Causes, Diagnosis, and Treatment of Major Depressive Disorder - Essay Example

?"Major Depressive Disorder" Introduction Major depressive disorder, also called as major depression or clinical depression or recurrent depressive disorder, displays low self-worth, poor concern in day-to-day activities and the individual does not find any interest in usually pleasurable deeds. The condition is capable of putting an individual totally out of action and in turn adversely influences the lives of those who are associated, work place, behaviour of the individual, habits and ultimately the health. Statistics reveal that in United States, 3.4% of the cases suffering from major depressive disorder perform suicide on the other hand, 60% of the suicidal cases suffered depression or related ailment (Barlow, 2005). Diagnosis is based on the self-assessment of the individual, early detection is always beneficial else it may affect the health of the individual. Research studies depicts that the onset of depressive disorder may occur as early as in school going children in some cases while in majority of the cases it occurs between the age of 20 to 30 years or in the late thirties (Major Depressive Disorder). The treatment of the disorder encompasses antidepressant medication along with psychoanalysis, but severe cases need admission to the hospital to prevent any kind of harm that may be caused by the patient to self or to others and therefore the individuals display shorter life as compared to the normal individuals. Individuals suffering with major depressive disorder are more prone to other medical conditions as well as attempt to commit suicide. Till date no specific reason for major depressive disorder has been ruled out. Research reveals that it could be related to psychological predisposition of the individual which may encompass the upbringing, social atmosphere, the culture, inheritance, biological condition or any other associated ailment or it could be evolutionary or behavioural. Research also reveals that prolonged use of drugs may also enhance the symptoms or deteriorate the health condition. On the other hand psychological impact to alter behaviour, enhancing communication, education and learning abilities could result in instituting messaging between the nerve cells as there is alteration in the level of serotonin or dopamine in case of major depressive disorder. Various research studies have exhibited analogous advantages of psychosocial intrusions along with the pharmacological management to treat cases with major depressive disorder. The combination is widely used in treating major depressive disorder. In the two treatment modalities are often combined in clinical practice. This attempt is a good and beneficial step in the treatment of depressive disorder. According to Schramm et al (2007), an inpatient management strategy encompassing concise as well as rigorous psychotherapy along with the pharmacotherapy turns out to be the better treatment for major depressive disorder. Their findings reveal that combined treatment involving psychotherapy and the pharmacotherapy could prove to be beneficial to treat major depressive disorder over the solitary medication. Their findings illustrate that a tough comparative analysis could be procured when analysis was made using a small and elongated period of psychotherapy incorporation to pharmacotherapy. The results obtained highlight that almost 70% of high retort was observed and 49% reduction rate could be obtained while relapse pace was as small as 13% in the period of one year. Symptoms of Major Depressive Disorder Symptoms of the major depressive disorder encompass low down temper, a feeling of saturation in all aspects of life, unable to derive happiness, lost in thoughts, inattentive, sense of insignificance, guiltiness or be disappointed, despondency and self-disgust. In severe cases the individuals are known to report about hallucinations. All these culminate into poor concentration and memory, communal pulling out, hallucination etc. In certain cases insomnia is also found to be associated with major depressive disorder (American Family Physician). Causes Depression is psychopathological state which could be periodic, unbearable and yet deadly or suicidal generating financial encumber. According to Greenberg et al (2003), depression costs >$83 billion per year, in USA. The situation is alarming and therefore it is essential to observe the causes of major depressive disorder; which could be varied and can be explained by means of various models encircling different constraints such as biological, psychological and social. The diathesis- stress model proposes that depression is the result of a pre-existing exposure to any kind of stressful event in life and aggravates when something goes off beam, it could be due to genetic factors or due to the psychological predispositions which is the resultant of upbringing. Studies postulate that discrepancy amid the serotonin transporter gene (5-HTT) influences the likelihood of depression among the individuals who have experienced traumatic life incidents or they may possess one or two short alleles of 5-HTT gene (Haeffel et al, 2008). According to Kendler et al, (2006), major depressive disorder is reported in 40% of the females as compared to 30% in males. The biological reasons apart from genetic encompasses the disturbance in brain (the control centre) functioning that directly affects the release of neurotransmitters and hormones and various physiological progressions leading to the onset of depression. The limbic system and the neurotransmitters of the brain account for the clinical depression (Biological Causes of Depression). Biological Model The biological model encompasses monoamine hypothesis, as majority of the anti-depressants enhance the level of serotonin and norepinephrine in synapse. According to monoamine hypothesis low level of serotonin is associated with symptoms of anxiety, obsession and compulsive behaviour, whereas low level of norepinephrine is associated with lack of energy, motivation and interest in life, so drugs like SSRIs (Selective Serotonin Re-uptake Inhibitor) like Fluoxetine are effective in depression, obsessive compulsive disorders. Norepinephrine enhancing drugs are required for patients suffering from lack of energy and interest in life. Some drugs also affect dopamine levels like Bupropion which enhance the level or dopamine and norepinephrine and can be used in patients with poor attention, enthusiasm and those who are unable to derive pleasure from life and sense of reward (dopamine). Maximal efficacy of these drugs is visible only after continuous intake for one to two weeks period. This lag phase in efficacy of antidepressant activity is because of neuroadoptation as these drugs modulate various hetero and auto receptors present in serotonergic and adnergic neurons. Antidepressant drugs are evaluated in animal models by inducing the phenomenon of learned helplessness in experimental animals e.g. forced swimming test in mice, separation of baby monkey from mother monkey. Effect of the drugs in these models can be extrapolated in human studies (clinical trials). Psychological Model Depression depends upon the nature and personality traits of the individual. A negative predisposition acts as a precursor to depression. The coping mechanism of the individual and outlook plays an imperative role in managing with low self worth, twisted thoughts that are associated and linked with depression. Observations reveal that depression occurs to a lesser extent and rapidly goes off in religious individuals (Morris, 2009, Dein, 2006). American psychiatrist, Aaron T. Beck, developed a cognitive model of depression; the model is based on the chord of unenthusiastic thoughts comprising of cognitive inaccuracies about self and surroundings, leading to the development of Cognitive Behavioural Therapy (CBT) and thereby paved the way for recognition of psychotherapy and this could be made possible through clinical trial. According to Klerman, cases of major depressive disorder receiving drugs along with the psychotherapy. This therapy gained popularity as interpersonal psychotherapy (IPT). As long as thirty years, IPT along with cognitive therapy were the most extensively tested psychological therapies of treating major depressive disorder (Cognitive Therapy and Interpersonal Psychotherapy: 30 Years Later). A novel form of cognitive therapy and IPT emerged with the efforts of Thase et al, Wisniewski et al, worked on the effectiveness of the cognitive therapy and IPT while Frank et al, worked on dose and Schramm et al worked on new indication (Rush, 2006). Cognitive therapy deal with twisted, unenthusiastic thoughts related with depression while IPT deals with taxing community and interpersonal associations linked to the commencement of major depressive disorder symptoms. Psychologists believe that all psychotherapies are interconnected and lead to some behavioural alterations with an intention to have something good for the individual (Cognitive Therapy and Interpersonal Psychotherapy: 30 Years Later). According to social aspect of depression, it is associated with scarcity of resources and funds leading to depression and non-fulfilment of and aspirations. Abuse in childhood may culminate into social isolation, emotional impairment, leading to the onset of depressive thoughts and major depressive disorder. Neglect from parents or abuse by the care providers distorts mental state leading to disturbance in psychological development. This lasts till adulthood where coping mechanism carries no meaning. Resulting in social rejection and depression and further deterioration of confidence, affecting job, dissatisfaction from job, poor decision-making temperament which further augments depressive disorder (Slavich, 2009). Management of Major Depressive Disorder A combination of psychotherapy and medication has been proved to be the major treatment to combat depression. Mild depression can be treated with physical work or exercise but it does not work for major depressive disorder. On the other hand psychotherapy and psychoanalysis plays an essential role in treating depression. Cognitive behavioural therapy works well for combating depression in children and adult while interpersonal psychotherapy (IPT) works well for adolescent depression (Information About Depression & Related Disorders). Conclusion Major depressive disorder is attributed to numerous factors that require comprehensive and cohort strategy to procure appropriate response. Various attempts were made to combat depressive disorder either by means of medications or by means of behavioural therapy to change the thinking pattern of the individual. Research reveals that a combined treatment encompassing psychotherapy as well as pharmacotherapy could work well but it is noted that they do possess limitations and may not hold true for more severe cases. More severe cases should be dealt with precision and care to inculcate confidence and sense of belongingness. Essentially, individual require deviation from depressive thoughts and some involvement to overcome negative thoughts. References American Family Physician. Available at http://www.aafp.org/afp/990600ap/3029.html. [Accessed on 7th October 2011]. Barlow, D. H. (2005). Abnormal psychology: An integrative approach (5th ed.). Belmont, CA, USA: Thomson Wadsworth. Biological Causes of Depression. Available at http://www.allaboutdepression.com/cau_02.html. [Accessed on 7th October 2011]. Cognitive Therapy and Interpersonal Psychotherapy: 30 Years Later. (2007). Am J Psychiatry. 164(5). Editorial. Dein, S. (2006). Religion, spirituality and depression: implications for research and treatment. Primary Care and Community Psychiatry. 11(2), 67–72. Greenberg, P.E., Kessler, R.C., Birnbaum, H.G., Leong, S.A., Lowe, S.W., Berglund, P.A., Corey-Lisle, P.K. (2003). The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry. 62, 1465–1475. Haeffel, G. J., Getchell, M., Kaposov, R. A., Yrigollen, C. M., DeYoung, C. G., Klinteberg, B., Oreland, L., Ruchkin, V. V., Grigorenko, E. L. (2008). Association Between Polymorphisms in the Dopamine Transporter Gene and Depression. Association of Psychological Science. 19(1). 62- 69. Information About Depression & Related Disorders. Available at http://www.abct.org/sccap/?m=sPublic&fa=pub_Depression. [Accessed on 7th October 2011]. Kendler, K. S., Gatz, M., Gardner, C. O., Pedersen, N. L. (2006). A Swedish national twin study of lifetime major depression. American Journal of Psychiatry. 163(1), 109–14. Major Depressive Disorder. Available at http://www.health.am/psy/major-depressive-disorder/. [Accessed on 7th October 2011]. Morris, B. H., Bylsma, L.M., Rottenberg, J. (2009). Does emotion predict the course of major depressive disorder? A review of prospective studies. Br J Clin Psychol. 48 (3), 255–73. Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Stewart, J. W., Nierenberg, A. A., Thase, M. E., Ritz, L., Biggs, M. M., Warden, D., Luther, J. F., Shores-Wilson, K., Niederehe, G., Fava, M. (2006). STAR*D Study Team: Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 354, 1231–1242 Schramm, E., Calker, D. V., Dykierek, P., Lieb, K., Kech, S., Zobel, I., Leonhart, R., Berger, M. (2007). An Intensive Treatment Program of Interpersonal Psychotherapy Plus Pharmacotherapy for Depressed Inpatients: Acute and Long-Term Results. Am J Psychiatry. 164, 768- 777. Slavich, G. M., Thornton, T., Torres, L.D., Monroe, S. M., Gotlib, I. H. (2009). Targeted rejection predicts hastened onset of major depression. Journal of Social and Clinical Psychology. 28, 223–243. Read More