Major Depressive Disorder
The first guideline chosen by Quest Behavioral Health is the American Psychiatric Associations (APA) Guideline for the treatment of major depressive disorder: Practice Guideline for the Treatment of Patients with Major Depressive Disorder (Revision). The American Psychiatric Association was founded in 1844 and is a nation-wide professional medical society. Members of the APA include medical professionals who specialize in the diagnosis and treatment of mental health and substance use disorders.
Major depressive disorder is a real illness that many people experience. Some symptoms of depression are depressed mood, loss of interest or pleasure, changes in appetite, changes in sleep pattern, fatigue or loss of energy, feelings of worthlessness or guilt, and inability to make decisions or concentrate. Significant progress has been made in the understanding of the disorder and its treatment. Depression may begin at any age but usually appears in the late 20's. The length of a depression is variable and can be decreased with treatment. Without treatment, depression can last six months or longer.
Some individuals will also have manic episodes. A definition of mania is excess energy with little need for sleep. A manic person often increases activities like shopping, cleaning, gambling, or walking. Persons with both depression and mania will have a diagnosis of bipolar disorder.
Studies indicate that people who experience one episode of depression have a 50% to 85% greater chance of experiencing another episode. The next episode is usually within two to three years. There can be many years between each depression experience. Other individuals may have clusters. At times, the frequency can increase with age. The pattern of depression can also follow the seasons. The symptoms may begin and end at the same time each year. In this part of the world, symptoms typically appear in October or November and leave between February and April. Between each depression, life usually returns to normal. Only 20% to 35% of the cases experience ongoing symptoms. A family history of recurrent major depressive disorder increases the possibility that a person's own illness will be recurrent and will not fully recover between episodes.
In addition to a family history, there are other demographic and psychosocial variables which can impact the identification and treatment of depression. Major depressive disorder may follow a significant life event such as the loss of a loved one. Bereavement is considered a severe stressor and often includes depressive signs and symptoms. Family distress can predispose an individual to depression and hinder the response to treatment. Cultural differences such as a language barrier may also hinder accurate assessment. Symptoms may vary between cultures. Both ethnicity and gender can impact on responses to medications. There are also generational differences in presentation. Small children often have behavioral problems while adolescents may present with somatic complaints, poor grades in school, and rebelliousness. Symptoms of depression in older age often involve more cognitive, sleep, appetite, and energy disturbance. The elderly complain less and may be misdiagnosed with physical illness, dementia, or as simply getting older.
There are many complications related to depression. Major depressive disorder can result in suicide or other violent acts. It can also cause marital, parental, social, and employment problems. The family and friends of the individual may also experience distress. Depression often interferes with personal relationships and decreases the ability to parent. Work attendance and quality often suffer and could lead to unemployment. Major depressive disorder may also complicate recovery from medical illnesses.
Treatments are both needed and available. Treatment begins with an evaluation. The evaluation compares the symptoms of the individual to the definition in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) to determine the diagnosis. A physical is important to determine if medical problems, including the effects of drugs and alcohol, are causing or contributing to the depression. The provider will make treatment suggestions after completing the evaluation. Treatment options include medication, counseling, and electroconvulsive therapy (ECT). Symptoms and individual preference will direct the treatment choice.
A single type or combination of treatments may be used. Research shows that the use of psychotherapy and medication has better results than a single modality alone. Recent studies indicate that adding therapy for persons who only experience a partial response to medication may be beneficial and prevent relapse. If more than one clinician is providing care, communication is important. The clinicians should have regular contact with each other and the individual in treatment. The sharing of information will help guide treatment decisions. It is also important to keep appointments and take medications as directed for treatment to be successful.
