What is Major Depression Disorder - Essay Example

RUNNING HEAD: MAJOR DEPRESSION DISORDER Major Depression Disorder Customer’s Name Customer’s Grade Course Customer tutor’s Name 13th May, 2011 Abstract What is Major Depression Disorder (MDD)? How is it described and diagnosed? What treatments are available? What is the society’s perception of this disorder? The author attempts to address these questions by analyzing the condition of Tina, a 23 year old woman who is suffering from depression after being left by her husband. Introduction Tina was once an energetic, active and healthy young woman who exercised at the local gym at least thrice in a week but not anymore. The black 23 year old lady has not been to the gym for over four weeks and has not been going to any of her two jobs consistently for about the same duration. Four weeks ago, Tina was left by her husband Joe who went on to marry another woman. Since then she has not been her usual self and there are a lot of changes in her routine. In addition, she is losing weight even though her feeding habits are yet to change and her movements which used to quick and marked are now getting sluggish. She now spends most of her time locked up in her apartment. Tina is suffering from Major Depression Disorder (MDD).The condition is also known as major depression, clinical depression or uni-polar depression. It is referred to as uni-polar since there is presence of only one pole or one extreme depressed mood. This is in contrast with bipolar depression which has two poles of depressed mania. MDD affects different people in various ways. There is no one way of telling whether a person is suffering from the disorder or not. However, for the majority of the victims, they will either have a depressed mood or a general interest of interest in activities that they once enjoyed. Some will have a combination of both of such signs and in addition they might show physical or mental symptoms such as reduced concentration, fatigue, feelings of helplessness, hopelessness and self pity, body aches and headaches as well as suicidal thoughts. This group of symptoms were first grouped and named mood disorders in the 1980 edition of the diagnostic manual which was written by the American Psychiatric association (Psychiatric Association, 1980). Epedimiology A 2003 report by the National Comorbidity Survey Replication (NCS-R) found that major depression disorder was common in adults aged between 25-44 years of age and is least common in people aged over 65 years. The average age for developing clinical depression is in the mid-20’s although that age appears to be decreasing with time. The disorder affects children at the same rate for both boys and girls. At any one time, 2% - 3% of men and 5% - 9% of women are likely to be suffering from the condition. During a lifetime, MDD will affect 5%-12% of men and 5% - 9% of women (Kessler, 2003).According to the report, the prevalence of MDD was 16.2% for a lifetime while fo a 12-moth period, the prevalence was 6.6%. All composite international diagnostic interview were classified independently as clinically significant using the quick inventory of depressive symptomatology self-report(QIDS - SR) with 10.4% being classifed as mild, 38% severe, 38.6% moderate and 12.9% very severe. Advances in the field of epidimiology has revealed that tens of millions of Americans are suffering from the disorder. Majority of these people are in the prime of their working lives. In addition to personal, medical and social costs major depression disorder may have a huge impact on the working lives of affected individuals. However, little is known about the prevalence and consequances of the disorder in the economy. According to a recent study by Dave Marcotte (1999) “major deprssion is not a disorder confined to the non-economic part of individual’s lives”. The report found that depression was as prevalent within the labor force as without. Interestingly, the disorder was found to be dominant among the unemployed as compared to their working counterparts. While prevalence of MDD is higher for the women, the report found that it was uniformly higher among the unemlployed men than women. Signs and Symptoms When Tina found out that her husband had left her for another woman, she locked herself in her appartment and cried herself to sleep where she was in slumber for about half a day. That however was her last long bout of sleep. Since the time she discovered of her husband’s extra-marital aaffairs, Tina’s sleeping patterns can be best described as erratic. She is unable to sleep for longer than four hours and finds herself sleeping a few hours in the day and a few hours during the night. When she is awake , all she thinks about is her broken marriage and wondering where the rain started beatting her.Most of the time she arrives to the conclusion that it was her fault that her marriage went south blaming it on her busy worjking schedule which leaves her very sad. Trouble sleeping or excessive sleeping is one of the hallmark synptomps of Major Depression Disorder.According to guidelines provided by the instructions provided by the guidelines and protocol advisory committee in 2004, fan MDD victim must have a depresssed mood or loss of interest and at least four other symptomps, most of the time, most days, for at least fourteen days (Guidelines and Protocol Advisory Committee for Depression, 2004). The committee summarised the major symptomps into what is now known as the SIGECAPS Mnemonic for symptomp criteria for major depressive episode. The S in SIGECAPS represents sleep disturbances like insomnia and hypersomnia while the I stands for reduced interest or reduced pleasure or enjoyment. Guilt and self-blame is denoted by the G while the E reprents energy loss and fatigue, the C represents concentration problems which is also a major symptom. Appetite changes which represent themselves as low appetite or weight loss are denoted by the A. P is for psychomotor changes such as retardation and agitation while S is for suicidal thoughts all which Tina has. Mental disorders like major depression disorder are diagnosed according to a manual called the Diagnostic and Statistical Manual of Mental Disorders (DSM - IV) which is produced by the American Psychiatric Association (Psychiatric Association, 1980). This strategy is referred to as the multiaxial sytem. This system provides a more comprehensive evaluation of an individual and it is best used for prognosis and treatment planning because it brings out the interrelated complexities of the different biological, psychological and social aspects aspects (NIMH, 2008). Each part of the multiaxial system which is referred to an axis provides a different type of informatiom about the diagnosis. The first axis provides information about clinical disorders such as mental health conditions fall in this part. Common disorders in this axis include depression, autism spectrum disorders, schizophrenia, bulimia nervosa, anorexia nervosa, bipolar disorders and attention deficit hyperactivity disorder (ADHD). These are conditions that are not attributable to a mental disorder. Conditions that make up the first axis are ones that require medical attention from a clinician.Tina’s displayed disorders that are addressed by this axis. First and foremost she was in depression; the 23 year old like any other woman was in mental pain after her husband not only left her but also went and settled with another woman. What made tina more depressed was the fact that she kept thinking about the issue all the time trying to find answers why her marriage had ended. Although Tina did no display eating disorders like anorexia nervosa or bulimia nervosa she was loosing weight and her movements were becoming fraile and sluggish. The lady was also having problems paying attention to anything for long even those activities that’ she enjoyed prior to the end of her marriage a clear indication that she was displaying a condition known as attention deficit hyperactivity disorder (ADHD). The second axis includes personality disorders and mental retardation. Conditions in this axis include dependent personality disorder, antisocial personality disorder, avoidant personality behaviour, border line personality disorder and schizoid personality disorders. Tina was displaying behaviours that occur as personality disorders. She has obsesive compulsive disorder because she is always fixated on what went wrong wrong in her marriage; she is always making conclusions on what happenned to her marriage and she believes that because of who she is and what she has done, she will never be loved. Tina is also displaying characteristics of antisocial disorder and avoidant personality behaviour. She has neither been to the gym nor to work which she took very seriously only four weeks ago. She is afraid that people will judge her for the collapse of her marriage and therefore she decides to stay locked up in her apartment. She is also displaying dependent personality behaviour; after Joe left her she decided to call her girlfriends to tell them of her woes and she did this day after day, after a while, her friends stopped picking her calls since all she did was complaining in search of sympathy. The third axis provides information about any medical conditions that could be present. According to Trivedi (2006), this axis includes such conditions as brain injuries which could aggravate existing diseases.The physical disorder in this axis is etiologically related to the mental syndrome identified by the first axis. For example a patient with delirium where the delirium was caused by a disease like malaria. As far as we know Tina, did not have any medical conditions; her busy working schedule and her love for the gym are characteristics of a young healthy lady. The fourth axis describes psychosocial and environmental factors affecting the person.According to Beck (1987), such a problem could be a negative life event, an environmental difficulty or deficiency, a familial stress inadequacy of personal resources or social support or any other problem relating to the context in whicha an individual’s problem’s have developed. We are told that Tina concludes that the reason why Joe left her was because she was not good enough just like her mother and herself were not good enough which made her father abandon them when she was just seven years old. The fifth and the final axis is a rtaing scale referred to as Global Asessment of functioning (GAF). It goes from zero to one hundred and provides a method to summarize in just a single number how well the person is functioning overall (Fava, 2008).This scale is particularly usefuul in tracking the clinical progress of individuals. It is only rated with respect only to psychological, social and occupational functioning, it does not include impairment due to physical or environment limitations.A scale of 0 denotes inadequate information while a scle of 1-10 shows some danger of hurting self or others. A scale score of between 40-60 reflects serious and moderate symptoms while a score of 91-100 denotes superior functioning. The SIGECAPS Mnemonic for symptomp criteria for major depressive episode states that for a patient to be diagnosed as suffering from major depression disorder, he or she must have depressed mood or loss of interest and at least 4 other symptoms, most of the time, most days, for at least 2 weeks. Tina has had depressed mood and loss of interest with at least four other symptoms such as obsessive compulsive disorder most of the time, everyday for the last four weeks. Treatment and Management Treatment of Major Depression Disorder is addressed on four fronts; psychotherapy, medication and electroconvulsive therapy. Also known as electroshock, Electroconvulsive therapy (ECT) is the application of a strong electric current to the brain that induces seizures, convulsions and coma.ECT is rare and is often recommended as a last result for severe depression which has failed to respond to other treatment such as mania and catatonia. It carries with it several risks such as loss of memory. The other type of treatment involves psychotherapy. This usually involves a patient being admitted in a psychiatric hospital. When successful, psychotherapy has been found to reduce the dominance and recurrence of depression. The most effective form of psychotherapy is Cognitive behavioral therapy (CBT).This therapy teaches patients to shun self-defeating ways of thinking and adopt counter-productive behaviors. Sigmund Freud proposed a principle known as psychoanalysis which emphasizes the remedy of unconscious mental conflicts which is today part of psychotherapy. The other form of treatment for MDD involves medication. The group of medicines used here are referred as to as anti-depressants. These medications have been proven to work and patients can get better within as quickly as four weeks. The most appropriate treatment strategy for Tina under the circumstances is psychotherapy. She has not reached the point of being delusional and we are told that after she was left by the husband, she tried reaching out to her friends. Therefore it seems that Tina could use some talking to from a friend, a social counselor, a psychologist or a psychiatric. We are also informed that she has thought about suicide although she has not reached the point of carrying out the act, the only remedy for a suicidal thought is psychotherapy to remove the thoughts of helplessness and hopelessness. Society’s Perception of Major Depression Disorder Society’s perception of major depression disorder varies widely from culture to culture. Cultural differences exist on the extent to which depression is considered an illness or a disease. The western culture has been accused of medicalizing sadness or misery. This may be true especially because diagnosis of the disease varies with cultures with the western culture having most of the cases. A recent study revealed that antidepressants are the most prescribed drug in the United States; 118million of the 2.4 billion medicine prescriptions in 2005, were antidepressants closely followed by blood pressure drugs which is also related to depression disorders like clinical depression (Rohan, 2004). In most parts of the world, especially in Africa and parts of Asia, mental health is not taken as a serious health issue. There is little or no mental health staff, medication and psychotherapy is often inaccessible while development of mental health policy and or institutions is almost non-existent. Despite evidence to the contrary, these countries view depression as a reserve of the developed world. Some scientists are of the opinion that mental disorders such as clinical depression are linked to creativity and intelligence. In their personal writings, early scientists and philosophers like John Mill and Aristotle expressed actions and emotions that are linked to mental illness. Us President Abraham Lincoln is reported to have suffered from a condition known as melancholy which is today’s MDD. Conclusion There is a lot of stigma for people suffering from clinical depression most of which is linked to ignorance of diagnosis or treatments. Opinions on treatment differ greatly among the public and the health officials. Alternative treatments are seen to be more helpful than pharmacological ones. In some parts of the world, patients result to witchcraft to cure mental illness (Hergenhahn, 2005), but the truth is that Major depression disorder is a condition which is medically known and can be managed and controlled. References Beck, A. T. (1987). Cognitive Therapy of depression. NY: Guilford Press. Dave, E. and Marcotte, P. (1999). Prevalence and Patterns of Major Depressive Disorder in the United States Labour force. The Journal of Mental Health Policy & Economics, 14-25. Fava, M. (2008). Mood disorders: Major depressive disorder and dysthymic disorder. Philadelphia: Mosby Elsevier. Guidelines and Protocol Advisory Committee for Depression. (2004). Depression (MDD) – Diagnosis and Management. GPAC. Hergenhahn, B. R. (2005). An Introduction to the History of Psychology. Belmont: Thomson Wadsworth. Kessler, R. C. (2003). The epidemiology of Major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Boston: Department of Health Care Policy, Harvard Medical School. NIMH (2008). Depression. Bethesda: Science Writing, Press & Dissemination Branch. Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Revised. Washington: APA. Rohan, K. J. (2004). Cognitive-behavioral therapy, light therapy and their combination in treating seasonal affective disorder. Journal of Affective Disorders, 200-256. Trivedi, M. H. (2006). Sertraline, or Venlafaxine-XR after failure of SSRIs for depression. New England Journal of Medicine , 1000-1200. Read More