Major Depressive Disorder
Ethan Scott
Oral Roberts University

Major Depressive Disorder
Overview and Symptoms “Depression is related to the normal emotions of sadness and bereavement, but it does not remit when the external cause of these emotions dissipates, and it is disproportionate to their causes” (Belmaker, 2008, p. 55). Severe states of depression often have no external precipitating cause, but it is hard to truly know if there was an external cause or not when dealing with severe depression (Belmaker, 2008). It is also known to occur with other mental health conditions such as anxiety, eating disorders, substance abuse, etc. Major depressive disorder affects approximately 14.8 million American adults, which equals about 6.7 percent of the U.S. population age 18 and older in a given year. It is also the leading cause of disability in the U.S. for ages 15-44. While major depressive disorder can develop at any age, the median age at onset is 32 and is more prevalent in women than in men (Numbers Count, 2014).
Diagnosis of Major Depression “The diagnosis of major depression requires a distinct change of mood, characterized by sadness or irritability and is accompanied by some psychophysiological changes” (Belmaker, 2008, p. 56). Major depression can be easy to diagnose from anyone with experience dealing with depression, but understanding the cause of the depression, internally or externally, can be a tough challenge (Carey, 2013). Symptoms of major depression can vary in impact and severity, and many people who have major depression have a combination of multiple symptoms listed.
List of Symptoms * Feelings of sadness, emptiness or unhappiness. * Angry outbursts, irritability or frustration, even over small matters. * Loss of interest or pleasure in normal activities, such as sex. * Sleep disturbances, including insomnia or sleeping too much. * Tiredness and lack of energy, so that even small tasks take extra effort. * Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people. * Anxiety, agitation or restlessness — for example, excessive worrying, pacing, hand-wringing or an inability to sit still. * Slowed thinking, speaking or body movements. * Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that are not your responsibility. * Trouble thinking, concentrating, making decisions and remembering things. * Frequent thoughts of death, suicidal thoughts, suicide attempts or suicide. * Unexplained physical problems, such as back pain or headaches. (Mayo Clinic Staff, 2014) As you can see, depression changes the way you see yourself, the goodness in your life, and everyone around you. It also has some very extreme physiological changes that affect your health and well-being, as wells your ability to do tasks that seem normal.
Treatment of Major Depressive Disorder Treating major depression can be difficult and enduring, but even in the most severe cases, depression can be treated. The earlier that treatment can begin, the more effective it is. The first step to getting appropriate treatment is to visit a doctor or mental health specialist. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression (Griffin, 2014). A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If a doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation. It is best to visit a mental health doctor to get a complete history of the patient’s symptoms and his or her family’s history with depression or other mental disorders (Griffin, 2014). The mental health professional may also ask if the patient is using alcohol or drugs, and if he or she is thinking about death or suicide. Once diagnosed, a person with depression can be treated in several ways. The most common treatments are medication, psychotherapy, and electroconvulsive therapy (Depression, 2009). Since there are many causes for major depression, some people need to combine treatment techniques until they find the best fit (Long, 2000).
Medication
Anti-Depressants primarily work on neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work (Depression, 2009). Anti-depressants are some of the most effective treatments for major depression with a rating of “good” or 50-75% effectiveness in benefiting the patient (Long, 2000). Some of the newest and most popular antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are some of the most commonly prescribed SSRIs for depression. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). SSRIs and SNRIs tend to have fewer side effects than older antidepressants, but they sometimes produce headaches, nausea, jitters, or insomnia when people first start to take them. These symptoms tend to fade with time. Some people also experience sexual problems with SSRIs or SNRIs, which may be helped by adjusting the dosage or switching to another medication (Depression, 2009). Tricyclics are older antidepressants that are powerful, but they are not used as much today because their potential side effects are more serious than the newer drugs. They may affect the heart in people with heart conditions. They sometimes cause dizziness, especially in older adults. They also may cause drowsiness, dry mouth, and weight gain. These side effects can usually be corrected by changing the dosage or switching to another medication. However, tricyclics may be especially dangerous if taken in overdose. Tricyclics include imipramine and nortriptyline (Depression, 2009).
Psychotherapy
Two main types of psychotherapies—cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT)—are effective in treating depression (Mayo Clinic Staff, 2014). CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help people recognize things that may be contributing to the depression and help change behaviors that may be making the depression worse. IPT helps people understand and work through troubled relationships that may cause their depression or make it worse (Hunter, 2013).
For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for preferences of certain people, psychotherapy may not be enough (Depression, 2009). For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back (Long, 2000). Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years (Depression, 2009). Because there are many variables with therapy (who the therapist is, why the client is going, how often he or she is going, etc.), it can be hard to determine how effective it is in general, but it is always assumed to be helpful especially when coupled with another treatment (Carey, 2013).
Electroconvulsive Therapy
For cases in which medication and/or psychotherapy does not help relieve a person’s treatment-resistant depression, electroconvulsive therapy (ECT) may be useful. Electroconvulsive therapy is a procedure in which electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses, including major depression (Mayo Clinic Staff, 2012).
Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. He or she sleeps through the treatment and does not consciously feel the electrical impulses. Within 1 hour after the treatment session, which takes only a few minutes, the patient is awake and alert. A person typically will undergo ECT several times a week, and often will need to take an antidepressant or other medication along with the ECT treatments. Although some people will need only a few courses of ECT, others may need maintenance ECT—usually once a week at first, then gradually decreasing to monthly treatments. ECT also has a “good” effectiveness, with 50-75% of patients benefitting from the treatment (Mayo Clinic Staff, 2012). After researching ECT thoroughly, there appears to be no real understanding from scientists on how the treatment works to relieve depression. There are many changes that occur that deal with the chemistry and functioning of the brain, but this procedure still has mystery surrounding how it works and why it works.
Physiological Changes Evidence from neuroscience, genetics, and clinical investigation demonstrate that depression is a disorder of the brain. Modern brain imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters are out of balance (Hunter, 2013). Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. According to James Hunter, “Studies of brain chemistry and of mechanisms of action of antidepressant medications continue to inform the development of new and better medical and psychotherapy treatments” (Hunter, 2013). That being said, there are still many questions regarding the physiological differences between someone who is depressed and someone who is not. Scientists and researchers learn most of their information regarding the physiology of depression through trial and error. Trying different treatments on patients allows them to make theories on what exactly is happening in a person’s brain that causes the depression.
Genetics Research
Researchers are increasingly certain that genes play an important role in vulnerability to depression (Levinson, 2011). In recent years, the search for a single, defective gene responsible for each mental illness has given way to the understanding that multiple gene variants, acting together with yet unknown environmental risk factors or developmental events, account for the expression of psychiatric disorders. Identification of these genes, each of which contributes only a small effect, has proven extremely difficult.
However, new technologies, which continue to be developed, are beginning to allow researchers to associate genetic variations with disease, such as unraveling the human genome (Levinson, 2011).
Hormonal Abnormalities The hormonal system that regulates the body's response to stress, the hypothalamic-pituitary-adrenal (HPA) axis, is overactive in many patients with depression, and NIMH researchers are investigating whether this phenomenon contributes to the development of the illness (Hunter, 2013).
The hypothalamus, the brain region responsible for managing hormone release from glands throughout the body, increases production of a substance called corticotropin releasing factor (CRF) when a threat to physical or psychological well-being is detected. Elevated levels and effects of CRF lead to increased hormone secretion by the pituitary and adrenal glands which prepares the body for defensive action. The body's responses include reduced appetite, decreased sex drive, and heightened alertness. Research suggests that persistent over-activation of this hormonal system may lay the groundwork for depression. The elevated CRF levels detectable in depressed patients are reduced by treatment with antidepressant drugs or ECT, and this reduction corresponds to improvement in depressive symptoms (Hunter, 2013).
Conclusion
Major depression is a widespread disorder affecting people of all ages around the globe. Although there are treatments that are known to be effective at combating major depression, there is still plenty of uncertainty about the physiological problems that cause depression and how certain treatments are effective. There is promising research that is slowly beginning to uncover some of the brain, hormone, and genetic issues that could be a cause of depression. This new research will hopefully give us more information about the causes of depression and allow us to treat it more effectively.

References
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Hunter, J. (2013, October 9). Depression research- Psych Central. Retrieved from http://psychcentral.com/disorders/depressionresearch.htm
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