According to the Diagnostic and Statistical Manual of Mental Disorders
According to the Diagnostic and Statistical Manual of Mental Disorders, Major Depressive Disorder, or MDD, is a mental disorder categorized by symptoms of low energy, abnormal sleeping patterns, increase, or decrease in appetite, irritability, thoughts of worthlessness or suicide, pessimism, and the loss of interest in pastimes once found pleasurable. The effects of the disorder have also been shown to negatively impact physical health such as sudden weight gain or weight loss, aches and pain, digestive problems, and headaches. In order for MDD to be diagnosed in a person, they must experience symptoms for the duration of at least two weeks or more. Though the debilitating impacts of the disorder on someone’s life can last for that short amount of time, symptoms can be recurrent for an entire lifetime if left untreated.
Though there have been tremendous strides in recent decades in understanding certain elements of what can potentially trigger Major Depressive Disorder, the exact cause of the disorder remains relatively elusive. Medical experts have, however, discovered that a variety of factors can play a role in the development of MDD. Genetics, for instance, have recently been linked as a large contributor. In a genome-wide association analysis study conducted by Nature Genetics (2018), it was reported that in over the 300,000 subjects tested, 44 genetic risk variants were detected and associated with MDD. Though this discovery does not definitively prove that the cause of the disorder is strictly genetic, it does offer some of the clearest insight to date in how many people carry a potential predisposition to depression. Among the array of other possible causes, environmental stressors can also impact the development of MDD, especially if a person is already susceptible. Drastic life events such as divorce, death, abuse, poverty, and certain personality traits such as low self-esteem or pessimism, can exacerbate someone’s probability of being affected by the disorder. Another possible cause for MDD can be found in a person’s brain structure. According to a research study done by Romanian psychiatrists, individuals suffering from depression often show signs of hyperactivity in regions of the brain that relate to pain, aggression, eating behaviors, and a decrease in other parts that regulate risk assessment and maladaptive states. MRI scans also found that people with depression, when compared to those without the illness, harbor a loss of hippocampal neurons which directly corresponds with impaired memory and mood (2018). The causes of MDD are rarely simple and usually vary from person to person which has led many health professionals to analyze different aspects of the disorder in individuals instead of singular factors.
Prevalence. Major Depressive Disorder is among the most common ailment in humans around the world, approximately effecting 300 million people globally. In a recent data report from Blue Cross Blue Shield, there was an indication of a surge in the number of commercially insured Americans suffering from depression with diagnosis notably rising 33 percent since 2013. MDD currently effects 9 million people in the United States alone and the increase seen in younger generations imply a growing prevalence of the disorder in millennials and adolescents. In a recent survey conducted for JAMA Psychiatry, it was observed that among 36,309 American adult participants, 12-month prevalence for the disorder reached 10.4% and lifetime prevalence was 20.6%. There was changes in the prevalence of Major Depressive Disorder among different ethnic groups. Men of African-American, East/Pacific Island, or Hispanic decent were far less likely to have several bouts of depression during their lifetime. And individuals with a low income of $19,000, had a higher chance of developing a 12-month prevalence for MDD. The disorder is said to be most common amongst women, nearly 3 percent higher than men, though some medical professionals argue that gender plays no variable in its susceptibility and its most likely that men are simply far less prone to seek treatment openly. The same could be said for people with low income or individuals that are born and raised in specific cultures that don’t normally address the issues of mental health.
Anti-depressant Medication. Several different types of medication can be used to minimize the symptoms of MDD. Among the most commonly prescribed are Serotonin and Norepinephrine Reuptake Inhibitors (SNRI’s), an FDA approved class of medicine that eases depression by effecting communication in brain nerve cells. SNRI’s block reabsorption of serotonin and norepinephrine neurotransmitters to alter brain chemistry and effectively regulate mood and alleviate the symptoms of major depression. Selective Serotonin Reuptake Inhibitor (SSRI’s) is another commonly used antidepressant, though unlike SNRI’s, the medication focuses solely on serotonin neurotransmitters. While the effectiveness of prescription medication has proven successful in most cases, the side effects and withdrawals often carry added risks to people suffering from MDD. For example, in children, teens, and young adults, taking antidepressants could potentially increase suicidal thoughts and behavior. Certain SNRI’s and SSRI’s, such as venlafaxine or citalopram, can raise blood pressure, worsen liver problems, and cause abnormal heart rhythms in patients. Missing doses or ending use abruptly can also cause withdrawal-like symptoms like nausea, dizziness, lethargy, and flu-like symptoms. While the most commonly used treatment for major depression is prescription medication, anti-depressants should be given to patients in a more controlled manner that assesses their propensity for addiction and acknowledges their current state of physical health to not put them at risk of other illnesses.
Interpersonal Psychotherapy. The treatment of MDD with interpersonal psychotherapy (IPT) can also be an effective method for relieving depressive symptoms. This type of therapy focuses on an individual’s personal relationships and usually, a therapist can utilize several techniques such as role-playing to help patients learn how to handle interpersonal challenges. Though depression is not always caused by the stress of negative relationships, the issues that arise from them usually fuel the development of MDD in its early stages. IPT aids individuals with these problems and uses a non-judgmental approach to address role disputes, interpersonal shortcomings, grief, life stage transitions, relational conflicts, and attachment issues. Within the span of twenty weeks or less, a person may begin to experience relief from their depressive symptoms and continue working with a mental health professional to discuss other serious underlying issues. The benefits of IPT for people suffering from depression have been scientifically supported but there is a downside. For one, the model for this mode of treatment relies on the self-awareness of a patient to recognize their own role in problems associated with interpersonal relationships. This is not always possible for individuals with MDD as the mental condition can impair cognitive function.
Electroconvulsive Therapy. In earlier treatments of Electroconvulsive Therapy (ECT), electricity was used on the brain without anesthesia, causing bone fractures and serious memory loss. This antiquated technique eventually created a stigma amongst the general population but recent advances in technology and a clearer understanding of the dangerous impacts of major depression, has led to ECT becoming a more viable option for patients that a more treatment resistant or pregnant women that are unable to take medication. Nowadays, the therapy provides smaller currents of electricity through the brain while a patient is put under general anesthesia and given a muscle relaxer. These short waves of electricity work to incite a quick seizure that lasts sixty seconds or less. Treatment is also given to patients usually two to three times weekly for a month though some doctors have used a newer form of ECT called Right Unilateral Ultra-Brief Pulse which can be administered more frequently during the weekdays. The exact reason for why electroconvulsive therapy is effective is still surprisingly unknown though what has been inferred by medical professionals is that the triggered seizures change the chemistry of the brain and potentially reduce or increase the production of certain neurotransmitters to significantly minimize the symptoms of major depressive disorder. However, there are risky side-effects involved with this procedure such as memory loss, headaches, confusion, jaw and muscle aches, and the risk of heart complications. Some doctors have also been skeptical of the validity of using the treatment on patients with MDD as the methods and specific changes to cognition have yet to be determined.
Cognitive Behavioral Therapy. A highly potent treatment known as CBT has also been shown to significantly reduce the symptoms of MDD. This short-term, goal-oriented form of therapy can be approached in a number of ways but all usually allow for patients to become actively involved in their own recovery. CBT is based on the notion that thoughts ultimately dictate behavior and emotion, not external factors like people or situations. The average amount of sessions for an individual is sixteen. Due to the fast-paced nature of this method, the results seen in people with depression are more quickly established as opposed to Interpersonal Psychotherapy, which can take years of treatment for improvement in behavior to be noticeably detected. CBT enables a person to develop mental habits that intervene with unrealistic or distorted thoughts, builds sense of control, self-confidence, and teaches patients coping skills that are helpful in their daily life. Therapists will also generally assign a patient with homework to track depression-related behavior or emotional patterns and work with an individual to form healthier thought processes. The treatment can be a safer alternative from medication for those seeking to treat their disorder in a way that drastically improves their mental state and thought patterns in a quicker manner. And recent studies have also indicated that, when compared to usual treatments using anti-depressants, CBT significantly reduced the likelihood of recurrence or relapse (2017). Overall, CBT has become a widely favored form of therapy among those suffering from depression as it allows for patients to realize that their path towards improved mental health is not open-ended like other various psychotherapy treatments.
Conclusion. The prevalence of Major Depressive Disorder in the US is staggering and though the causes vary widely for each person; more research needs to be conducted to fully gain an understanding of how treatment, especially anti-depressants, should be administered. Medication often carries the risk of creating dependency or other various health diseases therefore other methods of treatment need to be more readily available to individuals with MDD. This includes psychotherapies and other health recourses that can positively affect those with either financial or psychological limitations.