Major depressive disorder

Major depression (clinical depression, monopolar depression) is an affective disorder, which is a complex of mental, somatic, and behavioral symptoms. The definition of “monopolar depression” implies the course of the disease in one range of emotional state, which can be characterized as a depressing, depressed mood, fading sadness, a complete lack of joy and pleasure, a pessimistic assessment of what is happening. A person loses interest in earlier exciting activities, he loses the desire to perform activities that bring pleasure to the norm. As a rule, the patient’s self-esteem is greatly underestimated, the past appears to be a series of catastrophic mistakes, reality is perceived as boring, and the future seems hopeless. The individual always has a feeling of unconditional personal guilt, he considers himself a worthless and useless person for society. When the disease is also noted: problems with sleep, difficulty concentrating, changing dietary habits, physical manifestations. However, there is a peculiarity of the disease - the possible absence of depression and depression, called masked depression.

According to statistics, more than 15% of the world's population experienced at least once symptoms meeting the ICD-10 diagnostic criteria for major depressive disorder, of which 2% were suicidal. However, only 50% of people who have experienced such manifestations seek psychological and medical assistance and receive a diagnosis confirming the disorder. Most people with symptoms of the disease prefer to remain silent, hide, ignore their oppressive state. The reason for such “conscious negligence”, first of all, is the fear of diagnosing an “ugly” affective disorder in oneself, fear of taking antidepressants and waiting for pronounced side effects. Also a stopping factor is flaws in ideology, because some patients believe that controlling and controlling emotions is their personal duty, the fulfillment of which depends solely on the presence of a strong will.

Clinical depression can occur in people of any age group and social status, but most of the first primary episodes are recorded in people aged 25 to 45 years.

With major depression, the onset and development of symptoms occurs consistently and rather slowly, but over time, the form of the disorder acquires pronounced symptoms. A timely visit to the doctor, a thorough examination, a correctly chosen scheme of therapy allows the patient to return to his usual life activity and normal functioning in society.

    Major Depression: Subtypes

  • Psychotic depression. In addition to depressive manifestations, psychotic symptoms (delusions or hallucinations) are present.
  • Atypical depression. The combination of symptoms: typical for MDD and atypical signs. It has a protracted nature.
  • Postpartum depression. Occurs due to fluctuations in the hormonal background some time after birth.
  • Postpartum psychosis. A serious illness, including hallucinations and delusions, most often focused on a newborn baby.
  • Premenstrual dysphoric disorder (syndrome). The syndrome inherent in many women, manifested monthly before the onset of menstruation.

Major depression: symptoms

According to DSM-IV, the criteria for major depressive disorder are the presence of five or more symptoms that have been observed for at least two weeks and interfere with the normal functioning of a person. It:

  • Depressed, depressed mood, present daily for most of the day, manifested by a feeling of sadness or tearfulness;
  • Severe emotional irritability in children and adolescents;
  • Significant reduction or loss of interest or lack of pleasure from the usual pleasant activities;
  • Loss or weight gain with a pronounced decrease or increase in appetite;
  • Sleep disturbances: sleeplessness at night or daytime sleepiness;
  • Objectively recorded psychomotor agitation - agitation or motor retardation;
  • Feeling weak, reduced energy, increased fatigue;
  • Feelings of worthlessness and insolvency, unreasonable self-incrimination up to the delusional level;
  • Difficulties with concentration of attention, mental retardation, indecision of actions;
  • Periodically occurring suicidal thoughts or attempts.

In case of major depressive disorder, various somatic manifestations are observed. The symptoms of the disease are intense and constant, aggravated without appropriate therapy and lead to violations in the professional, social, personal spheres of the individual's activities.

When diagnosing an ailment, it is necessary to exclude somatic conditions for which symptoms of depression are characteristic, such as:

  • chronic lung disease;
  • migraine;
  • thyroid pathology;
  • problems in the locomotor system;
  • multiple sclerosis;
  • oncological diseases;
  • stroke;
  • epilepsy;
  • bronchial asthma;
  • diabetes;
  • cardiovascular diseases.

All patients who show symptoms of major depression should be screened for the likelihood of suicidal action. The severity of the disease should also be identified and determined.

The subtype of the disorder is resistant depression, which is characterized by the absence or insufficiency of a therapeutic response to the course of treatment with antidepressants. Primary resistance is rare, the causes are biological factors. Secondary resistance causes the phenomenon of adaptation to pharmacological drugs. The reason for pseudoresistance is the use of incorrect medicines. In some patients, intolerance occurs - intolerance to the medications taken.

Major depressive disorder: causes

The unequivocal reason for the occurrence of this depressive disorder today has not been established, however, there are various hypotheses about the influence of provoking and predisposing factors, mechanisms of the development of the disease.

It has been established that the risk of a major depression is present to a greater degree among residents of megalopolises and large industrial cities in comparison with people living in small cities and rural areas. Moreover, cases of major depression are more often recorded among residents of developed, economically prosperous states than among the population of developing, backward countries. A definite role in this distinction is played by more sophisticated diagnostic methods, a significantly higher level of medical care and better awareness of the disease among residents of developed countries. At the same time, the overpopulation of megacities, the intensive pace of life, high social and professional requirements, a huge number of stress factors cause a greater susceptibility to depression of people in developed countries, especially large cities.

A high percentage of people suffering from clinical depression is observed in people who are constantly in a state of chronic stress. At risk: unemployed with insufficient qualifications, people with poor material situation - poorly paid staff, people performing heavy, monotonous, boring, unloved or uninteresting work, entrepreneurs and professionals experiencing significant mental overload.

Often, a provocative factor in the development of a major depressive disorder is a significant stressful situation for a person: bankruptcy, dismissal from work, change of social status, serious illness or death of a loved one, divorce or separation from a loved one. However, clinical depression often develops without any visible influence from the outside or from insignificant, but long-lasting, stress.

A high incidence of depressive disorders is observed in patients suffering from or suffering from migraine. A “melancholic” condition can be one of the signs of another rather serious illness, such as atherosclerosis. The disorder can also occur as a result of taking certain medications: analgesics, antibiotics, hormonal drugs, and pharmacological agents of other groups. Conducted research has put forward a version of the relationship of the use of certain pesticides in agriculture and the likelihood of development of depressive episodes among workers in contact with them.

Of great importance in the emergence of a major depression is the conditions in which the person grew up, was brought up and stayed in childhood. The study of case histories of persons suffering from this disease confirms their “programmed” depressive and anxious reactions, a constant feeling of anticipation of tragic events. People who experience frequent stresses due to mistreatment in childhood, who have experienced physical violence: slapping, beating, rape or psychological violence: carping, unfair criticism, abuse by adults, overt or covert provocations to cause a feeling of shame, guilt, worthlessness, in adulthood or adolescence there is a chance of falling into a depressive state. They have an increased, compared to normal, level of cortisol, a stress hormone, and its sharp rise is recorded even under the influence of insignificant stress factors.

The high-risk group includes people whose immediate relatives suffer from or have a history of mental affective disorders, which confirms the theory of hereditary predisposition (genetic component) in the development of clinical depression.

The main role of the supporters of the biological theory is assigned to the presence of biochemical defects in the patient - disorders in the processes of the brain's biochemical activity. Another probable hypothesis of the occurrence of depressions is the malfunctioning of the internal biological clocks: disturbances in the timing mechanism, irregular periodicity of all the processes occurring in the body.

According to some scientists, the significant factors in the emergence of the disease is an imbalance between the personality’s own “I” and the moral standards of society that occurs in people with low resistance to stress factors.

A significant factor — the age of the patient — was not ignored by scientists: the older the patient, the more likely the “perspective” of the development of depression, which is explained by the lower stability of the nervous system in old age.

Summarizing the above, we can assume that the true reason for the development of clinical depression is to participate in different proportions:

  • hereditary genetic factors
  • reduced stress resistance
  • deficiency of individual neurotransmitters
  • imprinting in childhood
  • chronic stress or exposure in the recent past of the psychotraumatic factor
  • individual characteristics of the nervous system and individual personality characteristics.

Major depression: treatment

The treatment of a major depressive disorder involves taking pharmacological drugs and using psychotherapeutic methods. Such a complex combination of therapy is necessary, as most people who first experienced the symptoms of clinical depression are not aware of the seriousness of the illness and often treat their condition as an indisposition or a bad mood. However, this disorder is something much larger and fraught with dangerous consequences than the usual sad mood. It has been established that with major depressive disorder, a number of biological measurements in the biochemistry of the brain take place: the level of neurotransmitters changes, mental and physical activity decreases. In the nature of depressive disorders, there is an uncontrollable sphere of a person’s uncontrolled, irrational and intensive influence on a person’s thinking and behavior, which is often not possible for a person to take the necessary steps to improve his condition. It should be borne in mind that without professional help and adequate therapeutic measures, with major depression, there is a tendency to a progressive deterioration and transition to a chronic form, which is not always amenable to therapy. Persons suffering from clinical depression can cause themselves social, professional, financial and physical harm, including the tragic, but very common outcome - suicide. Pharmacological and psychotherapeutic treatment significantly reduces the risk of such actions, is vital and very productive.

The main goal of the treatment of the acute phase of the disorder is to achieve stable and complete remission, to return the patient to normal psychosocial functioning. Supporting and preventive measures are necessary to fully restore psychological status and prevent the occurrence of relapses.

Modern medicine has many groups of antidepressant drugs with different mechanisms of action. When choosing an antidepressant, a doctor considers a complex of clinical factors, such as:

  • prevailing symptomatic profile;
  • the presence of chronic somatic ailments;
  • the presence in the history of other mental disorders;
  • the presence or likelihood of pregnancy;
  • personal preferences of the patient;
  • therapeutic results achieved with past treatment;
  • individual tolerance of the drug;
  • the risk of withdrawal symptoms;
  • drug compatibility;
  • cost of medication.

As a rule, the first choice of the drug is the first line antidepressants. If their intake does not bring the desired therapeutic response after 2 weeks of administration in the maximum allowable dose, or an individual intolerance of side effects is observed, the antidepressant is replaced with another class of drug.

In addition to assistance from the attending physician to patient compliance with antidepressants, for successful treatment it is necessary to take into account the natural concern of the patient and conduct explanatory informative work. The patient should be aware that:

  • antidepressants are not narcotic drugs and do not cause dependence;
  • the termination of the course of treatment is forbidden even in case of improvement of state of health and disappearance of symptoms;
  • it is necessary to strictly observe the regimen of antidepressants and the prescribed dosage;
  • the disappearance of individual symptoms occurs no earlier than 1-2 weeks after the start of the course, however, the full therapeutic effect is observed not earlier than 4 weeks;
  • possible the occurrence of mild side effects, but their manifestation stops at the end of therapy;
  • during the treatment is strictly prohibited the use of alcoholic beverages.

Reception of antidepressants should be continued for at least 6 months to achieve a stable remission. It is recommended to take drugs in the same dosage that were used in the acute phase of the disease. It should regularly monitor the presence of side effects from medication and observe the concomitant somatic and psychological status of the patient.

Reception of antidepressants should be continued for at least 6 months to achieve a stable remission. It is recommended to take drugs in the same dosage that were used in the acute phase of the disease. It should regularly monitor the presence of side effects from medication and observe the concomitant somatic and psychological status of the patient.

Upon completion of the prescribed course of drug therapy should take into account the likelihood of withdrawal syndrome. The patient should be aware of the early harbingers and the first symptoms of the recurrence of major depression. It is recommended to continue monitoring with the attending physician for 6–9 months after discontinuation of pharmacologic treatment.

Consultations and supervision of a psychiatrist are mandatory in cases where an individual has:

  • pronounced psychotic symptoms;
  • the risk of suicidal action or harm to others;
  • severe chronic somatic ailments;
  • resistance to standard medical therapy in history;
  • lack of results of standard pharmacological therapy when patients receive adequate doses of drugs;
  • difficulty in diagnosis, the need for more thorough and complete examination.

Actually psychotherapeutic work is to work out the emotional states of the client and personal response to their condition. The essence of the techniques used by psychotherapists and psychologists is to involve the patient in the process of their own healing, to prevent the possible resistance of the ongoing medical therapy. The most effective methods is cognitive-behavioral therapy. This technique allows you to define destructive automatic thoughts, distorted ideas that provoke the development of depression.

The presence of long-acting stress factors, the presence of problems in interpersonal relations, the social isolation of the patient have a significant negative impact on the outcome of treatment. It is extremely important to assess the damage caused by these factors, to take effective measures to get rid of them.

In addition, it is necessary to discuss with the patient the importance of maintaining a healthy lifestyle and the importance of such things as:

  • regular exercise;
  • balanced, healthy diet;
  • enough sleep;
  • prohibition of the use of psychoactive substances;
  • rational and adequate labor regime;
  • implementation of stress management strategies;
  • conducting activities that bring joy and pleasure;
  • possession of self-help techniques.
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This article does not consider recommendations for the diagnosis and treatment of varieties of major depressive disorder, other pathological conditions with the presence of a depressive syndrome, anxiety-phobic diseases and disorders resulting from the use of psychoactive drugs.


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