Sequelae Of Major Depressive Disorder
MDD is a serious medical condition characterized by high mortality rates and significant morbidity. MDD leads to loss of productivity in the workplace, impaired interpersonal relationships, and difficulty meeting life goals. If untreated, an episode of MDD tends to last about 1-2 years. More than half of individuals with a single episode of MDD will go on to have subsequent episodes . Serial episodes of MDD, not surprisingly, erode families, lead to downward social mobility, and contribute to long-term disability.
Strengths And Limitations Of This Study
This is the first systematic review and meta-analysis to provide a comprehensive estimate of the prevalence of depression or depressive symptoms among outpatients considering different clinical specialties.
The information provided by this study highlights the importance of developing effective management strategies for the early identification and treatment of depression among outpatients in clinical practice.
The substantial heterogeneity between included studies was not fully explained by the variables examined.
The paucity of longitudinal data may decrease the generalisability of the study outcomes.
Other Systems And Pathways
There is no doubt that several other systems or pathways are also involved in the pathophysiology of depression, such as oxidant-antioxidant imbalance , mitochondrial dysfunction , and circadian rhythm-related genes , especially their critical interactions . The pathogenesis of depression is complex and all the hypotheses should be integrated to consider the many interactions between various systems and pathways.
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Are There Risk Factors For Depression
While genetics is believed to confer some susceptibility, there is no single gene or set of genes implicated so far, it appears that a very large number of geneslikely modifiable by diet or behavioreach contributes a very tiny degree of vulnerability that could precipitate depression under conditions of stress. People can also be at risk of depression because of their personality attributes, particularly if they have a tendency to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative. Of the Big Five personality dimensions, the one most consistently associated with depression susceptibility is the trait of neuroticism. It denotes the degree to which the negative affect system is readily activated. People high in trait neuroticism are inclined to find experiences distressing, to worry, and to doubt themselves disproportionate to the circumstances they are in. In addition, studies indicate that women are at especially high risk for depression after divorce and men are at high risk following following financial, occupational, or legal problems.
Depressive Disorder: Course Of Illness
The importance of treating this condition cannot be overestimated. The World Health Organization global burden of disease study places unipolar affective disorder amongst the 10 leading medical causes of disability in the world and second only to ischaemic heart disease.
Depression is a highly prevalent psychiatric disorder with a lifetime risk close to 20% and is associated with high levels of morbidity and mortality. Depressed patients are at higher risk of serious physical health problems such as coronary artery disease and diabetes and worsening of the prognosis of other medical conditions.
Follow-up studies show depression to be a long term, relapsing condition associated with significant morbidity and mortality and a tendency towards chronicity. Three quarters of the patients experience more than one episode of depression and the risk of recurrence is higher if the first episode occurs at a younger age and if there is a family history of depression. The risk of recurrence increases with each new episode and as the number of depressive episodes increases, the influence of life stress on recurrence wanes.
Given these findings, the need for effective treatment in the first episode of depression is obvious. Maintenance treatment for several months during remission is essential after an acute episode of depression to prevent relapse as well as long-term treatment to prevent recurrence in patients with more than one episode.
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Clinical Features And Epidemiology
Diagnostic criteria for unipolar depression centre on core symptoms of persistent and pervasive sadness, along with a loss of interest or pleasure in activities associated symptoms include low self-esteem, excessive guilt, suicidal thoughts or behaviours, sleep and appetite disturbances, and psychomotor agitation or retardation. In the main, these criteria are applied independent of age . In the DSM-IV criterion set, however, marked irritability is allowed as the cardinal mood symptom for children and young people only.
Past-year estimates of the prevalence of major depressive disorders in early adulthood range from 10%17% , with women about twice as likely to be affected as men. Earlier in development rates are much lower, and show a distinct age- and gender-related profile. Depression is relatively uncommon in pre-pubertal children , and rates differ little between boys and girls . Levels then begin to rise in the early teens, more sharply in girls than in boys. As a result, by the mid-teens the median 12-month prevalence of unipolar depression is in the region of 45%, and the female preponderance characteristic of adult depression is clearly established .
How Stress Affects The Body
Stress can be defined as an automatic physical response to any stimulus that requires you to adjust to change. Every real or perceived threat to your body triggers a cascade of stress hormones that produces physiological changes. We all know the sensations: your heart pounds, muscles tense, breathing quickens, and beads of sweat appear. This is known as the stress response.
The stress response starts with a signal from the part of your brain known as the hypothalamus. The hypothalamus joins the pituitary gland and the adrenal glands to form a trio known as the hypothalamic-pituitary-adrenal axis, which governs a multitude of hormonal activities in the body and may play a role in depression as well.
When a physical or emotional threat looms, the hypothalamus secretes corticotropin-releasing hormone , which has the job of rousing your body. Hormones are complex chemicals that carry messages to organs or groups of cells throughout the body and trigger certain responses. CRH follows a pathway to your pituitary gland, where it stimulates the secretion of adrenocorticotropic hormone , which pulses into your bloodstream. When ACTH reaches your adrenal glands, it prompts the release of cortisol.
The boost in cortisol readies your body to fight or flee. Your heart beats faster up to five times as quickly as normal and your blood pressure rises. Your breath quickens as your body takes in extra oxygen. Sharpened senses, such as sight and hearing, make you more alert.
Whats The Difference Between Normal Grief After A Loss And Mdd
When you experience a loss of someone close to you, its normal to grieve and feel down and empty for a period of several weeks or more, but it should get better, says Dr. Murrough. If youre starting to feel worse instead of better as time goes on, thats a red flag. Perhaps, more critically, a typical grief reaction isnt: My life is not worth living anymore. Consider seeking treatment if you or someone experiences this.
Why Are Rates Of Depression Rising
Depression rates are rising especially among the young. While the lifetime risk of depression is approximately 20 percent, for the general population the highest rates currently occur among young adults, those between the ages of 18 and 29, while individuals over 65 have the lowest rates.
Experts cite several reasons why the young are especially susceptible. They range from social factors, such as decreasing availability of meaningful work, to individual factors, such as lack of coping skills due to overprotective parenting. Cultural factors figure in, too. An increased concern with safety and decreased tolerance for risk has curtailed the opportunities children have for free play, in which children experience joy, gain friends and learn social skills, and discover how to exercise control over their own life.
The Role Of Verbal Behavior In Depression
Perhaps the biggest obstacle for traditional behavioral theorists to overcome when discussing depression is the role of language. In general, an extremely large and unquestionable body of research establishes the presence of negative cognitive content during depressive episodes, leading cognitive researchers to assume a causal role for cognition in depression . Although longitudinal research has failed to establish negative cognitive biases as independent predictors of depression , it is clear that thinking influences feeling on a moment-to-moment basis. Cognitive researchers see this influence as sufficiently causal, but behavior analysts instead search for environmental conditions responsible for such behaviorbehavior relations . Regardless, it is clear that negative thinking predominates in many depressions, and such thinking may elicit aversive affect.
Growing research on relational frame theory extends these findings. According to RFT, verbal behavior is technically seen as the behavior of framing events relationally: responding to one stimulus in terms of its given or inferred relation to other stimuli. For example, a woman caught speeding receives a ticket. If that person thinks that people who get speeding tickets are bad drivers, she may then consider herself a bad driver. RFT views equivalence as just one type of relation and views deriving relations among stimuli in the absence of direct conditioning as a generalized operant .
Deterrence And Patient Education
Patient education has a profound impact on the overall outcome of major depressive disorder. Since MDD is one of the most common psychiatric disorders causing disability worldwide and people in different parts of the world are hesitant to discuss and seek treatment for depression due to the stigma associated with mental illness, educating patients is very crucial for their better understanding of the mental illness and better compliance with the mental health treatment. Family education also plays an important role in the successful treatment of MDD.
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Major Depressive Disorder With Seasonal Pattern
Previously called seasonal affective disorder, or SAD, this type of depression is related to the reduction in daylight during the fall and winter.
It lifts during the rest of the year and in response to light therapy.
People who live in countries with long or severe winters seem to be affected more by this condition.
Bipolar Disorders In Young Adults Presenting With Depression
Given that bipolar disorders tend to present initially in a depressive phase, that the majority of people with bipolar illness experience their first episode in adolescence and that rates of progression from adolescent depression to bipolar disorder are about 20% , there is a strong case for careful consideration of bipolar illness in young adults presenting with recurrent or chronic depressive episodes.
Case 2 Bipolar-spectrum disorder
Case 2 is an example of depression in a young woman who has a first-degree relative with bipolar disorder. She had been difficult to treat and antidepressants led to fluctuations in her mood with recurrent, brief periods of hypomania occurring against a background of residual depressive symptoms. This kind of treatment-emergent hypomania and a history of a first-degree relative with bipolar disorder have both been included in the proposed diagnostic criteria for bipolar-spectrum disorder . It is likely that a significant proportion of young adults presenting with recurrent depression will satisfy these diagnostic criteria.
Case 3 Bipolar depression
Manic symptoms induced by electroconvulsive therapy or antidepressants
Hyperthymic personality traits at baseline
Brain Imaging And Neuroimaging Studies
Neuroimaging, including magnetic resonance imaging and molecular imaging, provides a non-invasive technique for determining the underlying etiology and individualized treatment for depression. MRI can provide important data on brain structure, function, networks, and metabolism in patients with depression it includes structural MRI , functional MRI , diffusion tensor imaging, and magnetic resonance spectroscopy.
Diffusion tensor imaging detects the microstructure of the white matter, which has been reported impaired in patients with depression . A recent meta-analysis that included first-episode and drug-naïve depressive patients showed that the decrease in fractional anisotropy was negatively associated with illness duration and clinical severity .
fMRI, including resting-state and task-based fMRI, can divide the brain into self-related regions, such as the anterior cingulate cortex, posterior cingulate cortex, medial prefrontal cortex, precuneus, and dorsomedial thalamus. Many previous studies have shown the disturbance of several brain areas and intrinsic neural networks in patients with depression which could be rescued by antidepressants . Further, some evidence also showed an association between brain network dysfunction and the clinical correlates of patients with depression, including clinical symptoms and the response to antidepressants , ECT , and repetitive transcranial magnetic stimulation .
Table 1. Findings of the ENIGMA Consortium.
Is Depression Linked To Chronic Pain
When pain lingers for weeks to months, it’s called “chronic.” Not only does chronic pain hurt, it disturbs your sleep, your ability to exercise and be active, your relationships, and your productivity at work. Can you see how chronic pain may also leave you feeling sad, isolated, and depressed?
There is help for chronic pain and depression. A multifaceted program of medicine, psychotherapy, support groups, and more can help you manage your pain, ease your depression, and get your life back on track.
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Data Extraction And Quality Assessment
Data extraction was a multistep process based on the eligibility criteria. The following information was extracted from each study independently by two investigators independently using a standardised form: study design, research year, country, specialty category, disease, sample size, diagnostic or screening method used and reported prevalence of depression and depressive disorders. A modified version of the Newcastle-Ottawa Scale was used to evaluate the quality of non-randomised studies. Studies were identified as having a low risk of bias or a high risk of bias . The effect of individual studies on the overall prevalence estimate was explored by serially excluding each study in a sensitivity analysis. Additionally, two reviewers cross-checked the reference lists of all selected articles to identify other relevant studies. All discrepancies were resolved by discussion and consensus.
How Common Is Depression
Major depression is one of the most common mental illnesses in the country. An estimated 17.3 million adults in the US reported having at least one major depressive episode over the course of a year, a 2017 report by the Substance Abuse and Mental Health Services Administration shows.
Thats 7.1% of all adults ages 18 and older. Women have a higher prevalence of experiencing a major depressive episode than men .
Depression is especially crushing for the workforce: Its the number one leading cause of disability worldwide, according to the World Health Organization. The total economic burden of MDD is estimated to be $210.5 billion per year in the United States alonea figure that reflects costs associated with missed days, reduced productivity, treatment for depression, and suicide.
Depression: An Illness Not A Weakness
Perhaps the most important message about MDDâfor both health care professionals and patientsâis that depression is an illness, not a personal weakness or failing. Like many other medical conditions, MDD is a biologic process that interacts with life circumstances and responds to proper treatment. It is heritable, serious, and associated with both death and poor functioning. As physicians, we should routinely consider MDD as part of our differential diagnosis in patients with multiple somatic complaints, vague feelings of malaise, or the specific constellation of complaints listed in the criteria above.
What Is The Link Between Smoking And Mental Health Conditions
Smoking is much more common among adults with mental health conditions, such as depression and anxiety, than in the general population.6 About 3 out of every 10 cigarettes smoked by adults in the United States are smoked by persons with mental health conditions.6 Why smokers are more likely than nonsmokers to experience depression, anxiety, and other mental health conditions is uncertain. More research is needed to determine this. No matter the cause smoking is not a treatment for depression or anxiety. Getting help for your depression and anxiety and quitting smoking is the best way to feel better.
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Child And Adolescent Depression: A Review Of Theories Evaluation Instruments Prevention Programs And Treatments
- 1Developmental and Educational Department, University of the Basque Country, Donostia/San Sebastián, Spain
- 2Developmental and Educational Psychology Department, University of the Basque Country, Lejona, Spain
- 3Personality, Evaluation and Psychological Treatments Department, University of the Basque Country, Donostia/San Sebastián, Spain
Signs And Symptoms Of Major Depression
According to the Diagnostic and Statistical Manual, 4th Edition , an episode of major depression is defined as 5 or more of the following symptoms occurring nearly all day every day for at least 2 weeks:
- Depressed mood,
- Fatigue or loss of energy,
- Feelings of worthlessness or guilt,
- Diminished ability to think or concentrate,
- Recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt .
To meet DSM-IV criteria for an episode of major depression, 1 of the 5 symptoms must be either depressed mood or diminished interest. These symptoms must cause clinically significant stress or impairment in functioning and cannot be directly attributable to another medical condition.
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Child And Adolescent Depression Prevention Programs In The School Environment
Extant scientific literature was reviewed in order to summarize the main depression prevention programs for children and adolescents in school settings. The databases used for conducting the searches were PubMed, PsycINFO, Web of Science, Scopus, Science Direct, and Google Scholar, along with a range of different manuscripts. With the constant key word being depression, the search for information cross-referenced a series of other key words also, namely: child* OR adolescent*,prevent*program, and school OR school-based. Searches were conducted for information published between January 1, 1970 and December 31, 2017.
First, articles were screened . The inclusion criteria were that the study analyzed all the research subjects of the review study , that study participants were aged between 6 and 18, that the study was published in a peer-reviewed journal and that it was written in either English or Spanish. Review studies and their references were also analyzed. Studies focusing mainly on psychiatric disorders other than depression were excluded.