Video:Major depressive disorder

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Overview

Major depressive disorder (MDD), also known simply as depression, is a mental disorder, characterized by at least two weeks of low mood, that is present across most situations.[1]

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Symptoms

It is often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause.[1]

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Other symptoms

People may also occasionally have false beliefs, or see or hear things that others cannot.[1] Some people may have periods of depression, separated by years in which they are normal, while others nearly always feel its effects.[2]

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Effects

Major depressive disorder can negatively affect a person's personal life, work life, or education, as well as sleeping, eating habits, and general health.[1][2]

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Suicide

Between 2–8% of adults with major depression die by suicide,[3][4], and about 50% of people who die by suicide had depression, or another mood disorder.[5]

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Cause

Depression is believed to be cause by a combination of genetic, environmental, and psychological factors.[1]

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Diathesis-stress model

One theory, is the diathesis–stress model. It theorizes, that depression occurs when someone has a preexisting vulnerability (such as an inherited link to depression) that is activated by stressful life events.[6]

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Risk factors

Risk factors include, a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse.[1][2]

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Genetics

About 40% of the risk appears to be related to genetics.[2]

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Diagnosis

The diagnosis of major depressive disorder, is based on the person's reported experiences, and a mental status examination.[7]

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Testing

There is no laboratory test for major depression.[2] Testing however, may be done to rule out physical conditions that can cause similar symptoms.[7] Major depression is more severe, and lasts longer than sadness, which is a normal part of life.[2]

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Screening

Some have recommended screening for depression, in people over 12 years old,[8][9], but a Cochrane review found that the routine use of screening questionnaires, has little effect on detection or treatment.[10]

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Treatment

Depression is treatable, as long as it's recognized. The three most common treatments for depression, are psychotherapy, medication, and electroconvulsive therapy, in combination with lifestyle changes. Psychotherapy is the treatment of choice for people under 18[11].

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Mild depression

Even for people over 18, it is recommended that antidepressants should not be used for the initial treatment of mild depression, because the risks, often out-weigh the benefits.[12].

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Exercise and counselling

Instead, increasing exercise[13], smoking cessation,[14] and counseling, such as cognitive behavioral therapy and interpersonal therapy, are advised.[1][15].

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Medication

Recommendations are that antidepressants, in combination with psychosocial counselling, should be reserved for the following situations;

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Medication1

people with a history of moderate, or severe depression,

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Medication2

those with mild depression that has been present for a long period,

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Medication3

as a second line treatment for mild depression that persists after other interventions,

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Medication4

or as a first line treatment for moderate or severe depression.

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Medication limitations

Medication can be effective, but the effect may only be significant in the most severely depressed.[16][17] It is unclear whether medications affect the risk of suicide.[18]

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ECT and hospitalization

If other measures are not effective, electroconvulsive therapy (ECT) may be considered.[1] Hospitalization may also be necessary, especially when a person is at risk of hurting themselves, even if it is against their wishes.[19]

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Epidemiology

Major depressive disorder affected approximately 3% of the world's population in 2015,[20] with as many as 21% affected at one point in their life.[21]

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Age and gender

The most common time of onset, is in a person's 20s and 30s.[2][21] Females are affected about twice as often as males.[2][21]

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History

Historically, depression was called melancholy, and even the 16th American president Abraham Lincoln, suffered from a condition that now may be referred to as clinical depression.[22]

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References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 "Depression". NIMH. May 2016. Archived from the original on 2016-08-05. Retrieved 2016-07-31.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 160–68, ISBN 978-0-89042-555-8, archived from the original on 31 July 2016, retrieved 22 July 2016
  3. Richards CS, O'Hara MW (2014). The Oxford Handbook of Depression and Comorbidity. Oxford University Press. p. 254. ISBN 978-0-19-979704-2.
  4. Strakowski S, Nelson E (2015). Major Depressive Disorder. Oxford University Press. p. PT27. ISBN 978-0-19-026432-1.
  5. Bachmann, S (6 July 2018). "Epidemiology of Suicide and the Psychiatric Perspective". International Journal of Environmental Research and Public Health. 15 (7): 1425. doi:10.3390/ijerph15071425. PMC 6068947. PMID 29986446. Half of all completed suicides are related to depressive and other mood disorders
  6. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, McClay J, Mill J, Martin J, Braithwaite A, Poulton R (July 2003). "Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene". Science. 301 (5631): 386–89. Bibcode:2003Sci...301..386C. doi:10.1126/science.1083968. PMID 12869766.
  7. 7.0 7.1 Patton LL (2015). The ADA Practical Guide to Patients with Medical Conditions (2 ed.). John Wiley & Sons. p. 339. ISBN 978-1-118-92928-5.
  8. Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP (January 2016). "Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement". JAMA. 315 (4): 380–87. doi:10.1001/jama.2015.18392. PMID 26813211.
  9. Siu AL (March 2016). "Screening for Depression in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement". Annals of Internal Medicine. 164 (5): 360–66. doi:10.7326/M15-2957. PMID 26858097.
  10. Gilbody S, House AO, Sheldon TA (October 2005). "Screening and case finding instruments for depression". The Cochrane Database of Systematic Reviews (4): CD002792. doi:10.1002/14651858.CD002792.pub2. PMID 16235301.
  11. NICE (2005). NICE guidelines: Depression in children and adolescents. London: NICE. p. 5. ISBN 978-1-84629-074-9. Archived from the original on 24 September 2008. Retrieved 16 August 2008.
  12. "Depression". National Institute for Health and Care Excellence. December 2004. Archived from the original on 15 November 2008. Retrieved 20 March 2013.
  13. "Management of depression in primary and secondary care" (PDF). National Clinical Practice Guideline Number 23. National Institute for Health and Clinical Excellence. 2007. Archived (PDF) from the original on 17 December 2008. Retrieved 4 November 2008.
  14. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P (February 2014). "Change in mental health after smoking cessation: systematic review and meta-analysis". BMJ. 348 (feb13 1): g1151. doi:10.1136/bmj.g1151. PMC 3923980. PMID 24524926.
  15. Driessen E, Hollon SD (September 2010). "Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators". The Psychiatric Clinics of North America. 33 (3): 537–55. doi:10.1016/j.psc.2010.04.005. PMC 2933381. PMID 20599132.
  16. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J (January 2010). "Antidepressant drug effects and depression severity: a patient-level meta-analysis". JAMA. 303 (1): 47–53. doi:10.1001/jama.2009.1943. PMC 3712503. PMID 20051569.
  17. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT (February 2008). "Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration". PLoS Medicine. 5 (2): e45. doi:10.1371/journal.pmed.0050045. PMC 2253608. PMID 18303940.
  18. Braun C, Bschor T, Franklin J, Baethge C (2016). "Suicides and Suicide Attempts during Long-Term Treatment with Antidepressants: A Meta-Analysis of 29 Placebo-Controlled Studies Including 6,934 Patients with Major Depressive Disorder". Psychotherapy and Psychosomatics. 85 (3): 171–79. doi:10.1159/000442293. PMID 27043848.
  19. American Psychiatric Association (2006). American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. American Psychiatric Pub. p. 780. ISBN 978-0-89042-385-1.
  20. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  21. 21.0 21.1 21.2 Kessler RC, Bromet EJ (2013). "The epidemiology of depression across cultures". Annual Review of Public Health. 34: 119–38. doi:10.1146/annurev-publhealth-031912-114409. PMC 4100461. PMID 23514317.
  22. Wolf, Joshua "Lincoln's Great Depression" Archived 20 October 2011 at WebCite, The Atlantic, October 2005, Retrieved 10 October 2009