Major Depression: Overview
Major Depression affects 15% of Americans at some point during their lives, and 100 million people are affected on any given day. The age of onset is fairly evenly spread among people. The mean age is 40, but can onset from childhood to seniors. It can come on suddenly in days, or build over years. It can be predated by anxiety, phobias, panic and Dysthymia. On average, the course of Major Depression runs 3 to 9 months if untreated, and 85% cases resolve within 1 year. Over 1/2 of people who experience major depression only have one episode. With each successive episode, the patient has a 15% risk that their next episode will be a manic episode, changing their diagnosis to Bipolar Disorder.
In the end, approximately 15-20% of those with major depression become chronically depressed. Approximately 15% of patients with major depression may commit suicide, as well, with men committing suicide at a rate 2 times as often as women.
The main feature of Major Depression is either an unpleasant mood (feeling down, irritable or apprehensive) or a loss of pleasure in normally enjoyable activities. Contrary to popular thought, this second feature, loss of enjoyment is the main symptom described by many depressed people, rather than the more well known unpleasant mood.
There are 3 major subtypes of major depression: psychotic, melancholic, and atypical features. Major Depression with psychotic features, as it implies means that the client displays either delusions or hallucinations. The psychotic symptoms are worse during the first 6 months, and lessen after that. Major depression with melancholic features means that the client has features that are primarily seen in strictly biologically based depressions. This means they tend to feel worse, but have a higher chance of being cured by biological treatments such as medication and ECT, rather than straight psychotherapy. Finally, major depressive episode with atypical features is the reverse of a melancholic episode. This appears to be a reaction to an extreme reaction to some stimulant in the environment. They tend to respond better to Selective Serotonin Re-uptake Inhibitors and Monamine Re-uptake Inhibitors.
Other symptoms of Major Depression may include the loss of appetite, unintentional loss or gain of weight of over 5% of body weight, sleeping too little or too much, psychomotor retardation or agitation (slow or excessive movements), decreased energy and fatigue, and decreased sex drive. Additionally, sufferers often feel worse in the morning and better at night.
They often have decreased concentration and slowed thinking, along with a negative world-view. When taken together, this combination makes the person with Major Depression prone to the inability to make decisions, and they are overwhelmed by seemingly easy tasks. They often view decisions in their personal lives as choices between something bad and something worse.
Treatment for Major Depression begins with chemical anti-depressants. There are a number of different classes of antidepressants, including the tricyclic antidepressants, selective serotonin reuptake inhibitors, monamine-oxidase inhibitors to name a few. Each class acts differently upon the body, offering the person a wide variety of options that can be tried in order to control their major depression. For psychotic features, antipsychotic medications such as Zyprexa or Geodon might be prescribed.
When conventional treatments fail, Electro Convulsive Therapy (ECT) can also be used, and has a success rate of 78%. Contrary to what was seen in “One Flew of the Cuckoo’s Nest”, ECT is very humane, and the client is put under a general anesthesia for a few minutes while a mild shock is applied either unilaterally or bilaterally. A muscle relaxant is also given to prevent the generalized seizures that are commonly thought to be associated with this procedure. The main side effects are a headache after the procedure and short-term memory loss.
Psychotherapy is also utilized to help the patient in a number of areas. These include learning about their disorder, learning to identify and avoid situations that may induce another depressive episode, view themselves and their situations more realistically, and to improve their interpersonal relationship skills. This therapy may be conducted in either individual, family or group settings.
Revision date: July 6, 2011
Last revised: by Janet A. Staessen, MD, PhD