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Depression is closely associated with a lack of confidence and self-esteem and with an inability to express strong feelings. Repressed anger is thought to be a powerful contributor to depression. The person feels inadequate to cope with the situations that arise in everyday life and so feels insecure.
Treatment of profound and chronic depression is often very difficult, requiring in most cases intensive psychotherapy to help the patient understand the underlying cause of the depression. antidepressant drugs such as imipramine hydrochloride (Tofranil) and amitriptyline (Elavil) are often used in the treatment of profound depression. They are not true stimulants of the central nervous system, but they do block the reuptake of neurotransmitter substances, which may potentiate the action of norepinephrine and serotonin. monoamine oxidase (MAO) inhibitors are also used. When antidepressants fail, a different technique such as electroconvulsive therapy may be used in conjunction with the psychotherapy.
When patients are depressed, they are likely to isolate themselves and avoid social contact even with those who are trying to help them. Since loss of contact with others contributes to depression, members of the health care team should persist in attempts to talk with these patients, by asking them questions, and actively listening when they attempt to express their feelings. One should be especially careful to avoid being judgmental when the patient does express despair, anger, hostility, or some negative feeling. Above all, it is important not to be condescending or to respond to statements with a meaningless cliché such as “Don't worry,” or “I'm sure everything will turn out okay.” These responses convey a lack of empathy with the patient's suffering and are an unrealistic approach to a problem that is very real.
Physical contact and touching may be misunderstood by depressed patients. Sometimes, it is better just to sit with them and calmly observe them without making them feel uncomfortable. Honest dialogue and expressions of support and concern can often improve their mood and sense of self worth.
Severely depressed patients usually express three basic feelings associated with their mental state. These are a lack of desire for socializing or physical activity, feelings of worthlessness and loss of self esteem, and thoughts of self-injury or destruction. In planning the care of the depressed patient, one must always consider these feelings and strive for some understanding of the reasons for the patient's behavior. Only by gradually gaining their attention and pointing out encouraging signs of progress can they be helped in their early attempts to return to reality and socialize with others.
Physical inactivity will require attention to adequate nutrition, a normal balance of fluid intake and output, proper elimination, and good skin care. Patients will need help in maintaining good personal hygiene. Severely depressed patients may be totally out of touch with reality and completely unresponsive to anyone else's presence. In such instances the health care provider may be able to do little more than demonstrate caring and empathy by remaining with the patient.
Consistency of care is helpful to depressed patients. They know what to expect, and thus are not repeatedly disappointed when their expectations are not met. An example is consistency in scheduling and carrying out treatments and routine care at the same time each day. A supportive family and interested friends should be involved in choosing and planning activities that are helpful.
Constant vigilance must be maintained to prevent the profoundly depressed patient from injuring himself or committing suicide. Self-destructive behavior is a manifestation of the patient's feeling of worthlessness and loss of self esteem. An awareness of the potential dangers in such a situation should help the provider plan and provide a safe and congenial atmosphere, remaining alert to the early signs of a patient's intention to harm or destroy himself. In most cases suicide is most likely to occur when the patient is recovering from severe depression.
Major depression is the most common psychiatric disorder. According to the World Health Organization, it is the leading cause of disability worldwide among people aged 5 years and older. About 10% of men and 25% of women experience major depression at some time in their lives. Approximately 20 million people a year suffer depressive illness in the U.S., where the negative impact of this disease on the economy is estimated at $16 billion annually. Risk factors for depression are drug or alcohol abuse, chronic physical illness, stressful life events, social isolation, a history of physical or sexual abuse, and a family history of depressive illness. Depression can be masked by substance abuse. In old people, it may be mistaken for senile dementia, and vice versa; the two may coexist. The disorder is believed to result from an electrochemical malfunction of the limbic system involving disturbances in the metabolism of the neurotransmitters dopamine and serotonin. In people with familial depression, the number of glial cells in the subgenual prefrontal cortex is significantly smaller than in mentally healthy people. Treatment with psychopharmaceutical agents, including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase (MAO) inhibitors, and others, effectively controls most cases of clinical depression. Cognitive-behavioral psychotherapy has demonstrated some success in reversing depression. Refined methods of electroconvulsive shock therapy (ECT) are used in cases that do not respond to other treatment. Even in severe depression the response rate with ECT is 80% or higher. This mode of therapy has a faster onset of action, causes fewer side effects than drug therapy, and is particularly useful in elderly patients.
major depressionA mental disorder characterised by severe depression lasting essentially without remission for at least two weeks, with symptoms that interfere with the ability to work, sleep, eat and enjoy once-pleasurable activities.
Feelings of guilt, hopelessness, all-encompassing low mood accompanied by low self-esteem, persistent thoughts of death or suicide; difficulties in concentration, memory and decision-making capacity, behaviour (changes in sleep patterns, appetite, weight), physical well-being; persistent symptoms (e.g., headaches or digestive disorders) that do not respond to treatment; disabling episodic major depression can occur several times in a lifetime.
major depressionUnipolar depression Psychiatry A form of depression with Sx that interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities Clinical Feelings of guilt, hopelessness, persistent thoughts of death or suicide, difficulties in concentration, memory, decision-making capacity, behavior–changes in sleep patterns, appetite, weight; physical well-being; persistent Sx–eg, headaches or digestive disorders, that don't respond to treatment; disabling episodic MD can occur several times in a lifetime See Depression.
ma·jor de·pres·sion, major depressive disorder (mājŏr dĕ-preshŭn, dĕ-presiv dis-ōrdĕr)
ma·jor de·pres·sion, major depressive disorder (mājŏr dĕ-preshŭn, dĕ-presiv dis-ōrdĕr)
Patient discussion about major depression
Q. What is MDD? I have heard this term on the radio referring to general depression, however I wanted to know what exactly is MDD.
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Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.
Q. I like to know the signs of serious major depression in women? I am lecturer in a college who is very approachable to students. If you take the top 10 lectures in the college the students will vote me first. Though I am proud of it I am not jealous. One of the clubs chose me as the best lecturer of the year and wanted me to send to another country for a special training in their own expense. Now I am here in this training which lasts for 6 more months. First week I fell home sick without seeing my students and got depressed and moreover I could not CONCENTRATE in the training and COULD NOT SLEEP. I like to know the signs of serious major depression in women?
Common complaints include:
• Depressed mood Loss of interest or pleasure in activities you used to enjoy
• Feelings of guilt, hopelessness and worthlessness
• Suicidal thoughts or recurrent thoughts of death
• Sleep disturbance (sleeping more or sleeping less)
• Appetite and weight changes
• Difficulty concentrating
• Lack of energy and fatigue