Short paper 1: Major Depressive Disorder (MDD)
Mood disorder that causes severe symptoms which can lead to self-destructive behaviors and suicidal thoughts if it is left untreated. MDD is the leading cause of disease in women worldwide. Prevalence of MDD is higher in women than in men ( 5.5 % and 3.2 % respectively in 2010). Signs and symptoms of MDD are repeated for two weeks or more such as: persistently sad and anxious, feelings of hopelessness or guilt, loss of interests, difficult to concentrate or make decisions, difficult to sleep or oversleeping, weight gain or loss and developing suicidal thoughts. The causes of MDD could be from a combination of genetic, biological, environmental and psychological factors. Some high risk factors that could develop MDD such as: personal or family history of depression; trauma and chronic stress; physical illness and abusing medications.
Scientists still don’t really understand what changes in what brain regions causes MDD. Different treatments such as cognitive therapies or pharmacological treatments will affect brain activity in different regions, but it only correlates these changes with clinical improvement .They don’t know if there is a causal relationship between them. There are some hypotheses about what causes MDD such as monoamine hypothesis and dopamine production under the influence of stress. According to, monoamine hypothesis illustrated how serotonin production was significantly decreased in patients with MDD. They believed that depression caused lower serotonin metabolism and vice versa. However, this study showed an inconsistent results because some of their patients with MDD showed an increased serotonin level without taking substances to boost up serotonin production. According to , depression can be caused by lower level of dopamine in the brain reward system under the impact of stress. This study showed that dopamine reward system can predict specific brain region’s actives which could also predict early onset of depressive episodes in patients. However, this study was lack of supportive scientific evidences and it needed to further study and retested.
Patient T was diagnosed with MDD in the early of her thirty’s. She is a full time mother, Asian-American and her family showed no signs of MDD. She started to experience with depressive symptoms such as loss of sleep, loss of appetite, and having suicidal thoughts and these symptoms were consistently occurred more than 3 weeks. Her doctor firstly prescribed her with antidepressants like Prozac. After taking the medication for a month, her depressive episodes slightly decreased, so her doctor started giving her a cognitive behavior therapy (CBT) twice a week. Her doctor still recommended to take Prozac but he did not increase her dosage. After two weeks, she started to fell better and significantly improved especially her mentally condition. She slept better and she no longer experienced suicidal thoughts.
Depression can be treated with either medications or psychotherapies. Common medications are used to treat MDD: Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paraxetine (Paxil), sertraline (Zoloft), or Serotonin and norepinephrine reuptake inhibitors (SNRIs). Psychotherapies are used to treat MDD: CBT (cognitive behavioral therapy), IBT (interpersonal therapy), ECT (electroconvulsive therapy), or problem solving therapy. The advantages of using CBT was it could showed long term behavior changes in the patients. It shows that specific change in selective regions of the brains would give a specific behavior. CBT was more effective in treating the activity in frontal cortex for MDD. The disadvantage of using CBT was it reflected the progression of the disease rather than clearly showed short term behavior changes. The advantages of using paroxetine treatment was it could showed short term behavior changes in patients. It provided more crucial clues for future investigations. It was more effective in treating the activity of limbic regions for MDD. The disadvantages of using this treatment was the placebo effect could rule out the efficacy of paroxetine treatment.
I think the most effective treatment for MDD is the combination of psychotherapist and medications to help changing behaviors in MDD patients. According to , combination of CBT and fluoxetine was the best to treat MDD in terms of long term safety and rapid effectiveness. Using only fluoxetine gave immediate changes but increased suicidal thoughts in MDD patients. Using only CBT had slow behavior changes but increased in the end of the treatment. Taking benefits and harms into account, combined treatment of psychotherapies and medications showed a better results than mono-therapy as a treatment for major depression.
In addition, life style factors can play an important role in reducing the prevalence of MDD. According to , they found that increasing physical activities, social support, and practicing mindfulness meditations could be one of the best depression prevention programs for MDD patients. MDD patients can have better mental health outcomes when adding these positive life style elements while taking other treatments such as CBT or medications.
Short paper 1: Major Depressive Disorder (MDD)