Introduction
Major depressive disorder is a mental disorder characterized by a pathologically lowered mood with a negative, pessimistic assessment of oneself, one’s current situation and the future. A person in this state is characterized by deep, persistent despondency, loss of interest in what previously gave pleasure, inability to do the usual things, as well as a sense of guilt and a decrease in self-esteem. According to the DSM-5, major depressive disorder is the leading cause of disability in the world (DSM-5, 2013). Major depressive disorder causes a feeling of sadness, weakens interest in activities that the patient once liked. It can lead to a lot of emotional and physical problems and affect how successful a person is at work and in their personal life.
Women suffer from major depressive disorder one and a half times more often than men. Scientists tend to explain this phenomenon primarily by biological factors: reproductive function and hormonal shifts (DSM-5, 2013). During pregnancy, after childbirth and during menopause, depression occurs more often in women than in other periods of life. Cultural and social factors also play an important role. However, researchers attribute such statistics also to the fact that women are more likely than men to seek psychological help. Men are usually less likely to seek help from a psychiatrist or psychotherapist, as they are hindered by social stereotypes. At the same time, major depressive disorders in men are directly related to dependent behaviors (alcoholism, drug addiction, gambling addiction, extreme sports).
Causes
Major depressive disorder usually occurs for two reasons: psychological and physiological. For psychological reasons, major depressive disorder can develop as a result of stress or some traumatic situation. It can be the death of someone from close or relatives, physical or moral violence, a terrible catastrophe in which a person has become a participant. Usually, after two months, the depressive state can pass, but without proper help, it drags on and major depressive disorder can develop. A number of seemingly insignificant unpleasant life situations present in a person’s life for a long time can become a source of constant stress. Major depressive disorder can develop due to frustration caused by those situations – this is a condition in which a person constantly feels that his desires are unfulfilled (Kim & Won, 2017). Existential crisis can simultaneously act as a cause and a manifestation of major depressive disorder. It is expressed in the loss of life goals, a sense of meaninglessness of existence, an imbalance of harmony.
The physiological causes of depression have completely different roots. Alcohol and drug use, menopause, cerebral circulatory disorders, severe fatigue, chronic diseases, lack of proper nutrition – these are just a small list of physiological disorders that can lead to major depressive disorder. It is important that major depressive disorder rarely develops for any one reason, often several factors lead to this at once. Successful treatment is possible only if all the causes of this mental disorder are taken into account.
Symptoms
The symptoms of major depressive disorder are divided into problems with the emotional sphere, physical and cognitive components. In the emotional sphere, a person experiences guilt for their own past, and anxiety with disappointment in relation to the future. The volitional sphere suffers – patients are not able to make efforts to achieve goals; general emotionality is increased, and the person becomes more sensitive, vulnerable (Köhler-Forsberg et al., 2019). The patient has a violation of social intelligence -this is a parameter that helps a person correctly perceive and interpret the external behavior of other people. Social intelligence is needed to improve interpersonal relationships, social adaptation in society. Emotional disorders are combined with apathy – complete indifference to what is happening, lack of desire to do anything.
Somatic syndrome major depressive disorder is the main criterion for the severity of the disease. A person is daily disturbed by specific unpleasant bodily sensations. The muscular system is also in tension, it is very difficult for a person to relax. Symptoms from the somatic sphere are most often digestive disorders (more often Рconstipation, abdominal pain) and sleep disorders (K̦hler-Forsberg et al., 2019). The patient also suffers from palpitations, tachycardia, arrhythmia, chronic pain in various parts of the body, including migraine headaches. Due to multiple physical manifestations, diagnosis of major depressive disorder is difficult.
Cognitive impairment in major depressive disorder is expressed in problems with speech, attention, thinking and memory. Patients are characterized by problems with the analysis and synthesis of information coming from the outside world. Major depressive disorder is characterized by similar cognitive impairments as in patients with moderate brain injuries (Köhler-Forsberg et al., 2019). The purposefulness of actions, their consistency suffers. The speech of patients is excessively slow, the sentences are monosyllabic, disinterest, passivity is felt in the conversation. In severe cases, the patient is silent most of the time – they lack the spontaneous speech characteristic of healthy people.
Physiological Factors
With major depressive disorder, neurochemical disorders are noted in many neurochemical systems. In the synaptic cleft, there is a deficiency of the main neurotransmitters: norepinephrine, serotonin and dopamine (Vancampfort et al., 2017). Changes in the sensitivity of dopaminergic and serotonergic receptors underlie the pathogenesis of psychotic symptoms in the structure of a depressive episode. Disorders in the pathogenesis of anxiety-phobic, disomic and vegetative disorders are significant. Neurodynamic disorders are closely correlated with functional disorders of neurochemical systems and are multicomponent in nature.
Complex violations of diencephalocortical interaction should be noted. They are associated with violations of hemispheric-diencephalic interaction characteristic of major depressive disorder. At the same time, the shift of the gradient of interhemispheric interaction towards the activation of the structures of the right hemisphere and the diencephalic divisions correlates with the affects of longing, apathy, psychomotor retardation (Vancampfort et al., 2017). Activation of left-hemisphere formations is combined with anxiety affect and psychomotor agitation. A significant component of the pathogenesis of major depressive disorder is a violation of the regulation of biological rhythms with a violation of sleep architectonics. These phenomena are associated with the melatonergic system, the activity of the circadian oscillators of the hypothalamus and the increment of the epiphysis.
Effects
There are a number of characteristic qualities experienced by people who have experienced major depressive disorder. The consequences of depression include decreased mental activity and increased irritability, especially in relation to loud sounds, such as laughter. A person is dominated by negative emotions and phobias appear that have not previously manifested themselves, such as fear of heights or confined spaces (Young et al., 2017). Libido also decreases, as well as other intimate problems manifest themselves. A person has problems with communication in the work team and at home, manifestations of irritability, apathy, a constant desire for privacy. They are constantly in a state of despondency and have suicidal tendencies.
All these problems can accumulate and worsen, especially the reluctance to live. A common problem after major depressive disorder is the unwillingness to contact groups of people; a person turns into an unsociable and withdrawn person. They can not force themselves to go to entertaining public places like bars, restaurants and clubs. Depressive disorders can have an effect not only on the psyche, but also on the whole body, as they disrupt its work. As a rule, the brain, heart and nervous system suffer, but in the case of major depressive disorder, much more internal organs are at risk.
Among the most common consequences of major depressive disorder are insomnia, weakening of the immune, nervous and cardiovascular systems. The patient begins to have problems with the thyroid and pancreas and increases the risk of autoimmune diseases. A person feels chronic fatigue, their skin condition worsens, their hair falls out. In addition, the patient’s pain threshold significantly decreases due to a lack of serotonin (Young et al., 2017). Major depressive disorder is especially dangerous for people with chronic diseases that can cause its appearance. In such a case, more serious manifestations of chronic diseases can be observed. Being in major depressive disorder, people stop caring about their health, which also causes further aggravation of all symptoms.
Ways of Coping
When complaints and symptoms of major depressive disorder appear, the patient should not treat the disease on one’s own, they should contact a psychiatrist as soon as possible. It is best to take a course of inpatient therapy. The basic method of treating major depressive disorder is taking medications. To date, a large number of antidepressants with a diverse mechanism of action have been developed in pharmacology. The main groups of these drugs are tricyclic, selective serotonin reuptake inhibitors, noradrenergic antidepressants (Suzuki et al., 2018). These groups consist of a large number of drugs that are prescribed strictly individually, often based on the intuition and experience of the doctor. Each patient has his own antidepressant threshold, below which the drugs of this group do not have the proper effect, but exhibit either mild sedative or side effects.
During the main treatment, all signs of major depressive disorder disappear. Nevertheless, antidepressant therapy does not stop completely, but goes into a supportive stage. It is a prerequisite, despite the absence of negative symptoms. Its duration varies from six months to a year, but can be extended according to indications (Suzuki et al., 2018). When anxiety and fears dominate in complaints, treatment is supplemented with tranquilizers (sedatives). Simultaneously with drug therapy, psychotherapeutic techniques are used to treat major depressive disorder. Individual sessions of rational psychotherapy, hypnosis, methods of persuasion and suggestion gradually bring the patient out of a severe depressive state. Then family and group psychotherapy are connected, which consolidate the result and allow the patient to include the available individual opportunities for the process of self-healing. Closer to the end of treatment, the patient is taught auto-training skills, which they must use independently throughout their life.
Conclusion
Psychologists advise to be attentive to one’s body, if signs of depressive disorder immediately consult a doctor. It is necessary to fight the disease, but it should be done gently, without strong pressure on the psyche. The patient should try to accept oneself as they are at a particular moment. A psychotherapist will advise meditations that can be used when the first symptoms of a depressive state are approaching. Such techniques help to develop a sense of inner integrity. An exhausted body needs help, so a full eight-hour sleep helps restore its reserves, promotes inner peace. With the joint efforts of the doctor and the patient, it is possible to achieve a long-term remission and stop the disease in time.
References
Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, DC: American Psychiatric Association.
Kim, Y. K., & Won, E. (2017). The influence of stress on neuroinflammation and alterations in brain structure and function in major depressive disorder. Behavioural Brain Research, 329(4), 6-11.
Köhler-Forsberg, O., Lydholm, C. N., Hjorthøj, C., Nordentoft, M., Mors, O., & Benros, M. E. (2019). Efficacy of anti-inflammatory treatment on major depressive disorder or depressive symptoms: Meta-analysis of clinical trials. Acta Psychiatrica Scandinavica, 139(5), 404-419.
Suzuki, M., Furihata, R., Konno, C., Kaneita, Y., Ohida, T., & Uchiyama, M. (2018). Stressful events and coping strategies associated with symptoms of depression: A Japanese general population survey. Journal of Affective Disorders, 238(6), 482-488.
Vancampfort, D., Firth, J., Schuch, F. B., Rosenbaum, S., Mugisha, J., Hallgren, M., … Stubbs, B. (2017). Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: A global systematic review and meta-analysis. World Psychiatry, 16(3), 308-315.
Young, K. D., Siegle, G. J., Zotev, V., Phillips, R., Misaki, M., Yuan, H., … Bodurka, J. (2017). Randomized clinical trial of real-time FMRI Amygdala neurofeedback for major depressive disorder: Effects on symptoms and autobiographical memory recall. The American Journal of Psychiatry, 174(8), 748-755.