Major depression: symptoms, causes and treatment

A very serious mood disorder that requires psychological therapy.

Throughout our lives, it is possible to feel sad for some reason or go through a rough patch emotionally. And although no one likes to go through these bumps in the road, the truth is that suffering can even make you grow as a person, and ultimately be positive for you.and, ultimately, be positive for your personal development.

However, it is necessary to be aware that, in some cases, what we might think is simple sadness or an emotional slump, is actually a depressive process; that is, pathological. There are different types of depression, and in this article we will talk about the most severe depressive disorder: major depression.. Let's see what this psychopathological phenomenon consists of.

• Related text: "Are there several types of depression?"

Major depression: what is it?

Major depression, also known as unipolar depression, is a mood disorder characterized by the occurrence of one or more depressive episodes. a mood disorder characterized by the occurrence of one or more depressive episodes of at least two weeks' duration, with a set of predominantly affective symptoms (pathological sadness, apathy, anhedonia, hopelessness of at least two weeks duration, and presents a set of predominantly affective symptoms (pathological sadness, apathy, anhedonia, hopelessness, despondency, irritability, etc.). However, cognitive, volitional and somatic symptoms are also usually present during its course.

Thus, people with major depression are not simply "sad", but tend to show an extreme lack of initiative to do anything, as well as an inability to be joyful and feel pleasure, a phenomenon known as anhedonia. They also experience other physical and psychological problems that significantly impair their quality of life.

On the other hand, major depression also affects how one thinks and reasons. In general, the total or partial lack of motivation makes people who have entered a crisis of this type seem absent and do not feel like doing anything, not even thinking much (which does not mean that they are mentally disabled).

The major depressive disorder can be divided into mild, moderate or severe, and usually has its onset during young adulthood, although it can arise at almost any stage of life. The individual suffering from this condition may experience phases of normal mood between depressive phases that may last for months or years.

On the other hand, major depression is a type of unipolar depression, that is, it does not present phases of mania (which differentiates it from bipolarity), and the patient can have very serious problems if he or she does not receive adequate treatment.

Is it a unique psychopathological phenomenon?

Although major depression is one of the most important concepts in the world of psychiatry and clinical and health psychology, many researchers question whether it is anything more than a collection of disorders that are similar to each other and that in fact share no common causes or rationale for functioning. This is because people who experience depression may manifest symptoms in a variety of ways, and respond to treatment in a way that is also very diverse.

It is likely that, as more research is done on the subject, new ways of classifying these symptoms will emerge. However, at present, the psychological construct of "major depression" helps to treat many people in need of treatment. helps to treat many people who need treatment by professionals and who can benefit from therapy.This is important if we take into account that this mental health disorder is linked to the risk of suicide and that it usually causes great suffering.

Frequent symptoms

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), for the diagnosis of major depression, the subject must have five (or more) of the following symptoms during the depressive period (at least two weeks).

These must represent a change from the patient's previous activity; and one of the symptoms must be (1) depressed mood or (2) loss of interest or ability to feel pleasure (anhedonia).

• Depressed mood most of the day, most of the dayalmost every day (1)
• Loss of interest in once rewarding activities (2) that were once rewarding (2)
• Weight loss or weight gain
• Insomnia or hypersomnia
• Low self-esteem
• Concentration problems and trouble making decisions
• Feelings of guilt
• Suicidal thoughts
• Psychomotor agitation or retardation on most days
• Fatigue or loss of energy nearly every day

It is important not to confuse major depression with other similar mood disorders, such as dysthymia. This psychological disorder is also associated with many of the symptoms of major depression, but has some differences. Mainly, what makes it possible to distinguish dysthymia from major depression is that the former develops over longer cycles (at least two years), the intensity of symptoms is lower, and anhedonia is typically not present.

Types of major depression

In addition, the DSM-V specifies that symptoms must cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The episode cannot be attributed to the physiological effects of a substance or other medical condition, and the episode of major depression is not better explained by a schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum disorder and other psychotic disorders.

There are two types of major depression:

• Single-episode major depression.There is only the presence of a single depressive event in the patient's life.
• Relapsing major depressionDepressive symptoms appear in two or more episodes in the patient's life. The separation between depressive episodes must be at least 2 months without symptoms.

Causes of this mood disorder

Major depression is a multifactorial phenomenonTherefore, different factors could cause this psychopathology: genetic factors, childhood experiences and current psychosocial adversities (social context and personality aspects).

In addition, difficulties in social relationships, cognitive dysfunctions or socio-economic status could be risk factors for the development of this disorder. Probably, however, the interaction of biological, psychological and social factors favors the onset of major depression.

Also major depression has also been linked to a lack of dopamine in the brain's reward system in the brain's reward system, which makes the person aimless. This fact may be the trigger for a sedentary and monotonous lifestyle and the severe self-esteem problems that often appear in these cases.

Treatment

Major depression is a serious but, fortunately, treatable pathology.. Treatment options usually vary depending on the severity of the symptoms, and in severe cases, the administration of psychotropic drugs (antidepressant type) combined with psychotherapy seems to be the most appropriate treatment.

However, in recent years the efficacy of other treatments has been shown, for example, that of Electroconvulsive Therapy (ECT)which is usually used when the depressive symptomatology is severe or drug therapy is unsuccessful. This therapy, however, is not comparable to the old electroshockThe intensity of the shocks is much lower and it is painless, since it is performed under anesthesia.

In psychotherapy sessions, patients with depression are trained to develop habits to actively participate in daily activities. These types of interventions based on behavioral activation help the person to discover new ways of self-motivation. As we will see, we also The skills of self-awareness and recognition of emotions and the questioning of dysfunctional beliefs through cognitive restructuring are also enhanced..

On the other hand, while Mindfulness has shown some efficacy in intervening in cases of mild depression, with major depression it does not seem to work other than to prevent relapse. People diagnosed with major depression can easily relapse in this type of crisis, so that the treatmentThe treatment is therefore intended as a lifelong support (although not necessarily on a weekly basis). In addition, the methods used to prevent relapse are different from those used when the patient is experiencing a depressive crisis.

Treatment with psychotherapy

Psychological therapy has proven to be an effective tool for the treatment of depression, especially cognitive-behavioral therapy.especially cognitive-behavioral therapy. This type of therapy considers the patient as a system that processes information from the environment before issuing a response. That is, the individual classifies, evaluates and gives meaning to the stimulus according to his or her set of experiences from the interaction with the environment and his or her beliefs, assumptions, attitudes, worldviews and self-evaluations.

Cognitive behavioral therapy uses different techniques that aim to have a positive effect on low self-esteem, negative problem-solving styles or the way of thinking and evaluating the events that occur around the patient. Some of the most common cognitive behavioral techniques are shown below:

• Self-observationSelf-observation, log sheets or setting realistic technical goals are techniques that are commonly used and have been shown to be effective.
• Cognitive RestructuringCognitive restructuring is used so that the patient can become aware of his or her own emotions or thoughts and can detect irrational thoughts and replace them with more adaptive ideas or beliefs. Among the best known programs for the treatment of depression are: Aaron Beck's cognitive restructuring program or Albert Ellis' program.
• Development of problem-solving skillsProblem-solving deficits are related to depression, so problem-solving training is a good therapeutic strategy. In addition, social skills training and assertiveness training are also useful treatments for this condition.

Other forms of psychological therapy have also been shown to be effective in the treatment of depression. For example: interpersonal psychotherapy, which treats depression as an illness associated with dysfunction in personal relationships; or mindfulness-based cognitive therapy or MBCT (Mindfulness-based cognitive therapy).

Pharmacological treatment

Although in less severe cases of depression or in other types of depression the application of psychotropic drugs is not always necessary, in severe cases of depressive disorder it is advisable to administer various drugs for a certain period of time.

The most commonly used Antidepressant drugs are the following:

• Tricyclic antidepressants (TCAs).These are known as first generation antidepressants, although they are rarely used as a first pharmacological alternative because of their side effects. Common side effects caused by these drugs include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These drugs can also affect blood pressure and heart rate, so they are not recommended for older people. Some examples are: Amitriptyline, Clomipramine or Nortriptyline.
• Monoamine oxidase inhibitors (MAOIs).MAOIs are antidepressants that act by blocking the action of the monoamine oxidase enzyme. Like the previous ones, they are less frequently used because of their serious side effects: weakness, dizziness, headaches and tremors. Tranylcypromine or Iproniazid are some examples of this drug.
• Selective Serotonin Reuptake Inhibitors (SSRIs)These are the most commonly used and are usually the first choice in the pharmacological treatment of depression. These drugs usually have fewer side effects than other antidepressants, although they can also cause dry mouth, nausea, nervousness, insomnia, sexual problems and headaches. Fluoxetine (Prozac) is the best known SSRI, although other drugs in this group are also commonly used, such as: Citalopram, Paroxetine or Sertraline.

Serotonin excess and Serotonergic Syndrome

Although it is also possible to find other types of antidepressants such as Selective Noradrenaline Reuptake Inhibitors (SNRI), Selective Noradrenaline and Dopamine Reuptake Inhibitors (SNRIND) or atypical antidepressants, when consuming antidepressants that have the ability to increase the release of serotonin it is necessary to be careful with their overdose or interaction with other drugs.

The excess of serotonin stimulation on the postsynaptic 5-HT1A and 5-HT2A receptors at central and peripheral level has negative effects on the organism that can become very serious and even fatal due to the Serotoninergic Syndrome.

• You can learn more about this syndrome in our article: "Serotonergic syndrome: causes, symptoms and treatment".

Bibliographic references:

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