Major Depressive Disorder - MDD :
Certainly. Major Depressive Disorder (MDD), also known as clinical depression, is a mental health condition characterized by a persistent and pervasive low mood, loss of interest or pleasure in most activities, and a variety of other cognitive, emotional, and physical symptoms that significantly impair daily functioning.
Diagnostic Criteria (DSM-5) :
To diagnose MDD, at least five of the following symptoms must be present for a minimum of two weeks, and they must represent a change from previous functioning. At least one of the symptoms must be either depressed mood or anhedonia (loss of interest or pleasure).
- Depressed mood : Most of the day nearly every day.
- Anhedonia : Markedly diminished interest or pleasure in all, or almost all, activities.
- Significant weight change : Either weight loss when not dieting or weight gain.
- Sleep disturbances : Insomnia or hypersomnia.¨
- Psychomotor changes : Observable psychomotor agitation or retardation.
- Fatigue : Loss of energy nearly every day.
- Feelings of worthlessness or guilt : Excessive or inappropriate guilt.
- Cognitive impairments : Diminished ability to think, concentrate, or make decisions.
- Recurrent thoughts of death : Suicidal ideation, with or without a specific plan.
These symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning and must not be attributable to the physiological effects of a substance or another medical condition.
Etiology :
MDD is multifactorial in origin :
- Genetic predisposition : Family history increases risk.
- Neurochemical dysregulation : Abnormal levels of neurotransmitters, such as serotonin, norepinephrine, and dopamine.
- Neuroanatomical changes : Altered function in brain regions like the prefrontal cortex and hippocampus.
- Psychosocial : stressors : Chronic stress, trauma, or significant life changes.
- Medical comorbidities : Conditions like hypothyroidism, chronic pain, or diabetes.
Pathophysiology :
MDD involves disruptions in :
- Monoamine neurotransmitter systems : Reduced serotonin, norepinephrine, and dopamine activity.
- Hypothalamic-pituitary-adrenal (HPA) axis : Hyperactivity leading to elevated cortisol levels.
- Neuroplasticity : Impaired and neurogenesis, particularly in the hippocampus.
- Inflammatory markers : Elevated levels of pro-inflammatory cytokines have been implicated.
Management :
Pharmacological Treatment :
Antidepressants :
- Selective serotonin reuptake inhibitors (SSRIs) : First-line agents (e.g: fluoxetine, sertraline).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) : Venlafaxine, duloxetine.
- Tricyclic antidepressants (TCSs) : Amitriptyline (used less frequently due to side
effects). - Atypical antidepressants : Bupropion, mirtazapine.
- Monoamine oxidase inhibitors (MAOIs) : Rarely used due to dietary restriction.
- Atypical antipsychotics or mood stabilizers in treatment-resistant cases.
Psychotherapy :
- Cognitive-behavioral therapy (CBT) : Effective for modifying negative thought patterns.
- Interpersonal therapy (IPT) : Focuses on improving relationships and social functioning.
- Psychodynamic processes influencing behavior.
Other Interventions :
- Electroconvulsive Therapy (ECT) : For severe or refractory depression.
- Transcranial Magnetic Stimulation (TMS) : Non-invasive neuromodulation technique.
- Lifestyle modifications : Regular exercise, sleep hygiene, and nutritional improvements.
- Mindfulness-based therapies : Meditation and stress management techniques.
Prognosis :
- Course : MDD is episodic in nature, with variable duration and recurrence.
- Risk of recurrence : Higher in those with multiple prior episodes, ongoing psychosocial stressors, or incomplete recovery from prior episodes.
- Complications : Suicidal behavior, substance abuse, and significant functional impairment if untreated.
Preventive Strategies :
- Early identification and management or risk factors.
- Ongoing support systems and adherence to treatment.
- Regular follow-ups to monitor symptoms and adjust therapy as needed.
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