Throughout our lives, it is possible to feel sadness for some reason or go through a bad patch emotionally. And even though no one likes going 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 downturn, is actually a depressive process; that is, 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.
Major depression, also known as unipolar depression, is a mood disorder characterized by the appearance of one or more depressive episodes lasting at least two weeks, and presents a set of predominantly affective symptoms (pathological sadness, apathy, anhedonia, hopelessness, depression, 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 happy and feel pleasure, a phenomenon known as 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 we think and reason. In general, the total or partial lack of motivation makes people who have entered into a crisis of this type seem absent and do not feel like doing anything, not even thinking much (which does not mean that they have a mental disability).
Major depressive symptoms can be divided into mild, moderate or severe, and It usually begins during young adulthood, although it can arise at practically any stage of life. The individual suffering from this condition may experience phases of normal mood between depressive phases that can last 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 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 more than a set of disorders that are similar to each other and that do not actually share causes or logic. of operation. This is because people who experience depression can 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 topic, new ways of classifying these symptoms will emerge. However, today the psychological construct of “major depression” helps treat many people who need treatment from professionals and who can benefit from therapy something important if we take into account that this alteration of 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 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 the ability to feel pleasure (anhedonia).
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 there are some differences. Mainly, what allows dysthymia to be distinguished from major depression is that the former develops over longer cycles (of at least two years), the intensity of the symptoms is lower, and anhedonia is typically not present.
Types of major depression
Additionally, 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 major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified disorder of the schizophrenia spectrum and other psychotic disorders.
There are two types of major depression:
Causes of this mood disorder
Major depression is a multifactorial phenomenon so different factors could cause this psychopathology: genetic factors, childhood experiences and current psychosocial adversities (social context and aspects of personality).
Furthermore, 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 appearance of major depression.
Also Major depression has been linked to a lack of dopamine in the brain’s reward system, which makes the person goalless. 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 pathology 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 treatment.
However, in recent years the effectiveness 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 does not work. Of course, this therapy is not comparable to the old electroshocksince the intensity of the discharges is much lower and 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 to motivate themselves. As we will see, also the skills of self-knowledge and recognition of emotions and the questioning of dysfunctional beliefs are enhanced through cognitive restructuring.
On the other hand, while Mindfulness has shown some effectiveness 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 They can easily relapse into this type of crisis so that the treatment is considered as a help for life (although not necessarily weekly). Furthermore, the methods used to avoid relapses are different from those used when the patient is experiencing a depression crisis.
Psychotherapy treatment
Psychological therapy has proven to be an effective tool for the treatment of 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 his or her set of experiences from interaction with the environment and his or her beliefs, assumptions, attitudes, worldviews and self-assessments.
In cognitive behavioral therapy, different techniques are used 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. Below are some of the most common cognitive behavioral techniques:
Other forms of psychological therapy have also been shown to be effective in treating depression. For example: Interpersonal psychotherapy, which treats depression as an illness associated with a 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 the administration of different medications for a certain period of time is recommended.
The most used antidepressant drugs are the following:
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, altered 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 enzyme monoamine oxidase. Like the previous ones, they are used less frequently due to their serious side effects: weakness, dizziness, headaches and tremors. Tranylcypromine 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 generally 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.
Although it is also possible to find other types of antidepressants such as Selective Norepinephrine Reuptake Inhibitors (SNRI), Selective Norepinephrine and Dopamine Reuptake Inhibitors (SRIND) or atypical antidepressants, when consuming antidepressants that have the ability to increase release of serotonin it is necessary to be careful with its overdose or interaction with other medications.
Excess 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 Serotonin Syndrome.
You can learn more about this syndrome in our article: “Serotonin syndrome: causes, symptoms and treatment”
Bibliographic references:
Belloch, A.; SandÃn, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
Blazer, D.G., Kessler, R.C., McGonagle, K.A., & Swartz, M.S. (1994). The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. Am. J. Psychiat.
Drake RE, Cimpean D, Torrey WC. (2009). Shared decision making in mental health: prospects for personalized medicine. Dialogues Clin Neurosci.
Kramer, Peter D. (2006). Against depression. Barcelona: Six Barral.
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.
