other aforementioned physical or emotional symptoms. The symptoms must have been present for most of the day and for at least two weeks, and they must be significant enough to make daily tasks much harder than they otherwise would be for that individual.

How Is This Condition Diagnosed?

An assessment for major depressive disorder can be carried out by a psychiatrist, general practitioner, nurse practitioner, or primary care physician. Since the symptoms of depression may be due to a medical condition, doctors often choose to conduct a health history questionnaire and perform a complete physical examination to rule out potential medical causes. In particular, patients will be asked about any medications they are taking, and they should mention all prescription and over-the-counter drugs as well as herbal supplements and vitamins. Patients will be asked about their personal and family history of major depressive disorder and related disorders, and they may also be asked about any previous suicide attempts or thoughts of suicide.

To begin the physical examination, a patient will have his or her vital signs measured. These include weight, blood pressure, and pulse. Since this mental health condition may lead to weight changes, having a baseline weight measurement can help doctors monitor changes. In addition, since depression and cardiovascular disease are linked, doctors will thoroughly examine the heart using a stethoscope to listen for murmurs, palpitations, and other abnormal sounds. Thyroid conditions are a major medical cause of MDD, and doctors will feel the thyroid gland to see if it is enlarged or otherwise abnormal. Additionally, neurological conditions such as strokes, brain tumors, concussions, and head trauma sometimes lead to MDD, so the physician will perform an exam to check the health of the patient’s nervous system, including checking cranial nerve function, vision, sensation, and reflexes.

A series of blood tests will likely be needed for a proper diagnosis. These usually include checks of vitamin D, calcium, and vitamin B levels; being deficient in these may cause MDD. The tests will check for any abnormalities in hormone levels related to the thyroid, and they can also detect anemia, another condition that may result in MDD. If the physician anticipates that the patient may need to take antidepressants, blood tests for kidney and liver function will be ordered. Some antidepressants can affect the function of these organs, so it is important to have this baseline measurement.

After examining the patient, the health care professional will ask a series of questions that screen for MDD. These questions ask the patient to think about the past two weeks of his or her life and estimate how many days he or she experienced feelings of sadness, emptiness, or hopelessness. Patients are also asked if they have lost interest in activities they once enjoyed and if they find it difficult to do daily tasks.

While this information is typically sufficient for a physician to make a diagnosis of MDD, some patients may be referred to a psychiatrist for further evaluation.

How Is Major Depressive Disorder Treated?

Treatment options for this condition generally involve a combination of both medication and psychotherapy.

One of the most commonly prescribed antidepressant drugs is a selective serotonin reuptake inhibitor. This class of drugs works by increasing the level of serotonin in the brain, which experts believe may improve a patient’s mood. Fluoxetine, paroxetine, and sertraline are some examples of these drugs, and they are generally well-tolerated. When starting a patient on a first antidepressant, most doctors will choose to begin with this type of medication.

Other types of antidepressants that may be prescribed include bupropion, vortioxetine, venlafaxine, and duloxetine. While taking any type of antidepressant, patients will be closely monitored by their health care team. In particular, patients should alert their medical team if they develop any bothersome or concerning side effects. Potential side effects that may develop with antidepressant use include dry mouth, constipation, nausea, blurry vision, confusion, insomnia, and memory problems. Patients may also experience suicidal thoughts, weight gain or loss, and drowsiness. Patients who experience suicidal thoughts immediately call 911, go directly to an emergency room, or make an urgent call to their healthcare provider. Other side effects should also be brought to a doctor’s attention promptly. Patients may need to take an antidepressant for several months in order to notice an improvement in symptoms. If necessary, patients can be switched to another type of antidepressant.

In addition to an antidepressant, patients with MDD will typically have counseling sessions. These can be given as individual sessions or as group therapy. Sometimes, patients may elect to treat their major depressive disorder with counseling alone. Typically, psychotherapy for MDD focuses on teaching patient healthy ways to cope with stress and feelings of sadness. The patient also learns to identify, reframe, and challenge his or her negative thoughts. Working with a therapist can help patients in identifying potential triggers that worsen their symptoms and enable them to modify their behavior to avoid the trigger or reduce their impact. Therapists help patients with MDD learn how to set realistic goals for themselves and regain a sense of control over their situation. Patients explore their relationship with themselves and others to process their past experiences, and they are taught how to create more positive interactions and stronger relationships with others.

A newer treatment option known as transcranial magnetic stimulation may help patients with MDD who have not obtained enough symptom management with other methods. Carried out by a specially trained health care professional, the treatment is entirely noninvasive, and it does not cause pain. While the patient relaxes in a chair, the health care provider places a magnetic coil against the patient’s scalp, and repetitive magnetic pulses are delivered through the coil to the brain. The pulses stimulate an area of the brain that is responsible for regulating mood. In people with MDD, this region is believed to be underactive. By stimulating the area, the magnetic pulses increase activity in the region; this can help patients achieve improved symptom management and relief.

While these treatments are typically given as outpatient therapy, some depressed patients may need to receive inpatient treatment in the hospital. Patients who have trouble taking care of themselves, including individuals who have trouble bathing, dressing, or getting out of bed and those who are in immediate danger due to suicidal thoughts or actions, typically need hospitalization until their mood is stabilized. Some patients can be partially hospitalized for day treatment.

How Can MDD Patients and Caregivers Manage Symptoms at Home?

While coping with this disease, patients and caregivers may feel overwhelmed by even the smallest tasks. The need to remember to take medication and the stress of traveling to or attending frequent doctor’s appointments and therapy sessions can increase strain on patients and their families.

To help reduce stress and provide as much stability as possible, patients and their families should try to create a home environment that prioritizes healthy living and self-care. Where possible, patients should aim to stick to a daily routine and set a regular time for going to bed and waking up. This can minimize insomnia and other sleep disruptions that may occur due to the disease or as a result of medication. Patients should aim to get seven to nine hours of sleep each night, and a health care provider should be informed of any new or worsening sleep difficulties.

Exercise and dietary choices can help individuals with this condition reduce their symptoms. Exercise releases feel-good endorphins that naturally boost mood, and some studies have shown that it can be as effective as antidepressants for milder forms of this illness. Although MDD is more severe and cannot be treated with exercise alone, taking a gentle walk outdoors, perhaps with a pet, may help patients experience less anxiety and manage stress more easily. Studies have shown that yoga, which combines gentle movement with deep breathing and meditation, may also be beneficial for those with this disorder.

Since mood changes are often influenced by changes in blood glucose, opting for foods that are low on the glycemic index can help patients avoid the sugar spikes and crashes that may worsen this illness. Brown rice, quinoa, lentils, and green vegetables may be especially beneficial. If possible, patients should try to reduce added sugars in their diets and choose unrefined sweeteners whenever possible.

By talking with a physician about how to treat a major depressive disorder, you or your loved one may be able to find effective and long-term solutions.

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