Depression is a prevalent disease that affects a large part of the population. To deal with this disease, we must be aware of it.
History of depression:
Throughout history, depression has always been a health problem for humans. Historical written records of therapists, philosophers, and writers over the centuries point to the long-term presence of depression as a health problem. They also describe people’s persistent and intelligent efforts to find ways to treat this problem.
Depression was initially called melancholia. The first reports of melancholy are found in ancient Mesopotamian texts in the second millennium BC. At this time, it was thought that all mental illnesses occur when demons dominate people. Priests treated these diseases. A separate group of physicians treated physical injuries but did not treat conditions such as depression. The first historical understanding of depression was that depression was not a physical illness but a mental illness.
The ancient Greeks and Romans had different ways of thinking about the cause of melancholy. The literature of the time suggested that the cause of the mental illness was ghosts or demons. About 400 BC, the Greek historian Herodotus wrote about a king who had gone mad because of evil spirits.
Early Babylonian, Chinese, and Egyptian civilizations also considered mental illness a form of demon possession. They used sex techniques such as beatings, restraints, and starvation for treatment. The goal of these treatments was to drive the demons out of the infected person’s body. In contrast, ancient Roman and Greek physicians thought that depression was a biological and mental illness. Gymnastics, massage, special diets, music, baths, and a combination of poppy extract and donkey milk were used to treat depressive symptoms.
The Greek physician Hippocrates suggested that personality traits and mental illnesses were associated with fluid imbalance or imbalance. The four types of fluids were: yellow bile, black bile, phlegm, and blood. Hippocrates classified mental illness that included mania, melancholy, and Bersama. He believed that melancholia was caused by too much black bile in the spleen. He used cupping, bathing, exercise, and diet to treat the disease.
Contrary to Hippocrates’ views, the famous Roman philosopher and politician Cicero argued that the cause of melancholy was intense grief, fear, or anger. Instead of a physical explanation, it was a psychological explanation for depression. In the last years before Christ, the influence of Hippocrates faded. The educated Romans’ prevailing view was that demons and the gods’ wrath caused mental illnesses such as depression. For example, Aulus Cornelius Celsus recommended methods of starvation and confinement to treat the disease.
In contrast, the Iranian physician Zakaria Razi, the Baghdad hospital’s chief physician, saw the brain as mental illness and melancholy. Her mental illness treatments often included hydrotherapy (baths) and necessary behavioral therapy forms (positive rewards for appropriate behaviors).
After the fall of the Roman Empire, scientific thinking about the cause of mental illness and depression came back. During the Middle Ages, religious beliefs, especially Christianity, overcame other justifications for the cause of mental illness in Europe. Most people thought that demons, evil spirits, or witches possessed people with mental illness. Treatments included ghosting and other cruel methods such as drowning and burning.
A small minority of physicians still believed that mental illness was caused by an imbalance of body fluids, a low diet, and sadness. Some people with depression were held in psychiatric hospitals. The Renaissance began in Italy in the 14th century and spread throughout Europe. During this time, thinking about mental illness was both progressive and regressive. On the one hand, witch hunts and the mentally ill’s execution were quite common throughout Europe. On the other hand, some physicians returned to Hippocrates’ view, stating that natural causes caused mental illnesses and that those who were stigmatized and persecuted as witches were the ones who needed compassionate medical treatment.
In 1621, Robert Burton, in his book The Anatomy of Melancholy, cited the psychological and social causes of depression. These causes included poverty, fear, and social isolation. He explained that diet, exercise, distraction, detoxification, cupping, herbal remedies, marriage, and even music therapy were effective treatments for depression.
At the beginning of the Enlightenment, depression was thought to be an invariable inherited mood disorder. This led to the exclusion of these patients from society and their homelessness and poverty. Towards the end of the Enlightenment, physicians theorized that aggression was at the root of the problem. Therapies such as exercise, diet, music, and medication were prescribed, and doctors suggested that the patient talks to a friend or physician about their problems. Some doctors speak of depression as an internal conflict between “what you want” and “what you know is right.” Others continued to seek to identify the physical causes of the disease.
Enlightenment treatments for depression include water immersion (people were kept underwater as much as possible without drowning) and standing on a rotating platform to believe that the move would put the brain’s contents in place. To return, was. Benjamin Franklin also developed an early form of electroconvulsive therapy during this time. Also, horseback riding, diet, cleansing, and vomiting were recommended treatments.
In 1895, the German psychiatrist Emile Kriplin was the first to define mania depression (what we now know as bipolar disorder) as a separate disease from premature insanity (a term used for schizophrenia at the time). It was at this time that the theory of psychoanalysis and psychoanalysis developed.
In 1917, Sigmund Freud wrote about mourning and melancholy, in which he defined melancholy as a reaction to loss (real (for example, a death) or symbolic (failure to achieve the desired goal). Also, Freud believed that one’s subconscious anger about this loss leads to hateful and hurtful behaviors towards oneself. He felt that psychoanalysis could help resolve these unconscious conflicts and reduce self-harming thoughts and behaviors. During this period, however, physicians considered depression to be a brain disorder.
In general, in the late 19th and early 20th centuries, treatments for major depression were not designed to help patients, leading many patients who became frustrated with these treatments to undergo a lobotomy. In this surgery, the frontal part of their brain was destroyed. This surgery was believed to relieve the disease. Unfortunately, lobotomy often causes personality changes, loss of decision-making power, poor judgment, and sometimes even death.
During the 1950s and 1960s, physicians divided depression into endogenous (of physical origin) and neurological or reactive (environmental) subtypes. Endogenous depression appeared to be the result of genetics or some other physical defect. In contrast, the neurological or reactive type appeared to be the result of some external problem such as death or job loss.
The 1950s were a critical decade in the treatment of depression. At this time, doctors realized that a tuberculosis drug called isoniazid effectively treated depression in some people. From now on, drug therapies were considered. Also, new schools of thought, such as the theory of family systems and cognitive-behavioral systems, have emerged as other treatments for depression.
At present, depression is believed to be caused by several causes, including biological, psychological, and social factors. In general, psychotherapy and drugs that target neurotransmitters are preferred therapies. However, electroconvulsive therapy is also used in certain conditions, such as refractory depression or severe cases that require immediate patient relief. Other newer therapies include the brain’s magnetic stimulation through the skull and vagus nerve stimulation, developed in recent years to help people who do not respond to treatment and medication. Because the causes of depression are unfortunately more complicated than we know, there is no single treatment that works for everyone.
A brief overview of major depressive disorder:
Major depressive disorder (MDD), also known as depression, is a mental disorder characterized by at least two weeks of low mood present in most conditions. This condition is often accompanied by decreased self-esteem, decreased interest in normally enjoyable activities, low energy, and pain for no apparent reason. Affected people may sometimes have misconceptions or see or hear things that do not exist externally. Some people have periods of depression, and between these intervals, a few years are standard, while others have these symptoms almost continuously.
Major depressive disorder can negatively impact a person’s personal, professional, academic life, sleep, eating habits, and general health. Between 2% and 8% of adults who suffer from depression die from suicide, and about 50% of people who die from suicide suffer from depression or another mood disorder.
The cause of this disease seems to be a combination of genetic, environmental, and psychological factors. Risk factors include a family history of the disease, significant life changes, certain medications, chronic health problems, and substance abuse. Diagnosis of depressive disorder is based on self-reported experiences and a test of mental health. There are no laboratory tests to diagnose major depression. However, tests may be performed to rule out physical illnesses that cause similar symptoms. Major depression is more severe and longer-lasting than feeling sad, which is a natural part of life.
People are usually treated with counseling and antidepressants. Types of therapeutic counseling include cognitive behavioral therapy and interpersonal psychotherapy. If other measures do not work, electroconvulsive therapy may be used. In cases where there is a risk of self-harm, there may be a need for hospitalization, which is sometimes done against the person’s wishes.
Major depressive disorder affected about 216 million people in 2015. The percentage of people affected in their lives varies from 7% in Japan to 21% in France. Women get about twice as much as men.
The American Psychiatric Association added Major Depressive Disorder to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. In the DSM-II version, major depression was considered a branch of psychotic depression, which also included conditions now known as mood disorders (depressive disorder and mood disorder).
Signs and symptoms of depression:
Major depression significantly affects family and personal relationships, work or study life, sleep and eating behaviors, and general health. A person with depression usually has a low mood that permeates all aspects of his or her life and an inability to experience previously enjoyable activities.
Depressed people may experience feelings such as worthlessness, remorse and guilt, frustration, and disgust. In severe cases, depressed people may develop symptoms of psychosis. These symptoms include hallucinations and sometimes even delusions. Other symptoms of depression include low concentration and memory, withdrawal from social activities and situations, decreased sexual desire, irritability, and thoughts of death or suicide.
Insomnia is also common among depressed people. In the usual pattern, the person wakes up too early and cannot sleep again. Excessive sleep can also occur. A depressed person may also report physical symptoms such as fatigue, headaches, or digestive problems. Appetite is often reduced and leads to weight loss, although there may be increased appetite and weight gain.
Older adults with depression may experience cognitive symptoms such as forgetfulness and noticeable slowing of movements while dealing with depression. Depression in the elderly is often associated with common physical disorders such as stroke, other cardiovascular diseases, Parkinson’s disease, and chronic obstructive pulmonary disease.
Depressed children may exhibit irritability instead of depressed behavior and may have different symptoms depending on their age and situation. Most of them lose interest in school and suffer from academic failure. They may be defined as dependent and insecure personalities. When these symptoms are confused with regular mood swings, the diagnosis of depression will be delayed, or the child will not be diagnosed at all.
Depression is often associated with other psychiatric problems. According to the US National Combination Survey, half of the people with depression suffer from anxiety and related disorders, such as generalized anxiety disorder. Anxiety symptoms can significantly impact depression and lead to delayed recovery, increased risk of recurrence, increased disability, and increased risk of suicide.
Substance abuse, alcoholism, and addiction are more common among these people, and about one-third of people diagnosed with Attention Deficit Hyperactivity Disorder also suffer from depression. Post-traumatic stress disorder and depression often occur together.
Pain and depression are also often present together. 65% of depressed people have one or more pain symptoms, and usually, 5 to 85% of people with pain, depending on their condition, also suffer from depression. Depression is also associated with an increased risk of cardiovascular disease and is also directly or indirectly associated with risk factors such as smoking and obesity. People with depression are less likely to follow medical guidelines for treating and preventing cardiovascular disease, which increases their risk of other medical problems. The cardiologist may also not notice the problem of depression behind the scenes of the patient’s cardiovascular problem.
Causes of depression:
The cause of significant depression remains unknown. Biopsychological models suggest that biological, psychological, and social factors all play a role in depression.
According to the hereditary stress vulnerability model, depression occurs when stressful life events trigger a pre-existing vulnerability. This history of vulnerability can be genetic, indicating an interaction between heredity and the environment, or patterned and the result of worldviews acquired in childhood. Whether physical, sexual, or psychological, a history of childhood abuse is all risk factors for this illness. Childhood trauma is also associated with the severity of depression, failure to respond to treatment, and illness duration. However, some people are more susceptible to developing mental illness, such as post-traumatic stress disorder, and various genes have been suggested to control this sensitivity.
The role of genetic factors in the incidence of depression:
Like many other psychiatric disorders, major depressive disorder is affected by numerous individual genetic changes. In a genome-level correlation study, 44 genomic variants were associated with a higher risk of depression. A study followed this study in 2019 in which 102 gene variants associated with depression were identified. Using this information, scientists combine the entire genome’s estimated effects and calculate an individual score to assess a person’s genetic predisposition to this illness. Of course, this score explains only a small part of the individual differences in the risk of depression.
Some studies have shown that the 5-HTTLPR gene, or short allele promoter of the serotonin-transmitting gene, is associated with an increased risk of this illness. However, some studies have not confirmed its effect. Other genes involved in gene-environment interactions include CRHR1, FKBP5, and BDNF, the first two associated with the hypothalamic-pituitary-adrenal (HPA) stress response, the latter of which is involved in neurogenesis.
Relationship between health problems and depression:
This illness can be caused by a chronic or incurable disease such as HIV, AIDS, or asthma, called secondary depression. Of course, it is not clear whether behind-the-scenes disease causes depression through effects on quality of life or through common causes (such as the breakdown of normal ganglia in Parkinson’s disease or an immune system disorder in asthma).
Pathophysiology of depression:
The pathophysiology of this illness is not yet well understood. Current theories still revolve around monoaminergic systems, circadian rhythms, immunological disorders, hypothalamic-pituitary-adrenal axis disorders, and structural and functional abnormalities of emotional circuits.
Monoamine theory, which results from monoaminergic drugs in treating this illness, has been the dominant theory until recently. According to this theory, the leading cause of this illness is the insufficient activity of monoamine neurotransmitters. The supporting evidence for monoamine theory comes from various fields. First, a severe decrease in tryptophan, an essential precursor to serotonin (a monoamine), can exacerbate this illness in depressed individuals or families of depressed patients. This suggests that reducing serotonergic neurotransmission is important in depression. Second, the correlation between the risk of depression and the polymorphism in the 5-HTTLPR gene encodes serotonin receptors and indicates an association. Finally, a decrease in the locus circles’ size, a decrease in tyrosine hydroxylase activity, an increase in the density of alpha-2 adrenergic receptors, and evidence from mouse models indicate that adrenergic neurotransmission is reduced in depression.
However, this theory is not consistent because low serotonin does not cause depression in healthy people. Also, antidepressants rapidly increase monoamine levels, but it takes weeks to see their effects, and there are unusual antidepressants that can affect the treatment of this illness without targeting it.
In depression, immune system abnormalities are also seen, including increased cytokines involved in pathological behavior production. The effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) and cytokine inhibitors in the treatment of depression and the normalization of cytokine levels after successful treatment suggest the role of immune system abnormalities in the development of depression.
Considering the relationship between CRHR1 and depression and the positive results of the dexamethasone suppression test (DST) in depressed patients, the role of HPA-based abnormalities in depression has also been suggested. In some patients with depression, cortisol secretion increases due to a disorder in the HPA axis. A synthetic glucocorticoid lowers and lowers serum cortisol, so it makes sense that in depressed patients, if cortisol levels are elevated, dexamethasone may not be able to reduce it as much as usual, as the DST test indicates. This is the issue. Of course, this anomaly is not enough as a diagnostic tool because this test’s sensitivity is only 44%.
Theories have also been proposed based on findings related to brain imaging. A proposed model is the cortical, limbic model, which refers to the hyperactivity of the abdominal paralympic regions and the frontal regulatory regions’ inactivity in emotional processing. Another model is the cortico-striatal model, which shows that anterior cortical abnormalities in the regulation of striated and subcortical structures lead to depression. Another proposed model is that the inactivation of prominent brain structures in identifying negative stimuli and inactivating cortical regulatory structures leads to emotional bias and depression.
Diagnosis of depression:
Diagnostic evaluation may be performed by a trained general practitioner, psychologist, or psychiatrist who looks at a person’s current condition, life history, symptoms, and family history. The main clinical goal is to formulate biological, psychological, and social factors that may affect a person’s mood. The evaluator also considers factors such as alcohol and drug use. The assessment also includes examining the individual’s mental state, current mood, and intellectual content, especially in frustration or pessimism, self-harm or suicide, and lack of positive thoughts and plans.
Specialized mental health services are scarce in rural areas, and therefore the diagnosis and management of this problem is mostly the responsibility of primary care physicians. This is more common in developing countries. Primary care physicians and other non-psychiatrists are more challenging to diagnose and treat depression than psychiatrists. . This is due to this illness’s physical symptoms and the various barriers between the patient and the treatment system. The results of a review study show that non-psychiatrists do not diagnose about two-thirds of cases of depression, although this has improved somewhat, according to recent studies.
A mental health examination may include using a rating scale such as the Hamilton Rating Scale for Depression, the Beck Depression Inventory, or the Revised Suicide Behavior Questionnaire.
A score based on a scale alone is not enough to diagnose depression, but it does provide a measure of its severity. Accordingly, a person whose score exceeds a threshold should be further evaluated for the final diagnosis of depression. Different scales are used for this purpose.
Before diagnosing the major depressive disorder, your doctor will perform a medical examination and selective tests to rule out other causes. These include blood tests to measure thyroid-stimulating hormone and thyroxine to rule out hypothyroidism; Measurements of basal electrolytes and blood calcium to rule out metabolic disorders; and blood tests to rule out systemic infections or chronic diseases.
The possibility of adverse emotional reactions to certain medications or alcohol abuse is also often considered. Testosterone levels may also be measured to diagnose hypogonadism, a cause of this illness in men. Vitamin D levels may also be measured because decreased levels of this vitamin have been associated with an increased risk of depression. (Vitamin A; Benefits, Symptoms Of Deficiency, And Sources Of This Vitamin)
Mental cognitive complaints are seen in depressed older people, but they can also sign the onset of another illness, such as Alzheimer’s. Cognitive tests and brain imaging can help differentiate between depression and dementia.
A CT scan of the brain can also look at the risk of brain damage in people who have symptoms of psychosis, who develop symptoms quickly, or who have some unusual symptoms.
There are no biological tests to confirm depression.; various biomarkers have been studied. These markers include brain-derived neurogenic factors and several fMRI techniques.
DSM and ICD criteria:
The most common criteria used to diagnose depressive disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association and the International Statistical Classification of Diseases (ICD) of the World Health Organization. The recurrence is used for recurring episodes. The second system is commonly used in European countries, while the first classification system is used in the United States and many non-European countries.
The ICD-10 defines three common symptoms of depression (depressed mood, anhedonia, and low energy), two of which are essential for diagnosing the depressive disorder. According to the DSM-5, there are two main symptoms of depression: decreased mood and loss of interest and enjoyment of activities. These symptoms, along with a few other symptoms, should be present frequently for two weeks to interfere with a person’s functioning. A major depressive disorder is classified in the DSM-5 as a mood disorder. Diagnosis depends on the presence of one or more episodes of major recurrent this illness. Descriptors are used to classify the episode itself as well as the period of the disorder.
An unspecified depressive disorder is diagnosed if a depressive episode’s onset does not fit primary depressive episode criteria. The ICD-10 system does not use the term major depressive disorder but uses the same criteria to diagnose an episode of this illness (mild, moderate, or severe); The term recurrent is also added to the diagnosis if multiple episodes occur frequently and without manic interval between episodes of depression.
Major Depression Episode:
A major depressive episode is defined by the presence of a severely depressed mood that lasts for at least two weeks. Episodes may be isolated or recurrent and may be mild, moderate, or severe. An episode with the characteristics of psychosis (psychotic depression) is automatically rated as severe. If the patient has an episode of mania, the diagnosis will be bipolar disorder. Mania-free depression is sometimes referred to as unipolar because mood swings remain on an emotional state or “pole.”
The DSM-IV-TR classification system does not take into account cases of mourning. However, if this mood persists, natural mourning may progress to a depressive episode, and the hallmarks of a major depressive episode may develop. There is no standard of mourning in the DSM-5, and it is now up to physicians to distinguish between natural reactions to death and depression.
Sometimes, these criteria are criticized because they ignore other aspects of life in which this illness can occur. Also, there is little empirical support for the DSM-IV threshold.
Rejection causes of this illness include a range of related diagnoses, including mood disorders that include a milder chronic mood disorder, transient recurrent depressive disorder consisting of shorter depressive episodes, mild depressive disorder in which there are only a few significant depressive symptoms disorder. Accompanied by a depressed mood, the symptom is low mood due to a psychological reaction to an identifiable event or stressor.
Three new depressive disorders have been added to the DSM-5: Disruptive Mood Disorder, characterized by significant childhood irritability and mood disorders, Premenstrual Disorder, which causes periodic anxiety, depression, or irritability in the one or two weeks before menstruation. Women and chronic depressive disorder.
In addition to the duration, severity, and presence of psychotic features, the DSM-5 classification system defines six other subsets of significant depression called specifiers:
- Depressive melancholy is characterized by loss of pleasure in most or all activities, inability to respond to pleasurable stimuli, a depressed mood that is stronger than grief, worsening symptoms in the morning, waking up in the morning, slowing down, slowing down, and slowing down—excessive weight or guilt.
2. Atypical depression has the characteristics of mood responsiveness (paradoxical anhedonia) and positivism, significant weight gain or increased appetite, excessive sleep or insomnia, heaviness in the limbs (lead paralysis), and significant social disturbance resulting in hypersensitivity as a consequence of hypersensitivity. It is interpersonal.
3. Catatonic depression is a rare and severe form of major depression that includes impaired motor behaviors and other symptoms. Here the person is silent and almost confused and shows immobility or aimless and strange movements. Catatonic symptoms may also be seen in schizophrenia or episodes of mania and malignant neuroleptic syndrome.
4.Depression associated with an anxiety disorder was added to the DSM-V as a tool to emphasize the common occurrence between depression or mania and anxiety and the suicide risk of depressed people with anxiety. Such a definition can also help predict the prognosis for people with depression or bipolar disorder.
5.Childbirth-related depression refers to severe, persistent, and sometimes debilitating depression that some women experience after a child’s pregnancy. The term DSM-IV-TR used the term postpartum depression but was changed to depression with peripartum onset because it did not include cases of depression during pregnancy. The prevalence of postpartum depression in mothers experiencing their first pregnancy is about 10 to 15%. Postpartum depression can last up to three months. Many researchers believe that this depression is not specific to women and can occur in men after birth.
6.Seasonal Affective Disorder is a type of depression in which episodes of depression appear in the fall or winter and disappear during the spring. Diagnosis is made if at least two episodes have occurred in the colder months of two years or more and no episodes have occurred in another period.
it is necessary to consider other possible diagnoses such as mood swings, depressive mood disorder, or bipolar disorder. Mood swings are a milder, chronic mood disorder in which a person reports a low mood daily for at least two years. The symptoms of this condition are not as severe as those of major depression. However, people with mood disorders are vulnerable to secondary episodes of major depression (sometimes referred to as major depression).
Depressive mood adjustment disorder is a mood disorder that manifests as a psychological response to an identifiable event or stressor. The resulting emotional or behavioral symptoms are significant but do not meet the major depressive episode. criteria
Bipolar disorder, also known as a depressive-manic disorder, is a condition in which depressive and manic states manifest intermittently. Although depression is currently classified as a separate disorder, there is much debate about it. People diagnosed with major depression often show mild mania symptoms, indicating a link between the two disorders.
Other disorders should be considered before diagnosing the major depressive disorder. These include chronic fatigue syndrome, depression caused by physical illness, medications, and substance abuse. Depression caused by a physical illness is defined as a mood disorder caused by a general medical condition. This condition is diagnosed based on history, laboratory results, or physical examination. When depression is caused by a drug, drug abuse, or exposure to a toxin, it is diagnosed as a specific mood disorder (formerly referred to as substance-induced mood disorder in the DSM-IV-TR).
Treatments for depression:
The three most common treatments for depression are psychotherapy, medication, and electric shock therapy. Psychotherapy is the preferred treatment for people under 18 years of age. The 2004 recommendations of the National Institutes of Health and Clinical Excellence state that antidepressants should not treat mild depression in the early stages because it has a low risk-to-benefit ratio. These guidelines state that antidepressant therapy should be continued for at least six months to reduce the recurrence risk. Serotonin reuptake inhibitors (SSRIs) are better tolerated than tricyclic antidepressants (TCAs).
According to the American Psychiatric Association’s treatment guidelines, initial treatment should be designed individually based on the severity of symptoms, co-occurring disorders, past treatment experiences, and patient preference. Options may include medication, psychotherapy, exercise, electroconvulsive therapy (ECT), magnetic resonance imaging (TMS), or phototherapy.
There is evidence that a group of health care professionals’ collaborative care is better than the usual care provided by a specialist. Treatment options are more limited in developing countries, as access to mental health, medication, and psychotherapy staff are often tricky in these areas. The development of mental health services is fragile in many countries; Depression is considered a phenomenon in the developed world, although there is evidence to the contrary, and depression is not thought to be a life-threatening illness.
- Lifestyle change
Physical exercise is recommended for the management of mild depression and has a moderate effect on its symptoms. Exercise also appears to be effective in major (unipolar) depression. In most people, this approach is the equivalent of using medication or psychotherapy. In older people, too, this method seems to reduce depression. In observational studies, smoking cessation on depression has been as significant as that of drugs and even more significant. In addition to exercise, sleep and diet may play a role in depression, and intervention in these areas can help depressed patients.
One study found that waking up at night improved depressive symptoms and its effects were visible overnight. Of course, this effect is usually temporary, and in addition to drowsiness, this method can also cause manic side effects.
Psychotherapy can be provided individually, in groups, or in families. A review study in 2015 showed that the effect of cognitive-behavioral therapy (CBT) is as effective as antidepressants. In the context of more chronic and complex forms of depression, a combination of medication and psychotherapy may be more effective. A 2014 Cochrane review found that occupational interventions combined with clinical interventions can help reduce the number of days of depression. There is moderate-quality evidence that psychological therapies, in addition to standard treatment, are effective short-term antidepressants for the treatment of refractory depression.
- Cognitive-behavioral therapy
Cognitive-behavioral therapy (CBT) currently has the most research evidence for treating depression in children and adolescents, and CBT and interpersonal psychotherapy (IPT) are the preferred treatments for adolescent depression. According to NICE, in people under 18, medications must be given and psychological treatment such as CBT, interpersonal therapy, or family therapy. Several types of cognitive-behavioral therapy have been used in people with depression, the most important of which are mindfulness, emotional and behavioral therapy, and mindfulness-based cognitive therapy. Mindfulness-based stress reduction programs may reduce depressive symptoms.
Cognitive-behavioral therapy is a common type of speech therapy that can be as effective or even more effective than antidepressants in some people. This method is usually effective in cases of mild to moderate depression. Still, if the therapist is skilled enough, he can also use it to treat severe depression. In some cases, CBT can be combined with other treatments, such as medication. In this way, the therapist helps the patient identify their negative or incorrect thoughts and replace them with healthier and more realistic thoughts. For example, a person may feel worthless or believe that their life is terrible and getting worse. Or he is severely tormented because of his weaknesses and shortcomings. In the first stage, CBT informs the person about having these thoughts. It then teaches him to replace those thoughts with positive ones. Changes in a person’s attitude lead to changes in their behavior and can help reduce depressive symptoms. When waking up in the morning, a person may ask himself, “Why should he try?” With CBT, he learns to say to himself, “This is not a useful idea; There are many rewards to trying. “I start my struggle by getting out of bed.” Of course, to reach the stage where a person feels good, it takes weeks and sometimes even months to attend these sessions.
CBT is the most approved method of speech therapy. This method is sometimes as effective in treating some types of depression as antidepressants. Some studies show that people treated with CBT are 50 percent more likely to recur at depression than those on medication alone.
Medications work well in treating depression, but if a person also receives CBT, their treatment may be more effective, and the benefits may last longer. Most people treated for CBT due to depression or anxiety continue to use their skills until a year later.
Suppose a person is taking medication to treat depression. In that case, even if he or she is working with a CBT therapist, he or she should never stop taking the medication without consulting the prescribing physician. If someone abruptly stops taking their medication, it can lead to severe depression and other problems.
- Interpersonal psychotherapy to treat depression
Interpersonal Therapy (IPT) is a treatment for patients with depression that focuses on past and present social maps and interpersonal interactions. During treatment, the therapist generally focuses on one or two areas of the patient’s life that appear to be the source of their problems. Some of these areas include conflict with friends, family, co-workers, grief over loss, and divorce and retirement changes. The IPT does not seek to enter the realm of internal conflicts from past experiences but seeks to help the patient find better ways to deal with problems.
There are two types of IPT. The first type is used in the short-term treatment of episodes of depression. The patient and therapist usually see each other weekly for 2 to 4 months, and when the symptoms subside, the treatment ends. The second type is maintenance therapy (IPT-M), a long-term treatment aimed at preventing or reducing future episodes of depression. IPT-M may include monthly meetings over two to three years.
In interpersonal therapy, four primary areas of problems are considered. The therapist helps the patient determine which area is most responsible for his or her depression, and then the treatment is directed to help the patient deal with the problem in that area. The four primary areas of problems that are recognized in interpersonal therapy are:
- Unresolved grief: In normal mourning, the person usually returns to normal within a few months. Unresolved grief is delayed and persists for a long time afterward, or is distorted grief in which a person may not feel emotional but experience other symptoms instead.
- Role conflicts: Role conflicts occur when the patient and the critical people in his or her life have different expectations about their relationship.
- Role change: When a person’s role in life changes, he or she may not know how to cope, and this change will be the source of his or her problems.
- Interpersonal conflicts: If the patient has problems establishing and maintaining quality relationships, this area may be of interest to the therapist.
5.Use of psychoanalysis in the treatment of depression
Psychoanalysis is a school of thought founded by Sigmund Freud and emphasizes conflicts in the subconscious mind. Some physicians use psychoanalytic techniques to treat patients with major depression.
Scanning psychotherapy is a subset of psychoanalysis whose schedule is low-intensity, and its sessions are held once or twice a week. Scanning psychotherapy is designed to help patients fully explore their emotions, including emotions they may not be aware of. By making subconscious components of life part of current life experiences, dynamic psychotherapy helps people understand how their behavior and moods are affected by unresolved issues and unconscious emotions.
Scanning psychotherapy is one of the three main types of psychotherapy used to treat depression. The other two are CBT and IPT, as described earlier. What distinguishes these methods is the nature of their focus. CBT and IPT methods focus on understanding and modifying specific processes or behaviors. At CBT, the focus is on how one thinks. Thoughts determine how a person acts and how they feel and react; CBT focuses on identifying and changing abnormal thinking patterns. IPT emphasizes identifying issues and problems in interpersonal relationships and finding ways to improve them. Both CBT and IPT have a time limit and are considered short-term treatments. The emphasis of these methods is on learning new patterns rather than analyzing the cause of abnormal patterns.
On the other hand, psychotherapy is modeled on Freud’s theories and methods of psychoanalysis. Psychoanalysis is based on the idea that their subconscious mind and past experiences influence a person’s behavior. Psychoanalysis involves the intensive and open-ended investigation of the patient’s emotions, often several sessions a week. The first sessions are devoted to discovering the patient’s emotions and the emotions that he is unaware of.
Scanning psychotherapy sessions are usually held once a week, and each session lasts about 50 minutes. Patients usually sit in a chair while not seeing a therapist. Unlike IPT and CBT, both involve formal, structured sessions; dynamic psychotherapy sessions are often open-ended and open-ended. In dynamic psychotherapy, the patient is encouraged to talk freely about what has happened to him or her or what is on his or her mind. As the patient does this, the behavioral and emotional patterns are rooted in past experiences, and his or her new emotions become apparent. Those patterns are then considered to become more aware of how past experiences and the subconscious mind affect their current life. Scanning psychotherapy is not necessarily a short-term, time-limited treatment. While some treatment courses may end after 16 to 20 weeks, others may last for more than a year.
Scanning psychotherapy involves exploring a patient’s entire range of emotions. With the help of a therapist, the patient finds ways to talk about their feelings, including conflicting feelings, distressing or threatening feelings, and unfamiliar feelings. This discovery occurs in the context of one, recognizing that the ability to explain a problem’s cause does not necessarily mean the ability to deal with it. In the following, it is tried to cultivate the internal resources needed to deal with and effectively manage those problems in the individual.
In addition to focusing on emotions, dynamic psychotherapy focuses on recognizing and addressing the defense mechanisms, that is, the reactions and behaviors that a patient uses to avoid disturbing thoughts and feelings. For example, a person may try to suppress memories of unpleasant experiences or have a habit of changing the subject when it comes to specific topics. Other reactions may include being late or not attending meetings that have reached very unpleasant topics or focusing on external details instead of focusing on one’s role in an issue. As the sessions continue, repetitive patterns of patient thinking, emotions, and behavior will emerge. These patterns are often subtle, and the patient is unable to identify them.
The therapist helps the patient recognize these patterns and understand their importance and how they affect their mood and reactions. Often, the discussion of patterns leads to a review of past experiences that are still relevant today. There is also an emphasis on dynamic relationships, especially the relationship between therapist and patient, in scanning psychotherapy. Observing how the patient responds in that relationship gives the therapist insight into how they react and interact with others.
Most psychological problems are rooted in a person’s problems with others and the difficulty meeting their emotional needs. One of the goals of scanning psychotherapy is to identify these problems and find ways to solve or better deal with them. In psychodynamic therapy, the imaginary dimension of a person’s life, including the possible psychological concepts behind the imaginary scene or the emotional content of dreams, is also examined. Because the patient is encouraged to speak freely, he will discover everything in his mind.
Psychodynamic therapy’s primary goals are to gain more knowledge about one’s subconscious conflicts and self-awareness of one’s emotions and motivations. This insight is thought to be the mechanism by which symptoms are relieved. Also, dynamic psychotherapy aims to help the patient develop internal psychological resources and increase their capacity to deal with the psychological problems that cause them emotional pain and suffering. The person does this by dealing with subconsciously suppressed issues that affect his or her life or learn healthier ways to deal with them.
Until recently, it was thought that there was no evidence to support the effectiveness of dynamic psychotherapy as a treatment for depression. Part of the reason was that experimental research did not focus on scanning psychotherapy participants as participants in CBT and IPT. But over the past few decades, that situation has changed, and studies have emerged.
In early 2010, a report published in the journal American Psychologist reviewed data from existing dynamic psychotherapy and depression studies. The authors conclude that dynamic psychotherapy is at least as effective as other evidence-based therapies and that the benefits of this treatment appear to be more lasting.
Studies that have examined the effectiveness of antidepressants in treating people with acute, moderate, and mild depression have yielded conflicting results. More substantial evidence supports the usefulness of antidepressants in treating severe or chronic depression. One review found that SSRIs such as citalopram, paroxetine, and sertraline were more effective than placebo at reducing depression scores in primary and moderate major depression. There was evidence that such effects were also seen in mild depression.
A systematic review of Cochrane’s clinical trials of the amitriptyline tricyclic antidepressant shows that it is more effective than placebo. In 2014, the Food and Drug Administration conducted a systematic review of all antidepressant tests submitted to the agency between 1985 and 2011. The authors concluded that maintenance therapy reduced recurrence risk by up to 52% compared with placebo.
The amount of medication should be adjusted, and different groups of antidepressants are used if necessary. The response rate to the first antidepressant used is 50 to 75%, and it takes at least 6 to 8 weeks to observe the effect of the drug.
Antidepressant medications usually last 4 to 6 months after recovery, and it is sometimes recommended that they be continued for up to a year. People with chronic depression may need to take medication indefinitely to avoid recurrence. SSRIs are usually the first drugs to be prescribed because of their relatively mild side effects and the fact that high doses are less toxic than other antidepressants.
SSRIs not affected by SSRIs can take another antidepressant, which can improve about 50% of cases. Another option is to use the unusual antidepressant bupropion. Venlafaxine is also an antidepressant with different mechanisms of action that may be more effective than SSRIs. However, venlafaxine is not recommended as a first-line drug in some countries, such as the United Kingdom, due to its potential risks and adverse effects on children.
Some studies have recommended the use of the antidepressant fluoxetine in children. However, the drug is not recommended for children with mild illnesses.
Antidepressants can lower blood sodium levels, although this has been reported more often in SSRIs. SSRIs can cause insomnia or worsen existing insomnia so that the unusual sedative antidepressant mirtazapine can be used.
Irreversible monoamine oxidase inhibitors are an older group of antidepressants that are less well-known because of their potential interactions with diet and medication.
In adults, it is not clear whether this group of drugs affects the risk of suicide. In 2007, SSRIs and other antidepressants were issued a black box warning in the United States to increase the risk of suicide in patients younger than 24 years. The Japanese Ministry of Health issued such precautionary warnings.
7.Three-ring and four-ring antidepressants
Tricyclic and quadruple antidepressants are antidepressants that affect brain chemicals. These antidepressants, also called ring antidepressants, were one of the first drugs developed to treat depression. They are effective but have generally been replaced by antidepressants that cause fewer side effects.
However, ringworm antidepressants may be a good option for some people. In some cases, they can treat depression when other therapies are ineffective. Cyclic antidepressants are designed in three cycles or four cycles. These numbers refer to the number of rings in their chemical structure.
Ring antidepressants treat depression by acting on neurotransmitters used to communicate between brain cells. These drugs inhibit the neurotransmitters’ reabsorption of serotonin and norepinephrine and increase these two neurotransmitters’ levels in the brain. Ring antidepressants also affect other chemical messengers and can therefore cause a variety of side effects. The Food and Drug Administration has approved the following three-pronged antidepressants for the treatment of depression:
Maprotiline, a four-cycle antidepressant, has also received FDA approval for the treatment of depression. Cyclic antidepressants are sometimes used to treat problems other than depression, such as anxiety disorders or nerve pain.
Due to the different routes of action of antidepressants, the side effects also vary somewhat from drug to drug. Some side effects may go away over time, while others may cause another medicine to be prescribed. Side effects may also depend on the amount of medication, and higher doses may cause more side effects. Some possible side effects include:
- Blurred vision
- Dry mouth
- Hypotension when changing position from sitting to standing
- Urinary retention
- Increased appetite and weight gain
- Weight Loss
- Excessive sweating
- Sexual problems in the field of erection, orgasm, or decreased sexual desire
In general, we can say:
- Amitriptyline, doxepin, imipramine, and trimipramine are more likely to cause drowsiness than other tricyclic antidepressants. Taking these medications at bedtime may help solve this problem.
- Amitriptyline, doxepin, and imipramine are more likely to cause weight gain than other tricyclic antidepressants.
- Side effects of nortriptyline and desipramine appear to be easier to tolerate than other tricyclic antidepressants.
- Some tricyclic antidepressants may cause safety-related side effects:
- Loss of direction or confusion, especially in the elderly when the dose of the drug is very high
- Increased heart rate or irregular heartbeat
- More seizures occur in people who have seizures.
Your doctor may order blood tests to determine the best amount of medicine. Some of the side effects and benefits of tricyclic antidepressants depend on the amount of medication. Overuse of antidepressants can be dangerous. Ringworm antidepressants can cause problems in people with specific health problems. For example, suppose a person has glaucoma, an enlarged prostate, heart problems, diabetes, liver disease, or a history of seizures. In that case, they should talk to their doctor about whether this antidepressant is right.
- Stop the antidepressant treatment regimen:
Ring antidepressants are not considered addictive drugs. However, abrupt discontinuation of treatment or postponement of several uses can cause pseudo-withdrawal symptoms. Symptoms may vary depending on how the medicine works. This condition is sometimes referred to as withdrawal syndrome. Consult your doctor for a gradual and safe reduction in the amount of medication.
Symptoms of quasi-withdrawal may include:
- Confusion, irritability, or anxiety
- Influenza-like symptoms such as chills and muscle aches
9.Selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors (SSRIs) are the most common prescription antidepressants. They can reduce the symptoms of moderate to severe depression and are relatively safe, and usually have fewer side effects than other antidepressants.
SSRIs reduce depression by increasing serotonin levels in the brain. Serotonin is a neurotransmitter that transmits signals between brain cells. This group of antidepressants inhibits the reuptake of serotonin in the brain and increases access to serotonin. SSRIs are called “selective” because they only affect serotonin. SSRIs are also used to treat conditions other than depression, such as anxiety disorders.
Approved SSRIs for the treatment of depression: The Food and Drug Administration has approved these SSRIs for the treatment of depression:
Fluvoxamine is an SSRI approved by the FDA to treat obsessive-compulsive disorder and is sometimes used to treat depression.
Possible side effects:
All SSRIs have the same mechanism of action and can cause the same side effects. However, some people may not experience any of these side effects. Many side effects may go away within the first few weeks of treatment, while some may cause the patient to see a doctor and prescribe another medication. Possible side effects of SSRIs include:
- Dry mouth
- Burning, confusion, or restlessness
- Sexual problems such as decreased libido or orgasm or erectile dysfunction
- Blurred vision
Taking these medications with food may reduce the risk of nausea. Also, if the drug does not interfere with sleep, it can reduce nausea during sleep. Which antidepressant is right for a person depends on factors such as their symptoms and other health problems.
SSRIs are generally safe for most people, but in some cases, they can cause problems. For example, high doses of citalopram can cause dangerous abnormal heart rhythms. Other issues that should be considered before taking this type of medication are:
- Drug Interactions: Before taking an antidepressant, consult your doctor about other medications. Some antidepressants can cause dangerous reactions when combined with certain herbal medicines or supplements.
- Serotonin Syndrome: Rarely can an antidepressant drug cause high serotonin levels to build up in the body. Serotonin Syndrome often occurs when two drugs that increase serotonin levels are combined. These include other antidepressants, specific and headache medications, and St. John’s wort herbal supplements. Signs and symptoms of serotonin syndrome include anxiety, aggression, transpiration, confusion, tremors, restlessness, lack of coordination, and increased heart rate. If any of these symptoms occur, it is necessary to see a doctor.
- Antidepressants and pregnancy: The patient should talk to their doctor about the risks and benefits of using a particular antidepressant. Some antidepressants may harm the fetus and baby if used during pregnancy or lactation.
- Suicide risk and antidepressants: Most antidepressants are generally safe, but the FDA requires all antidepressants to have a black box warning. In some substances, children, adolescents, and young people may experience suicidal thoughts or behaviors while taking antidepressants, especially in the first few weeks after starting or when the dose changes. Anyone taking an antidepressant should be monitored for worsening symptoms or abnormal behaviors. If a person develops suicidal thoughts while taking these drugs, it is necessary to see a doctor. However, it should be noted that antidepressants generally reduce the risk of suicide in the long run by improving mood.
Discontinuation of SSRI treatment:
SSRIs are not considered addictive. However, abrupt discontinuation of antidepressants or failure to take medication several times can lead to suspected withdrawal symptoms. This is sometimes called “withdrawal syndrome.” To reduce the dose of the drug should follow the advice of your doctor. Symptoms of suspicion may include:
- The feeling of general malaise
- Flu-like symptoms (What Is The Flu? Symptoms, Treatment, And Effectiveness Of Vaccine)
There is evidence that fish oil supplements containing omega-3 fatty acids, which have high levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are effective in treating rather than preventing major depression. However, a Cochrane review found insufficient evidence for the effect of omega-3 fatty acids on depression.
There is little evidence that vitamin D supplementation effectively reduces depressive symptoms in people with vitamin D deficiency. There is also preliminary evidence that COX-2 inhibitors such as celecoxib have a beneficial effect on major depression. Lithium also appears to effectively reduce the risk of suicide in people with bipolar disorder and unipolar depression to the general population level. Of course, there is a fine line between practical and safe lithium, so care must be taken to use this element. Low doses of thyroid hormone may also be added to existing medications to treat the symptoms of chronic depression in people who have taken several courses of medication. Stimulants such as amphetamines and modafinil may also be useful in the short term or as adjunctive therapy. Folate supplements may also play a role in managing depression. There is also empirical evidence regarding the benefits of using testosterone in males.
Find the right antidepressant:
Different people may not have the same reaction to a similar antidepressant. For example, a particular drug may work for one person or have no effect on another, or side effects may occur only in some people. Hereditary traits play a role in how antidepressants affect an individual. In some cases, specific blood tests may explain how a person responds to an antidepressant. However, variables other than genetics can also play a role in a person’s response to these drugs. When choosing an antidepressant, your doctor will consider your patient’s symptoms, health problems, and other medications, as well as your history. It usually takes weeks for an antidepressant to be fully effective. You may have to change the type or amount of medication to find the right type and amount of medication recommended by your doctor.
Electroshock therapy (ECT) is a standard psychiatric treatment in which patients are electrically induced seizures to relieve mental illness. This method is used as a last resort option to treat major depressive disorder and patient satisfaction. An ECT cycle is effective in about 50% of people with refractory major depressive disorder (bipolar or unipolar), but about half of those who respond to this treatment and return to the disease within the next 12 months. Apart from this method’s effects on the brain, this method’s side effects are like general anesthesia, and the person may be confused and have a poor memory for a short time after treatment. A typical ECT course involves using the shock several times (usually two or three times a week) until the patient no longer shows symptoms.
Electroshock therapies differ in several ways: the electrodes’ location, the frequency used for the treatment, and the electrical waveform of the stimulus. These methods differ in terms of possible side effects and terms of symptom relief. After this treatment, medication is usually continued, and some patients receive ECT maintenance treatment. It seems that the short-term effects of this method are due to the anticonvulsant effect on the frontal lobes and its long-term effects are due to neurotrophic effects on the temporal lobe.
Magnetic stimulation of the brain through the skull
Cranial magnetic stimulation (TMS), or deep magnetic stimulation, is a non-invasive way to stimulate small brain areas. In 2008, the TMS method was approved by the FDA as the treatment for major refractory depression, and in 2014, evidence was obtained that it was effective. The American Psychiatric Association, the Network for Anxiety and Mood Disorders in Canada, and the Royal College of Psychiatrists in Australia and New Zealand have endorsed TMS to treat major refractory depression.
Phototherapy reduces the severity of depressive symptoms and has benefits for seasonal affective disorder and non-seasonal depression, and has an effect similar to regular antidepressants.
Prognosis of depression:
Significant episodes of depression, whether treated or not, usually resolve over time (but recurrence is possible). Studies show that outpatients who have not yet been treated have a 10 to 15 percent reduction in symptoms after a few months, and about 20 percent no longer meet the full criteria for depressive disorder. It is estimated that the middle of an episode is 23 weeks, and the highest recovery rate occurs in the first trimester. Studies have shown that 80% of people who experience a significant episode of depression once in their lifetime will experience at least one or more episodes in their lifetime (average four episodes in their lifetime).
If the symptoms are not entirely treated, they are more likely to come back or become chronic. Current guidelines recommend that antidepressants continue to be used for six months after recovery to prevent a recurrence. People who experience recurrent episodes of depression need long-term treatment to prevent more severe and long-term depression.
Depressed people have a lower life expectancy than non-depressed people because depressed patients are at risk of suicide. However, they also have a higher risk of dying from other factors and are more susceptible to heart disease diseases.
Up to 60% of people who die from suicide have a mood disorder such as major depression. The risk is exceptionally high when the person experiences significant frustration or has depression and borderline personality disorder.
Depression is often associated with unemployment and poverty. Major depression is currently the leading cause of illness in North America and other high-income countries and is the fourth leading cause worldwide. According to the World Health Organization, by 2030, the disease will be the second leading cause of disease worldwide after HIV. Delay or failure to seek treatment after relapse and the inability of health professionals to provide treatment are obstacles to reducing disability caused by the disease.
Epidemiology of Depression:
Major depressive disorder affected approximately 216 million people in 2015 (3% of the world’s population). In most countries, the number of people who get the disease in their lifetime is 8 to 18 percent. In North America, the probability of having a significant episode of depression over an annual period is 3 to 5 percent for men and 8 to 10 percent for women.
Prevalence of depression:
The first episode of depression is more likely to occur between the ages of 30 and 40, and there is a second, smaller peak between the ages of 50 and 60. The risk of major depression increases during the first year after delivery, despite neurological problems such as stroke, Parkinson’s disease, or multiple sclerosis. The prevalence of this disease is after cardiovascular diseases.
Depressive disorders are more common in urban communities than in rural communities, and the prevalence of this disease is higher in people with socioeconomic problems such as lack of housing.
Aging and depression:
Depression is especially prevalent among people over the age of 65, and its prevalence increases with age. Also, the risk of developing depression increases as a person becomes weaker. Depression is one of the most critical factors affecting the quality of life in adults and the elderly.
Both the symptoms and the treatment differ among the elderly and those in the community. Like many other diseases, the classic symptoms of the disease may not be seen in the elderly. Because older people often have other illnesses and medications simultaneously, it is more challenging to diagnose and treat depression.
Depression in old age:
Different treatments are used in this group of people. The results of studies have shown that the effect of SSRIs on the elderly is not satisfactory. On the other hand, although drugs such as deluxe (a serotonin reuptake inhibitor) have been significant, side effects such as dizziness, dry mouth, diarrhea, and constipation are complicated to tolerate in the elderly prevent the drug from being prescribed.
Research related to depression:
MIR scans of depressed patients show differences in people’s brain structure with depression compared to non-depressed people. According to a meta-analytic study, depressed patients had increased volume in the lateral ventricles and adrenal glands and smaller volumes in the basal ganglia, thalamus, hippocampus, and frontal lobe (including the cortex and right gyrus) compared with controls. In the brains of people with this disorder in old age, there are signs of congestion on brain scans, which has led to the theory of “vascular depression.”
Experiments are investigating the effects of botulinum toxin on depression. The idea is that this drug prevents frowning on the patient’s face, and this prevents negative facial feedback. However, the results of 2015 showed that the positive effects observed could be due to placebo effects.
In 2018, the US Food and Drug Administration approved a Phase 2 study of psilocybin to treat refractory depression.