Major Depressive Disorder
COURSE#: PRN1555 Psychosocial Nursing Section 02
May 17th, 2020
Major depressive disorder (MDD), also referred to as clinical depression, is a mental disorder that is characterized by at least two weeks of low mood that is manifested across most of the situations. Depression is often characterized by low energy, loss of interest in things and activities that were previously enjoyed, pain without a clear cause as well as low self-esteem (Ready et al., 2016). Besides, individuals who might have been affected by depression may occasionally experience false beliefs, or they may hear or see things that others cannot see or hear. Depression varies depending on the individual affected, as there are individuals who may have periods of depression, which are separated by years in which they are normal, while in others, they always experience the symptoms at all times. Major depressive disorder can adversely affect an individual’s personal life, education, work, and even normal daily activities such as eating, sleeping, and general health. According to statistics, about 2 to 8 percent of adults with major depressive disorder succumb by suicide. About 50 percent of the individuals who die by suicide had depression or any other mood disorder. The depressive syndrome can be caused by a variety of current factors that include a combination of genetic, environmental, and psychological factors.
Types of Depression
There are various types of depression that include major, persistent, manic, or bipolar and postpartum depression.
Major depression is also known as major depressive disorder, unipolar or classic depression (Herane-Vives et al., 2020). In the United States, this kind of depression is relatively common, with about 16.2 million adults having experienced at least one major depressive episode. Individuals with the major depressive disorder do experience the symptoms most of the day, daily. Major depression, just like many of the mental health conditions, has very little to do with what is happening around an individual as a person can have tons of friends, a loving family, as well as the dream job and still be diagnosed with major depressive disorder. However, even if there is no obvious reason to point out the reason for this type of depression, it doesn’t mean that depression isn’t real.
Major depression in its severe form manifests with such symptoms as despondency, difficulty sleeping, loss of appetite, unexplained pains and aches, and loss of interest in formerly pleasurable activities. Besides, the major depressive disorder can manifest with a lack of concentration, feelings of worthlessness, constant worry and anxiety and thoughts of death, self-harm, or suicide. The symptoms of major depression can last for weeks and even months, with some of the individuals having a single episode of major depression. In contrast, others experience it throughout their life. Regardless of how long the symptoms last, major depression can result in problems in a person’s activities and even in their daily activities.
A persistent depressive disorder is a type of depression that lasts for more than two years. The persistent disorder is also referred to as chronic depression or dysthymia and is not as intense as a major depressive disorder (Liebherz et al., 2017). However, it can still negatively impact relationships and also make it difficult to perform daily tasks. Persistent depression is manifested by symptoms such as deep sadness or hopelessness, low self-esteem, appetite changes, and the lack of interest in things that were previously enjoyed. Besides, persistent depression may present with changes in sleep patterns, concentration and memory problems, social withdrawal, difficulty in functioning at school, and the inability to feel joy even at happy occasions. Persistent depression is a long-term type of depression, but despite this, the condition manifests its severity after several months after onset. Some individuals have an onset of major depression before experiencing persistent depression, a situation often referred to as a double depression. However, persistent depression may last for years after onset. Therefore, individuals with this kind of depression may begin to feel like their symptoms are part of their normal outlook on life.
Manic Depression or Bipolar Disorder
Bipolar disorder is a mental health condition that consists of periods of hypomania or mania, such feelings of extreme happiness on some occasions and episodes of depression at other times. Manic depression is characterized by episodes of mania that lasts for more than seven days or less if the individual requires hospitalization (Carmassi et a., 2020). A depressive episode may occur before or after the manic episodes. Symptoms of depressive episodes manifest in the form of feelings of sadness or emptiness, lack of energy, trouble in concentration, sleep problems, and fatigue. Other symptoms include decreased activity, suicidal thoughts, as well as a loss of interest in previously enjoyable activities. Manic episodes manifest with such symptoms as irritability, high energy, racing thoughts and speech, reduced sleep, feeling elated, increased self-esteem, grandiose thinking, and unusual, risky and self-destructive behavior. In the severe cases of manic depression, an individual can experience episodes of hallucinations and delusions.
Postpartum depression is a mental condition that occurs after pregnancy, and this is attributed to the shifts in hormonal balance, thus affecting the woman’s mood (Okun, 2016). Depression might onset during pregnancy or after the birth of the child. After giving birth, mood changes, irritability, and anxiety are common symptoms associated with giving birth and often last up to two weeks. However, postpartum depression symptoms tend to be more severe and long-lasting. Postpartum depression manifests with such symptoms as low moods and feelings of sadness, severe mood swings, social withdrawal appetite changes, and trouble bonding with the newborn. Other symptoms of postpartum depression include feeling helpless and hopeless, anxiety and panic attacks, and thoughts of suicide and self-hurting, as well as the loss of interest in things the individual previously used to enjoy. Postpartum depression can range from persistent lethargy and sadness that require medical treatment to postpartum psychosis, which are mood episodes accompanied by hallucinations, confusion, and delusions. If postpartum depression is left untreated, it can last up to a year, affecting individual relationships as well as the ability to carry on with their daily life activities.
Causes of Depression
There are three major causes of depression and which include biochemistry, genetics, and environmental factors.
Depression is a medical condition that is involved with mood, thoughts, and body. As a result, it tends to affect how an individual eats, sleeps as well as how they feel about themselves. One of the major causes of depression is the biochemical causes (de Castro Chaves et al., 2019). Depression can be triggered by traumatic events, blood sugar imbalances, genetic conditions, poor diet, hormonal imbalances, medical illnesses, digestive problems as well as drug and substance abuse. However, a combination of all these results to neurotransmitter imbalances in the body of an individual. According to evidence, brain chemistry plays a significant role in depressive disorders. Neurotransmitters are the chemicals in the brain that are responsible for the carrying signals to the brain and nerves. If the message is not relayed correctly, depression, along with other mental and physical problems do occur. A single neurotransmitter imbalance can result in multiple symptoms of depression. Therefore, it is significant to run neurotransmitter tests to check whether the brain’s biochemistry is functioning to the optimum.
Mental conditions are more common among individuals whose blood relatives also depict issues of mental illness. Clinical depression is one of the most common forms of depression, as according to research by the Stanford School of Medicine, about 10% of the Americans experience clinical depression at some points in their lives. Clinical depression is also more likely to be transferred to siblings and children, and this means that a person whose relative suffers from depression is more likely, almost five times to get depression as well. The reason behind this is that there is a gene behind family susceptibility to depression. According to research, a gene postulated to be prevalent in multiple family members with depression have been isolated. The chromosome 3p25-26 was found in more than 800 families with recurrent episodes of depression. According to scientists, more than 40% of depressed individuals can trace their cause back to genetic links (Van Hecke et al., 2017). However, only 60% of the depression cases result from environmental and other factors.
Depression is not only triggered by genetic and biochemistry factors, but it can also result from environmental predisposition. Depression, therefore, can be triggered by stressful life events (Kendler & Gardner, 2016). The death of a loved one is the common environmental causation of depression as it leads to trauma. Other factors such as divorce, job loss, or financial difficulties can be considered as stressful life events that may increase an individual’s susceptibility to depression. Another environmental factor that can lead to depression is social isolation. Most of the individuals who tend to isolate themselves from the general population have poor coping mechanisms as they have no one to share their problems with, and this increases the chances of depression becoming severe. Demanding work or a stressful workplace can, on the other hand, be attributed to trigger the onset of depression as an individual may get frustrated as they try to fulfill the demands of the job. The inability to satisfy the job requirements may be stressful as it puts the employee at risk of being fired. Finally, health issues, especially when an individual is suffering from chronic health problems, can be stressful may impact on the family as well as the patient increasing their chances of getting depression.
Diagnosis of Depression
Every condition requires to be diagnosed so that the right treatment can be administered. Depression can be diagnosed in for main ways. One way to diagnose depression is through physical exams. The doctor conducts a physical exam and asks questions regarding the individual’s health. In some cases, depression may be linked to an underlying physical health problem, and this provides a basis for physical diagnosis. Another way to diagnose depression is through lab tests. A doctor or health professional may conduct a blood test referred to as a complete blood count. Besides, the health professional may perform thyroid tests to make sure that it is functioning properly. Psychiatric evaluation is another way to diagnose depression. A mental health professional may ask questions regarding the symptoms, feelings, thoughts, and behavioral patterns, and this may either be done through an oral interview or through answering a questionnaire. Assessing behavioral patterns helps in identifying whether an individual is suffering from depression.
Demographics of Depression
The onset of depression can occur at any age and can affect people of all races. Besides, individuals from all socioeconomic statuses as well are susceptible to depression. According to statistics, the median age of the onset of depression is 32.5 years old. However, the prevalence of adults with a major depressive episode tends to be high among individuals aged between 18 years and 25 years. About 11.3% of the adults of mixed races report having experienced a major depressive episode in the past year. Besides, 8.7% of women in the United States suffer from depression, while about 5.3% of men are diagnosed with depression. A survey conducted by the CDC found that the prevalence of depression decreases with an increase in family income levels. The reason behind it is that it can be inferred that high-income results in less money-related stress as well as improved access to mental health services. Statistics also have it that the prevalence rates among men and women have been fairly consistent over the past decades. Demographic data depicts that women experience depression at a higher rate, roughly twice the rate as men.
Effects of Depression on the Brain
Three parts of the brain play a vital role in the development of major depressive disorder, and that is the amygdala, hippocampus, and the prefrontal context. During the incidence of mental and physical stress, such as depression, the body releases cortisol to try and contain the situation. However, excessive production of cortisol results in a chemical imbalance in the brain. Long term exposure to high levels of cortisol slows down the production of new neurons and, as a result, causes the neurons in the hippocampus to shrink, leading to memory problems (Olson, 2018). The prefrontal context is involved with the regulation of emotions, forming memories as well as making decisions. High amounts of cortisol in the brain results in shrinking of the prefrontal context. The amygdala facilitates emotional responses such as fear and pleasure. Exposure to a more elevated amount of cortisol makes it enlarged, leading to disturbances in sleep and activity patterns.
Treatment of Depression
Depression, if left untreated, can be fatal, and therefore, there is a need for diagnosis and treatment. There are various treatment options for depression. Psychotherapy is one of the treatment methods and involves talk therapy. Three main types of therapies can be used in the treatment of depression, and they include cognitive behavioral therapy, psychodynamic therapy, and interpersonal therapy (Lorenzo-Luaces et al., 2017). All three are combined in a blended approach to ensure an effective treatment of depression. Another treatment option for depression includes medication. Depression medication helps in restoring the chemical balance in the brain and also helps in relieving some of the symptoms of moderate and severe depression. Most commonly administered medications include antidepressants to reduce depression. Finally, brain stimulation therapies, such as transcranial magnetic stimulation (TMS), is also an effective depression treatment method. TMS involves directing recurring magnetic energy pulses to the regions of the brain that are involved in mood regulation.
Depression is one of the common issues that have been prevalent not only in the United States but also to the rest of the world. There are various types of depression, with the major depressive disorder being the most prevalent. A large number of people, especially adults, have at one time in their lives suffered from depression, which has affected their relationships and daily activities. Depression can be triggered by various factors such as environmental factors, genetic as well as the biochemistry of a person. If left untreated, depression can be fatal, and therefore, diagnosis and treatment through therapy and medication are necessary.
Carmassi, C., Shear, K. M., Corsi, M., Bertelloni, C. A., Dell’Oste, V., & Dell’Osso, L. (2020). Mania Following Bereavement: State of the Art and Clinical Evidence. Frontiers in Psychiatry, 11.
de Castro Chaves, R., Mallmann, A. S. V., Oliveira, N. F., Oliveira, I. C. M., Capibaribe, V. C. C., da Silva, D. M. A., … & Vasconcelos, S. M. M. (2019). Reversal effect of Riparin IV in depression and anxiety caused by corticosterone chronic administration in mice. Pharmacology Biochemistry and Behavior, 180, 44-51.
Herane-Vives, A., Arnone, D., de Angel, V., Papadopoulos, A., Wise, T., Alameda, L., … & Cleare, A. J. (2020). Cortisol levels in unmedicated patients with unipolar and bipolar major depression using hair and saliva specimens. International Journal of Bipolar Disorders, 8(1), 1-9.
Kendler, K. S., & Gardner, C. O. (2016). Depressive vulnerability, stressful life events and episode onset of major depression: a longitudinal model. Psychological medicine, 46(9), 1865-1874.
Liebherz, S., Machmutow, K., Jansen, A., Meister, R., Watzke, B., Härter, M. C., & Kriston, L. (2017). Continuation and maintenance treatments for persistent depressive disorder. Cochrane Database of Systematic Reviews, (11).
Lorenzo-Luaces, L., Driessen, E., DeRubeis, R. J., Van, H. L., Keefe, J. R., Hendriksen, M., & Dekker, J. (2017). Moderation of the alliance-outcome association by prior depressive episodes: Differential effects in cognitive-behavioral therapy and short-term psychodynamic supportive psychotherapy. Behavior Therapy, 48(5), 581-595.
Okun, M. L. (2016). Disturbed sleep and postpartum depression. Current psychiatry reports, 18(7), 66.
Olson, E. (2018). Effects on the Hippocampal Volume and Function: Stress and Depression Versus Physical Exercise.
Ready, R. E., Mather, M. A., Santorelli, G. D., & Santospago, B. P. (2016). Apathy, alexithymia, and depressive symptoms: Points of convergence and divergence. Psychiatry research, 244, 306-311.
Van Hecke, O., Hocking, L. J., Torrance, N., Campbell, A., Padmanabhan, S., Porteous, D. J., … & Smith, B. H. (2017). Chronic pain, depression and cardiovascular disease linked through a shared genetic predisposition: Analysis of a family-based cohort and twin study. PloS one, 12(2).