MAJOR DEPRESSIVE DISORDERS

MOOD DISORDERBY

NAGOOR GHANY , RUZA ICAJUN IOR INTERN, VMU .

OVERVIEW• Major Depressive Disorder is also known as Major Depression, Clinical Depression or Unipolar Disease.• The term depression was derived from the Latin

verb deprimere - "to press down".• The most Common type of Mood Disorders.• At least 2 weeks of a major depressive episode

which causes significant distress or disability• No history of mania or hypomania• Not due to a medical or substance use disorder

HOW DOES DEPRESSION FEEL?

SYMPTOMS• In typical depressive episodes, the person

experiences –depressed mood– loss of interest and enjoyment (anhedonia), and

–reduced energy • leading to diminished activity for at least 2

weeks. Many people with depression also suffer from anxiety symptoms and medically unexplained somatic symptoms. 

SYMPTOMS•Usually significant weight loss and decrease

in appetite–Increase in appetite and weight can occur, but

not commonly•Feeling worthless, immense guilt, and regret•Frequent insomnia or hypersomnia•Fatigue, loss of energy frequently, lethargy•Markedly less ability to think and

concentrate•Recurring thoughts of death

–These are serious thoughts, sometimes even with plans or attempts for suicide

CAUSES of MDD• Biological factors

– genetic predisposition, – brain structures, – neurotransmitters

• Personality Styles• Socio-cultural factors

– Divorce– Death– Child Abuse

• Early family relationships • Cognitive styles

GENETIC FACTORS

• Family studies:Relatives of those with MDD are two to three times more likely to have a mood disorder (usually major depression).

• Twin studies:If one identical twin has a depressive disorder the other twin is 3 times more likely than a fraternal twin to have the disorder .

• Severe depressive episodes may have stronger genetic contribution than less severe episodes.

• Heritabi l i ty rates are higher for females.

Brain structure abnormalities (MRI findings)• Low Frontal lobe volume and increase

ventricular volume• Smaller hippocampus – important

serotonin receptorNeurotransmitters• Monoamine hypothesis.• Low levels of serotonin

(norepinephrine, and/or dopamine) deregulates the activity of other neurotransmitters and leads to mood destabilization and depression.

Endocrine system• Elevated cortisol levels• Increased level of Growth Hormone

(Prepubertal Children)

Psychological CausesOne psychological theory is the

Attachment Theory.The Attachment Theory predicts a relationship between depressive disorder in adulthood and the quality of the earlier bond between the infant and their adult caregiver.

SUBTYPES5 subtypes recognized by the DSM-IV(Diagnostic and Statistical Manual of Mental Disorder)• Melancholic Depression• Atypical Depression• Catatonic Depression• Postpartum Depression• Seasonal Affective Disorder

DIAGNOSIS• Self report and complains or observation

of others• Self screening Instruments

– Patient Health Questionnaire-9– Beck Depression Inventory (BDI) or the Beck

Depression Inventory-II (BDI-II)– Zung Self-Rating Depression Scale: A 20-item

survey.• Rating perform by the Consultant

– Hamilton Depression Rating Scale (HDRS)– Geriatric Depression Scale

TREATMENT• Medicinal

– Antidepressants (sertraline, citalopram)• Selective serotonin reuptake inhibitors (SSRIs)• Serotonin/norepinephrine reuptake inhibitors (SNRIs)• Atypical antidepressants• Tricyclic antidepressants (TCAs)• Monoamine oxidase inhibitors (MAOIs)

• work by restoring chemicals in the brain to the right levels

- Tranquilizers

• Therapy– Cognitive Behavioral Therapy• focuses on fighting off negative thoughts

– Psychotherapy• focuses on issues behind thoughts and feelings

– Group Therapy• share problems with other people in the same

situation– Electroconvulsive therapy• in severe cases of major depression.

“HOPE is Being able to see that there is lightdespite all of darkness”- Desmund Tutu