Major Depressive Disorder
Definition
A major depressive disorder, sometimes called endogenous depression, is not merely sadness or grief but is a genuine psychiatric illness that affects both your mind and your body. If you are depressed, you tend to retreat from human relationships, have trouble functioning in society and using your talents, be unable to enjoy life, and even feel suicidal.
Stricken with much more desperate feelings than merely the "blues" or being "down in the dumps," you may become incapacitated, unable to hold a steady job, derive no pleasure from your life, and have difficulty interacting with others. Sometimes, although not always, you may have psychotic symptoms such as hallucinations or delusions. By and large, however, the physical symptoms of depression-a characteristic hollowness around your eyes, uninflected speech, and a slowed gait-are the signs of depression.
Depression is more common among women than among men. Because it is both debilitating and associated with suicidal tendencies, a major depressive disorder is considered serious. But this type of depression, even in its most severe form, occasionally is self-limited. It may run its course and terminate without treatment within 6 months to a year. Meanwhile, however, your existence may be almost intolerable, and suicide is a great temptation.
Symptoms
- Change in physical demeanor-either a noticeable slowing down or "dragging," or a discernible speeding up or agitation.
- Distinct quality to the depressed mood (different from the feeling one has after the death of a loved one).
- Lack of response to environmental changes (day/night, sun/rain, leisure/work).
- Loss of interest in activities usually enjoyed, including sex.
- Fatigue or loss of energy.
- Poor appetite and attendant weight loss.
- Insomnia or hypersomnia.
- Self-reproach or inappropriate guilt.
- Suicidal behavior.
- Sometimes, hallucinations or delusions.
- No apparent "trigger" (precipitating event).
Conventional Treatment
Because depression is so common, many therapies have been developed to treat it. At first, treatment of a major depression often includes hospitalization, especially if you threaten suicide or display suicidal behavior.
The various types of therapy have some characteristics in common. Virtually all therapeutic situations operate on the assumption that you can change, that you can learn to cope better with life traumas and inner struggles. If you are depressed, you usually visit the psychiatrist because you believe that there is hope for relief.
Psychotherapy is used, often in conjunction with medication, to help you understand the sources of your depression and to find other ways of coping with inner conflicts.
Cognitive therapy is a short-term psychotherapy developed to treat both depression and anxiety. The idea is that self-defeating patterns of thinking make us feel depressed because our negative thoughts influence our feelings. In cognitive therapy, you may be asked to write down your negative thoughts. The therapist then helps you identify the distortions in them and suggests constructive alternatives.
Medications to treat depression come in three main types, the tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRI's), and the monoamine oxidase inhibitors (MAOIs).
Antidepressants are more helpful when your depression has discrete episodes that seem to have a life of their own rather than in chronic or situational depression. Imipramine (Tofranil) and amitriptyline (Elavil) are the most frequently used tricyclic antidepressants, but the most common type of antidepressant medication used today is the SSRI's. Examples are fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil). However, no medications deal with the intrapsychic and interpersonal issues that may have contributed to your depression. For this reason, the most effective treatment may be to combine both medication and psychotherapy.
In the movies, electroconvulsive therapy (ECT) has been depicted as repressive and cruel, but most psychiatrists consider it one of the most effective and humane treatments for depression. It is used primarily for major depressive episodes.
Unlike antidepressants, ECT works quickly (often within a few days) and is more likely to be decisively helpful when the problem is serious. Physicians do not know exactly how it works, but it may alter the rate at which brain chemicals, called catecholamines, affect your central nervous system cells.
Before undergoing ECT, you are anesthetized with a barbiturate and given a muscle relaxant. Side effects commonly include temporary memory loss, headaches, and muscle aches. Nonetheless, ECT remains the most effective treatment available for major depression. Its risks are significantly lower than the risks of untreated severe depression (which include suicide). ECT can be safely used in most medically ill and elderly patients.
Other Types of Depression
Depression
Manic-Depressive Illness
Seasonal Affective Disorder
Situational Depression
Suicide (Potential)