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Major Depressive Disorder (MDD)

Major depressive disorder (MDD), all the more usually known as depression, is a mental issue classified by a steady and industrious low temperament that is supplemented by low self-regard and by lost interest or joy in regularly activities.

As with majorly depressed individuals in general, the borderline patient is likely to exhibit familiar symptoms of major depression, such as fluctuation of weight, irregular sleep patterns, sadness, loneliness, lack of energy, anxiety, feelings of guilt and worthlessness, suicidal gestures or ideation of suicide, lack of interest in once enjoyable activities and persistent irritability (Beatson & Rao, 2012). For example, a man who has missed work or school in light of their discouragement, or has quit going to classes by and large or going to regular social engagements.

An environmental cause may trigger the development of MDD, stress, traumatic events, childhood difficulties account for 60% with the genetic link 40% A discouraged inclination brought about by substances, (for example, drugs, liquor, meds) is not viewed as a noteworthy depressive issue, nor is one which is created by a general therapeutic condition. Real depressive issue for the most part can’t be analysed if a man has a past filled with hyper, hypomanic, or blended scenes (e. . , a bipolar issue) or if the discouraged mind-set is better represented by schizoaffective issue and is not superimposed on schizophrenia, a hallucination or insane issue (Depression Symptoms, Major Depressive Disorder, 2016). Population studies have consistently shown major depression to be about twice as common in women as in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this.

The relative increase in occurrence is related to pubertal development rather than chronological age, reaches adult ratios between the ages of 15 and 18, and appears associated with psychosocial more than hormonal factors (Revolvy, 2016). MDD is a heterogeneous disease, each patient can be confronted with diverse indications of MDD. A Relentless discouraged mind-set or loss of interest are basic characterizing components of MDD, other MDD side effects are likewise determined and changed by the patient. o

Insomnia or hypersomnia o Weight gain or weight loss; increase or decrease in appetite Psychomotor agitation or psychomotor retardation o Fatigue or loss of energy o Feelings of worthlessness or excessive/inappropriate guilt o Diminished ability to think/concentrate or indecisiveness o Recurrent thoughts of death/suicide or suicide attempt MDD determination requires 5 (or more) of the manifestations recorded above, which must be available for no less than 2 weeks, and represent a change from previous functioning. At least one of the symptoms must be either depressed mood or loss of interest or pleasure (Fava & Kendler, 2000).

Depression affects millions of people. But every patient with depression responds to treatment differently. Individuals that suffer from MDD have shorter life expectancies than those without MMD, in part because of greater susceptibility to medical illnesses and suicide. It is unclear whether medications affect the risk of suicide (“Major Depressive Disorder — NEJM”, 2016). The three treatments that are going to be critically analysed are: 1. A minority are treated with electroconvulsive therapy (ECT). 2. Selective serotonin reuptake inhibitors (SSRIs) .

Cognitive Behavioural Treatment (CBT) Treatment 1 – Electroconvulsive Therapy ECT is a form of medical treatment for severe depression, bipolar disorder, and psychotic illnesses such as schizophrenia. It may be recommended when symptoms are severe or other forms of treatment are ineffective. A carefully-controlled electrical current is passed through the brain, affecting the brain’s electrical activity and producing an improvement in depressive and psychotic symptoms (ECT – Electroconvulsive Therapy, 2016).

For some people, other forms of treatment such as medication and counselling have little or no effect on the symptoms of depression or psychosis. This is particularly concerning where symptoms are causing severe distress and the person may even be suicidal. In these cases, ECT seems to be especially helpful, with over 80% of people with depression who receive it reporting an improvement. The brain works through complex electrical and chemical processes. These are affected by mental illnesses, so that they don’t work properly (It’s Allright – SANE, 2016).

Like medication, ECT works by having certain times that the procedure must occur by. ECT is known as an extremely safe treatment, that has no evidence of long term brain damage to the function such as reasoning and creativity. The procedure is always performed under the direct supervision of a psychiatrist and an anaesthetist, nurses also assist during the procedure. A common side effect is memory impairment, many patients report having difficulty with memory which only last or some weeks after treatment.

However, this effect is generally mild and improves with time. It is important that the treating doctor clearly explains these negative as well as positive effects with the person before treatment goes ahead. Treatment 2 – Selective Serotonin Reuptake Inhibitors Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant they include, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline. SSRIs are one of the first choices when someone is first prescribed an antidepressant.

This is because they are as effective as other types of antidepressant, but tend to have fewer side effects than some older types, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) (SSRIs – Selective serotonin reuptake inhibitors, 2016). Serotonin is a neurotransmitter; this is one of the chemicals responsible for transmitting signals between the cells in your brain. SSRIs block the approval of serotonin back into the brain cells which will increase the amount of serotonin available in the brain for transmitting signals.

This increase in serotonin is thought to improve the symptoms of depression. 50% of people claim that their symptoms of depression have more than halved after 8 weeks of taking the medication. SSRIs have an insignificant role in treating children with depression and can only be used under the supervision of a child psychiatrist (SSRIs – Selective serotonin reuptake inhibitors, 2016). Not everyone experiences side effects, All SSRIs work in a similar way and generally cause similar side effects. However, each SSRI has a different chemical makeup, so one may affect you a little differently than another.

You’ll usually need to see your doctor every few weeks when you first start taking SSRIs to discuss how well the medication is working. You can also contact your doctor at any point if you experience any troublesome or persistent side effects. Common (1% of people or more) Infrequent (between 0. 1% and 1% of people) Rare (fewer than 0. 1% of people) Nausea Agitation Insomnia (sleep problems) Drowsiness Tremor (shaking) Dry mouth Diarrhoea Dizziness Headache Sweating Weakness Anxiety Weight gain or loss Sexual dysfunction Runny nose Myalgia (muscle pain) Rash Unusual movements, including trembling of the ands and fingers, twisting movements of the body, shuffling walk, limb stiffness Sedation Confusion Feeling your heart racing or thumping (palpitations) Increased heart rate Low blood pressure Bleeding problems (e. g. bruising, nose bleeds, gastrointestinal or vaginal bleeding) Syndrome of inappropriate antidiuretic hormone secretion (SIADH). This causes low blood sodium, which can have serious consequences (seizures, coma or death). Abnormal changes in liver function tests Galactorrhoea (milk production from the breast) Imbalance in numbers of different types of blood cells

Seizures (fits) Restlessness Paraesthesia (reduced sense of touch) Taste disturbance Table 1. 2 (“SSRIs – Selective serotonin reuptake inhibitors”, 2016) Treatment 3 – Cognitive Behavioural Treatment CBT is a structured psychological treatment which recognises that the way we think (cognition) and act (behaviour) affects the way we feel. CBT involves working with a psychologist or psychiatrist to identify thought and behaviour patterns that are either making you more likely to become depressed, or stopping you from getting better when you’re experiencing depression (Beyond Blue, 2016).

Once you’ve recognised any unhelpful patterns that are contributing to your anxiety, you can make changes to replace these with new ones that reduce anxiety and improve your coping skills (Scott, Palmer, Paykel, Teasdale, & Hayhurst, 2003). For example, you might find yourself stuck in catastrophizing thinking patterns. This means thinking the worst, believing something is far worse than it actually is, or anticipating things will go wrong. CBT helps by teaching you to think that more realistically and focus on problem-solving.

If you actively avoid situations or things that cause depresion, CBT can help you face your fears and approach these situations more rationally. MDD can cause the brain to get stuck in thinking patterns, the mind will blow even the smallest problem in to a major catastrophe or constant that things will go wrong. By using CBT to teach the rethinking more realistically and refocussing on problem-solving. CBT will also aid in the reduction of anxiety associated with MDD with the avoidance socialisation and withdrawal from society by assisting in approaching these situations more rationally and facing fears.

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