Major Depressive Disorder (MDD) is a medical condition that includes abnormalities of mood, neurovegetative functions, cognition, and psychomotor activity (Fava, p.335). Moreover, Major Depressive Disorder is an arguably well-known disorder, but the way that people understand the etiology, symptoms, causes, treatment, and prevalence of this disorder is often misinterpreted. MDD is referred as clinical depression that can affect many aspects of how one lives his or her life. The increased prevalence of depression has caused uproar in the amount of research conducted and found on the disorder, and contributes to newly developed treatment plans to reduce symptoms.
DSM-IV Criteria and Symptoms
According to The Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV Criteria, there can be a number of contributing factors related to the cause of depression. The prevalence of MDD is different in every person. However, there is a range of symptoms that most people experience that contributes to his or her diagnosis. These symptoms include depressed mood, decreased interest or pleasure, weight change, change in sleep patterns and fatigue, change in activity, guilt, loss of concentration, and even suicidal thoughts (American Psychiatric Association, 1994).
Depressed mood is the most common symptom in MDD and is considered the hallmark of this disorder. This can be described as having negative feelings such a sadness or hopelessness. The negative feelings an individual has are typically so powerful that the person cannot feel many positive thoughts. In addition to these negative feelings, some patients may complain of irritability. It is important to note the individual’s facial expressions, posture, and tone of voice when they are experiencing classic signs of a depressed mood.
To be diagnosed with Major Depressive Disorder under the DSM-IV criteria, patients must have decreased interest or pleasure in most activities for more than two weeks. Patients with MDD will often become uninterested in activities that they previously found pleasure in participating in and may become agitated in these situations. As an example, for an individual who previously enjoyed listening to music, the idea of music playing may worsen their mood. Unfortunately, in people who suffer from MDD, feelings of worthlessness or excessive inappropriate guilt tend to occur. They may feel as if every action they make is the wrong action, and that they have no value to the world. Correspondingly, those who suffer from an MDD episode often feeling undeserving and may obsess over what they believe was an improper action in past or present events.
Those with MDD often experience indecisiveness and concentrating on any sort of task. They also exemplify impaired function in focusing issues that are seen in occupational, educational, and relationship settings. All of these symptoms typically indicate that there is a mood change that highlights a difference from the person’s baseline self. The most concerning symptom that occurs in MDD is the recurrent thought of death or suicide. These symptoms may vary depending on the severity of the depression (American Psychiatric Association, 1994).
In addition to this symptom, there are also physical changes that are often prevalent in individuals with MDD. These changes impact weight and loss of energy. Appetite changes that occur lead to a significant weight change of at least a five percent difference. This difference is most manifested in a loss of appetite, although some may crave fatty foods that lead to weight gain. The loss of energy stems from fatigue. One may lack their usual amount of energy to perform daily tasks, which relates to poor sleep patterns that lead to insomnia or difficulty falling asleep and staying asleep. In contrast to insomnia, hypersomnia may also occur. This refers to excessive fatigue and time spent sleeping. According to the DSM-IV criteria for MDD, individuals must exhibit at least five of these nine symptoms every day (American Psychiatric Association, 1994). Depression impacts many people worldwide and can become prevalent in many different symptoms.
Despite years of research, the exact etiology of Major Depressive Disorder is unknown. However, many different causes have been discussed and evaluated as theories that this disorder can occur. The most universal understanding of the cause of MDD involves one’s brain chemistry and their neurotransmitters. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and the effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability, may play a significant role in depression and its treatment (Mayo Clinic, 2018). Serotonin is a neurotransmitter that is responcible for an individual’s feelings of well-being and happiness. The low levels of the serotonin neurotransmitter that is active in the brain may lead to one’s MDD.
Similarly to brain chemistry, changes in the body's balance of hormones may be involved in causing or triggering MDD. The changes of levels of hormones, such as those produced by the thyroid gland, can be factors in an individual’s depression. Furthermore, hormone changes can result from thyroid problems, pregnancy and during the weeks or months after delivery (postpartum), and problems related to menopause. Lastly, a possible cause of someone’s MDD is through his or her inherited traits. This type of depression is more common in people whose blood relatives also have this condition. Researchers discovered that polymorphisms, the presence of genetic variations, have been linked to an increased risk for MDD. This meaning that the inherited genes that are involved with neurotransmitters can change their characteristics based on stressors. The most popular gene that is studied in regard to MDD is the serotonin transporter gene. This gene contains a polymorphism that slows down the synthesis of the gene, which results in the serotonin neurons adapting slowly, causing a mood that is not being regulated properly (Fekadu, et al., p. 3).
The DSM-IV Major Depressive Disorder (MDD) diagnosis is highly prevalent in US adults with a high morbidity. The increase in prevalence seems to be due to more updated and reliable diagnostic criteria. The lifetime prevalence in the United States of America (US) is estimated at 16.2% (Hardeveld et al., p.189). Currently, MDD is worldwide and the third leading cause of burden of disease and will rise to the first place spot in the year 2030. In a study conducted by Hardeveld and colleagues, it concluded that in the past 15 years, 85% of people diagnosed with MDD experienced recurrence and that demographic determinants play a role in the onset of the first depressive episode. The research determined the US had a higher prevalence than other foreign countries. Comparatively, the researched concluded that African Americans, and Black Caribbeans had a higher prevalence rate than Caucasians (Hardeveld et al., p.191). In the past few decades, the prevalence of depression has been spoken about timidly. In today’s society, it is more common than not to know someone who has a type of depression, including MDD. As the prevalence of MDD continues to increase in society, research is conducted to develop a more impactful treatment.
Treatment
There are ongoing discussions regarding the effectiveness of treatment of Major Depression Disorder. It is important to note that although there are many types of treatments for MDD, depending on the severity of the diagnosis and how the patient responds, treatment will vary. The two most popular types of treatments among medical professionals include medication and psychotherapy.
Medication
Medication requires patience, as some need several weeks or longer to take full effect and for the side effects to ease as your body adjusts. Anyone taking an antidepressant should be watched closely for worsening depression symptoms or unusual behavior, especially when starting a new medication or with a change in dosage. Some of the most well-known medications are called Selective serotonin reuptake inhibitors (SSRIs). This is a type of antidepressant that works by contributing to the breakdown of serotonin in the brain, which results in a larger amount of this neurotransmitter that will regulate the patient’s mood. These drugs are considered safer for patients and generally cause fewer side effects than other types of antidepressants. Popular SSRIs include Lexapro and Prozac. In addition to SSRIs, another common medication for those with MDD are called Monoamine oxidize inhibitors (MAOIs). This type of medication, such as Marplan, may cause serious side effects, which is why it is used when other drugs have not worked.
Psychotherapy
In addition to medication, psychotherapy is a common treatment for those suffering from MDD. Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health professional. Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy. This type of treatment can help one adjust to a crisis or other current difficulty by helping them identify negative beliefs and behaviors and replace them with healthy, positive ones. It may also give the patient tools for them to regain a sense of satisfaction and learn to set realistic goals for themselves. It is recommended to attempt to treat a person’s MDD by participating in psychotherapy on a regular basis, and if further treatment is needed, to combine therapy with medication.
Long-Term Prognosis
Major depressive disorder (MDD) is a lifelong illness for a majority of patients, with high rates of chronicity and recurrence. In addition, MDD is often a chronic disease that can come back periodically throughout one’s life. Chronic depression can affect about one-quarter of a person's lifetime. Although, in most cases, MDD is a long-term diagnosis, according to Rice University, “a majority people diagnosed with this condition (around 70%) recover within a year” (OpenStax College, 2014). Treated episodes last from 6 weeks to 3 months. However, Untreated depressive episodes can last from 6 to 18 months, but the average is about 8 months. This is a reason why seeking treatment for MDD is imperative to the quality of one’s life. In addition to seeking treatment, it is necessary that if the treatment calls for medication, that they are taking for the full indication provided by the clinician because if not, episodes tend to return prematurely when antidepressants are not taken for the full indication.
Conclusion
Major Depressive Disorder is a type of unipolar depression that is currently increasing in the prevalence of people. Although MDD is often recurrent and chronic, depressive episodes can last up to a few months depending on treatment methods and use. Treatment preferences vary among mental health professionals, but most agree that psychotherapy and medication are the two most effective treatment options in regards to treating and preventing recurrences within the diagnosis. It is imperative to understand that although MDD is common, every patient has a different level of severity and symptoms, and treatment methods vary depending on an individual’s needs. MDD is a mental illness that causes enormous emotional pain, and symptoms can get so severe they lead to death by suicide. Through understanding MDD’s potential etiology, symptoms and how it manifests, Major Depressive Disorder can be managed and an individual diagnosed can manage their life well.