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Severe Depressive Episode

Major Depression Single Episode

Major depressive disorder is characterized by the occurence of one or more major depressive episodes and is one of the most common mental disorders.


Presentation

Depression can occur only once in life but people can show multiple episodes of depression over the cause of their lives [7]. During these episodes, the following symptoms can be seen either daily or intermittently:

Weight Loss
  • […] of sadness, unhappiness or emptiness Angry outbursts or frustration over small matters Loss of interest in normal activities like sex Sleep disturbances such as insomnia or excessive sleeping Tiredness and lack of energy Changes in appetite (usually weight[symptoma.com]
  • Symptoms of a Major Depressive Episode: persistently depressed or irritable mood diminished interest or pleasure in activities significant decrease or increase in appetite, or weight loss or weight gain increased or decreased sleep decreased mental and[bpddemystified.com]
  • loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.[behavenet.com]
  • Those with melancholic depression often exhibit the most typical signs of depression including weight loss and decreased interest in activities they once loved.[psycom.net]
  • loss or weight gain by greater than 5% when not trying to lose or gain weight OR a change in appetite nearly every day Sleeping too little or too much Physical agitation or restlessness that is observed by others Being tired and having a lack of energy[gulfbend.org]
Disability
  • Major depressive disorder is a disabling condition that often affects the family of an individual, their work, school life, sleeping and eating habits as well as general health. This condition is highly linked with incidences of suicide.[symptoma.com]
  • Information: Social care and support guide If you: need help with day-to-day living because of illness or disability care for someone regularly because they're ill, elderly or disabled - including family members Our guide to care and support explains[nhs.uk]
  • […] adverse event (SAE) is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability[clinicaltrials.gov]
  • It may be quite severe and even disabling. Feelings of worthlessness and/or feelings of guilt that are excessive or not related to anything a person who isn't depressed would feel guilty about.[verywellmind.com]
  • According to the World Health Organization, major depressive disorder carries the heaviest burden of disability among mental and behavioral disorders. 1 It’s likely that the burden of disease is attributable to multiple factors, including mood disturbances[psychiatryadvisor.com]
Falling
  • People with season-related depression are usually depressed during the fall and winter, and become healthier in spring and summer. Although rare, some become depressed in spring and summer, and healthier in the fall and winter.[healthcommunities.com]
  • Continue Reading: Everything You Ever Wanted To Know About BIPOLAR DEPRESSION (Part 2) Printed as “The Downside of Up,” Fall 2010 About the author Related[bphope.com]
  • He describes trouble falling asleep at night, decreased appetite, and recent feelings of intense guilt regarding the state of his personal relationships. He says that everything "feels slower" than it used to.[medbullets.com]
  • Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia). Behavior that is agitated or slowed down. Others should be able to observe this. Feeling fatigued, or diminished energy.[allaboutdepression.com]
  • You have trouble falling asleep or want to sleep more than usual. You experience feelings of restlessness. You feel unusually tired and have a lack of energy.[healthline.com]
Fever
  • Sometimes I even have a low grade fever. The war in my mind is spilling out into my body, and it’s hard to make sense of it all. I’m tired, so tired. I lay in bed a lot.[themighty.com]
  • You start experiencing pain or discomfort, burn with fever, or just ache all over. But when you have a mental illness like depression, the symptoms may not be as clear. They can develop gradually, even when you're undergoing treatment.[everydayhealth.com]
Collapse
  • . — Maya Mcdowell, House Beautiful, "8 Ways to Feel Happier at Home When Winter’s Bringing You Down," 15 Feb. 2019 Silverman explains that in the DSM-5, experts essentially collapsed two mood disorders—chronic major depressive disorder and dysthymia—into[merriam-webster.com]
  • For example, a realtor may become preoccupied with self-blame for failing to make sales even when the market has collapsed generally and other realtors are equally unable to make sales.[health.am]
Common Cold
  • Studies have shown that the extreme stress associated with grief can also trigger medical illnesses—such as heart disease, cancer, and the common cold—as well as psychiatric disorders like depression and anxiety.[verywell.com]
Overeating
  • Depression can occur only once in life but people can show multiple episodes of depression over the cause of their lives.[symptoma.com]
  • This is because in order to qualify for a diagnosis of Dysthymia, you have to show evidence of consistently mild depressive symptoms occurring more days than not over a period of at least two years.[gulfbend.org]
  • Introduction Think back over your life. There may have been times when you socialized, thought about the future, had things to look forward to, and had a good time with family and friends.[study.com]
  • Over 12% of the American population suffers from depression over the course of their lifetime. Drug Therapy There are a number antidepressant medications designed for major depressive disorder treatment.[brainsway.com]
  • Then, in addition, three to four of the following symptoms also need to be present: Increase or decrease in appetite most days, or a significant increase or decrease in weight over a month (more than 5% of body weight).[verywellmind.com]
Loss of Appetite
  • […] of appetite, weight loss, and loss of libido.[apps.who.int]
  • Significant loss of weight or weight gain that is not intentional but is triggered by overeating or loss of appetite. Sleep changes. Either excessive sleep or insomnia and difficulty sleeping. Agitation or retardation.[bridgestorecovery.com]
  • Physical symptoms of depression include: Decreased energy or fatigue Headaches, body aches, pains, cramps or digestive problems Difficulty remembering details, making decisions or concentrating Loss of appetite or overeating Excessive sleeping or insomnia[psychguides.com]
  • Additional symptoms of MDD include sleep disturbances, loss of appetite, and suicidal thoughts.[amboss.com]
  • However, these reactions may contribute to low mood and worsen other symptoms, such as loss of appetite and disrupted sleep. Instead, focus on staying calm. Remember that depression is treatable and the feelings will not last forever.[medicalnewstoday.com]
Constipation
  • Treatment of Adverse Effects Associated with Antidepressants Effect Associated antidepressant Treatment Anticholinergic Constipation TCAs Adequate hydration; bulk laxative Delirium TCAs Assess for other causes Dry mouth TCAs, SNRIs, bupropion (Wellbutrin[aafp.org]
  • Common side effects include drowsiness, blurred vision, constipation, dry mouth, agitation, drowsiness, nausea and headache. Some side effects of bipolar disorder medications often go away within the first few weeks.[psychguides.com]
  • Side effects of tricyclics may include drowsiness, dizziness upon standing, blurred vision, nausea, insomnia, constipation, and dry mouth. MAO inhibitors include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).[allpsych.com]
  • Some people may experience side-effects while taking antidepressants, including: Nausea and vomiting Weight gain Diarrhea or constipation Feeling sleepy Sexual problems While less common, other side-effects may include serotonin syndrome, a potentially[ada.com]
Hypotension
  • ., labetalol, nitroprusside [Nitropress]) may be needed Increased cholesterol levels Mirtazapine (Remeron) Statin drugs Orthostatic hypotension TCAs, trazodone, nefazodone, MAOIs Fludrocortisone; add salt to diet Neurologic Headache SSRIs, SNRIs, bupropion[aafp.org]
Hypertension
  • SNRIs, bupropion Monitor blood pressure; keep dosage as low as possible; add antihypertensive drug Hypertensive crisis MAOIs Seek emergency treatment; if hypertension is severe, intravenous antihypertensive agents (e.g., labetalol, nitroprusside [Nitropress[aafp.org]
Back Pain
  • pain or headaches Diagnosis for MDD may involve one or more of the following: Physical examination: This will involve questions concerning the medical history of the patient.[symptoma.com]
Feeling of Worthlessness
  • Major depressive disorder, also known as clinical depression, is marked by depressed mood, inactivity, lack of interest, insomnia, feelings of worthlessness, diminished ability to think, and may include thoughts of suicide.[patientslikeme.com]
  • […] of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) (8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective[behavenet.com]
  • […] of worthlessness, self-hate, and guilt Not being able to concentrate, think clearly, or make decisions Being irritable Ongoing thoughts of death or suicide - either thinking about suicide without a plan for how it would happen, having a specific plan[gulfbend.org]
  • The low mood tone, inability to accomplish tasks, and general shut-down of the brain's ability to think clearly and rationally can lead to exaggerated feelings of worthlessness, misery and despair.[mentalhelp.net]
  • Bereavement Major depressive disorder Identifiable loss is present Identifiable loss may or may not be present Major complaint is feeling of loss Major complaint is depressed mood Normal self-esteem Feeling of worthlessness Negative feelings of pain and[amboss.com]
Suicidal Ideation
  • The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation[behavenet.com]
  • ideation Often suicidal ideation Daily functioning maintained Daily functioning often impaired Persistent complex bereavement disorder [15] Certain medical conditions affect mood and may resemble major depressive disorder: Substance-induced mood disorder[amboss.com]
  • Frequently there may be thoughts of death, suicidal ideation, or suicide attempts ( Criterion A9 ).[health.am]
  • ideation (although acting on it is not required) As previously noted, these symptoms are also present in those diagnosed with Major Depressive Disorder, which is the perfect segway into talking about Major Depressive Disorder.[examinedexistence.com]
  • Recurring thoughts of death or of being dead; imagining committing suicide without making a plan ( suicidal ideation ); a suicide attempt or the making of plans to commit suicide.[verywellmind.com]
Indecisiveness
  • […] fatigue or loss of energy nearly every day (7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) (8) diminished ability to think or concentrate, or indecisiveness[behavenet.com]
  • Those symptoms might include: Fatigue or loss of energy almost every day Feelings of worthlessness or guilt almost every day Impaired concentration, indecisiveness Insomnia or hypersomnia (excessive sleeping) almost every day Markedly diminished interest[webmd.com]
  • ., ruminating over minor past failings) Diminished ability to think or concentrate, or indecisiveness, nearly every day (e.g., appears easily distracted, complains of memory difficulties) Recurrent thoughts of death (not just fear of dying), recurrent[psychcentral.com]
  • […] mental and physical activity, or increase in such activity as demonstrated by excessive worrying and agitated behavior fatigue, or loss of energy feelings of worthlessness or excessive or inappropriate guilt diminished ability to think or concentrate, or indecisiveness[bpddemystified.com]
Low Self-Esteem
  • Major depressive disorder (MDD) is a mental disorder that is characterized by a pervasive and persistent low mood often accompanied by a loss of interest in everyday activities and low self-esteem.[symptoma.com]
  • self-esteem), E nergy (low energy or fatigue), C oncentration (poor concentration or difficulty making decisions), A ppetite (decreased appetite or overeating), P sychomotor agitation or retardation, and S uicidality.[amboss.com]
  • People who tend to be pessimistic, have low self-esteem, worry too much, or feel they have little control over life events are at a higher risk for developing depression.[tech.mit.edu]
  • Personality: People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.[psychiatry.org]
  • self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness In addition, no Major Depressive Episode has been present during the first two years (or one year in children and adolescents) and there has never been a Manic Episode[ifred.org]
Anhedonia
  • A higher total score indicates higher levels of state anhedonia.[clinicaltrials.gov]
  • Clinical science Summary Major depressive disorder (MDD) is an episodic mood disorder primarily characterized by depressed mood and anhedonia that lasts for at least 2 weeks. Females are diagnosed more often than men.[amboss.com]
  • […] bipolar disorder premenstrual dysphoric disorder substance/medication induced depressive disorder depressive disorder due to another medical condition unspecified depressive disorder Presentation Symptoms SIG E CAPS S leep decreased I nterest decreased (anhedonia[medbullets.com]
  • […] every day Feelings of worthlessness or guilt almost every day Impaired concentration, indecisiveness Insomnia or hypersomnia (excessive sleeping) almost every day Markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia[webmd.com]
  • Most often a combination of these plus anhedonia Low self-attitude may manifest as self-blame, self-deprecation, guilt, lack of self-confidence about the future, or hopelessness.[hopkinsguides.com]
Agitation
  • […] like sex Sleep disturbances such as insomnia or excessive sleeping Tiredness and lack of energy Changes in appetite (usually weight loss as a result of reduced appetite but increased cravings for food and weight gain is seen in some people) Anxiety, agitation[symptoma.com]
  • ., body) agitation or retardation; either can't sit still, or can hardly move.[mentalhelp.net]
  • […] findings, not elsewhere classified ( R00-R99 ) Mental, Behavioral and Neurodevelopmental disorders F32 ICD-10-CM Diagnosis Code F32 Major depressive disorder, single episode 2016 2017 2018 2019 Non-Billable/Non-Specific Code Includes single episode of agitated[icd10data.com]
  • Common symptoms include: Changes in sleep Changes in appetite Lack of concentration Loss of energy Lack of interest in activities Hopelessness or guilty thoughts Changes in movement (less activity or agitation) Physical aches and pains Suicidal thoughts[nami.org]
Headache
  • […] restlessness may be seen Slowed thinking, speaking or body movements Fixations on past failure Difficulty in making decisions or concentrating on tasks Constant thoughts of death (suicide) Unexplained bouts of physical problems such as back pain or headaches[symptoma.com]
  • Side effects, which are usually temporary, include changes in sexual desire, digestive problems, headache, insomnia and nervousness.[livescience.com]
  • SSRIs, SNRIs, bupropion Assess for other causes (e.g., caffeinism, bruxism, migraine, tension headache) Myoclonus TCAs, MAOIs Clonazepam (Klonopin) Seizures Bupropion, TCAs, amoxapine Assess for other causes; add anticonvulsant drug, if indicated Sexual[aafp.org]
  • Common side effects include drowsiness, blurred vision, constipation, dry mouth, agitation, drowsiness, nausea and headache. Some side effects of bipolar disorder medications often go away within the first few weeks.[psychguides.com]
  • I have headaches and muscle aches. It feels like I have the flu, but I know I don’t because it doesn’t get better with time. I get hungry, so I eat something. Almost immediately afterward I feel nauseous and regret eating.[themighty.com]
Sleep Disturbance
  • During these episodes, the following symptoms can be seen either daily or intermittently: Feelings of sadness, unhappiness or emptiness Angry outbursts or frustration over small matters Loss of interest in normal activities like sex Sleep disturbances[symptoma.com]
  • People who have a history of sleep disturbances, medical illness, chronic pain, anxiety and attention-deficit hyperactivity disorder (ADHD) are more likely to develop depression.[nami.org]
  • Additional symptoms of MDD include sleep disturbances, loss of appetite, and suicidal thoughts.[amboss.com]
  • Questions are related to symptoms such as depressed mood, guilt feelings, suicide, sleep disturbances, anxiety levels and weight loss.The higher the score, the more severe the depression.[clinicaltrials.gov]
  • Start Monitoring Your Sleep And Wakefulness Sleep disturbance is one of the classic signs of a severe depressive episode. Now is the time to start checking your sleep patterns and habits. Don't let a disordered sleep cycle get on top of you.[bustle.com]
Dizziness
  • Side effects of tricyclics may include drowsiness, dizziness upon standing, blurred vision, nausea, insomnia, constipation, and dry mouth. MAO inhibitors include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).[allpsych.com]
Sexual Dysfunction
  • Treatment Pharmacotherapy Therapeutic principles First-line : SSRIs Other options SNRIs Atypical antidepressants Bupropion : lowers seizure threshold, less sexual dysfunction compared to SSRIs, and can also treat tobacco dependence Mirtazapine : significant[amboss.com]
  • These drugs usually produce fewer and milder side effects than do other types of antidepressants, although SSRI’s may cause anxiety, insomnia, drowsiness, headaches, and sexual dysfunction.[allpsych.com]

Workup

Diagnosis for MDD may involve one or more of the following [8]:

  • Physical examination: This will involve questions concerning the medical history of the patient.
  • Laboratory tests: This may include blood and thyroid tests.
  • Psychological evaluation: This is the chief diagnostic procedure for this condition as it focuses on finding out the symptoms, thoughts and behavioural patterns of the individual. 

However, results obtained from the use of depression screening or rating scales are not enough for diagnosing depression. They may also be imperfect when dealing with elderly patients.

Treatment

  • As soon as you notice signs of depression, get treatment as quickly as possible. To help prevent recurrence, long term maintenance treatment is advised.[symptoma.com]
  • The purpose of this retrospective controlled study was to evaluate the efficacy and safety of herbal medicine treatment of severe depressive episode.[ncbi.nlm.nih.gov]
  • […] anxiety disorders), continue to be classed as illnesses of unknown origin, and the validity of diagnostic concepts therefore also depends on extrinsic criteria such as course and outcome, results of biological and genetic investigation, and response to treatment[books.google.com]
  • ECT typically consists of a series of 6-12 treatment sessions, two to three times a week. Psychotherapy Psychotherapy is normally used to augment drug therapy or ECT as a depression treatment.[brainsway.com]
  • The symptoms of and the treatments for these depressions follow.[bpddemystified.com]

Prognosis

MDD is known for its major significant potential morbidity and mortality [6]. This is because it contributes to suicide, incidence and adverse outcomes on medical illnesses, lost work time, substance abuse as well as disruption in interpersonal relationships.

With appropriate treatment, 70-80% of individuals who have major depressive disorder can see a significant reduction in symptoms. 50% of patients will not respond to the initial treatment trial. 20% of people with untreated MDD in its first year will continue to meet the criteria for the diagnosis while an additional 40% can have a partial remission.

Etiology

The specific etiologic factor for major depressive disorder remains unknown. As is the case with most psychiatric disorders, major depressive disorder often appear to be a multifactorial and heterogeneous group of disorders which may involve a variety of factors such as [3]:

  • Biological factors: In people with MDD, physical changes in their brain have been noted. The significance of the changes remains uncertain but it is believed that it can be used to pinpoint causes. 
  • Neurotransmitter imbalance: This has been implicated as a major etiologic factor in dealing with depressive symptoms.
  • Hormonal changes: This may be as a result of thyroid problems, menopause as a well as a number of other conditions. 
  • Inherited traits: The genes responsible for MDD have not yet been identified but a genetic predilection has been suspected. 
  • Traumatic events: Some life events have been known to trigger MDD in some people. This may include loss of a loved one, financial difficulties, excessive stress etc.

Epidemiology

  • Pagina 15 - Schiffer RB, Babigian HM: Behavioral disorders in multiple sclerosis, temporal lobe epilepsy, and amyotrophic lateral sclerosis: an epidemiologic study. ‎[books.google.it]
  • […] the International Consortium of Psychiatric Epidemiology (ICPE) Surveys.[bmcmedicine.biomedcentral.com]
  • Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62(10):1097-106. [PMID:16203955] DePaulo, Jr., J.R, & and Ablow, K. (1989).[hopkinsguides.com]
  • Epidemiology References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified. Etiology The consensus today is that depression is influenced by genetic, neurobiological, socio-psychological, and environmental factors.[amboss.com]
  • Introduction Mood state, syndrome, and/or mental disorder characterized by dysphoria (sad/irritable) Most common psychiatric disorder Epidemiology 18% prevalence in the United States females affected twice as often as males not associated with economic[medbullets.com]
Sex distribution
Age distribution

Pathophysiology

  • Reduced levels of neurotransmitters ( serotonin, noradrenaline, dopamine ) are believed to be the pathophysiological basis in most cases. Additional symptoms of MDD include sleep disturbances, loss of appetite, and suicidal thoughts.[amboss.com]
  • The pathophysiology of a Major Depressive Episode may involve a dysregulation of a number of neurotransmitter systems, including the serotonin, norepinephrine, dopamine, acetylcholine, and gamma-aminobutyric acid systems.[health.am]

Prevention

There are no specific methods of preventing depression but these strategies have been proven to be helpful [10]:

  • Take active steps to control stress and undergo sessions geared towards boosting self-esteem.
  • Reach out to people when in crisis to help you go through rough patches.
  • As soon as you notice signs of depression, get treatment as quickly as possible. 
  • To help prevent recurrence, long term maintenance treatment is advised. 

Summary

Major depressive disorder (MDD) is a mental disorder that is characterized by a pervasive and persistent low mood often accompanied by a loss of interest in everyday activities and low self-esteem [1]. The condition is also known as clinical depression, major depression, unipolar depression, unipolar disorder and recurrent depression (when episodes are repeated).

Depression as a term can be used in a variety of ways. It is usually used to depict the MDD but it may also refer to other mood disorders or low mood [2]. Major depressive disorder is a disabling condition that often affects the family of an individual, their work, school life, sleeping and eating habits as well as general health. This condition is highly linked with incidences of suicide.

Patient Information

Major depressive disorder refers to the disorder that causes a persistent feeling of sadness and loss of interest. It is also known as a major depression, major depressive disorder or clinical depression. It affects the way you feel, think and behave and it can also lead to varying degrees of emotional and physical problems.

Patients of major depressive disorder can have difficulties in doing their normal daily activities and can make some people see life as not worth living.

This condition can affect anyone ranging from adolescents to adults and affects both sexes equally.

Contrary to what some people feel, depression isn’t a weakness and is not something that will pass over time. It can require long term treatment in some cases. The chances of recovery from depression are very good as long as the individual is given medical and psychological counselling.

References

Article

  1. Rohan ML, Yamamoto RT, Ravichandran CT, et al. Rapid mood-elevating effects of low field magnetic stimulation in depression. Biol Psychiatry. Aug 1 2014;76(3):186-93.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, Text Revision. 4th Edition. Washington, DC: American Psychiatric Association; 2000.
  3. Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression: a systematic review. Arch Gen Psychiatry. Jul 2004;61(7):714-9.
  4. Ishak WW, Ha K, Kapitanski N, Bagot K, Fathy H, Swanson B, et al. The impact of psychotherapy, pharmacotherapy, and their combination on quality of life in depression. Harv Rev Psychiatry. Dec 2011;19(6):277-89. 
  5. Dunlop BW, Nemeroff CB. The role of dopamine in the pathophysiology of depression. Arch Gen Psychiatry. Mar 2007;64(3):327-37.
  6. Alexopoulos GS. Depression in the elderly. Lancet. Jun 4-10 2005;365(9475):1961-70.
  7. Kessler RC, Nelson C, McGonagle KA. Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. British Journal of Psychiatry 1996 168 (suppl 30): 17–30.
  8. Hirschfeld RMA. The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care. Primary Care Companion to the Journal of Clinical Psychiatry 2001 3 (6): 244–254.
  9. Almeida AM, Lotufo-Neto F. Cognitive-behavioral therapy in prevention of depression relapses and recurrences: a review. Revista brasileira de psiquiatria 2003 25 (4): 239–44.
  10. Cuijpers P, van Straten A, Smit F. Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials. International Journal of Geriatric Psychiatry 2006 21 (12): 1139–49.

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Last updated: 2019-06-28 10:14