Major depressive disorder overview

Major depressive disorder Microchapters

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Major Depressive Disorder (Patient Information)

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Major depressive disorder from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Substance/Medication-induced Depressive Disorder

Depressive Disorder due to a Medical Condition

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Psychotherapy

ECT

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Follow-up

Follow-Up

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Mitra Chitsazan, M.D.[2]

## Overview

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Major depressive disorder a psychiatric disorder characterized by a pervasive low mood, loss of interest in usual activities, and a diminished ability to experience pleasure (anhedonia).

Depressive symptoms may affect quality of life more that the cardiac ejection fraction or cardiac ischemia[1] or other illnesses[2].

## Historical Perspective

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Clinical depression was originally considered to be a chemical imbalance in transmitters in the brain, a theory based on observations made in the 1950s of the effects of reserpine and isoniazid in altering monoamine neurotransmitter levels and affecting depressive symptoms.

## Classification

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Based on the duration of symptoms, timing, and the presumed etiologies, depressive disorders are classified into 7 subtypes: major depressive disorder, persistent depressive disorder (or dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder.

## Pathophysiology

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The exact pathogenesis of major depressive disorder is not fully understood. However, it is thought that major depressive disorder is the result of decreased levels of serotonin, norepinephrine, and dopamine.

## Causes

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Current theories regarding the causes of major depressive disorder can be broadly classified into two categories, Physiological and Sociopsychological.

## Differentiating Major depressive disorder from Other Diseases

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Major depressive disorder must be differentiated from other causes of depressive symptoms.

## Epidemiology and Demographics

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The one-year prevalence of major depressive disorder is approximately 7,000 per 100,000 (7%) of the overall population with marked differences by age groups.

## Risk Factors

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Risk factors for clinical depression include genetic, temperamental, environmental, and psychological factors.

## Screening

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According to theU.S. Preventive Services Task Force (USPSTF), screening for major depressive disorder is recommended in children and adolescents 12 to 18 years of age, in older adults, and in pregnant women (at least once during pregnancy and again 4-8 weeks after delivery).

## Natural History, Complications, and Prognosis

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Common complications of [[major depressive disorder include alcohol or substance abuse, physical health problems, and suicide.

## Diagnosis

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### Diagnostic Study of Choice

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Major depressive disorder is diagnosed based on the DSM-V Diagnostic Criteria.

### History and Symptoms

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Clinical depression can present with a variety of symptoms, but almost all patients display a marked change in mood, a deep feeling of sadness, and a noticeable loss of interest or pleasure in favorite activities.

### Physical Examination

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Physical examination of patients with major depressive disorder is usually normal.

### Laboratory Findings

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There are no diagnostic laboratory findings associated with major depressive disorder.

### CT scan

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There are no gross CT scan findings associated with major depressive disorder.

### MRI

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There are no MRI findings associated with major depressive disorder.

### Other Imaging Findings

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There are no other imaging findings associated with major depressive disorder.

### Other Diagnostic Studies

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A number of psychological tests can be used to help in the diagnosis and assessment of treatment efficacy in patients with major depressive disorder.

## Treatment

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### Medical Therapy

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The mainstay of treatment for major depressive disorder is pharmacologic therapy with serotonergic agents.

### Psychotherapy

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There are a number of psychotherapies for depression, which may be provided individually or in a group format. Psychotherapy can be delivered by a variety of mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers, or psychiatric nurses.

### ECT

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Electroconvulsive therapy (ECT), also known as electroshock or electroshock treatment, uses short bursts of a controlled current of electricity (typically fixed at 0.9 amperes) into the brain to induce a brief, artificial seizure while the patient is under general anesthesia.

### Surgery

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Surgery is not the first-line treatment option for patients with [[major depressive disorder]. Surgery may be used for selected patients.

### Primary Prevention

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There are no established measures for the primary prevention of major depressive disorder.

### Secondary Prevention

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Effective measures for the secondary prevention of major depressive disorder include antidepressant maintenance therapy and psychotherapy.

## References

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1. ↑ Ruo B, Rumsfeld JS, Hlatky MA, Liu H, Browner WS, Whooley MA (2003). "Depressive symptoms and health-related quality of life: the Heart and Soul Study". JAMA. 290 (2): 215–21. doi:10.1001/jama.290.2.215. PMC 2776689. PMID 12851276.CS1 maint: Multiple names: authors list (link)
2. ↑ Katon WJ (2011). "Epidemiology and treatment of depression in patients with chronic medical illness". Dialogues Clin Neurosci. 13 (1): 7–23. doi:10.31887/DCNS.2011.13.1/wkaton. PMC 3181964. PMID 21485743.

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