Major Depressive Disorder
Major Depressive Disorder
Major Depressive Disorder / Severe Depression is a serious illness affecting 9.9 million adults in the United States, the equivalent to about 5% of the population annually. Severe depression causes more cases of disability in the United States than any other disease. Compared with the number of annual cases of depressive disorders that occur in men (3.2 million), more than double (6.7 million) occur in women.
Unlike normal and transient feelings of sadness, loss and grief, severe depression continues and causes serious problems in thinking, behavior, mood, activities and health in person.
Often, severe depression begins between 15 and 30 years of age, but it may also occur in children and the elderly. All persons, regardless of age, ethnic or economic group, may suffer from depression. More than half of people who suffer from an episode of depression will continue to have episodes to once or twice a year if they are not treated. Without treatment, a person with depression can get to suicide.
Severe depression, also known as clinical depression or unipolar depression, is only a type of depressive disorder. Other depressive disorders include dysthymia (a chronic but less severe than clinical depression mode) and bipolar disorder (or maniacodepresion). People who suffer from bipolar disorder, usually suffer from alternating episodes of depression and mania. During periods of mania, people are in a mood of "exaltation" abnormal or feel unusually irritable. These people may have a perception of themselves or their extremely good but unrealistic skills; also there may be a marked increase of energy, sneaky thoughts and talking very fast.
Major Depressive Disorder Symptoms
The beginning of the first episode of severe depression may not be obvious if it is gradual or mild, but the person usually begins to behave and think in a way very different from the usual. Often symptoms include:
- very sad or irritable mood that does not improve
- considerable changes in the pattern of sleep, appetite and energy
- difficulty thinking, concentrating and remembering
- slow physical movements or unusual turmoil
- lack of interest or pleasure in activities that usually enjoyed
- guilt, not worth anything, hopelessness and a huge gap
- ideas again and again about suicide or death
- constant physical ailments that don't respond to treatment, for example, headache, digestive discomfort and chronic pain
- When several symptoms of depression that last more than two weeks and cause problems to carry out daily activities, the person needs professional treatment.
What causes severe depression?
There is not a single cause of severe depression. Most likely, that psychological and biological and environmental factors have to do with the cause of this disorder. Scientists have discovered that severe depression is a biological disorder of the brain, and studies that have been conducted show that depressed people may have a problem with chemical substances in the brain.
Norepinephrine, serotonin and dopamine are three chemicals that are found in the brain (called neurotransmitters) allowing that neurons or brain cells to communicate with each other. Scientists believe that these substances could have something to do with severe depression. If there is a very small amount of these substances necessary for the brain, there could be clinical depression. Antidepressant medications are useful because they produce larger amounts of the chemical substance needed either, make those substances to function more effectively.
The scientists also found that genes may predispose to one person rather than another to suffered severe depression. When you have family members who suffer from this disease, it runs one higher risk of also suffer from depression. Not all people who have or have had family members with depression will suffer, but some people have a biological predisposition which makes them more vulnerable to depression.
Sometimes, the circumstances of the life of a person, for example, the death of a loved one, a loss or a strong change, chronic stress or abuse drugs or alcohol might trigger depression, and it is also known that up to some diseases or medications can cause it. However, depression can occur without having any of these factors in the person's life, and even if there is no crisis or physical illness.
What is the treatment for severe depression?
Although severe depression can be a devastating disease, it usually responds very well to treatment. Between 80 and 90 percent of people with severe depression can greatly improve, resume your normal daily activities and feel good if they follow a good treatment. There are many treatments available, but the most suitable depends on the person and the severity of the disease.
There are three basic treatments for depression: drugs, psychotherapy and therapy electroconvulsive (ECT, acronym in English). At times, each of these used separately and combined at times according to what is best for each person.
Drugs. Problems with the chemicals in the brain called neurotransmitters (such as serotonin, dopamine and norepinephrine) can be corrected taking antidepressants. Most of the time the four groups following antidepressants are prescribed to combat depression:
Tricyclic antidepressants (TCAs) are widely used in cases of severe depression. The TCAs improve mood and behavior, but usually need three to four weeks so that they begin to take effect and the person begins to respond. These drugs include amitriptyline (Amititril, Elavil), desipramine (Norpramine, Pertofrane), Doxepin (Sinequan), imipramine (Antipress, Imavate, Tofranil), nortriptyline (Aventyl, Pamelor) and protriptyline (Vivactyl). & Inhibitors of monoamine oxidase inhibitor (MAOI) are frequently effective in people who do not respond to other medicines for depression or who have depression with a high degree of anxiety, which spend much time sleeping, and have characteristics of irritability, hypochondriasis (imagine having a physical illness) or phobia (extreme fear that is not realistic). These medications include phenelzine (Nardil) and tranylcypromine (Parnate) sulfate.
Selective inhibitors of the reuptake of serotonin (SSRIs) affect the neurotransmitter called serotonin. In general, the SSRIs cause fewer side effects than the TCAs and MAOIS. These medications include fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil).
Inhibitors of the reuptake of serotonin and norepinephrine (SNRIs) represent a useful treatment as first choice or if other medications have not had a good effect. In general, the SNRIs cause fewer side effects than the TCAs and MAOIS. The best-known SNRIS are venlafaxine (Effexor).
Bupropion (Wellbutrin) is a more recent antidepressant that affects the neurotransmitters dopamine and norepinephrine. In general, bupropion produces fewer side effects than the TCAs and MAOIS.
People who suffer from severe depression and their families must be very careful when treatment is started because recovering the energy levels and the ability to act before mood improves. This is the moment in which a depressed person is easier to make decisions - but remains depressed - and the risk of suicide is very high.
Psychotherapy. There are several types of psychotherapy are very useful in cases of depression, for example cognitive therapy / behavioral (CBT) and interpersonal therapy (IPT). Mild to moderate cases of depression can be treated successfully with any of these therapies individually, but in cases of severe depression, the person is more likely to respond better to a combination of psychotherapy and medication.
Cognitive therapy / behavioral (CBT) helps to change negative thoughts and behavior seen with depression. It teaches people to change the behaviors that contribute to their illness.
Interpersonal therapy (IPT) focuses on improving personal relationships that can make depression worse.
Therapy electroconvulsive (ECT) is a highly effective treatment for episodes of severe depression, especially when the medication, psychotherapy or combination of both does not work well or runs very slowly to relieve symptoms such as psychosis or ideas suicide.
What are the side effects of the medications for depression?
All medicines have side effects and different medicines have different side effects. In addition, each person side effects manifested in a different way.
In approximately 50 percent of people who take antidepressants side effects occur during the first weeks of treatment, but these are usually minor or passengers. Side effects that have problems in particular can be controlled by changing the dose of the medication, changing to another medication or giving treatment side effects with other medicines.
Tricyclic antidepressants (TCAs) side effects include dry mouth, constipation, problems of the bladder, sexual problems, blurred vision, dizziness, drowsiness, skin rashes and loss or weight gain.
Monoamine oxidase (Mao) inhibitors may have dangerous interactions with certain smoked, fermented or pickled foods and some drinks or specific drugs because they increase blood pressure when combined with MAOIS. Other less serious side effects may include weight gain, constipation, dryness of the mouth, dizziness, headache, drowsiness, insomnia and sexual side effects (excitement or sexual satisfaction problems).
The SSRIs and SNRIs tend to produce fewer side effects, but can cause nausea, nervousness, insomnia, diarrhea, rash, agitation or sexual side effects (excitement or sexual satisfaction problems).
Bupropion usually causes fewer side effects than the TCAs and MAOIS. Side effects that may occur with this drug include agitation, insomnia, headache or worsening of migraine headache, tremors, dry mouth, confusion, fast heart rate, dizziness, nausea, constipation, menstrual discomfort and skin rash. Bupropion (Wellbutrin) is temporarily withdrawn from the market little once it was introduced for the first time because some patients suffered seizures while taking it, but subsequent studies showed that seizures were mainly associated with high doses (doses greater than the highest dose currently recommended 450 mg/day). Other factors that increase the risk of having seizures are a history of seizures or trauma to the brain, eating, excessive alcohol use disorders or taking other drugs. With new warnings and lower doses recommended, has been greatly reduced the chance of having seizures when this medicine is taken.
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