### Date : 2024-05-31 11:25 ### Topic : Major Depressive Disorder (MDD) #medicine #psychiatry ---- ### Major Depressive Disorder (MDD) Major Depressive Disorder (MDD), commonly known as clinical depression, is a serious mood disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in nearly all activities. It can affect how a person feels, thinks, and handles daily activities. ### Symptoms To be diagnosed with MDD, an individual must experience at least five of the following symptoms for at least two weeks. These symptoms must represent a change from previous functioning, and at least one of the symptoms should be either depressed mood or loss of interest or pleasure. 1. **Depressed Mood**: Feeling sad, empty, or hopeless most of the day, nearly every day. 2. **Loss of Interest or Pleasure**: Markedly diminished interest or pleasure in all, or almost all, activities. 3. **Weight Changes**: Significant weight loss when not dieting, weight gain, or decrease or increase in appetite. 4. **Sleep Disturbances**: Insomnia or hypersomnia nearly every day. 5. **Psychomotor Changes**: Observable psychomotor agitation or retardation. 6. **Fatigue**: Loss of energy nearly every day. 7. **Feelings of Worthlessness or Guilt**: Excessive or inappropriate guilt or feelings of worthlessness. 8. **Cognitive Impairments**: Diminished ability to think, concentrate, or make decisions. 9. **Suicidal Thoughts**: Recurrent thoughts of death, suicidal ideation, or suicide attempts. ### Symptom Mnemonic in Korean "[주요 우울장애] 하루/살이가 자다가/정신 차리고 살(체중or식욕)찌려고 피/자/사묵자 - **하루**: 우울한 기분이 하루 종일 지속되나요? (Depressed mood) - **살이**: 평소 관심을 갖던 일에도 흥미가 없어지셨나요? (Loss of interest or pleasure) - **자다가**: 잠은 잘 주무시나요? (Sleep disturbances) - **정신**: 매사에 불안하고 초조함을 느끼진 않으시나요? (Psychomotor changes) - **살**: 체중 변화/식욕 변화 - 입맛은 좀 어떠세요? / 식사는 잘 하시나요? (Weight changes) - **피로**: 몸에 힘이 없고 피로하신가요? (Fatigue) - **자책감**: 자신이 쓸모없는 존재라고 생각이 드시나요? (Feelings of worthlessness or guilt) - **사고력**: 집중은 잘 되시나요? 건망증이 심해지진 않으셨나요? (Cognitive impairments) - **자살**: 자살을 생각하시나요? 자살을 계획하신 적 있으세요? 시도한 적 있나요? (Suicidal thoughts) ### Diagnosis Diagnosing MDD involves a comprehensive evaluation by a healthcare professional, typically including: - **Clinical Interview**: Detailed discussion about the patient's symptoms, medical history, and family history. - **Questionnaires**: Use of standardized screening tools like the Patient Health Questionnaire (PHQ-9). - **Physical Exam**: To rule out other medical conditions that might cause depressive symptoms. - **Laboratory Tests**: To rule out medical conditions like thyroid disorders that can mimic depressive symptoms. ### Causes and Risk Factors The exact cause of MDD is unknown, but it is believed to result from a combination of genetic, biological, environmental, and psychological factors. - **Genetic Factors**: A family history of depression can increase the risk. - **Biological Factors**: Neurotransmitter imbalances, hormonal changes, and brain structure abnormalities. - **Environmental Factors**: Traumatic or stressful events, such as the loss of a loved one, financial problems, or a major life change. - **Psychological Factors**: Low self-esteem, being overly dependent, self-critical, or pessimistic. ### Treatment MDD is treatable, and several effective treatments are available. Treatment typically includes a combination of the following approaches: #### 1. Psychotherapy - **Cognitive Behavioral Therapy (CBT)**: Focuses on changing negative thought patterns and behaviors. - **Interpersonal Therapy (IPT)**: Addresses interpersonal issues and relationship problems. - **Psychodynamic Therapy**: Explores unconscious patterns and past experiences. #### 2. Medications - **Antidepressants**: The most common medications include Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine and sertraline, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) like venlafaxine, and tricyclic antidepressants (TCAs). #### 3. Lifestyle Changes - **Exercise**: Regular physical activity can improve mood. - **Healthy Diet**: Balanced nutrition supports overall well-being. - **Sleep Hygiene**: Maintaining a regular sleep schedule and good sleep habits. - **Stress Management**: Techniques like mindfulness, meditation, and yoga. #### 4. Other Treatments - **Electroconvulsive Therapy (ECT)**: Used for severe depression that hasn't responded to other treatments. - **Repetitive Transcranial Magnetic Stimulation (rTMS)**: A non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. ### Prognosis The prognosis for individuals with MDD varies. Many people respond well to treatment and can achieve significant improvement in their symptoms. However, MDD can be a recurrent condition for some, requiring ongoing treatment and management. ### Prevention While it may not be possible to prevent MDD entirely, certain strategies can help reduce the risk or severity of future episodes: - **Early Intervention**: Seeking help at the first sign of symptoms. - **Support Systems**: Maintaining strong relationships with friends and family. - **Healthy Lifestyle**: Regular exercise, a healthy diet, and adequate sleep. - **Stress Reduction**: Techniques such as mindfulness, meditation, and avoiding excessive stress. ### Conclusion Major Depressive Disorder is a serious but treatable condition that affects millions of people worldwide. Understanding the symptoms, seeking timely diagnosis and treatment, and maintaining a supportive environment are crucial steps in managing and overcoming this disorder.