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:
- Feelings 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 loss as a result of reduced appetite but increased cravings for food and weight gain is seen in some people)
- Anxiety, agitation or 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
Entire Body System
- Weight Loss
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]
[…] 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 or restlessness may [symptoma.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
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The World Health Organization (WHO) currently ranks depression as the leading cause of disability globally [ 1 ]. It may become a chronic disorder with ongoing disability, particularly if inadequately treated. [patient.info]
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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]
Depression is the leading cause of disability in the United States among people ages 15-44. [adaa.org]
- Weight Gain
[…] 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]
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]
Various subtypes include atypical depression (e.g., weight gain, and increased appetite ), psychotic depression (e.g., hallucinations and delusions ), and peripartum depression (occurring during or shortly after pregnancy ). [amboss.com]
[…] loss as a result of reduced appetite but increased cravings for food and weight gain is seen in some people) Anxiety, agitation or restlessness may be seen Slowed thinking, speaking or body movements Fixations on past failure Difficulty in making decisions [symptoma.com]
Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder. [nimh.nih.gov]
- Epilepsy
Pagina 15 - Schiffer RB, Babigian HM: Behavioral disorders in multiple sclerosis, temporal lobe epilepsy, and amyotrophic lateral sclerosis: an epidemiologic study. [books.google.it]
Neurological disorders: multiple sclerosis, Parkinson's Disease, migraine, various forms of epilepsy, encephalitis, brain tumors. [psychnet-uk.com]
[…] dysthymia) Bipolar disorder Cyclothymic disorder Schizophrenia Schizoaffective disorder Anxiety disorder PTSD Delirium Central nervous system diseases can produce a true depressive syndrome: Parkinson disease Dementia Neoplasm Huntington disease Stroke Epilepsy [hopkinsguides.com]
[…] history of depression and its treatment; Family history of a mood disorder; Psychosocial stressors; Any medical conditions associated with depression (e.g., chronic obstructive pulmonary disease, migraine, multiple sclerosis, back problems, cancer, epilepsy [www2.gov.bc.ca]
- Increased Energy
Markedly increased energy Poor judgment Inappropriate social behavior Distractibility (i.e., attention easily drawn to unimportant or irrelevant external stimuli) Depressive episodes are characterized by symptoms described above for Major Depressive Episode [ifred.org]
Gastrointestinal
- Overeating
Depression can occur only once in life but people can show multiple episodes of depression over the cause of their lives. [symptoma.com]
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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]
- Loss of Appetite
[…] worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. [apps.who.int]
Additional symptoms of MDD include sleep disturbances, loss of appetite, and suicidal thoughts. [amboss.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]
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]
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]
Cardiovascular
- 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]
(American Association of Suicidology, 1996) The death rate from suicide (11.3 per 100,000 population) remains higher than the death rate for chronic liver disease, Alzheimer’s, homicide, arteriosclerosis or hypertension. [dbsalliance.org]
In the United States and Canada, the costs associated with major depression are comparable to those related to heart disease, diabetes, and back problems and are greater than the costs of hypertension. [7] According to the Nordic Journal of Psychiatry [en.wikipedia.org]
Psychiatrical
- 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]
[…] down) (6) 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 [behavenet.com]
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]
[…] or restlessness that is observed by others Being tired and having a lack of energy Feelings of worthlessness, self-hate, and guilt Not being able to concentrate, think clearly, or make decisions Being irritable Ongoing thoughts of death or suicide - [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]
- Fear
I quickly saw that the back door was open and immediately feared the worse. Ten minutes later, my worst fears were realized, as I found Spencer lying motionless on the side of the road. [psychologytoday.com]
[…] confirmed COVID-19 cases - tempo PBA holds special meeting to discuss ways to deal with rising Covid-19 cases - tempo Comelec suspends voter s registration March 10-31 - philstar LIST: Places with travel restrictions on Philippines over coronavirus fears [philippines.shafaqna.com]
[…] 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 account or as observed by others) (9) recurrent thoughts of death (not just fear [behavenet.com]
Shifting my perspective has helped me to react with less fear when my symptoms present themselves. They make more sense within the context of depression as a legitimate medical condition. [healthline.com]
- Suicidal Ideation
ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide B. [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]
ideation (which may or may not include a plan or actual attempt) or recurring thoughts of death A diagnosis of major depressive disorder is not made if any of the following criteria are met: The criteria are also met for a manic episode (in which case [psyweb.com]
- 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]
[…] depression a period during the 1930s when there was a worldwide economic depression and mass unemployment depression; low an air mass of lower pressure; often brings precipitation depression; clinical depression; depressive disorder a state of depression and anhedonia [tagalogtranslate.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]
- 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]
[…] tasks, like dressing or washing, seem difficult to do and take longer than usual Feelings of worthlessness or excessive or inappropriate guilt nearly every day (e.g., ruminating over minor past failings) Diminished ability to think or concentrate, or indecisiveness [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]
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]
Neurologic
- Agitation
Psychomotor Agitation and Psychomotor Retardation Psychomotor agitation and retardation occur in depression, producing states of over activity and under activity respectively. [psychnet-uk.com]
(No conscious dieting is occurring) Sleep changes (either sleeping more or less than normal) Psychomotor (e.g., body) agitation or retardation; either can't sit still, or can hardly move. [mentalhelp.net]
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]
Agitation or retardation. Agitated and restless expression or slowed down affect that is notable to anyone observing. Fatigue. Fatigue and loss of energy that is more than normal and can’t be explained simply by lack of sleep or low quality sleep. [bridgestorecovery.com]
- Echolalia
Catatonic: Patients have severe psychomotor retardation, engage in excessive purposeless activity, and/or withdraw; some patients grimace and mimic speech (echolalia) or movement (echopraxia). [merckmanuals.com]
- Echopraxia
Catatonic: Patients have severe psychomotor retardation, engage in excessive purposeless activity, and/or withdraw; some patients grimace and mimic speech (echolalia) or movement (echopraxia). [merckmanuals.com]
Urogenital
- Sexual Dysfunction
Specifically discuss the potential increase in suicidal ideation and potential for sexual dysfunction. Agitation and suicide risk may increase early in pharmacological treatment. [www2.gov.bc.ca]
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]
dysfunction Serotinin and norepinephrine reuptake inhibitors ( duloxetine, venlafaxine, desvenlafaxine ): major side effects include nausea, diarrhea, increased heart rate, increased blood pressure, and tremor Tricyclic antidepressants ( amitryptiline [en.wikipedia.org]
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]
[…] response to acute phase treatment. [columbia.edu]
The symptoms of and the treatments for these depressions follow. [bpddemystified.com]
Treatment and ongoing management. Pediatrics. 2007;120(5):e1313-e1326. 6. Emslie GJ, Mayes TL. Mood disorders in children and adolescents: psychopharmacological treatment. Biol Psychiatry. 2001;49(12):1082-1090. 7. [pharmacytimes.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
(Tinea corporis) 822 results Molecular epidemiology of tinea gladiatorum in contact sports in northern Iran. [unboundmedicine.com]
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]
Tinea pedis: the etiology and global epidemiology of a common fungal infection. Crit. Rev. Microbiol. 2015;41(3):374-88. [PubMed: 24495093] 13. Bowman J. Investigate all the options in skin care. Prof Nurse. 2004 Jul;19(11):43. [ncbi.nlm.nih.gov]
Pathophysiology
Temperature and serum factors, such as beta globulins and ferritin, appear to have a growth-inhibitory effect on dermatophytes; however, this pathophysiology is not completely understood. [emedicine.medscape.com]
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]
As indicated, the pathophysiology behind these factors’ predictive properties for recurrence remains far from understood. [bmjopen.bmj.com]
The mean age of onset was 15 years in one study.[4][6] Pathophysiology Occlusion of toe clefts, maceration, and wet conditions with a simultaneous increase in the bacterial flora probably contribute to tinea pedis infection. [ncbi.nlm.nih.gov]
The exact pathophysiological reason behind this association is not yet known but several possible theories have been suggested: some antidepressants may worsen glucose metabolism through weight gain; some research has suggested that depression can directly [patient.info]
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
- 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.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, Text Revision. 4th Edition. Washington, DC: American Psychiatric Association; 2000.
- 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.
- 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.
- Dunlop BW, Nemeroff CB. The role of dopamine in the pathophysiology of depression. Arch Gen Psychiatry. Mar 2007;64(3):327-37.
- Alexopoulos GS. Depression in the elderly. Lancet. Jun 4-10 2005;365(9475):1961-70.
- 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.
- 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.
- 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.
- 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.