Major depression: symptoms, causes and treatment

Throughout our lives, it is possible to feel sad for some reason or going through a bad streak in the emotional field. And even though no one likes to go through these potholes, the truth is that suffering can even make you grow as a person, 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 low, is actually a depressive process; that is to say, pathological. There are different types of depression, and in this article we will talk aboutthe most serious 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 lasting at least two weeks, and presents a set of predominantly affective symptoms (pathological sadness, apathy, anhedonia, hopelessness, weakness, 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 be extremely depressed. lack of initiative to do anything, as well as inability to be happy and feel pleasure, a phenomenon that is known What anhedonia. They also experience other physical and psychological problems that significantly damage their quality of life.

On the other hand, major depression also affects how you think and reason. In general, the total or partial lack of motivation makes people who have entered a crisis of this type appear absent and do not feel like doing anything, not even thinking hard (which does not mean that they are disabled) mental).

The major depressive picture can be divided into mild, moderate or severe, and It usually begins during young adulthood, although it can appear at almost any stage of life. The individual suffering from this condition may experience phases of normal mood between depressive phases that can 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 the difference from bipolarity), and the patient can have very serious problems if he does not receive adequate treatment.

Is it a unique psychopathological phenomenon?

While major depression is one of the most important concepts in the world of psychiatry and clinical and health psychology, many Researchers question that it is something more than a set of disorders similar to each other and that in fact they do not share causes or logics of functioning. This is so because people who experience depression can manifest symptoms in a variety of ways, and they respond to treatment in a way that is also very diverse.

As more research is done on the topic, new ways of classifying these symptoms are likely to emerge. However, today the psychological construct of "major depression" helps treat many people who need professional treatment and who may benefit from therapy, something important if we take into account that this alteration in mental health is linked to the risk of suicide and that it also normally produces great suffering.

Frequent symptoms

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

These should 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 the ability to feel pleasure (anhedonia).

• Depressed mood most of the day, almost every day (1)
• Loss of interest in activities that used to be gratifying (2)
• Weight gain or loss
• Insomnia or hypersomnia
• Low self-esteem
• Concentration problems and trouble making decisions
• Feelings of guilt
• Suicidal thoughts
• Psychomotor agitation or retardation almost every day
• Fatigue or loss of energy almost every day

It is important not to confuse major depression with other similar mood disorders, such as dysthymia. This psychological alteration is also associated with many of the symptoms of major depression, but has some differences. Mainly, what allows distinguishing dysthymia from major depression is that the former develops along of longer cycles (of at least two years), the intensity of symptoms is less, and typically does not occur anhedonia.

• You may be interested: "The 7 differences between major depression and dysthymia"

Types of major depression

Additionally, 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 another medical condition, and the episode of major depression is not better explained by a disorder schizoaffective, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum disorder and other disorders psychotic.

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.
• Recurrent major depression: Depressive symptoms appear in two or more episodes in the patient's life. The separation between depressive episodes must be at least 2 months without presenting 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, but the interaction of biological, psychological and social factors favors the appearance of major depression.

Also major depression has been linked to a lack of dopamine in the brain reward system, which makes the person have no objectives. This fact can be the trigger for a sedentary and monotonous lifestyle and the serious self-esteem problems that usually appear in these cases.

Treatment

Major depression is a serious condition, but fortunately, treatable. 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.

However, in recent years the efficacy of other treatments has been shown, for example, that of Electroconvulsive Therapy (ECT), which is usually used when depressive symptoms are severe or drug therapy is unsuccessful. Of course, this therapy is not comparable to the old electroshock, since the intensity of the discharges 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 day-to-day activities. These types of interventions based on behavioral activation make the person discover new ways of self-motivation. As we will see, too Self-knowledge skills and recognition of emotions and the questioning of dysfunctional beliefs are enhanced through cognitive restructuring.

On the other hand, while the Mindfulness has shown some efficacy when 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 into this type of crisis, so that the treatment is presented as a lifelong aid (although not necessarily with weekly frequency). In addition, the methods used to avoid relapses are different from those used when the patient is experiencing a crisis of depression.

Treatment with psychotherapy

Psychological therapy has proven to be an effective tool for treating depression, 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 based on their set of experiences coming from the interaction with the environment and its beliefs, assumptions, attitudes, worldviews and self-assessments.

In cognitive behavioral therapy, different techniques are used that claim to have a positive effect on low self-esteem, negative problem-solving styles or thinking and evaluating the events that occur around the patient. Here are some of the most common cognitive behavioral techniques:

• Self-observationTechniques, log sheets, or realistic goal setting are techniques that are widely used and have proven effective.
• Cognitive restructuring: Cognitive restructuring is used so that the patient can have knowledge about their own emotions or thoughts and can detect irrational thoughts and replace them with more ideas or beliefs adaptive. Among the best known programs for the treatment of depression are: the cognitive restructuring program of Aaron Beck or that of Albert ellis.
• Development of problem solving skills: Problem-solving deficits are related to depression, so problem-solving training is a good therapeutic strategy. Additionally, social skills training and assertiveness training are also helpful treatments for this condition.

Other forms of psychological therapy have also been shown to be effective in treating depression. For example: Interpersonal psychotherapy, which treats depression as a disease associated with dysfunction in personal relationships; or Mindfulness-based cognitive therapy (MBCT).

Pharmacotherapy

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 different medications over a period of time determined.

The antidepressant drugs more employees are as follows:

• Tricyclic antidepressants (TCAs)These are known as first-generation antidepressant drugs, although they are rarely used as a first pharmacological alternative due to their side effects. Common side effects caused by these medications include dry mouth, blurred vision, constipation, difficulty urinating, worsening 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 (MAOs): MAOIs are antidepressants that act by blocking the action of the enzyme monoamine oxidase. Like the previous ones, they are used less frequently due to their serious side effects: weakness, dizziness, headaches and tremors. Tranilcypromine or Iproniazid are some examples of this drug.
• Selective Serotonin Reuptake Inhibitors (SSRIs): They are the most used and are usually the first option in the pharmacological treatment of depression. These medications tend to 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 often used, such as: Citalopram, Paroxetine or Sertraline.

Excess Serotonin and Serotonin Syndrome

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

Excessive stimulation of serotonin on the postsynaptic 5-HT1A and 5-HT2A receptors at the central and peripheral level has negative effects on the body that can be very serious and even fatal due to the syndrome Serotonergic.

• You can know more about this syndrome in our article: "Serotonin syndrome: causes, symptoms and treatment"

Bibliographic references:

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• World Health Organization. ICD 10. (1992). Tenth Revision of the International Classification of Diseases. Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. Madrid: Meditor.
• Perestelo Pérez L, González Lorenzo M, Rivero Santana AJ, Pérez Ramos J. (2007). Decision support tools for patients with depression. Quality Plan for the SNS of the MSPS. SESCS; 2010. STD reports.