Major depressive disorder

Major depressive disorder
Depression (also called unipolar depression or clinical depression) is a type of mental illness or mood disorder. Most people feel sad, discouraged, or "down" sometimes, but that is not depression. In clinical depression, these feelings last for a long time and are combined with other symptoms. Someone with depression might have these symptoms: strong sad feelings or no strong feelings at all, feeling guilty, feeling helpless or hopeless, anxiety, fear, low self-esteem or a loss of interest in life. These are symptoms of depression when they last for long periods of times (usually for over two weeks). Some people who are depressed think about committing suicide (killing themselves). Some people with depression do kill themselves.
How common depression is.
Ten percent of people have depression at some time in their lives. Depression happens most often in people between the ages of 24 and 44 years. About two times as many women as men are diagnosed with depression.
Signs and symptoms.
In older children and adolescents (teenagers), another sign may be the use of drugs and alcohol. Most people who have not had depression do not completely understand its effects. Instead, they see it as simply being sad. Since it is not understood, many people with depression are criticized by others for not helping themselves.
Depression is a syndrome of many symptoms that relate to each other, and is not just feeling sad. Medical measurements have shown that there are big changes in the chemicals in the brain, and that the whole brain slows down during depression. Depression that is not treated may get worse.
Good exercise helps deal with depression, since exercise releases chemicals that put a person in a better mood. Having a supportive group of friends and doing outside activities can also help prevent or ease depression.
Types of depression.
Major depressive disorder is also referred to as major, biochemical, clinical, endogenous, or biological depression. It may also be called "unipolar affective disorder".
Causes of depression.
No one cause for depression has been found, but there are some things that can be involved.
Depression is usually treated with a combination of medication and other therapy.
Medications which can help the symptoms of depression have existed for several decades.
"Tricyclic antidepressants" are the oldest kind of medicine for depression. They are not used much now, because they do not work well, and they have many bad side-effects. An example is Nortriptiline (Allegron).
"Monoamine oxidase inhibitors" (MAOIs) may be used if other antidepressant medications do not work well. This kind of medicine can cause problems with many kinds of food and drugs. An example is Tranylcypramine.
"Selective serotonin reuptake inhibitors" (SSRIs) are now the most commonly used family of antidepressant medicine. These drugs work by allowing the brain to have more serotonin. There are fewer side-effects with this kind of drug. An example is Fluoxetine (Prozac).
"Tranquillizers and sedatives" may be used to ease anxiety (worries) and help sleep.
"Antipsychotics" are used to keep mood from changing and to reduce or get rid of hallucinations.
"Lithium" is often used for bipolar disorder, but also can help people with depression.
If people with depression do not take their medicine the right way, the depression can get worse. A doctor must help when depression patients want to change to another medication, or to take a different amount of a medication than before.
In psychotherapy, someone with depression is helped to understand and solve problems which cause depression.
Psychotherapy can help a person make changes in thought, help with relationship problems, find and fix relapses, and understand what makes depression worse. The most effective psychotherapy for depression is Cognitive Behavioral Therapy (CBT). In CBT the depressed patient is taught how to think in a more rational, positive, realistic manner.
Probably the most effective single treatment for the vast majority of depressed patients of all ages is physical exercise. (See, Dunn, A., Exercise for Depression Rivals Drugs, Therapy. American Journal of Preventive Medicine, January 2005; vol 28: pp 1-8. National Institutes for Mental Health, "Depression." News release, University of Texas Southwestern Medical Center at Dallas.)
Electroconvulsive therapy.
Electroconvulsive therapy (ECT), also called electroshock therapy or shock therapy is used to treat a small percentage of severely depressed people. ECT uses a small amount of electricity to cause an epileptic seizure while the patient is under anesthesia. This may cause some memory loss, amnesia.

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