Major Depressive Disorder Medical Procedure

What Is Major Depressive Disorder

Sadness is a natural part of the human experience. People may feel sad or depressed when a loved one passes away or when theyre going through a life challenge, such as a divorce or serious illness.

These feelings are usually short-lived. When someone experiences persistent and intense feelings of sadness for extended periods, then they may have a mood disorder such as major depressive disorder .

MDD, also referred to as clinical depression, is a significant medical condition that can affect many areas of your life. It impacts mood and behavior as well as various physical functions, such as appetite and sleep.

MDD is one of the most common mental health conditions in the United States. Data suggests that more than 7.8 percent of U.S. adults experienced a major depressive episode in 2019.

Some people with MDD never seek treatment. However, most people with the disorder can learn to cope and function with treatment. Medications, psychotherapy, and other methods can effectively treat people with MDD and help them manage their symptoms.

New Medications And Faster Results

There’s a long-held idea that depression takes weeks or months to resolve. But new fast-acting treatments have “changed what we think is possible in the field,” Sanacora says.

In 2019, the FDA approved brexanolone . It’s the first drug specifically for postpartum depression, which is a type of major depression. Experts aren’t exactly sure how it works. But it’s a human-made version of a steroid your body makes naturally. It affects your GABA receptors, which help regulate mood.

Brexanolone isn’t as easy to take as other antidepressants. You get it through a vein in your arm at a health care facility over the course of 60 hours. But it can work quickly. Your depression symptoms might start to lift by the end of your treatment.

Another breakthrough drug came out that same year.

Esketamine is a prescription nasal spray. The low-dose psychedelic drug boosts the activity of glutamate in parts of your brain related to mood. Glutamate’s job is to excite cells in the brain and nervous system. Esketamine can trigger new connections in your brain too. You may start to see improvements in your depression within hours or days of using it, Sanacora says.

Esketamine offers lifesaving hope for people with suicidal thoughts and relief for people with treatment-resistant depression. But used alone, symptom relief may only last a couple of weeks. That’s why experts agree you should take rapid-onset drugs alongside traditional treatments.

Selective Serotonin Reuptake Inhibitors

If a GP thinks you’d benefit from taking an antidepressant, you’ll usually be prescribed a modern type called a selective serotonin reuptake inhibitor .

Examples of commonly used SSRI antidepressants are paroxetine , fluoxetine and citalopram .

They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a “good mood” chemical.

SSRIs work just as well as older antidepressants and have fewer side effects, although they can cause nausea, headaches, a dry mouth and problems having sex. But these side effects usually improve over time.

Some SSRIs are not suitable for children and young people under 18 years of age. Research shows that the risk of self-harm and suicidal behaviour may increase if they’re taken by under-18s.

Fluoxetine is the only SSRI that can be prescribed for under-18s and, even then, only when a specialist has given the go-ahead.

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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.

Assessing The Severity Of Major Depression

The DSM-5 defines the severity of major depression based on the number of criterion symptoms, severity of those symptoms and degree of functional disability. Major depression is classified as mild if the patient has very few, if any, symptoms in excess of the five required to fulfil the criteria for diagnosis the symptoms are manageable and functional impairment is minor . At the opposite end of the spectrum, severe major depression has a substantially greater number of symptoms than that required to make the diagnosis seriously distressing and unmanageable symptoms and extensive impairment of social and occupational functioning. For moderate major depression, the number of symptoms, the intensity of symptoms and/or functional impairment are in-between those specified for mild and severe.

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Other Medications And Supplements

The combined use of antidepressants plus benzodiazepines demonstrates improved effectiveness when compared to antidepressants alone, but these effects may not endure. The addition of a benzodiazepine is balanced against possible harms and other alternative treatment strategies when antidepressant mono-therapy is considered inadequate.

Ketamine may have a rapid antidepressant effect lasting less than two weeks there is limited evidence of any effect after that, common acute side effects, and longer-term studies of safety and adverse effects are needed. A nasal spray form of esketamine was approved by the FDA in March 2019 for use in treatment-resistant depression when combined with an oral antidepressant risk of substance use disorder and concerns about its safety, serious adverse effects, tolerability, effect on suicidality, lack of information about dosage, whether the studies on it adequately represent broad populations, and escalating use of the product have been raised by an international panel of experts.

Freud Mourning And Melancholia

Sigmund Freud, the father of psychoanalysis, wrote about depression in his 1917 essay, Mourning and Melancholia. In it, he defined melancholy as built around a sense of loss where the lost object itself is unknown, following the mental process of repression.

Freud stated that depression interferes with the normal mourning process, thereby causing the individual experiencing it to feel a general sense of sadness, believing the anguish and hopelessness they are feeling to be inescapable.

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What Else Should You Know About Ketamine

• A much lower dose of ketamine is given for depression compared with the dose necessary for anesthesia.
• Like opioids, ketamine has addictive properties. Its important to understand this when weighing risks and benefits. If you have a history of substance abuse such as alcohol or drugs its especially important for you and your doctor to consider whether ketamine is a good option for you.
• When IV ketamine works, people usually respond to it within one to three infusions. If a person has no response at all, further infusions are unlikely to help. Instead, its probably best to try other treatments for depression.
• People who experience some relief from depression within one to three ketamine treatments are probably likely to extend these positive effects if the treatment is repeated several more times. The subsequent sessions may help prolong the effects of ketamine, rather than achieving further dramatic relief of symptoms. There are no standard guidelines for this. Many studies offer eight treatments initially . After this, patient and doctor decide whether to taper or stop ketamine treatments or continue treatments at longer intervals.

About the Author

Robert C. Meisner, MD, Contributor

Individual Or Group Therapy

When you hear the word therapy you might automatically think of one-on-one sessions with a therapist. However, group therapy can be very useful in depression treatment as well. Both group and individual therapy sessions usually last about an hour. What are the benefits of each? In individual therapy, you are building a strong relationship with one person, and may feel more comfortable sharing some sensitive information with one person than with a group. You also get individualized attention.

In group therapy, listening to peers going through the same struggles can validate your experiences and help build self-esteem. Often group members are at different points in their depression, so you might get tips from both someone in the trenches and someone who has worked through a challenging problem. As well as offering inspiration and ideas, attending group therapy can also help increase your social activities and network.

When the going gets tough in therapy

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Diagnosing Major Depressive Disorder

If you or a loved one have been feeling depressed and low, seek help as soon as possible. You can reach out to a mental healthcare provider or contact your primary care doctor for a diagnosis or referral.

Your healthcare provider will ask you a series of questions that will likely cover your symptoms, thoughts and feelings, and medical history. They may need to perform a physical or psychological exam, or conduct lab tests, in order to rule out other health conditions that can cause similar symptoms.

Your healthcare provider will determine whether or not your symptoms meet the diagnostic criteria for major depressive disorder, which include:

• Having a persistently depressed mood and lack of interest in activities
• Having five or more symptoms of depression
• Having symptoms every day, almost all day
• Having symptoms for over two weeks
• Being unable to function like you did before, due to the symptoms

Patient Characteristics And Comorbidities

Patient characteristics captured include demographics on the index date, the Charlson comorbidity index, medication use and individual comorbid conditions for the year preceding the index date. Comorbid conditions required a single diagnosis and were defined using Systematized Nomenclature of Medicine – Clinical Terms classification system .

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Lifestyle Changes To Treat Depression

Exercise.Regular exercise can be as effective at treating depression as medication. Not only does exercise boost serotonin, endorphins, and other feel-good brain chemicals, it triggers the growth of new brain cells and connections, just like antidepressants do. Best of all, you dont have to train for a marathon in order to reap the benefits. Even a half-hour daily walk can make a big difference. For maximum results, aim for 30 to 60 minutes of aerobic activity on most days.

Social support. Strong social networks reduce isolation, a key risk factor for depression. Keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself.

Nutrition. Eating well is important for both your physical and mental health. Eating small, well-balanced meals throughout the day will help you keep your energy up and minimize mood swings. While you may be drawn to sugary foods for the quick boost they provide, complex carbohydrates are a better choice. Theyll get you going without the all-too-soon sugar crash.

Sleep. Sleep has a strong effect on mood. When you dont get enough sleep, your depression symptoms will be worse. Sleep deprivation exacerbates irritability, moodiness, sadness, and fatigue. Make sure youre getting enough sleep each night. Very few people do well on less than seven hours a night. Aim for somewhere between seven to nine hours each night.

When To Call Your Healthcare Provider

If you have 5 or more of these symptoms for at least 2 weeks, call your healthcare provider:

• Lasting sad, anxious, or empty mood

• Loss of interest in almost all activities

• Appetite and weight changes

• Changes in sleep patterns, such as inability to sleep or sleeping too much

• Slowing of physical activity, speech, and thinking OR agitation, increased restlessness, and irritability

• Ongoing feelings of worthlessness and/or feelings of undue guilt

• Trouble concentrating or making decisions

• Repeating thoughts of death or suicide, wishing to die, or attempting suicide

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Beyond Treatment: Things You Can Do

Once you begin treatment, you should gradually start to feel better. Here are other tips that may help you or a loved one during treatment for depression:

• Try to get some physical activity. Just 30 minutes a day of walking can boost mood.
• Try to maintain a regular bedtime and wake-up time.
• Eat regular, healthy meals.
• Do what you can as you can. Decide what must get done and what can wait.
• Try to connect with other people, and talk with people you trust about how you are feeling.
• Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better.
• Avoid using alcohol, nicotine, or drugs, including medications not prescribed for you.

Medical Device Treatment Options

A number of cutting edge medical technologies have been shown to effectively treat depression. Out of the different options available today, ECT, TMS and Deep TMS have gained a greater level of professional and public recognition.

ECT: Electroconvulsive therapy is a medical treatment that induces a brief set of seizures to stimulate the brain and affect its neural functioning. The treatment was originally used for schizophrenia, before researchers during the 1960s-80s found it to be even more effective in treating mood disorders, and in particular depression. As a result, today it is primarily used to treat this condition.

The treatments effectiveness in treating depression has been well-established, especially in cases of severe depression. That said, it does hold several disadvantages: first, ECT necessitates full sedation under anesthesia, which complicates its recovery process second, the procedure can cause short-term memory loss, which deters many potential patients finally, ECT has gained a rather negative public perception, much of it due to misinformation that characterizes it as a traumatic, personality-altering procedure.

In addition to being able to reach deeper brain structures directly, Deep TMS manages to cover a wider area of the brain. This grants Deep TMS the ability to concurrently regulate more brain structures associated with the relevant mental health condition.

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How Is Depression Treated

Treatment for depression may include one or a combination of the following:

• Medicine. Antidepressants work by affecting the brain chemicals. Know that it takes 4 to 6 weeks for these medicines to have a full effect. Keep taking the medicine, even if it doesnt seem to be working at first. Never stop taking your medicine without first talking to your healthcare provider. Some people have to switch medicines or add medicines to get results. Work closely with your healthcare provider to find treatment that works for you.

• Therapy. This is most often cognitive behavioral and/or interpersonal therapy. It focuses on changing the distorted views you have of yourself and your situation. It also works to improve relationships, and identify and manage stressors in your life.

• Electroconvulsive therapy . This treatment may be used to treat severe, life-threatening depression that has not responded to medicines. A mild electrical current is passed through the brain. This triggers a brief seizure. For unknown reasons, the seizures help restore the normal balance of chemicals in the brain and ease symptoms.

With treatment, you should feel better within a few weeks. Without treatment, symptoms can last for weeks, months, or even years. Continued treatment may help to prevent depression from appearing again.

Tms Therapy For Depression

If youre suffering from major depression that has been resistant to therapy, medication, and self-help, then TMS therapy may be an option. Transcranial magnetic stimulation therapy is a noninvasive treatment that directs recurring magnetic energy pulses at the regions of the brain that are involved in mood. These magnetic pulses pass painlessly through the skull and stimulate brain cells which can improve communication between different parts of the brain and ease depression symptoms.

While TMS may be able to improve treatment-resistant depression, that doesnt mean its a cure for depression or that your symptoms wont return. However, it could provide sufficient improvements in your energy and drive to enable you to begin talk therapy or make the lifestyle changessuch as improving your diet, exercising, and building your support networkthat can help preserve your depression recovery in the long term.

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Improvements In Brain Stimulation

Medications aren’t the only treatment for depression. Electroconvulsive therapy has been around for more than 70 years. It remains one of the most effective ways to manage major depressive disorder, especially if you don’t respond to other treatments. While it isn’t new, scientists have fine-tuned the procedure over the past decades.

Today, electroconvulsive therapy uses less energy than it did in the past. The goal is to give you the same benefits but with less negative impact on your memory and thinking skills. “That’s been a huge improvement,” says Susan Conroy, MD, PhD, a psychiatrist and neuroscientist at Indiana University School of Medicine.

Conroy also uses transcranial magnetic stimulation to treat depression, which has fewer side effects than electroconvulsive therapy. It works by sending magnetic pulses around your skull.

Brain tissue translates these signals into electrical energy, Conroy says, which changes the way areas of your brain talk to each other. “By changing that circuitry, we think that’s how transcranial magnetic stimulation gets people better from depression.”

These and other forms of brain stimulation aren’t right for everyone. But tell your doctor if other treatments don’t help and your depression keeps you from doing daily activities, you aren’t eating, and you have constant suicidal thoughts.

“These are all signs your treatment needs to be escalated and pretty quickly,” Conroy says.