MAJOR DEPRESSION DISORDER

MARS HERVIE S. CUCHAPIN, RPH

NEUROLOGY

DEFINITION

Major Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how
you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing
normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression
may require long-term treatment.

TYPES OF DEPRESSION

Symptoms caused by major depression can vary from person to person. A specifier means that you have depression with
specific features, such as:

1. Melancholic depression — severe depression with lack of response to something that used to bring pleasure
and associated with early morning awakening, worsened mood in the morning, major changes in appetite, and
feelings of guilt, agitation or sluggishness. You might experience a depressed mood similar to losing someone
you love or intense grief. 

2. Atypical depression — depression that includes the ability to temporarily be cheered by happy events,
increased appetite, excessive need for sleep, sensitivity to rejection, and a heavy feeling in the arms or legs.

3. Postpartum depression —is a common occurrence among new mothers experiencing hormonal changes
following childbirth. The stress of raising a new child and changes in and to your body can greatly affect
your mood. Parents who adopt can also suffer some of the symptoms of postpartum depression.
4. Seasonal affective disorder or SAD— is categorized as a disease directly caused by the time of the year. It
occurs most often in the winter months when sunlight is not as readily available.

5. Psychotic depression — depression accompanied by delusions or hallucinations, which may involve

personal inadequacy or other negative themes. believe in delusions that are not cohesive with reality. This
can be caused by a traumatic event or if you have already had a form of depression in the past.

6. Mixed depression — simultaneous depression and mania, which includes elevated self-esteem,
talking too much and increased energy.
INCIDENCE
The WHO estimates that more than 300 million people worldwide suffer from depression. It's also
the world's leading cause of disability.
The most depressed country is Afghanistan, where more than one in five people suffer from the disorder.
The least depressed is Japan, with a diagnosed rate of less than 2.5 percent.

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are
diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Exact cause is unknown, variety of factors may be involved

a. GENETIC FACTORS: heritable, first degree relatives are more likely to develop esp. among twins.
Blood relatives with a history bipolar disorder, alcoholism or suicide.
b. BIOLOGICAL FACTORS: reduced level of neurotransmitters (monoamines) and hormonal
imbalance.
c. ENVIRONMENTAL FACTORS: stress, peer pressure, bullying
d. PSYCHOLOGICAL-SOCIAL FACTORS: childhood trauma, death or loss of a loved one,
physical or sexual abuse, difficult relationship, financial problems or abuse of alcohol or recreational
drugs. And also, serious or chronic illness, including cancer, stroke, chronic pain or heart disease

PATHOGENESIS
1. MONOAMINE HYPOTHESIS:
Depression is related to a deficiency in the amount or function of cortical and limbic serotonin (5-HT),
norepinephrine (NE), and dopamine
2. NEUROTHROPIC HYPOTHESIS:
Brain derived growth factor (BNDF) promotes the growth and development of immature neurons
including mono-aminergic neurons, enhance the survival and function of adult neurons.
Low BNDF level may be responsible for loss of mono-aminergic neurons and loss of function or atrophy
of hippocampus and other brain areas.

3. NEUROENDOCRINE HYPOTHESIS
Imbalances in stress HPA axis (hypothalamus-pituitory-adrenal gland axis)
Dysregulation in HPA axis results in increased corticotropic releasing factor (CFR) from
hypothalamus (results of hippocampus atrophy), enlarged adrenal gland and increased secretion
of cortisol (glucocorticoids).
SIGN & SYMPTOMS
Emotions Thoughts

 Sadness  Self-criticism
 Anxiety  Impaired memory
 Guilt  Indecisiveness
 Anger  Confusion
 Mood swings  Thoughts of death and suicide
 Irritability

Physical Behavior
 Chronic fatigue  Withdrawal from others
 Lack of energy  Neglect of responsibilities
 Sleeping too much or too little  Change in personal appearance
 Weight gain or loss
 Loss of motivation
 Substance abuse

I. MONITORING MANAGEMENT
There is no blood test, X-ray, or other laboratory test that can be used to diagnose major depression.
However, your doctor may run blood tests to help detect any other medical problems that have symptoms similar
to those of depression. For example, hypothyroidism can cause some of the same symptoms as depression, as can
alcohol or drug use and abuse, some medications, and stroke.
 Your doctor may determine a diagnosis of depression based on:

 Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases,
depression may be linked to an underlying physical health problem.

 Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to
make sure it's functioning properly.

 Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings and
behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.

 DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

DSM-5 Diagnostic Criteria (Diagnostic and Statistical Manual of Mental Disorders)

The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five
or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed
mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings
of restlessness or being slowed down).

5. Fatigue or loss of energy nearly every day.

6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for
committing suicide.

II. MANAGEMENTS
PHARMACOLOGIC MANAGEMENT
ANTI-DEPRESSANTS

MEDICATIONS MECHANISM OF SIDE- COMMENTS

ACTION EFFECTS

1. Selective serotonin reuptake inhibitors (SSRIS)

Citalopram (Celexa) increasing serotonin sweating Doctors often start by prescribing an
levels in the brain indigestion SSRI. These drugs are considered
dry mouth safer and generally cause fewer
Escitalopram(Lexapro) drowsiness bothersome side effects than other
Serotonin can
help contributes to decrease arousal types of antidepressants
Fluoxetine (Prozac) wellbeing and
happiness.
Sertraline (Zoloft)

2. Serotonin-norepinephrine reuptake inhibitors (SNRIS)

Duloxetine(Cymbalta) Snriswork by tremors

increasing serotonin nausea
Venlafaxine (Effexor XR) and norepinephrine headache
levels in the brain. dry mouth
blurred vision
Snris can help improve increase BP
a person's mood, reduce nervousness
feelings of anxiety, and
help alleviate panic
attacks.

3. Monoamine oxidase inhibitors (MAOIS)

Phenelzine (Nardil) Maoiselevate the levels insomnia Using MAOISrequires a strict diet
of norepinephrine, muscle aches because of dangerous (or even
Isocarboxazid(Marplan) serotonin, low BP deadly) interactions with foods ―
and dopamine by dry mouth such as certain cheeses, pickles and
inhibiting an enzyme nervousness wines ― and some
Selegiline (Emsam)- patch called monoamine medications(DECONGESTANTS)
oxidase. Monoamine and herbal supplements
(1st class of antidepressants to be oxidase breaks down
developed) norepinephrine,
serotonin, and
dopamine.

4. Tricyclic Antidepressants

Imipramine (Tofranil) TCA’S increase levels tremors Can be very effective, but tend to
of norepinephrine and indigestion
Amitriptyline serotonin, and block dry mouth cause more-severe side effects than
the action of drowsiness newer antidepressants. So tricyclics
Desipramine (Norpramin) acetylcholine. elevated HR generally aren't prescribed unless
you've tried an SSRI first without
improvement.

NON- PHARMACOLOGIC MANAGEMENT

 Psychotherapy is a general term for treating depression by talking about your condition and related issues with a
mental health professional. Psychotherapy is also known as talk therapy or psychological therapy.

For some people, other procedures, sometimes called brain stimulation therapies, may be suggested:

 Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain to impact the
function and effect of neurotransmitters in your brain to relieve depression. ECT is usually used for people who
don't get better with medications, can't take antidepressants for health reasons or are at high risk of suicide.

 Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven't responded to
antidepressants. During TMS, a treatment coil placed against your scalp sends brief magnetic pulses to stimulate
nerve cells in your brain that are involved in mood regulation and depression

III. PATIENT COUNSELING

A. ANTIDEPRESSANT MEDICATION
 Explain to the patient that it usually takes at least 2 weeks for medications to exert
antidepressant activity (ie, reduction in depressive symptoms).
 should counsel patients that, even after their mood has improved, it is crucial that they
continue their antidepressant for at least 6 to 9 months to prevent recurrence of the
depression.
 Antidepressants can increase suicide risk
FDA requires all antidepressants to carry a black box warning, the strictest warning for
prescriptions. In some cases, children, teenagers and young adults under age 25 may have an
increase in suicidal thoughts or behavior when taking antidepressants, especially in the first
few weeks after starting or when the dose is changed.
B. Lifestyle changes
In addition to taking medications and participating in therapy, you can help improve MDD symptoms
by making some changes to your daily habits.
Eating right: Consider eating foods that contain omega-3 fatty acids, such as salmon. Foods that are rich in
B vitamins, such as beans and whole grains, have also been shown to help some people with MDD.
Magnesium has also been linked to fighting MDD symptoms. It’s found in nuts, seeds, and yogurt.
Avoiding alcohol and certain processed foods: It’s beneficial to avoid alcohol, as it’s a nervous system
depressant that can make your symptoms worse. Also, certain refined, processed, and deep-fried foods
contain omega-6 fatty acids, which may contribute to MDD.
Getting plenty of exercise: Although MDD can make you feel very tired, it’s important to be physically
active. Exercising, especially outdoors and in moderate sunlight, can boost your mood and make you feel
better.
Sleeping well: It’s vital to get at least 6 to 8 hours of sleep per night. Talk to your doctor if you’re having
trouble sleeping.
SOCIALIZE: Reach out to family and friends, especially in times of crisis, to help you weather rough spells.

IV. REFERENCES
https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013
https://emedicine.medscape.com/article/286759-overview#a3
https://www.webmd.com/depression/guide/major-depression#3
https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/
healthline.com/health/chemical-imbalance-in-the-brain#causes
https://esource.dbs.ie/bitstream/handle/10788/3481/ba_hughes_s_2018.pdf?sequence=1&isAllo
wed=y

JOURNAL:

Current perspectives: the impact of cyberbullying on adolescent health

Charisse L Nixon
Additional article information

Abstract
Cyberbullying has become an international public health concern among adolescents, and as
such, it deserves further study. This paper reviews the current literature related to the effects of
cyberbullying on adolescent health across multiple studies worldwide and provides directions
for future research. A review of the evidence suggests that cyberbullying poses a threat to
adolescents’ 
Adolescents in the United States culture are moving from using the Internet as an “extra” in
everyday communication (cyber utilization) to using it as a “primary and necessary” mode of
communication (cyber immersion).1 In fact, 95% of adolescents are connected to the
Internet.2 This shift from face-to-face communication to online communication has created a
unique and potentially harmful dynamic for social relationships – a dynamic that has recently
been explored in the literature as cyberbullying and Internet harassment.
In general, cyberbullying involves hurting someone else using information and communication
technologies. This may include sending harassing messages (via text or Internet), posting
disparaging comments on a social networking site, posting humiliating pictures, or
threatening/intimidating someone electronically.3–7 Unfortunately, cyberbullying behavior has
come to be accepted and expected among adolescents.8 Compared to traditional bullying,
cyberbullying is unique in that it reaches an unlimited audience with increased exposure across
time and space,6,9 preserves words and images in a more permanent state,10 and lacks
supervision.6 Further, perpetrators of 

Effects of cyberbullying

The effects of cyberbullying have been predominantly explored in the area of adolescents’
mental health concerns. In general, researchers have examined the relationship between
involvement with cyberbullying and adolescents’ tendency to internalize issues (for example,
the development of negative affective disorders, loneliness, anxiety, depression, suicidal
ideation, and somatic symptoms).