Major Depressive Disorder

Chapter 2

This introduces some of this literature, its theories and findings in a way that will inform about engaging depression. This review was written so that the development of the ideas is not only a reflection on the literature, but also on insights from the study.

Major depressive disorder(MDD) affecects approximately 14.8 million American adults, or about 6.7 percent of the U.S population age18 and older in a given year (Kessler, Chiu, Demler, & Walters, 2005). MDD affect approximately 7% of the general population in a given year and is the most common cause of disability in the United States. The disorder is costly, with over $44 billion a year in direct and indirect costs in this country(Cross, 2007).

In a local study by Batar of 6,323 patients using Hospital Anxiety and Depression Scale (HADS), nationwide prevalence of depression was 31%. Those aged 51 to 65 and 65 above, those on first visit and those earning monthly income of Php 50,000 and below were significantly more likely to be depressed. Prevalence rate of depression was highest in Iloilo and Southern Luzon, while lowest in the National Capital Region (NCR). On the other hand, nationwide prevalence of anxiety was 36%. Females, 12 to 50 years old, compared to the 51 and older, those on first visit, those earning a monthly income of Php 50,000 and below were significantly most likely to be anxious. Prevalence rate of anxiety was highest in Iloilo, followed closely by Southern Luzon and Northern Central Luzon.

Results from the National Emphysema Treatment Trial showed that depression increases all hospitalization. Anxiety and depression was also linked to increased quality of life in these consequences. Anxiety and depression in COPD patients should be treated according to guidelines. Unfortunately, only a small proportion of patients with these conditions receive treatment. In two studies, fewer than one third of patients we’re receiving appropriate treatment.

Indirect consequences of depression are troublesome as well, and include increased failure to finish high school, likelihood of divorce, and substance abuse(Britton, 2006). Depression can lead to impaired concentration, memory, and attention, and a variety of structural brain abnormalities. Clearly it is not a condition from which we can walk away(Delgado and Scihillestrum, 2009).

Patient care for depression is usually given on an outpatient basis unless there is a significant risk to self or other (Woodill and Wright, 2011). The consenus among researchers is that depression is not a single entity with a single cause. Fasick(2010) says, “It is unlikely that depression is caused by a defect in a single neurotransmitter (NT) pathway, but by a combination of a genetic, biochemical, socio-economic, psychological, environmental, and life-experience factors, with the biggest risk factor being chronic stress.”

Psycho therapeutic approaches to the treatment of depression have a long history, going back at least to Freud and his theories of the unconscious. Freud thought that there was a, similarity between depression and the response to the death of a loved one.

The American Psychiatric Association sees major depressive disorder (MDD) as a mental disorder characterized by an all I encompassing low mood accompanied by low self-esteem, and by loss of interest of pleasure in normally enjoyable activities. The diagnosis of MDD depends on the recognition of the cluster of signs and symptoms that includes “depressed mood, and or lack of interest or pleasure, and at least four symptoms from a list that includes : weight or appetite changes; observable changes in psychomotor activity; feelings of worthlessness or guilt; poor ability t think or concentrate, or make decisions; and recurrent thoughts of death or suicide” (Britton, 2006). But, “many more patients are diagnosed with depressive illness, but not specifically MDD because they do not meet the criteria as listed above for MDD” (Bair, Robinson, Katon, and Kreonke). Research in developing countries suggestst that maternal depression may be a risk factor for growth in young children (Rahmab, 2008).

Underperformance at work is also a significant factor (Centre for Mental Health, Mental Health at work: Developing the business case, 2007) because depressive symptoms such as lack of attentionl, memory loss, and difficulties with planning and taking decisions are often overlooked,

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