Major depressive disorder
Major depressive disorder is a serious disabling illness that affects approximately 10% of children and 16% of adults. This mental health disorder is strongly associated with short- and long-term morbidity and death (Kessler et al., 2003). Major depressive disorder is strongly correlated with dysfunctional capabilities in daily routines including school activities and work responsibilities (Myers, 2007). The symptoms of this mental disorder are the same among affected children and adults, with the exception that pediatric patients do not present a despondent mood but instead show a significant frequency of irritability. Depression among individuals may be observed in individuals who show a sudden decrease in the quality of work productivity or an abrupt decrease in school grades. Patients also show some kind of modifications in terms of interrelationships with friends, by simply decreasing and at times, refusing to interact and spend time with his usual peers and relatives. Depression also involves significant changes in patterns of sleeping and eating, which can be observed at extremes of either not sleeping well or sleeping during most of the day that the individual does not get to finish what he is expected to do or complete for that day. Depressed individuals also chronically feel tired and carry a sense of worthlessness, hopelessness. In a considerable portion of depressed individuals, thoughts of committing suicide are also reported. Among depressed adolescents as well as adults, an increased activity of substance abuse is also detected.
Pharmacological treatment of major depressive disorder involves the administration of anti-depressants, which are classified as either first-generation or second-generation anti-depressants. The first-generation antidepressants include tricyclic antidepressants and monoamine oxidase inhibitors, while second-generation anti-depressants include the serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Hazell et al., 2002). Specific examples of SSRIs include fluoxetine, citalopram, escitalopram, paroxetine and sertraline, while SNRIs include mirtazapine, nefazodone and venlafaxine. The effectivity of these two generation types of anti-depressants has been reported to be the same (Song et al., 1993). Yet, it has also been observed that first-generation anti-depressants generally cause several side effects that provide discomfort and intolerability among patients that receive such specific treatment regimen (Anderson, 2001). In some cases, an overdose of first-generation anti-depressants is associated with a great risk for harming oneself. Such observations resulted in the created of second-generation anti-depressants. Patients diagnosed with major depressive disorder generally recover from their mental illness after 1 to 2 years, with or without pharmacological treatment. However, approximately 40% to 70% of these individuals succumb to a second episode of depression.
There has been active research on the efficacy and safety of anti-depressants in the past decade. This is mostly due to the controversy that originated from cases that involved violence and suicidal tendencies among adolescent patients, especially those treated with the second-generation anti-depressants. Currently, it is difficult to determine whether the suicidal thoughts of a patient are due to the drug itself, or is caused by a significant worsening of the depressive disorder itself. Research programs often include a control placebo group that would facilitate any comparative analysis of the efficacy of these pharmaceutical drugs.
To date, there are no specific predictive factors that may facilitate a clinician to determine whether the pharmacological treatment of a patient diagnosed with depression will be helpful or harmful. It is therefore imperative that the clinician be cautious regarding the presentation of any abrupt changes in the individual during his treatment. Hence, a good interaction between the clinician and the patient’s immediate family should be established so that any unexpected and untoward actions that the patient may attempt to do, such as suicide or pain instigation, may be avoided and prevented. In addition, the clinician should assess every patient with complete objectivity, in terms of whether the individual fits the criteria for the diagnosis of major depressive disorder. And once depression is diagnosed, the patient and the members of his immediate family should be educated about the mental health disorder. The clinician should also discuss options that are available for the treatment of such disorder, as well as disclose the side-effects of each treatment. It is also important that the clinician determine whether the family of the patient shows any history of suicidal behavior, as well as any new ideas and thoughts even during the treatment period. Pharmacological treatment for depression generally starts at the low dose, and the dosage is increased at regular intervals until the maximum effective dose is achieved. It is also essential that weekly or biweekly monitoring of the clinician be performed in order to adjust the treatment dose of the patient.
Anderson IM (2001): Meta-analytical studies on new antidepressants. Brit. Med. Bull. 57:161-78.
Kessler RC, Berglund P, Demler O, Jin R, Koretz D and Merikangas KR (2003): The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). National Comorbidity Survey Replication. JAMA 289:3095-105.
Myers DG (2007): Psychology (In Modules), 8th ed. New York City: Worth Publishers.
Song F, Freemantle N, Sheldon TA, House A, Watson P, Long A (1993): Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ. 306:683-687.