Major depressive disorder

• the history of mental illness and treatment
• history: The term Major depressive disorder was introduced by a group of US clinicians in the mid-1970s as part of proposals for diagnostic criteria based on patterns of symptoms (called the "Research Diagnostic Criteria"), and was incorporated in to the DSM-III in 1980. To maintain consistency the ICD-10 used the same criteria, with only minor alterations, but using the DSM diagnostic threshold to mark a mild depressive episode, adding higher threshold categories for moderate and severe episodes. The ancient idea ofmelancholia still survives in the notion of a melancholic subtype.
• treatments:
• psychotherapy - Initially, depression was always blamed on some conflict in the individual's life. This could mean emotional conflict or problems with her environment. For this reason, psychiatrists believed that depression could always be dealt with through psychotherapy. 
• Iproniazid - Originally developed to treat tuberculosis in the early 1950s, it was noticed that iproniazid worked to elevate the patients' moods. In 1957, iproniazid was first prescribed to patients with clinical depression. Studies revealed that the drug blocked the enzyme monoamine oxidase's destruction of norepinephrine, serotonin and dopamine.
• TCAs - The first tricyclic antidepressant (TCA) was called "imipramine." While this medication helped depressed patients, it had no mood-enhancing effects on nondepressed people. The drug was found to inhibit the reuptake of norepinephrine and serotonin into neurons in the brain, making it the first medication to specifically deal with depression and inspiring important research. 
• MAOIs - Like tricyclic antidepressants, monoamine oxidase inhibitors (MAOI) decrease the activity of the enzymes that destroy norepinephrine, serotonin and dopamine and are called "monoamines." MAOIs are still in use today, although MAOI popularity is waning due to potentially severe side effects.
• SSRIs - Selective serotonin reuptake inhibitors (SSRI) were the result of research based on what had been learned from MAOIs and tricyclics. To decrease the incidence of side effects, SSRIs target specific monoamines, thus increasing only the amount of serotonin in the brain.
• SNRIs - Serotonin-norepinephrine reuptake inhibitors (SNRIs) are very similar to SSRIs, except that SNRIs target both serotonin and norepinehprine. They are beginning to take over for SSRIs, but are still not as popular as their predecessor.

• symptoms:
• Difficulty concentrating, remembering details, and marking decisions fatigue and decreased energy
• Feelings of guilt, worthless, and/or helplessness
• Feelings of hopelessness and/or pessimism¨
• Insomnia, early-morning wakefulness, or excessive sleeping 
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable
• Overeating or appetite loss
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
• Persistent sad, anxious, or “empty” feelings
• Thoughts of suicide attempts
  

• Risk-factors:
• Having biological relatives with depression
• Being a woman
• Having traumatic experiences as a child
• Having family members or friends who have been depressed
• Experiencing stressful life events, such as the death of a loved one
• Having few friends or other personal relationships
• Recently having given birth (postpartum depression)
• Having been depressed previously
• Having a serious illness, such as cancer, diabetes, heart disease, Alzheimer's or HIV/AIDS
• Having certain personality traits, such as having low self-esteem and being overly dependent, self-critical or pessimistic
• Abusing alcohol, nicotine or illicit drugs
• Taking certain high blood pressure medications, sleeping pills or certain other medications (Talk to your doctor before stopping any medication you think could be affecting your mood.)

• treatments:
• There are four (4) groups of antidepressant medications most commonly used to treat depression:
  • Tricyclic antidepressants (TCAs), which include:amitriptyline (Elavil)
    imipramine (Trofanil,Janimine)
    nortryptyline (Pamelor)
    despiramine (Norpramin)
    TCAs work by slowing the rate at which neurotransmitters (chemical messengers) re-enter brain cells. This increases the concentration of the neurotransmitters in the central nervous system which relieves depression.
  • Monoamine oxidase inhibitors (MAOIs) include phenelzine (Nardil) and tranylcypromine (Parnate). MAO is an enzymeresponsible for breaking down certain neurotransmitters in the brain. MAOIs inhibit this enzyme and restore more normal mood states.
  • Lithium carbonates, including Eskalith and Lithobid. Lithium reduces excessive nerve activity in the brain by altering the chemical balance within certain nerve cells. This drug has been used to improve the benefit of SSRIs and alone is effective in treating bipolar disorder.
  • Selective serotonin reuptake inhibitors (SSRIs) include:fluoxetine (Prozac)
    fluvoxamine (Luvox)
    paroxetine (Paxil)
    sertraline (Zoloft)
    citalopram (Celexa)
    escitalopram oxalate (Lexapro)
    SSRIs act specifically on serotonin, making it more available for nerve cells, thus easing the transmission of messages without disrupting the chemistry of the brain. Two other antidepressants that affect two neurotransmitters, serotonin and norepinephrine, are venlafaxine (Effexor) and nefazodone (Serzone). Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin.
  Medication usually produces a marked improvement by six weeks, but may require up to 12 weeks for full effect.
  Psychotherapy
  Psychotherapy involves talking to family doctor, counselor, psychiatrist or therapist about things that are occurring in a person's life. The aim of psychotherapy is to remove all symptoms of depression and return a person to a normal life.
  There are three psychotherapies commonly used to treat depression: behavioral therapy, cognitive therapy or interpersonal therapy. Behavioral therapy focuses on current behaviors, cognitive therapy focuses on thoughts and thinking patterns, and interpersonal therapy focuses on current relationships.
  Although psychotherapy may begin to work right away, it may take eight to 10 weeks to show a full effect for some people.
  Electroconvulsive therapy (ECT)
  ECT, also called electroshock treatment, is used for severely depressed patients and/or those who have not responded to antidepressant medication and/or psychotherapy. During this therapy, an electric current travels through electrodes placed on the temples, causing a generalized shock that produces biochemical changes in the brain
  Atypical antidepressants
  These medications are called atypical because they don't fit neatly into another antidepressant category. They include trazodone (Oleptro) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep. The newest medication in this class of drugs is vilazodone (Viibryd). Vilazodone has a low risk of sexual side effects. The most common side effects associated with vilazodone are diarrhea, nausea, vomiting and insomnia.
  Tricyclic antidepressants
   These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more-severe side effects, a tricyclic antidepressant generally isn't prescribed unless you've tried an SSRI first without an improvement in your depression. Side effects can include dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Tricyclic antidepressants are also known to cause weight gain.
  Monoamine oxidase inhibitors (MAOIs)
   MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — are usually prescribed as a last resort, when other medications haven't worked. That's because MAOIs can have serious harmful side effects. They require a strict diet because of dangerous (or even deadly) interactions with foods, such as certain cheeses, pickles and wines, and some medications including decongestants. Selegiline (Emsam) is a newer MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs. These medications can't be combined with SSRIs.