Depression (Major Depressive Disorder) Symptoms Diagnosis and Treatments.

Depression (Major Depressive Disorder) Symptoms Diagnosis and Treatments

Definition:

Depression is a unipolar mood disorder described through persistent loss of interest and low mood  linked  with somatic symptoms like  difficulty in sleeping, decreased energy and weight loss. Depression is also called major depressive disorder (MDD). Depression change an individual’s actions and thoughts to  the extent that he will be unable to perform daily tasks.

Diagnostic Criteria according to DSM-5 :

A. During the conssective 2-weeks five (and more) of the subsequent symptoms must be present:

 change in prior functioning in at least one of the symptoms must be present:

(1) loss of pleasure or interest  and may be (2) depressed mood.

Note: Symptoms evidently attributable to some other medical condition must be excluded.

1. During the day,  and about  every day the depressed mood must be present as reported either by the subjec-

tive report (e.g., hopeless , empty, feels sad,) or by observed others (for example, appears tearful or sad). (Note: In adolescents and children, may be irritable mood.)

2. During the day, and about  every day, Clearly reduce pleasure or interest in all, or nearly all, activities (as point out by either observation or subjective account).

3. Considerable weight gain, loss of weight while not on a dieting (e.g., in a month an alteration of  5% of body weight), or increase or decrease in appetite almost every day.

(Note: consider failure to maintain projected weight gain In children,.)

4. Hypersomnia or Insomnia  about each day.

5. Psychomotor retardation or agitation approximately each day (noticeable by others, not simply subjective feelings of being slowed down or restlessness).

6. About each day loss of energy or fatigue.

7. Feelings of inappropriate guilt or excessive, worthlessness  ( that can  be delusional) approximately each day.

8. Reduce capacity to indecisiveness, concentrate or think, approximately each day (also by observed by others or subjective account).

9. Persistent thoughts of death , without a specific plan persistent suicidal ideation, a definite plan for committing suicide or a suicide attempt.

B. These symptoms cause clinically considerable impairment or distress in occupational, social or other significant areas of functioning.

C. The episode may not caused by the physiological consequence of a substance or to some other medical condition.

Epidemiology of Depression

In the year 2015 it was reported that, in the United States about 16.1 million of adults experienced at least one episode of depression during a year. This represented a 6.7 % prevalence. Moreover the depression considered to be two times more common in the women than the men because of psychosocial and hormonal differences.

Between the ages of 20–40 year the incidence of depression increases and after 65 years of age it gradually decreases. A study on the nature of presenting illness showed that depression represented 12 % of all new illnesses and 45 % of all mental illnesses.

The prevalence rate of depression among the older than 65 years of age is 15 % the numbers worsen with the age. The disease also accounts for 50 % of mental illnesses among the elderly. Somatic presentation  and suicidal ideation  are more widespread in this age group compared to others.

Treatment of Depression

Psychotherapy

Psychotherapy is the treatment of option for mild level of depression and is generally practiced in the outpatient setting. The types of psychotherapy consist of cognitive-behavioral therapy, brief interpersonal therapy and supportive therapy.

Pharmacotherapy

It is indicated for moderate to severe disease that requires hospital admission in the acute phase of treatment.

Tricyclic antidepressants(TCAs) such as Amitriptyline and Clomipramine

They are the original line of agents for the managing the major depressive disorder because of their response rate however they are linked with dangerous adverse effects such as anticholinergic  and sedation effect.

Selective serotonin reuptake inhibitors (SSRIs) like  Citalopram (Celexa) and sertraline (Zoloft)

They are used as first-line agents in the treatment of a major depressive disorder or in patients who are refractory to TCAs. General side effects comprise of gastrointestinal insomnia , upset, sexual dysfunction.

Monoamine oxidase Inhibitors (MAOIs) such as Phenelzine

They are second-line agents. A disadvantage of this class of drugs is their connection with dietary associated hypertension and orthostatic hypotension.

Atypical antidepressants

Bupropion can be prescribed because of its lesser rate of sexual dysfunction occurrence. However, it requires multiple dosing. Venlafaxine is related to the elevation of blood pressure because of noradrenaline inhibition.

Mood stabilizers and antipsychotics

Antidepressants are prescribed in combination with drugs such as Lithium in patients who also have anxiety. For the reduction of the recurrence rates they are too important.

Combination therapy

A combination of pharmacotherapy and psychotherapy show  more effective results in the treatment of a major depressive disorder.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy is an effective and safe method of treatment. The modality is reported to have a 90 % response rate. It is the treatment of choice in:

• Severe depression

• Patients with psychosis

• People with the contraindications to antidepressants, like people of advanced age

• The disease which is obstinate to other processes of treatment

1.     A short acting anesthetic agent

1.     A short-acting muscle relaxant

1.     Atropine

Airway secured Cardiac monitoring is initiated and the subsequent drugs are administered:

Mouth block of a rubber is placed and an electrical stimulus is introduced in the occipital and temporal part of the head.