How Is Persistent Depressive Disorder Treated
The most effective treatment for PDD combines medications and talk therapy, or counseling.
Antidepressants are prescription drugs that can relieve depression. There are many different kinds of medications for the treatment of depression. The most commonly used fall into two broad categories:
- Selective serotonin reuptake inhibitors .
- Serotonin-norepinephrine reuptake inhibitors .
You may need to take medication for a month or longer before you feel a difference. Make sure to continue taking the medication exactly as your healthcare provider prescribed. Even if you have side effects or feel much better, dont stop without talking to your healthcare provider first.
Counseling can also help manage PDD. One type of therapy, cognitive behavioral therapy , is often helpful for depression. A therapist or psychologist will help you examine your thoughts and emotions and how they affect your actions. CBT can help you unlearn negative thoughts and develop more positive thinking.
Depression Risk Factors For Women
According to the American Institute of Stress, the risk factors for depression among females include:
- Persistent hormonal changes that lead to depressive states
- Societal challenges such as unequal pay and unfair gender roles
Some races and employment types also have a higher prevalence of depression. White American adults comprised 70 percent of the 17.3 million who reported a major depressive episode. The next-highest figures by race were for Hispanic and Latino and Black .
Approximately 7.2 million Americans who identified as having full-time employment reported experiencing a major depressive episode. However, unemployed Americans had the highest rate of depression at 10.8 percent. The risk factors for depression among people who are unemployed or have part-time employment include having difficulties paying bills and uncertainty about their financial stability.
What Is Persistent Depressive Disorder
Persistent depressive disorder is mild or moderate depression that doesnt go away. A person with PDD has a sad, dark, or low mood and two or more other symptoms of depression. The symptoms last most of the day, on most days, over a long period of time.
Healthcare providers used to call the condition dysthymia or dysthymic disorder.
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Symptoms Of Major Depression
Depression isn’t just simply feeling sad or blue. It’s normal to feel bad over the loss of a job, the death of a loved one, or another sad event, Newman says. The difference is that symptoms of major depression last at least 2 weeks, run very deep, and are not at all normal for you. Here are some changes you might see in yourself if you have major depression:
Sadness, emptiness, or irritable mood. You can’t seem to shake the low mood. You may be irritable too. If you are normally cheerful and you’ve turned consistently cranky, it could be depression.
Loss of interest. You may stay away from friends or loved ones, or stop doing things you used to enjoy. You may lose interest in sex too.
Sleep problems. You may find it hard to fall asleep, or you could toss and turn all night long. On the flip side, you might sleep much more than usual or nap during the day.
Change in eating habits. You could lose interest in food and lose weight, or you might begin to eat too much and gain weight.
Lack of focus. Work may become difficult because you can’t keep your mind on it. Many people describe this as “brain fog.” You could also see this loss of focus in your home life, social life, and personal relationships and conversations.
Changes in energy. Overwhelming weakness and exhaustion may make it difficult or impossible to peel yourself off the couch or get out of bed. In contrast, you may be full of energy and feel fidgety or shift in your chair or bed to try to get comfortable.
How Is Prevalence Defined And Measured
The widespread issue of underreporting means accurate and representative data on the prevalence of disorders is difficult to define. If relying on mental health diagnoses alone, this underestimation would be severe. Prevalence figures would be likely to reflect healthcare spending rather than giving a representative perspective on differences between countries high-income countries would likely show significantly higher prevalence as a result of more diagnoses.
The data presented in this entry by the Institute of Health Metrics & Evaluation is therefore based on a combination of sources, including medical and national records, epidemiological data, in addition to survey data. Where raw data for a particular country is scarce, epidemiological data and meta-regression models must be used based on available data from neighbouring countries. Data quality issues are described below.
The data presented here therefore offers an estimate of mental health prevalence based on medical, epidemiological data, surveys and meta-regression modelling.
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Possible Complications Of Depression & Addiction
Depression can lead to many serious consequences, and depression usually worsens if untreated.2 Feelings of hopelessness and worthlessness may lead the individual to engage in self-defeating behaviors and unhealthy lifestyle choices .
Depression is associated with physical health problems such as:2,10,11
- Coronary artery disease.
At least some of the connection between depression and these issues may be because individuals with depression tend to have unhealthy eating patterns, exercise less, and have difficulties taking care of their health.10
Other possible complications linked to depression include:2
- Substance misuse.
- Other mental illnesses .
- Self-harm .
- Suicide attempts/death by suicide.*
*WHO reports that suicide is the second-leading cause of death in individuals aged 1529 and that nearly 800,000 people die by suicide each year.
Research has shown that areas of the brain known as the amygdala, hippocampus, and thalamus play an important role in depression. Some depressed people have a smaller hippocampus, which may be due to stress impairing the creation of new nerve cells in the hippocampus. This may also be related to how antidepressants work, as some animal studies have found that antidepressants can prompt nerve cells in the hippocampus to grow and branch.12
How To Tell If You Have Depression
Depression affects people in different ways and can cause a wide variety of symptoms.
They range from lasting feelings of unhappiness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.
There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and various aches and pains.
The symptoms of depression range from mild to severe. At its mildest, you may simply feel persistently low in spirit, while severe depression can make you feel suicidal, that life is no longer worth living.
Most people experience feelings of stress, anxiety or low mood during difficult times. A low mood may improve after a short period of time, rather than being a sign of depression.
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Who Is At High Risk For Depression
Those most at risk for developing depression include women, the elderly, those with a personal or family history of depression, chronic stressors, those with other concurrent mental and physical health conditions, low socioeconomic status, and those taking medications that may cause depression, like birth control or some anxiety medications.
Disease Burden Of Mental Health And Substance Use Disorders
Health impacts are often measured in terms of total numbers of deaths, but a focus on mortality means that the burden of mental health disorders can be underestimated.2 Measuring the health impact by mortality alone fails to capture the impact that mental health disorders have on an individuals wellbeing. The disease burden measured in Disability-Adjusted Life Years considers not only the mortality associated with a disorder, but also years lived with disability or health burden. The map shows DALYs as a share of total disease burden mental and substance use disorders account for around 5 percent of global disease burden in 2017, but this reaches up to 10 percent in several countries. These disorders have the highest contribution to overall health burden in Australia, Saudi Arabia and Iran.
In 2017, an estimated 264 million people in the world experienced depression. A breakdown of the number of people with depression by world region can be seen here and a country by country view on a world map is here.In all countries the median estimate for the prevalence of depression is higher for women than for men.
DALYs from depression
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Clinical Characteristics For Maintenance Therapy Candidacy For Major Depression
Dr. Dunner: Which patients should receive maintenance treatment for major depression, and which should not?
Dr. Thase: The key characteristics that qualify a patient with major depression for maintenance therapy are the number of prior episodes the patient has had and the frequency of recurrence. Patients who have had 2 episodes within several years or a lifetime history of 3 or more episodes would be likely to show the greatest benefit from longer-term, preventive therapy.
Dr. Keller: I would consider anyone who has had 2 lifetime episodes in addition to the current episode to be a candidate however, we need to also use good judgment when determining patients’ eligibility for maintenance therapy and consider remission and risk factors for recurrence.
Dr. Zajecka: Only patients who have achieved remission and a score of less than 7 on the Hamilton Rating Scale for Depression or 10 on the Montgomery-Asberg Depression Rating Scale should be considered for maintenance treatment. Additionally, some other clinical characteristicsfor example, residual symptoms or pregnancyshould be taken into account when supporting maintenance therapy candidacy.
Dr. Pollack: Ongoing psychosocial stressors and comorbidities should be considered too.
Dr. Dunner: Seasonal affective disorder should also be considered.
Dr. Thase: Thus, proper assessment of patients’ residual symptoms is essential to treat depression during the maintenance phase of therapy to optimize patient outcome.
What Causes Persistent Depressive Disorder
Scientists dont fully understand what causes PDD. But it might be related to low levels of serotonin. Serotonin is a natural hormone that controls our emotions and feelings of well-being. It also influences other body functions.
PDD may get triggered by a traumatic event in life. Examples include losing a job, having a loved one die, experiencing a crime or going through a breakup.
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How Is Depression Diagnosed
These days, a routine doctors visit with your general health practitioner may be all it takes to receive a diagnosis. Standard screening tools like the Patient Health Questionnaire a survey of yes, nine items, that physicians use to assess the severity of depressionare becoming widely used in primary care settings to screen for the condition.
In fact, most patients with depression are going to be diagnosed and treated by primary care doctors, not specialists or psychiatrists, says James Murrough, M.D., Ph.D., Director of the Depression and Anxiety Center for Discovery and Treatment at Mount Sinai.
Depression is mainly diagnosed by history and clinical presentations, or a specific pattern of symptoms, says Dr. Murrough, which is to say theres no blood test for MDD. But if you have symptoms like changes in sleep or appetite, your doctor may look into other conditions unrelated to mental health .
The first thing your doctor might do is order blood testsnot to make the diagnosis of depression, but to rule out things that could be masquerading as depression, explains Dr. Murrough. For example, an underactive thyroid can present as low mood and feeling sluggish, and iron deficiency anemia is another reason why some people might have low energy.
Major Depressive Disorder Prognosis And Outlook
Major depressive disorder prognosis depends on factors such as relapse and remission. One study shows that 80% of patients will have a recurrent episode of depression. According to another article, depression is likely to be the second leading cause of disability worldwide by 2020. By 2030, depression is expected to be the leading cause of disability worldwide, according to the World Health Organization.
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Additional Considerations For Maintenance Therapy
Dr. Blier: One factor that is often overlooked in maintenance treatment trials is the issue of substance or alcohol use or abuse. In general, patients with dual diagnosis are not admitted into treatment trials because this comorbidity can decrease the remission rate. Substance abuse can be a contributing factor for relapse, yet this comorbidity is often neglected when treating patients with recurrent depression.
Dr. Zajecka: Clinicians need to remain cognizant of the high comorbidity between affective disorders and substance use disorders.
Dr. Dunner: We need to discuss the topic of tachyphylaxis, or what has been called drug tolerance or the poop-out phenomenon, and consider how to deal with this confounding situation of apparent decreased medication effectiveness over time.
Dr. Zajecka: When the SSRIs came onto the market, some patients achieved a good response or full remission but, after some time, were described as apathetic and amotivated with a decreased range of affective response. Some people explained this experience by saying the medication stopped working. However, this phenomenon may be due to the fact that if medicines too selectively increase serotonin activity in the brain, there may be a compensatory decrease of norepinephrine and dopamine. To prevent this, physicians can start patients on a serotonin-norepinephrine reuptake inhibitor . Also, patients may respond to adjunctive nor-adrenergic or dopaminergic agents in addition to an SSRI.
Depression Statistics Everyone Should Know
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Depression affects people from all walks of life, no matter their background. It can affect people of all ages as well. Unfortunately, theres still a stigma that surrounds mental health issues, and some people view disorders like depression as a weakness. But, similar to the way anyone can develop certain physical health issues, mental health issues arent always preventable.
Understanding the latest depression statistics could increase awareness about mental health, and recognizing how widespread it is could also help reduce the stigmawhich might encourage more people to seek treatment.
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Major Depression And Genetics
How common is major depression? At least 10% of people in the U.S. will experience major depressive disorder at some point in their lives. Two times as many women as men experience major depression.
How do we know that genes play a role in causing depression? Scientists look at patterns of illness in families to estimate their heritability, or roughly what percentage of their cause is due to genes. To do this we find people with the disease who have a twin, and then find out whether the twin is also ill. Identical twins share 100% of their genes, while non-identical twins share 50% of their genes. If genes are part of the cause, we expect a patients identical twin to have a much higher risk of disease than a patients non-identical twin. That is the case for major depression. Heritability is probably 40-50%, and might be higher for severe depression.
This could mean that in most cases of depression, around 50% of the cause is genetic, and around 50% is unrelated to genes . Or it could mean that in some cases, the tendency to become depressed is almost completely genetic, and in other cases it is not really genetic at all. We dont know the answer yet.
We can also look at adoption studies, to see whether an adopted persons risk of depression is greater if a biological parent had depression. This also seems to be the case.
However, many people who develop major depression did not have this type of personality before their depression started.
How Can I Help My Teen Live With Major Depression
As a parent, you play a key role in your teens treatment. Here are things you can do to help:
Keep all appointments with your teens healthcare provider.
Talk with your teens healthcare provider about other providers who will be involved in your teens care. Your teen may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your teens care team will depend on his or her needs and how serious the depression is.
Tell others about your teens depression. Work with your teens healthcare provider and schools to develop a treatment plan.
Reach out for support from local community services. Being in touch with other parents who have a teen with depression may be helpful.
Take all symptoms of depression and suicide very seriously. Seek treatment right away. Suicide is a health emergency. Talk with your teens healthcare provider for more information on suicide including whom to call and what to do . Have a written emergency plan.
For several reasons, many parents never seek the right treatment for their teen with depression. This is true even though many people with major depression who seek treatment get better. They often improve within weeks. Continued treatment may help keep symptoms from coming back.
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Economic Impact Of Depression
- Depression is the leading cause of disability worldwide and is a major contributor to the overall global burden of disease.
- Neuropsychiatric disorders are the leading cause of disability in the U.S. with major depressive disorder being the most common
- Mental Health is the second leading workplace concern, following only family issues.
- Depression contributes to the estimated $100 billion annual cost of depression for U.S. employers, including $44 billion a year in lost productivity alone.
What Are The Challenges Of Measuring Depression
Content validity: We might want to know whether the questionnaires were measuring depression at all. How would we be sure of this?
We could first think about which emotions and behaviors we associate with depression sadness, tiredness, guilt, a loss of energy, and so on and we could make sure that the questionnaires ask about all of these emotions.
Criterion validity: We could also find out if peoples responses to the questions are correlated with other things we associate with depression.
For example, if someone is severely depressed, we might expect that they are also less sociable and that they perform poorly at work or school. We could test whether this is the case for people who scored high on a questionnaire for depression.
Discriminant validity: We could also test whether their responses are uncorrelated with things we dont associate with depression, such as their height or intelligence.
Internal consistency: Another important thing wed want to know is whether the questions were actually tapping into the same phenomenon.
Do all the questions measure depression or are some measuring other concepts instead? To test for this, we could look at how closely peoples answers to different questions align with each other.
One consequence of this focus is that scores shouldnt also measure other concepts.
Fortunately, there are straightforward ways to test this: we could measure how consistent different doctors were at diagnosing the same patients.
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