Depression
Depression is more than just feeling sad. depression is a common but serious mood disorder that can affect your thoughts feelings physical health and behaviors’ most people feel this way occasionally for short periods others can feel several symptoms all day nearly every day for two weeks or more this is called major depression.
Causes of Depression
Etiology
The several predisposing factors that contribute to Major Depression can be broken up into
three categories:
Three Major categories are
- biological,
- psychological,
- and social factors.
Category 1 Biological Depression
Biologically, genes, neurons, and hormones are factors that likely play a role in causing depression. The imbalance in Serotonin hormone due to the presence of the mutation
in the Serotonin Transporter gene (5-HTT) may underlie psychiatric disorders.
Category 2 Psychological Depression
Psychological causes include childhood trauma, such as parental loss, poor parenting,
parental drinking, and family violence.
Category 3 Social factor
Social causes include bullying, criminally assaulted, and stressful working environments.
The differential diagnosis of depression Includes
Endocrinopathies
(Thyroid and Adrenal disorders),
Nutritional deficiencies
(Vitamin D and B12),
Neurological causes
(Epilepsy and Alzheimer’s).
Treatment
Major Depressive disorder, like all psychiatric illnesses, is treated using the Bio-psycho-social model of care. A wide range of depression treatments, including mindfulness exercise, psychotherapy, and antidepressant medication.
In some cases, patients who had an acute response to antidepressant medication
continue their treatment with electroconvulsive therapy or ECT. ECT is the most effective
and commonly acute treatment for severe major depression
where medical professionals pass high doses of electricity through the brain.
A questionnaire will determine what stage of depression you are in, and the correct treatment for you.
Drugs
1- Selective Serotonin Reuptake Inhibitors,
(SSRIs), for example, Citalopram is usually the first- line used to alter the serotonin normal mechanism, where after carrying a message, serotonin is usually reabsorbed by the serotonin transporter.
These medications work by inhibiting the reuptake of serotonin and increasing the serotonin level.
Possible side effects related to SSRIs
Including diarrhea, headache, weight gain, and reduced essential desire.
2- Tri-Cyclic Antidepressants (TCAs) are usually second-line, including Imipramine and Clomipramine.
Common side effects are dry mouth, and constipation and they can induce a cardiac arrhythmia in susceptible patients.
3- Mono Amine Oxidase Inhibitors (MAOIs) including Phenelzine and Tranylcypromine is used for those who have not responded to other classes of medications. They are less frequently used due to their life-threatening drug and food interactions. Other side effects include sedation, weight gain, and orthostatic hypotension.
4- Atypical antidepressants including Bupropion, Mirtazapine, and Venlafaxine, are newer drugs in the market and are as effective as SSRIs and have lesser side effects compared to TCAs and MAO inhibitors. Duration of Treatment Antidepressants take two weeks to start their effect and are indicated for nine months after a response is observed. There is a 40% remission rate with a single adequate trial with an antidepressant. Most of the rest of the patients show some improvement. Common failure medications are more frequently due to inadequate dose and duration or human error factors.
