Major depression means suppressing and pushing down. It expresses the collapse in Mood. But in major depression, in addition to mood the organism collapses too .
MAJOR DEPRESSION DSM-IV CRITERIONS
A. 2 of 5 in the presence of the following week period with functionality changes, you must have at least one Depressive mood or loss of interest or inability to take pleasure
1. Being in depressive mood during the day. (Feeling sad, in space, tearful appearance)
2. Decreasing interest for the daily activities everyday
3. Losing weight or putting weight.
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation to be (extreme increase or decline in behavior)
6. Fatigue, weariness,losing energy
7. Worthlessness and extreme guiltness (delusional = unreal judgment)
8. Decreasing or instability in concentration
9. Recurrent thoughts of death ( releated to suicide)
B. The repeating of mazily this symptoms isn’t diagnostic criteria.
C. This symptoms don’t depend on substance abuse or general medical condition.
D. Symptoms that last more two months after deaths can’t be explained with mourn.
According to the DSM-V, the subgroups of Major Depressive Disorder
1. Major depressive disorder
2. Dysthymic disorder
– If there is the presence of depressive mood as chronic during at least 2 years, this situation could be defined such.
– People define their emotions as sad or hit rock bottom.
– Depressed mood periods
– Anorexia and bulimia
– Insomnia and hypersomnia
– Low self esteem
– Inability to concentrate or difficulty in making decisions
3. Inability to regulate destructive mood disorder
– That has continued at least for one year or that starts before being 10
– Chronic, irritable and angry mood
– Repeat at least three times a week tantrums
4. Premenstrual dysphoric disorder
– Symptoms; markedly depressed mood, anxiety, emotional lability,losing interest
– It regularly starts in the last week of luteal phase, several days after menstruation starts , it finishes.
5. Substance or drug-induced depression
– This is related to the physiological effects of drug, or toxin. It is evident and recalcitrant mood.
6. Depressive disorder that depends on other medical situation.
– Vascular (CVA / stroke)
– Dementia and depression
– Coronary Artery Disease
– A cancer diagnosis
– Chronic Fatigue Synd.
7. The other stated depressive disorder
8. Unspecified depressive disorder
– If decide suicide, preventing is impossible.
– The people that think dying is unwiling to want help
– Speaking about suicide is risky.
– The person that talks about sucide doesn’t do it. One that will do it, doesn’t tell.
– The person that tries to kill or kill himself is definetly crazy
– The person that tries suicide, repeat it.
Treatment Methods Psychotherapeutic Interventions
– Mild to moderate major psychotherapy alone may be enough effective as initial treatment of major Depressive Disorder.
– The frequency of treatment and follow-up physician
– The type and goals of psychotherapy
– The time required for the establishment and development of the therapeutic relationship
– Treatment monitoring and compliance to monitor the risk of suicide or needed to be set according to the time difference.
– The provision of these services is not possible in primary care, specialized mental health services are an indication of the orientation.
– Antidepressant drugs are given as first-line treatment for mild symptoms of Major Depressive disorder, but must be used for those symptoms in moderate-severe.
– 6-8 weeks after the start of treatment should be seen improvement in symptoms.
– Studies of the antidepressant maintenance therapy, showed that ensures that the continued well-being and prevent recurrence.
– Effective treatment must be planned in time and dose
– Treatment of the first episode at least 6 months and 2 years should take 2 attacks
– Medicines should improve starting in low doses and reducing the steps should be terminated.
– Now begins the desired effect principle (3 weeks)
– Which already benefit from using the drug should be first choice
– None of those who treat each other in a decisive advantage
– The only option the first 3 months of pregnancy ECT
– Alcohol should not be taken during antidepressant treatment
– Medication explain to the patient, to explain that we give the drug as a substance in the brain, which improves medication adherence decreased.
– These druSSR And should not be combined in principle MAOI therapy, transition should be done if in the meantime a cleaning duration of 2 weeksgs (except benzodiazepines) are not addictive.
– From 7 days of drug therapy is more likely to commit suicide some time, it should be followed closely.
– Primary care physician to assess the effectiveness of treatment should learn one depression scale
– Acute patients 1-2 weeks, one must be seen in 1-2 months during maintenance treatment
Electroconvulsive therapy (ECT)
– It is the most effective treatment method
– Success rate 90%
– Who do not respond to antidepressants, eating and drinking while for patients
– The patient is anesthetized with a short-acting anesthetic
– Succinylcholine is given.
– Then two given electrical current to the electrodes 15-45 seconds for patients with generalized tonic-clonic seizure is provided.
– Memory disorder after, muscle pain, post-ictal confusion
Commonly Used Antidepressant Medications
– Selective serotonin reuptake inhibitors (SSRI)
– Seroto Noradrenaline reuptake inhibitors (SNRI)
– Dopamine – Norepinephrine reuptake inhibitors
– Tricyclic Antidepressants
– Monoamine oxidase (MAO) inhibitors
Prevalence of Major Depressive
– The lifetime prevalence is about 3.5-5.8%
– One-year prevalence is about 2.6-6.2%
– Prevalence Shows gender differences.
– Males are up 3-12%
– Women are 10-20%
– The average age of onset is 27.
– 12-20% cases tend to chronicity
– 9% of episodes of depression who also give a history of mania.
– Any Affiktif disorder, lifetime prevalence is about 7-8%.