Major Depression and Antidepressant Treatment - Literature review Example

MAJOR DEPRESSION Major Depression Major depression is known to be one of the commonest mental illnesses prevalent in our society. In USA it is known as the fourth common cause leading to disability in the affected individual. Major Depression is not limited to any particular age group rather an individual can present with this psychological condition at any point of their life. Relapses or recurrences of this illness are also most likely. According to WHO, Major Depression is not only associated with increased risks for morbidity and mortality rates, it is also major cause of suicide cases in adults. Clinical psychologists find themselves treating major depression as a very common illness hence it is important for them to have a thorough understanding of this mental illness in order to reach a correct diagnosis (Thomas 2010). The clinical picture of the condition, diagnostic challenges, diagnostic tools, effective treatments and recent developments regarding major depression will be elaborated in the paper. According to DSM-IV-TR criterion, the disorders of mood are broadly classified into “Depressive Disorders, Bipolar Disorders, and Mood Disorder due to general medical condition and Substance-Induced Mood disorder”. The depressive disorders are further classified into “Major Depressive Disorder, Dysthymic Disorder and Depressive Disorder not otherwise specified”. The depressive disorders are differentiated from the bipolar disorders on the basis of important history findings. Absence of any Manic, Mixed or Hypo manic episode classifies the mood disorder as a depressive disorder (American Psychiatric Association 2000). A single event of depression without any occurrence of mania i.e. euphoric period, behavioral excess or events of the display of excessive energy are termed as MDD. The major depressive episode is characterized by depressed mood or anhedonia (no interest in daily activities) for almost the whole day and these symptoms extend for at least two weeks. It is important to mention here that the severity of the symptoms should be enough to cause hindrance in the affected individual’s usual social and occupational activities. The severity of the symptoms is described on the basis of the extent to which they cause disability. Mild degree is characterized by ability of the person to carry out his/her daily responsibilities. Moderate degree is described by inability of the person to take interest or perform his/her obligations and the sever form of MDD is when the individual starts thinking of death or exhibits psychotic behavior or completely isolates himself/herself. An individual is diagnosed with chronic MDD when the symptoms prevail for more than 2 years (Thomas 2010). It is important to thoroughly assess the individual’s history, drug history, family and medical history to make a correct diagnosis regarding MDD. First step is to rule out any medical illness that might be leading to the depressive symptoms. Substances like drug abuse or adverse effects of medications should also be excluded because they might also lead to the depressive clinical picture. These drugs of medications lead to intoxication which is the causative factor for depressive episodes. If both the above factors are absent, then the Substance-Induced Mood disorder and the Mood disorder due to general pathological conditions are excluded providing for the diagnosis of primary Mood disorder. According to the DSM-IV-TR the minimum duration for MDD is 2 weeks of depressive mood along with any four of the additional symptoms which include appetite change, sleep disturbance, altered motor activity, and suicidal tendencies. It should be differentiated from Dysthymic Depression which is characterized by chronic depression and a lower threshold of symptoms as compared to MDD. A history of major depressive episodes accompanied by manic episodes is classified as Bipolar disorder. It is also important for the clinician to distinguish MDD from the usual “mood swings” and “blues” that are common in the daily routine (First et al 2002). The diagnostic tools which are widely used for assessing MDD are “Structural Clinical Interview for DSM-IV (SCID), Mini-International Neuropsychiatric Interview (MINI) and the Composite International Diagnostic Interview”. The questions or prompts put forward by the clinician in these tools are helpful in guiding towards a correct diagnosis. The interview is commenced by asking a few relevant questions and they if the answers are positive for these questions then questions regarding the disorder are asked. The significant screening tools to assess the potential risk for MDD include “Beck Depression Inventory (BDI), Geriatric Depression Scale (GDS) and Patient Health Questionnaire (PHQ-9)”. These tools especially the PHQ-9 include questions regarding the symptoms, suicidal tendencies and the affect of the clinical features on the individual’s daily life. Each tool has its own diagnostic benefits for instance the PHQ-9 is famous for its convenience and is completed within 2 minutes. The GDS is especially significant in the older population and the disabled individuals (Thomas 2010). The evidence-based treatment approach for MDD is described as the treatment strategies that have shown positive outcomes exhibited by randomized contr0olled trials. The effective therapeutic strategies include “Cognitive-Behavioral Therapy (CBT), behavioral activation (BA), interpersonal psychotherapy (IPT) and problem solving treatment (PST)”. The CBT consists of mind exercises like object focusing techniques, though journaling, practices of thinking clearly and learning how to react in various situations. The BA focuses on changing the individual’s behavior by enhancing their behavior responses which leads to positive consequences rather than negative outcomes. The individual is encouraged to make a list of items or activities that they would like to follow the most and those that are least likely to be followed. Then the individual is encouraged to focus and engage on the positive and liked situations (Thomas 2010). Recent advancements in the psychiatric research and studies have brought into light many useful concepts and outcomes which will prove to be helpful in improving the therapeutics and understanding of MDD. According to a research, the use of “selective serotonin reuptake inhibitors” (SSRI) during the months of gestation are associated with health problems and pathologies of the baby. The study focused on four outcomes after taking SSRIs during the period of gestation. These included the physical pathologies of the infant and the assessment of the increase in the weight of the mother and alterations in the weight of the infant. Birth of the child before the completion of the gestational age was also associated with SSRI intake. This research is important because childbearing years are the high risk years for MDD in the women. The outcomes exhibited that SSRIs intake and untreated MDD leads to 20% increased chances of preterm babies (Wisner et al 2009). It has been observed that the hypothalamic-pituitary-adrenal axis becomes hyperactive in the patients with MDD. The Dexamethasone/corticotrophin-releasing factor (CRF) has established itself as the most sensitive test for measuring the hypothalamic-pituitary-adrenal (HPA) hyperactivity. The particular group of people with childhood traumatic events and MDD has been left unobserved and the studies proved that this group of study showed the hyperactivity of HPA. Normal subjects with no history of traumatic childhood, men with childhood trauma history and men with current MDD along with positive history were examined in the report. The CRF test exhibited enhanced HPA activity in those men with childhood traumatic history with MDD. This research is significant in understanding the events leading to MDD as well as proper diagnostic guidance for the clinicians (Heim et al 2007). Major Depressive Disorder is a very common mental illness and requires a very thorough understanding of its various aspects to formulate a correct and effective treatment. The clinical picture of the MDD described by the DSM-IV-TR helps in reaching a diagnosis and distinguishing it from other mood disorders. The diagnostic tools consist of questions and prompts that help in assessing the symptoms, past life events and the daily functioning levels of the individual. Recent advancements have proved helpful in understanding the risk factors associated with the intake of SSRIs during pregnancy and the relation of HPA hyperactivity with MDD and past childhood traumatic events. References American Psychiatric Association. (2000). DSM-IV-TR® Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Retrieved from: http://dsm.psychiatryonline.org/content.aspx?bookid=22§ionid=1890370  First, M. B., Frances, A., & Pincus, H. A. (2002). DSM-IV-TR handbook of differential diagnosis. Washington, DC: American Psychiatric Press. Heim, Christine, Mletzko, Tanja, Purselle, David, Musselman, Dominique L. & Nemeroff, Charles B. (2007). “ The Dexamethasone/ Corticotropin- Releasing Factor Test in Men with Major Depression: Role of Childhood Trauma”. Biological Psychiatry Journal. Retrieved from: http://www.biologicalpsychiatryjournal.com/article/S0006-3223(07)00640-3/abstract Katherine L. Wisner, Dorothy K.Y. Sit, Barbara H. Hanusa, Eydie L. Moses-Kolko, Debra L. Bogen, Diane F. Hunker, James M. Perel, Sonya Jones-Ivy, Lisa M. Bodnar and Lynn T. Singer. (2009). “Major Depression and Antidepressant Treatment: Impact on Pregnancy and Neonatal Outcomes”. Focus, American Psychiatric Association. Retrieved from: http://focus.highwire.org/cgi/content/full/7/3/374 Thomas, Jay C. (2010). Handbook of clinical psychology competencies. New York: Springer. Read More