Enhancing Healthcare Team Outcomes
An interdisciplinary approach is essential for the effective and successful treatment of MDD. Primary care physicians and psychiatrists, along with nurses, therapists, social workers, and case managers, form an integral part of these collaborated services. In the majority of cases, PCPs are the first providers to whom individuals with MDD present mostly with somatic complaints. Depression screening in primary care settings is very imperative. The regular screening of the patients using depression rating scales such as PHQ-9 can be very helpful in the early diagnosis and intervention, thus improving the overall outcome of MDD. Psychoeducation plays a significant role in improving patient compliance and medication adherence. Recent evidence also supports that lifestyle modification, including moderate exercises, can help to improve mild-to-moderate depression. Suicide screening at each psychiatric visit can be helpful to lower suicide incidence. Since patients with MDD are at increased risk of suicide, close monitoring, and follow up by mental health workers becomes necessary to ensure safety and compliance with mental health treatment. The involvement of families can further add to a better outcome of the overall mental health treatment. Meta-analyses of randomized trials have shown that depression outcomes are superior when using collaborative care as compared with usual care.
Major Depressive Disorder Definition
Depression, or major depressive disorder as it is defined by the American Psychiatric Association, is a mood disorder marked by a substantial decrease in quality of life, in a number of different areas.
Emotionally, depression is characterized by feelings of sadness, emptiness, loneliness and a lack of hope or pleasure. It is also marked by thoughts and actions that significantly hinder ones daily level of functioning.
A number of treatment options have been proven to safely and effectively treat depression. These include Deep TMS, psychopharmacology and psychotherapy, which will be elaborated on later.
Analysis Of Published Papers
In the past decade, the total number of papers on depression published worldwide has increased year by year as shown in Fig. A. Searching the Web of Science database, we found a total of 43,863 papers published in the field of depression from 2009 to 2019 or ts = ) and py = , Articles). The top 10 countries that published papers on the topic of depression are shown in Fig. B. Among them, researchers in the USA published the most papers, followed by China. Compared with the USA, the gap in the total number of papers published in China is gradually narrowing ,1C), but the quality gap reflected by the index is still large, and is lower than the global average .1D). As shown in Fig. E, the hot research topics in depression are as follows: depression management in primary care, interventions to prevent depression, the pathogenesis of depression, comorbidity of depression and other diseases, the risks of depression, neuroimaging studies of depression, and antidepressant treatment.
Analysis of published papers around the world from 2009 to 2019 in depressive disorder. A The total number of papers . B The top 10 countries publishing on the topic. C Comparison of papers in China and the USA. D Citations for the top 10 countries and comparison with the global average. E Hot topics.
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Use In Assessment Of Needs
Neglect of hygiene is considered as part of the Global Assessment of Functioning, where it indicates the lowest level of individual functioning. It is also part of the activities of daily living criteria used to assess an individual’s care needs. In the UK, difficulty in attending to their own physical cleanliness or need for adequate food are part of the criteria indicating whether a person is eligible for Disability Living Allowance.
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Treatment may involve treating the cause of the individual’s self-neglect, with treatments such as those for depression, dementia or any physical problems that are hampering their ability to care for themselves.
The individual may be monitored, so that any excessive deterioration in their health or levels of self-care can be observed and acted upon.
Treatment can involve care workers providing home care, attending to cleansing, dressing or feeding the individual as necessary, without reducing their independence and autonomy any more than is essential.In combination with other illnesses, self-neglect may be one of the indicators that a person would be a candidate for treatment in sheltered housing or residential care. This would also improve their condition by providing opportunities for social interaction.
Treatment For Major Depressive Disorder
Individuals who suffer with major depressive disorder have a few treatment options. These include:
- Psychotherapy: This involves talking about an individuals feelings of depression with a mental health professional. It is designed to help the individual find better ways to cope, identify issues that contribute to depression, and identify negative behaviors and replace them with positive ones.
- Medication: Antidepressants are typically used to treat major depressive disorder and other feelings of depression. These include SSRIs, SNRIs, and many others. One must go on their own medication journey, as the same drug does not work the same way for all individuals. It may be effective for one person and ineffective for another. But there are plenty of medications to try until you find the right one for you.
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An Intersection Of Contributing Factors
Opting for a more empirically-based approach to depression over Freuds psychoanalytic theory was Swiss psychiatrist Adolf Meyer. Eventually rising to the position of President of the American Psychiatric Association, Meyer pushed the mental health community into considering biological factors, as well as mental and familial ones, as potential sources of depression.
Major Depression A Chronic Illness
Major depression is a serious mental illness. It is classified as a mood disorder, which means that it is characterized by negative patterns in thoughts and emotions that dont line up with a persons actual circumstances. It is also a chronic mental illness. This means it is not curable and that it can come and go, sometimes for a persons entire life. Someone diagnosed with depression may feel fine for a long period of time and then have symptoms. The period during which someone experiences the symptoms is called a depressive episode.
Most people with major depression live with it as a chronic illness. Episodes come and go, although they may be made less severe and less frequent with good treatment. In some cases, though, a person may experience a singular episode of depression, just once in a lifetime. Often these episodes of depression are triggered by a situational event: a death in the family, the loss of a job or relationship, or some kind of trauma, like a physical assault. This single depressive episode may be just as serious as those experienced by someone with recurrent major depression, with all the same symptoms and persistence.
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Mdd Psychotherapy Treatment Options
Psychotherapy is built around conversations between the patient and a mental health professional. Through these discussions, the two strive to gain a deep and meaningful grasp of the patients experience in the world. This can include their perspective on life, significant relationships and formative experiences, their thought and emotional processes, as well as personal triggers and struggles.
Psychotherapy has been shown to offer relief from symptoms of depression. That said, the diverse array of psychotherapeutic theories and techniques can make choosing a treatment course quite challenging. Those who wish to begin psychotherapy are advised to look for a mental health professional they feel relatively comfortable, and could possibly develop a personal connection with. Additional aspects to consider are the therapists location, their availability, and the treatments cost.
Out of the many different forms of psychotherapy available to patients with depression, one branch has been recognized for its clinically proven ability to offer significant depression symptom relief: psychodynamics. FDA-approved for treating depression due to its safety and efficacy, psychodynamic therapy examines how the patients past and present, the central relationships in their lives, the use of defense mechanisms and other aspects of their internal world connect with one another.
Know The Signs Of A Major Depressive Episode
It is very common for a person with depression to be unaware that they are entering a depressive episode. Recognizing the signs in oneself is challenging, but it helps to be able to see an episode coming. By being more aware of the return of depression, an individual can better deal with it: asking for help, reaching out to socialize, taking self-care measures, practicing stress-relief strategies, or making extra therapy appointments. Being aware of a coming depressive episode isnt easy, but there are practices that can help:
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Major Depressive Disorder At A Glance
What Is Dysthymic Disorder
Also called dysthymia, dysthymic disorder is characterized by long-term but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. An individual with dysthymia may also experience one or more episodes of major depression during his or her lifetime.
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Understanding Major Depressive Disorder
The presentation of major depressive disorder varies across people. Some people will be very severely debilitated, while others may experience milder symptoms that are not evident to others. Youth are less likely to experience very severe MDD , this may contribute to the illness going undiagnosed.
Because the symptoms are primarily internal others may be unaware when a child or adolescent is depressed changes in functioning and activity, along with somatic complaints and irritability are important signs to pay attention to. Additionally, many youth with MDD will also experience anxiety, including generalized anxiety disorder, panic, or separation anxiety. In older youth, substance use is also very common among people who have depression. The prevalence of MDD increases sharply at puberty especially among females. The rate of depression among females is about twice as high following puberty.
Biological Breakthroughs In Treating Depression
The mid-20th Century also saw a revolution in major depressive disorder healthcare, when antidepressant medications were introduced as a viable treatment method. The proven efficacy of antidepressants underscored the biological and genetic factors related to this condition, while being able to offer many patients significant symptom relief.
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Diagnosis Of Major Depression
Major depression is usually diagnosed by a mental health professional or a primary care physician. After analysing the patients medical history, the health professional will perform an evaluation of the symptoms by asking certain questions. However, according to the Diagnostic and Statistical Manual of Mental Disorders , a person needs to exhibit at least five or more symptoms of MDD nearly every day for at least two weeks to be diagnosed as depressed. Moreover, the professional may also assess the patients personal and family psychiatric history.
Currently, no specific tests are conducted to diagnose depression. However, a primary care physician may run certain tests to determine if the symptoms are being caused by any other medical problems or medication.
Transcranial Direct Current Stimulation
Transcranial direct current stimulation is another noninvasive method used to stimulate small regions of the brain with the help of a weak electric current. Increasing evidence has been gathered for its efficiency as a depression treatment. A meta-analysis was published in 2020 summarising results across nine studies concluded that active tDCS was significantly superior to sham for response , remission and depression improvement. According to a 2016 meta analysis, 34% of people treated with tDCS showed at least 50% symptom reduction compared to 19% sham-treated across 6 randomised controlled trials.
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Stress Hormoneshormoneshormones Are Messenger Molecules That Are Synthesized In One Part Of The Body And Move Through The Bloodstream To Exert Specific Regulatory Effects On Another Part Of The Body Hormones Play Critical Roles In Coordinating Cellular Activities Throughout The Body In Response To The Constant Changes In Both The Internal And External Environments Hormones: Overview
- Stress hormonesHormonesHormones are messenger molecules that are synthesized in one part of the body and move through the bloodstream to exert specific regulatory effects on another part of the body. Hormones play critical roles in coordinating cellular activities throughout the body in response to the constant changes in both the internal and external environments. Hormones: Overview are increased in individuals with depression.
- Increase assumed to be a result of a hyperactive hypothalamic-pituitary-adrenal axisHypothalamic-pituitary-adrenal axisAdrenal Hormones
Neurotrophic Hypothesishypothesisa Hypothesis Is A Preliminary Answer To A Research Question There Are 2 Types Of Hypotheses: The Null Hypothesis And The Alternative Hypothesisstatistical Tests And Data Representation
- Untreated depression can damage vital brainBrainThe part of central nervous system that is contained within the skull . Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon mesencephalon and rhombencephalon . The developed brain consists of cerebrum cerebellum and other structures in the brain stem.General Structure of the Nervous System structures .
- This damage is mediated by glutamineGlutamineA non-essential amino acid present abundantly throughout the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells.Synthesis of Nonessential Amino Acids and glucocorticoid toxicity.
- The hippocampus is very sensitive to high levels of cortisol.
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Advances In Various Kinds Of Research On Depressive Disorder
Genetic, molecular, and neuroimaging studies continue to increase our understanding of the neurobiological basis of depression. However, it is still not clear to what extent the results of neurobiological studies can help improve the clinical and functional prognosis of patients. Therefore, over the past 10 years, the neurobiological study of depression has become an important measure to understand the pathophysiological mechanism and guide the treatment of depression.
The Symptoms Of A Major Depressive Episode
The diagnostic criteria for major depression include nine possible symptoms. To be diagnosed, a person must experience at least five of these symptoms and significant impairment as a result of those symptoms. The symptoms must last for at least two weeks. This is a depressive episode. The nine possible symptoms of major depressive episodes are:
- Depressed mood. A feeling of depression, sadness, and hopelessness that is intense and persistent. This may seem more like irritability in children, teens, and men.
- Loss of interest. A significant loss of interest or pleasure in doing normal activities, including daily activities like chores but also hobbies, work, or school.
- Weight changes. 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. 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 cant be explained simply by lack of sleep or low quality sleep.
- Excessive guilt. Feelings of deep guilt and shame, a feeling of being worthless.
- Impaired thinking. Difficulty concentrating, making decisions, and focusing on anything, even just watching television.
- Suicidal thoughts. Thoughts of death, suicide, and suicidal planning or suicidal attempts.
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Precision Medicine For Depression
Optimizing the treatment strategy is an effective way to improve the therapeutic effect on depression. However, each individual with depression may react very differently to different treatments. Therefore, this raises the question of personalized treatment, that is, which patients are suitable for which treatment. Over the past decade, psychiatrists and psychologists have focused on individual biomarkers and clinical characteristics to predict the efficiency of antidepressants and psychotherapies, including genetics, peripheral protein expression, electrophysiology, neuroimaging, neurocognitive performance, developmental trauma, and personality . For example, Bradley et al. recently conducted a 12-week RCT, which demonstrated that the response rate and remission rates of the pharmacogenetic guidance group were significantly higher than those of the non-pharmacogenetic guidance group .
Subsequently, Greden et al. conducted an 8-week RCT of Genomics Used to Improve Depression Decisions on 1,167 MDD patients and demonstrated that although there was no difference in symptom improvement between the pharmacogenomics-guided and non- pharmacogenomics-guided groups, the response rate and remission rate of the pharmacogenomics-guided group increased significantly .
Change In Eating Appetite Or Weight
In a major depressive episode, appetite is most often decreased, although a small percentage of people experience an increase in appetite. A person experiencing a depressive episode may have a marked loss or gain of weight . A decrease in appetite may result in weight loss that is unintentional or when a person is not dieting. Some people experience an increase in appetite and may gain significant amounts of weight. They may crave certain types of food, such as sweets or carbohydrates. In children, failure to make expected weight gains may be counted towards this criteria. Overeating is often associated with atypical depression.
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