Dysthymia dsm 5 criteria

Dysthymic Disorder: Background, Etiology, Epidemiology

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.
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Persistent depressive disorder - Symptoms and causes

Overview

Persistent depressive disorder is a continuous, long-term form of depression. You may feel sad and empty, lose interest in daily activities and have trouble getting things done. You may also have low self-esteem, feel like a failure and feel hopeless. These feelings last for years and may interfere with your relationships, school, work and daily activities.

If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions. You may be described as having a gloomy personality, constantly complaining or not able to have fun. Persistent depressive disorder is not as severe as major depression, but your current depressed mood may be mild, moderate or severe.

Because persistent depressive disorder is long term, coping with depression symptoms can be challenging. A combination of talk therapy and medicine can be effective in treating this condition.

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Symptoms

Persistent depressive disorder symptoms usually come and go over a period of years. The intensity of symptoms can change over time. But symptoms usually don't disappear for more than two months at a time. Also, major depression episodes may occur before or during persistent depressive disorder.

Symptoms of persistent depressive disorder can cause major problems in your life and may include:

Sadness, emptiness or feeling down.
Loss of interest in daily activities.
Tiredness and lack of energy.
Low self-esteem, self-criticism or feeling you're not capable.
Trouble focusing clearly and trouble making decisions.
Problems getting things done well and on time.
Quickly becoming annoyed, impatient or angry.
Avoidance of social activities.
Feelings of guilt and worries over the past.
Poor appetite or overeating.
Sleep problems.
Hopelessness.

In children, symptoms of persistent depressive disorder may include depressed mood and being irritable, which means easily becoming annoyed, impatient or angry.

When to see a doctor

If these feelings have been going on for a long time, you may think they'll always be part of your life. But if you have any symptoms of persistent depressive disorder, seek medical help.

Talk to your health care provider about your symptoms or seek help from a mental health professional. Or you can reach out to someone else who may be able to help guide you to treatment. This could be a friend or loved one, a teacher, a faith leader, or another person you trust.

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 888-628-9454 (toll-free).

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Causes

The exact cause of persistent depressive disorder is not known. As with major depression, it may involve more than one cause, such as:

Biological differences. People with persistent depressive disorder may have physical changes in their brains. It's not clear how these changes affect the disorder, but they may eventually help determine the causes.
Brain chemistry. Neurotransmitters are naturally occurring brain chemicals. Research indicates that changes in neurotransmitters may play a large part in depression and its treatment.
Inherited traits. Persistent depressive disorder appears to be more common in people whose blood relatives also have the condition. Researchers are trying to find genes that may be involved in causing depression.
Life events. As with major depression, traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people.

Risk factors

Persistent depressive disorder often begins early — in childhood, the teen years or young adult life — and continues for a long time. Certain factors appear to increase the risk of developing persistent depressive disorder, including:

Having a first-degree blood relative, such as a parent or sibling, with major depressive disorder or other depressive disorders.
Traumatic or stressful life events, such as the loss of a loved one or major financial problems.
Personality traits that include negativity, such as low self-esteem, being too dependent or self-critical, or always thinking the worst will happen.
History of other mental health disorders, such as a personality disorder.

Complications

Conditions that may be linked with persistent depressive disorder include:

Lower quality of life.
Major depression, anxiety disorders and other mood disorders.
Substance misuse.
Relationship difficulties and family conflicts.
School or work problems and trouble getting things done.
Continuing pain and general medical illnesses.
Suicidal thoughts or behavior.
Personality disorders or other mental health disorders.

Prevention

There's no sure way to prevent persistent depressive disorder. Because it often starts in childhood or during the teenage years, identifying children at risk of the condition may help them get early treatment.

Strategies that may help reduce or prevent symptoms include the following:

Take steps to control stress, to increase your ability to recover from problems — which is called resilience — and to boost your self-esteem.
Reach out to family and friends, especially in times of crisis, to help you get through rough spells.
Get treatment at the earliest sign of a problem to help prevent symptoms from worsening.
Consider getting long-term treatment to help prevent a relapse of symptoms.

By Mayo Clinic Staff

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New American classification of mental disorders DSM-5 released to the world

Home > News > The new American classification of mental disorders DSM-5 is released to the world

DSM-5 consists of three sections: it is (1) an introductory part with instructions for use and a warning about the forensic psychiatric use of the DSM-5; (2) diagnostic criteria and codes for routine clinical use; and (3) tools and techniques to inform clinical decision making. nine0003

Major changes:

Neurodevelopmental Disorders

The severity of the disorder is not determined by IQ, but by the level of adaptive functioning. Speech disorders have entered the new category "social communication disorder", in which some of the syndromes coincide with "autism spectrum disorder". The category "Autism Spectrum Disorders" replaces the DSM-4 diagnoses of autism, Asperger's syndrome, childhood disintegrative disorder, and an unspecified general developmental disorder, all of which cease to exist as separate diagnoses. ADHD can start later (before 12) and is treated differently in different areas. Learning disorders and movement disorders are organized differently in this chapter and somewhat combined. nine0003

Schizophrenia spectrum and other psychotic disorders

For the diagnosis of schizophrenia, symptoms of the first Schneider rank lose their special weight. One positive symptom is required for a diagnosis to be made. Subtypes are removed - in favor of the dimensional indicator of severity. For schizoaffective disorder, the mood aspect is emphasized, and for delusional disorder, frivolous content is no longer excluded – although it is evaluated separately. The "catatonia" section has been expanded: this code can now be entered as an adjacent diagnosis (specifying indicator) for depressive, bipolar and psychotic disorders. nine0003

Bipolar and related disorders

Bipolar and related disorders are now separated from depressive disorders and placed in a separate category. A clearer definition of mania is given and refinements for mixed episodes are introduced, which lowers the threshold for disorder. Added a residual subcategory ""other"" and a qualifying score for anxiety symptoms.

Depressive disorders

Disruptive mood dysregulation disorder and premenstrual dysphoric disorder added. Chronic depression and dysthymia are combined into one diagnosis, now it is ""persistent depressive disorder (dysthymia)"" with a number of clarifying indicators. Major depressive disorder remained virtually unchanged, however, for "subthreshold" symptoms, a clarifying indicator ""mixed manifestations"" was introduced. A clarifying indicator for anxious distress has also been introduced. Removed grounds for exclusion for grief. nine(see below) Various phobia criteria are slightly adapted, and agoraphobia and panic are decoupled. Panic attacks can act as a clarifying indicator for other diagnoses. The diagnoses of separation anxiety disorder and selective mutism are no longer specific "childhood" diagnoses. nine0003

Obsessive-compulsive and related disorders ""delusional character"". The same goes for "Pathological Picking" (Hoarding Disorder) - a completely new diagnosis in the DSM-5, as well as "Excoriation" (Skin-Picking) Disorder. This included trichotillomania, and, in addition, exogenous causes of OCD were added, in particular due to the use of psychoactive substances and drugs, as well as in connection with other medical conditions. nine0003
- Trauma- and stressor-related disorders
Both for acute trauma and for post-traumatic stress disorder, the stressor criterion has been changed: now the diagnosis takes into account the experience received in the role of a witness and indirect stressor impact. Also ruled out is the requirement to directly experience fear, horror, or feelings of helplessness. Avoidance and emotional flattening are separated, and at the same time, emotional flattening is added, incl. persistent depressed mood. Recklessness, (auto) destructive behavior, irritability and aggression are added to the already known symptoms of arousal. For children and adolescents in puberty, lower diagnostic thresholds are used. The adjustment disorder remained unchanged. Reactive attachment disorder has been moved to this chapter. nine0003
- Dissociative Disorders
Various changes have been made to the criteria for dissociative identity disorder, including, for example, the perception of identity transition by third parties. Depersonalization and derealization are combined into one disorder. Dissociative fugues have ceased to be a separate diagnosis, and have become a clarifying indicator in ""dissociative amnesia"".
- Somatic symptom and related disorders
These are what were previously called somatoform disorders. Removed somatization disorder, hypochondriasis, pain disorder, and unspecified somatoform disorder from DSM. A diagnosis of a "disorder with somatic symptoms" can be made on par with a diagnosis from another medical specialty only if the somatic symptoms are associated with abnormal thoughts, feelings, and behaviors. Unexplained medical symptoms play a decisive role only in false pregnancy and conversion (i.e. functional disorder with neurological symptoms). In other cases, positive symptoms should be sought in this group. nine0003
- Feeding and eating disorders regurgitation of food with repeated chewing), but the age criterion has been removed for them. There is also a new diagnosis: ""avoidant / restrictive food intake"" (Avoidant / Restrictive Food Intake). Anorexia no longer requires amenorrhea and binge eating episodes, although for bulimia nervosa and the new Binge-Eating Disorder category, binge eating episodes must occur at least once a week. nine0003
  - Sleep-Wake Disorders
  The distinction between truly psychiatric and other ("somatic") sleep disorders is no longer in the DSM-5, given the original concept of overlapping diagnoses. The chapter presents a large number of sleep disorders described in terms of physical characteristics in relation to circadian rhythms and respiratory disorders. This group includes Restless legs syndrome and REM Sleep Behavior Disorder. A large diagnostic choice predisposes to move away from the use of "unspecified" diagnoses. nine0003
  - Sexual Dysfunctions
  In order to avoid overdiagnosis, the thresholds for diagnosis in this group are raised. Vaginismus is grouped with dyspareunia under the category Genito-Pelvic Pain/Penetration Disorder. Removed sexual aversion disorder. All disorders are subtyped according to psychological or combined factors, situation, and achievement.
  - Gender Dysphoria
  This is a new category that is considered a separate category. Needs further research and development.
  - Disruptive, impulse control, and conduct disorders
  This is also a new chapter, which partly includes the missing chapter "Disorders usually first diagnosed in childhood and adolescence"". In addition to a variety of impulse control disorders, antisocial personality disorder, dubbed from the chapter on personality disorders, also got here. The criteria for oppositional defiant disorder have been revised and weighted. In conduct disorder (Conduct Disorder), the grounds for excluding the diagnosis have been removed, but the clarifying indicator “callous-unemotional” has been added. Intermittent Explosive Disorder can now be verbal, and the rest of the criteria for this disorder are much more refined. nine0003
  - Substance-related and addictive disorders
  This chapter includes for the first time a non-chemical disorder, gambling addiction. For chemicals, abuse and dependence are combined under the name Substance Use Disorder. "Craving" appears as a criterion, and problems with the justice authorities have been removed. There was a new code for tobacco related disorders, while caffeine was already in the DSM-IV TR. There is a measure of severity, as well as a mention of ""under controlled circumstances"" or ""as maintenance treatment"" (for methadone). nine0003
  Source: De Man J. De DSM-5 in 1 oogopslag. – De Psychiater, 2013, nr. 5 (juni), p.8-10.
  
  Source: mniip.org

ISSN 2588-0519 (Print)
ISSN 2618-8473 (Online)

Major depressive disorders (clinical depression)

Depression is distinct from everyday problems of normal emotional responses and short-term mood swings. Prolonged moderate to severe depression can become a serious illness. This results in patients suffering greatly and doing poorly at work, at school and have problems in their families. At its worst, depression can lead to suicide. nine0003

Depression is a common illness worldwide, affecting more than 264 million people. Major depressive disorder is one of the most common forms of mental illness, affecting approximately one in six men and one in four women in their lives.

Major depressive disorder (MDD) is a severe condition characterized by low mood, decreased interests, poor cognitive function, and autonomic symptoms such as disturbed sleep or eating. MDD can develop in one in six adults during their lifetime and affects about twice as many women as men. nine0003

Major symptoms of depressive disorder

Symptoms of major depressive disorder (MDD) may include:

depression almost every day
loss of interest in activities you once enjoyed
changes in appetite or weight
sleep problems
feeling lazy or restless
low energy
feelings of hopelessness or worthlessness
trouble concentrating
frequent thoughts of death or suicide

Depressive relapses:

This is a highly relapsing condition: at least 50% of people recovering from a first episode of depression have at least one additional episode in their lifetime, and about 80% of people have a history of two recurrent episodes.

Episodes typically recur within five years of the first episode, and the average person with a history of depression will have five to nine depressive episodes in their lifetime. nine0003

Symptoms of recurrent depression:

difficulty concentrating
disturbed sleep
reduced energy levels
permanent light alarm

Major depression in adults:

Depression is a common adult disorder that often leads to poor quality of life and impaired role functioning. Depression is also associated with high rates of suicidal behavior and death. When depression occurs in the context of a medical illness, it is associated with increased healthcare costs, longer hospital stays, poor collaboration in treatment, etc.

Causes of depression in adults may be related to the difficulty of changing roles:

low education and low income
early pregnancy and childbirth
divorces
unstable operation
highly competitive and intense work

Major symptoms of depression in adults include:

Mostly sad or depressed mood
Loss of interest or pleasure and avoidance of social gatherings
Decreased energy and frequent fatigue
Decreased concentration and attention
Decreased self-esteem and self-confidence
Thoughts on guilt and unworthiness
A gloomy and pessimistic view of the future
Thoughts or actions of harming oneself or suicidal thoughts
Sleep disturbance or insomnia
Great or reduced appetite

DSM-5 Criteria for Major Depressive Disorder

According to the DSM-5, the following criteria must be met for a diagnosis of major depression:

At least five of the following symptoms must have been present for at least two weeks and reflect a change in previous functionality. In addition, at least one of the symptoms is a low mood or loss of interest or pleasure.

The person is depressed most of the day, almost every day, as noted by himself or others. nine0015
He or she is not interested in all or most activities most of the day, almost every day.
Every day a person gains or loses a large amount of weight or has a decreased or increased appetite.
Almost every day he or she suffers from insomnia or hypersomnia.
Every day a person develops psychomotor disturbances that are visible to others and can also be reported.
Almost every day he or she feels exhausted or tired. nine0015
Almost every day a person has thoughts of worthlessness or guilt.
Every day a person's ability to think, concentrate, or make judgments deteriorates.
He or she has recurrent suicidal thoughts, suicidal thoughts (without a definite plan), a suicide attempt, or a definite plan to commit suicide.
Symptoms listed above cause clinical distress or interfere with daily activities. nine0015
The episode of depression is not associated with the physiological effect of the drug or other disease.
The onset of the episode is not better explained by specific or unspecified schizophrenia spectrum illness or other psychotic disorders.
The person has never had a manic or hypomanic episode.

The diagnostic code for major depressive disorder is based on the frequency of recurrent episodes, the severity of the episodes, the presence of psychotic characteristics, and the state of remission. Below are the varieties of depression:

Severity of depression:

Minor
Moderate
Heavy
Psychotic
In partial remission
In complete remission
Undefined

Epidemiology

Major depressive illness is a common mental illness. Its lifetime prevalence ranges from 5 to 17 percent. The incidence in women is about twice as high as in men. This is due to hormonal variations, the consequences of childbearing, different psychological pressures in men and women, and a behavioral model of learned helplessness. Although the median age of onset is around 40 years old, new studies show an increase in the incidence among younger populations due to the use of alcohol and other psychoactive substances. nine0003

MDD is more common in divorced, separated, or bereaved individuals who do not have meaningful interpersonal interactions. There is no difference in the prevalence of MDD between races or socioeconomic status. People with MDD often have comorbidities such as substance abuse, panic disorder, social anxiety disorder, and obsessive-compulsive disorder.

The presence of these comorbidities in people with MDD increases the risk of suicide. Depression is more common in older people with underlying medical problems. Depression is more common in rural areas than in cities. nine0003

Pathophysiology of major depressive disorder

The genesis of major depressive disorder is believed to be multifaceted, with biological, genetic, environmental and psychological factors at play. It used to be thought that MDD was caused mainly by abnormalities in neurotransmitters, especially serotonin, norepinephrine, and dopamine.

This has been demonstrated by the use of several antidepressants in the treatment of depression, such as selective serotonin receptor inhibitors, serotonin-norepinephrine receptor inhibitors, and dopamine-norepinephrine receptor inhibitors. Serotonin metabolites have been found to decrease in people who have had suicidal thoughts. However, recent hypotheses suggest that this is largely due to more complex neuroregulatory systems and brain circuits, leading to subsequent disruption of the neurotransmitter systems. nine0003

GABA, an inhibitory neurotransmitter, as well as glutamate and glycine, important excitatory neurotransmitters, have been shown to play a role in the genesis of depression. Depressed people have reduced plasma, cerebrospinal fluid, and brain levels of GABA. GABA is believed to act as an antidepressant by blocking the ascending monoamine pathways, including the mesocortical and mesolimbic systems.

The antidepressant properties of drugs that oppose NMDA receptors have been investigated. Thyroid and growth hormone imbalances have also been linked to mood disorders. Numerous adversity and trauma in childhood have been linked to the development of depression later in life. nine0003

Severe early stress can cause dramatic changes in neuroendocrine and behavioral responses, leading to anatomical abnormalities in the cerebral cortex and severe depression later in life. Structural functional tomography of the brain in people with depression revealed greater hyperintensity in the subcortical regions and a decrease in the metabolism of the anterior brain regions on the left.

Family, adoption and twin studies have shown that genes play a role in the risk of depression. According to genetic studies, twins with MDD have a very high level of concordance, especially monozygotic twins. Life experience and personal qualities also have an impact. nine0003

According to the theory of learned helplessness, the onset of depression is associated with the experience of uncontrollable events. Depression, according to cognitive theory, results from cognitive errors in those who are predisposed to depression.

Somatic illnesses associated with depression

Somatic sensations are especially common in depression and other mental illnesses. Although somatic symptoms are common in depressed individuals, they are of much lesser importance than major depressive symptoms in the diagnosis of depression. nine0003

The clinical stages of sad mood are characterized by both painful and non-painful bodily symptoms.

Major depressive disorder diagnosis

Major depressive disorder is a clinical diagnosis; this is mainly determined by the patient's medical history and assessment of mental status. Along with symptomatology, the clinical interview should include medical history, family history, social history, and history of drug use. Related information from the patient's family/friends is an important component of the psychiatric evaluation. nine0003

Although there are no objective tests to diagnose depression, routine laboratory tests such as CBC with a differential diagnosis, a comprehensive metabolic panel, thyroid-stimulating hormone, free T4, vitamin D, urinalysis, and toxicology screening are done to rule out organic or medical diseases. causes of depression.

People with depression often see their primary care physicians for medical problems related to their depression rather than seeking a mental health professional. In nearly half of the cases, patients deny experiencing depressive symptoms and are often referred to therapy by family members or sent by employers to be tested for social isolation and decreased activity. At each visit, it is critical to assess the patient for thoughts of suicide or murder. nine0003

Being in a bad mood or feeling tense is common for all of us. When these feelings persist, you may suffer from depression or anxiety—or both. The self-assessment quizzes contain relevant questions to help you assess your current situation and develop a strategy to help you feel better sooner.

When you are going through a difficult moment, it is natural to feel depressed for a while; feelings like melancholy and loss help define who we are. However, if you feel sad or uncomfortable most of the time for an extended period of time, you may be suffering from depression. nine0003

Take a self-test to see if you are showing any warning signs of depression. This won't give you a diagnosis, but it will help you determine what to do next.

Major depressive disorder with psychotic features

Psychotic depression, also known as major depressive disorder with psychotic features, is a serious medical or mental illness that requires prompt treatment and constant monitoring by a physician or mental health professional. nine0003

Major depression is a common mental condition that can have a detrimental effect on many aspects of a person's life. It affects mood and behavior as well as various bodily processes such as eating and sleeping. People who are severely depressed often lose interest in things they used to love and have difficulty doing daily activities. Sometimes they may even feel that life is not worth living.

Bipolar disorder (BD)

Depression in patients with bipolar disorder (BD) is a significant clinical problem. Since schizophrenia dominates even in the treatment of BD, depression is associated not only with schizophrenia, but also with BD and comorbid medical disorders with a high risk of suicide.

Diagnosis of bipolar disorder (BD) and risk factors:

Approximately 12-17% of cases of bipolar disorder are not recognized until the mood "transforms" into hypomania or mania, either spontaneously or under the influence of substances uplifting mood. nine0003

Factors suggesting a diagnosis of BD:

Family mania, psychosis, "nervous breakdown" or psychiatric hospitalization
Early onset, often with depressive symptoms
Cyclothymic mood
Multiple relapses (eg 4 episodes of depression in 10 years)
Depression with characteristic agitation, anger, insomnia, irritability, talkativeness.
Other features are "mixed" or hypomanic or psychotic symptoms. nine0015
Clinically "worsens", especially with mixed properties, during antidepressant treatment.
Suicidal thoughts and actions
Alcohol or drug abuse

Major depressive disorder in children and adolescents:

Major depressive disorder (MDD) can have a significant impact onset during childhood and adolescence. Associated with this are poor school performance, interpersonal problems later in life, early parenthood, and an increased risk of other psychiatric and substance use disorders. Diagnosing MDD in childhood is difficult. Children with MDD are often underdiagnosed and undertreated, and only 50% of adolescents are diagnosed before reaching adulthood. nine0003

Symptoms of depression in children aged 3-8 years include:

unsubstantiated claims.
irritability
less signs of depression
anxiety
behavioral changes

As the child becomes adolescence and adult, the presentation of symptoms meets the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria:

Irritability. nine0015
Expected weight gain.
Lethargy or inner restlessness.
May be delusional and not limited to feelings of guilt.

Postpartum depression

Postpartum depression affects one in seven women (PPD). While most women recover quickly from childhood blues, PPD lasts much longer and has a significant impact on women's ability to return to normal activities. nine0003

PDD affects the mother and her relationship with the child. PRD impairs maternal brain response and behavior. Postpartum depression most often occurs within 6 weeks after delivery. PDD affects 6.5 to 20% of women. It is more common in teenage girls, mothers who have given birth prematurely, and women living in cities.

In one study, African American and Hispanic mothers reported onset of symptoms within 2 weeks of birth, while white mothers reported onset of symptoms later. nine0003

Premenstrual dysphoric disorder

Premenstrual symptoms are a group of psychological, behavioral and physical symptoms that cyclically occur before menstruation and subsequently resolve after menstruation in women of reproductive age. Most women experience relatively mild pain and the symptoms do not interfere with their personal, social, or professional lives; however, 5% to 8% of women experience moderate or severe symptoms that can cause significant distress and functional impairment. nine0003

All women of reproductive age, from menarche to menopause, may have premenstrual symptoms. Premenstrual symptoms are a common problem for women of reproductive age. In the United States, 70 to 90 percent of women of reproductive age report at least some premenstrual pain.

Approximately one third of these women have symptoms severe enough to warrant a diagnosis of PMS. PMDD, the most severe type of premenstrual symptom complex, occurs in 3-8% of these women. nine0003

Treatment of major depressive disorder

Treatment of major depressive disorder (MDD) in adults:

Treatment options for major depressive disorder include medication, psychological, interventional and lifestyle changes. Medications and/or psychotherapy are used initially to treat MDD.

Combination treatment, including both drugs and psychotherapy, has been shown to be more effective than either treatment alone. Electroconvulsive therapy has been shown to be more effective than any other treatment for severe major depression. nine0003

Patient psychotherapy:

Depression education and treatment can be provided to all patients. When appropriate, education may be provided to eligible family members.

Information about available treatment options will help patients make informed decisions, anticipate side effects, and follow prescribed treatment. Another important aspect of education was informing patients and concerned family members about the delayed duration of antidepressant onset of action. nine0003

Pharmacotherapy and acute treatment:

Antidepressants may be used as the primary treatment for patients with moderate or severe depression.

Clinical features that may indicate that the drug is a preferred therapeutic agent include a history of previous positive response to antidepressants, severity of symptoms, significant sleep disturbance and appetite disturbance.

Patients with severe depression with psychotic features will require antidepressant and antipsychotic and/or electroconvulsive therapy (ECT). nine0003

All antidepressants are effective, although their side effects vary. The following drugs have been approved by the FDA for the treatment of MDD:

Fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine are examples of selective serotonin reuptake inhibitors (SSRIs). They are commonly used as first line therapy and are the most commonly prescribed antidepressants.
Venlafaxine, duloxetine, desvenlafaxine, levomilnacipran and milnacipran are examples of serotonin and norepinephrine reuptake inhibitors (SNRIs). They are often used to treat depressed people who also have pain problems. nine0015
Trazodone, vilazodone and vortioxetine are serotonin modulators.
Bupropion and mirtazapine are examples of atypical antidepressants. When patients experience sexual side effects from SSRIs or SNRIs, they are often recommended as monotherapy or as adjunctive drugs.
Amitriptyline, imipramine, clomipramine, doxepin, nortriptyline and desipramine are tricyclic antidepressants (TCAs).
Tranylcypromine, phenelzine, selegiline, and isocarboxazid are examples of monoamine oxidase inhibitors (MAOIs). Due to the high prevalence of side effects and death in overdose, MAOIs and TCAs are not commonly used. nine0015
Other drugs that can be used to increase the effectiveness of antidepressants include mood stabilizers and antipsychotics.

The role of yoga and meditation in managing depression:

Originating in ancient India, yoga is recognized as a form of alternative medicine using mind-body practice. Yoga philosophy is based on 8 elements that are best described as the ethical principles of a meaningful and purposeful life. Yoga can help with depression through the following mechanisms:

Muscle relaxation resulting in less pain
Creating Balanced Energy
Decreased breathing and heart rate
Lowering blood pressure and cortisol levels
Increase blood flow
Reducing stress and anxiety through tranquility
Improve pre-existing ailments such as arthritis, cancer, mental illness and more.

Treatment of Major Depressive Disorder (MDD) in Children and Adolescents

Psychotherapy is important for both patients and their families, so everyone is aware of the plan and goals of treatment. When the patient receives information, the severity of symptoms decreases. Mental education may include knowledge about the signs and symptoms of depression, the clinical course of the illness, the risk of exacerbation, treatment options, and parental advice on how to interact with depressed young people.

According to research by Sandra Mullen, psychotherapy, along with medication, is often recommended for the treatment of major depressive disorder (MDD) in children and adolescents diagnosed with depression, suicidal ideation, and transient hypomania/mania. nine0003

Treatment of bipolar depression

Bipolar depression remains a clinical problem. Treatment options are limited, especially in the treatment of the acute phase of bipolar depression. There are currently only three approved drugs: OFC, quetiapine (immediate or extended release) and lurasidone (lithium monotherapy or adjuvant therapy or valproate). All three agents have similar efficacy profiles. They differ in duration. nine0003

Non-approved agents and treatments

Non-pharmacological drugs such as lamotrigine, antidepressants, modafinil, pramipexole, ketamine, and electroconvulsive therapy (ECT) are often prescribed for the treatment of acute bipolar depression.

Treatment of recurrent depression:

Some patients may experience recurrent episodes of depression throughout their lives unless supportive care is used to prevent relapse. Treatment should include psychotherapy and pharmacotherapy, and the dose should generally not be reduced after remission has been achieved. nine0003

Differential

Critical to rule out depressive disorder due to another medical condition, depressive disorder due to substance/drug, dysthymia, cyclothymia, bereavement, adjustment disorder with depressed mood, bipolar disorder, schizoaffective disorder, schizophrenia, anxiety disorders and eating disorders when assessed for DMD. Depressive symptoms can develop as a result of the following factors:

Neurological causes such as cerebrovascular accident, multiple sclerosis, epilepsy, Parkinson's disease and Alzheimer's disease.
Endocrine diseases such as diabetes, thyroid disease and adrenal disease.
Metabolic disorders such as hypercalcemia, hyponatremia
Drugs/substances causing dependence: steroids, antihypertensives, anticonvulsants, antibiotics, sedatives, sleeping pills, alcohol, stimulant withdrawal. nine0015
Nutrient deficiencies such as vitamin D, B12, B6, iron or folic acid deficiency
Infectious diseases such as HIV and syphilis
Malignant neoplasms

Prognosis

Episodes of depression in untreated major depressive disorder may last 6 to 12 months. Approximately two-thirds of people with MDD think about suicide, and 10 to 15% commit suicide. MDD is a chronic relapsing disease; the recurrence rate after the first episode is about 50%, 70% after the second episode and 90% after the third episode. Approximately 5-10% of people with MDD develop bipolar disorder.

Patients with mild episodes, no psychotic symptoms, improved adherence, a reliable support system, and adequate premorbid functioning have a positive prognosis for MDD. In the presence of a concomitant mental disorder, personality disorder, multiple hospitalizations and advanced age, the prognosis is poor.

Complications

MDD is one of the leading causes of disability in the world. This not only causes severe functional impairment, but also negatively affects interpersonal relationships, reducing the quality of life. Individuals with MDD are at significant risk of developing comorbid anxiety and drug use disorders, which increase the risk of suicide.

Diabetes, hypertension, chronic obstructive pulmonary disease and coronary heart disease may be aggravated by depression. People who are depressed are more likely to engage in self-destructive behavior as a coping method. Left untreated, MDD can be quite debilitating.

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