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What is Depression?

Depression is a debilitating condition that affects millions of individuals throughout the world. MDD has become one of the most prevalent forms of mental illness, currently experienced by 16-22 million Americans (O'Shields, 2017). Depression can be defined as feelings of sadness, loss of interest in pleasurable activities, weight gain or loss, fatigue, excessive thoughts of death, and suicidal tendencies. Depression has a very large array of symptoms and is most often difficult to precisely and properly diagnose and treat.

Symptoms and Diagnosis of Depression

​Some emotions are normal and can last for a few days, but when those symptoms are still present following two weeks that is an indicator that the individual is having a depressive episode. Common causes of depression can include genetic factors (first-degree family), environmental factors (surroundings), and psychosocial stressors (death of a loved one). In order for a patient to be diagnosed with depression, (s)he must notice a change in their previous daily functioning and be suffering from a combination of 5 symptoms including irritable mood, change in appetite, loss of interest in pleasurable activities, change in weight, insomnia or hypersomnia, physical slowness, fatigue, feelings of worthlessness, guilt, indecisiveness, poor concentration, medications, and rumination of death. While insomnia is a symptom of depression it is not a cause, as it has been found that good sleep at night did not improve symptoms in major depressive disorder (MDD) (Victor, 2019).

Biological Effects of Depression

​Dysfunction of the brain’s neurochemicals, specifically dopamine (DA), norepinephrine, and serotonin are a major indicator of depression. The process of neurotransmitters consists of the neurotransmitters being released from vesicles and binding to postsynaptic receptors although some of those molecules are deactivated by reuptake or enzymatic degradation. This can happen by neurotransmitters being released and rapidly reabsorbed, decreasing of neurotransmitters due to inadequate storage, and sometimes neurotransmitters are shut down due to overactive monoamine oxidase enzymes.

Treatment of Depression

Medication is needed when the patient’s daily functioning is altered. The most common medications that are used to treat depression are dependent upon side effects and neurotransmitter reaction and include selective serotonin reuptake inhibitors (SSRI’s) when there are symptoms of anxiety, obsessive thoughts, rumination of death, and aggression this is the first choice. Some examples of SSRI’s are Celexa, Lexapro, Paxil, Prozac, and Zoloft. If symptoms include apathy, fatigue, and a decrease in pleasure medication should include dopamine or noradrenergic reuptake inhibitors by producing more dopamine, norepinephrine, and epinephrine and making the rewards center more accessible. Some examples of this medication include Naltrexone, Contrave, Forfivo XL. Monoamine oxidase inhibitor enzymes (MAOI’s) are a more powerful medication for depression because they affect more transmitters but have more side effects. Some examples of MAOI’s include Marplan, Nardil, and Parnate. Some side effects of these drugs include weight gain/loss, headache, dry mouth, insomnia, low sex drive, nausea, dizziness, and slow motor function.

Medication Management

​The patient must start with a low dose of medication and gradually build to a dose that shows improvement after using the medication for five weeks. The length of time that the patient takes the medicine will be determined by age and occurrence of the first episode of depression and can range from acute treatment at six to eight weeks, six months if symptoms are still present, or for a chronic case of depression that is ongoing, the medication should never be discontinued. Medication needs to be reduced gradually when discontinuing. When the medication proves to not be successful an alternate diagnosis should be considered such as sleep apnea, caffeine use, alcohol use, drug use, hypothyroid issues, anxiety disorder, bipolar disorder, or PTSD to name a few.

Alternatives or Addition to Medication

​In a lot of cases of depression, the patient can greatly benefit from talk therapy, group therapy, or cognitive behavioral therapy in conjunction with medication. Another successful mode of treatment includes electroconvulsive therapy (brain stimulation), which has shown to be the highest effective. Transcranial magnetic stimulation is also an option using an MRI to target and stimulate nerve cells that have a positive effect on neurotransmitters with magnetic pulsing.

​In the event that the patient refuses any form of treatment, this will have a detrimental effect on the patient causing poor health, poor quality of life, drug and alcohol addiction (self-medicating), and even suicide. When a patient is depressed there is a greater chance of developing diabetes, cardiovascular disease, and vitamin deficiency from maintaining a poor diet. The rate of suicide is greater when depression is coupled with a chronic illness. The annual suicide rate in the U.S. is over 14 deaths per 100,00 population (Holmes, 2019). The American Association of Suicidology estimates that depression is present in about half of all suicides (Holmes, 2019).

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