Major depression, also known as depressive disorder, is a complex mental illness characterized by a long-term (weeks to months) state of depressed mood, loss of interest in life, and impairment in a person’s functional state. This illness affects all aspects of a patient’s life, including physical health, emotional state, and behavioral reactions. According to the WHO, major depression is one of the most common disorders in the world and can lead to serious consequences, including suicidal thoughts and actions. It can affect people of all ages and socioeconomic groups, making it one of the most serious public health problems.
History of the disease and interesting historical facts
Historically, ideas about depressive disorders have changed. In ancient times, such as Ancient Egypt and Greece, depression was perceived as a “mental illness” associated with an imbalance in the “train” of bodily fluids. Galenica and Avicenna described in detail symptoms reminiscent of modern concepts of depression. In the Middle Ages, there was often talk of a “court of madness” where connections between the spirit and the body were recognized, but views remained largely mystical. Periodic recurring depression was noted and documented by such notables as Vincent van Gogh and Winston Churchill.
Modern views of major depression began to develop in the 20th century, when psychiatrists began using terms and methods based on scientific research to classify and describe depressive disorders. Important advances in psychopharmacology and psychotherapy have greatly improved treatment methods, but depressive episodes remain a common problem.
Epidemiology
According to research, the prevalence of major depression varies by region, gender, and age group. The highest incidence is recorded in countries with highly developed economies, where it reaches 12-20% of the population. Among women, major depression is observed twice as often as among men. This is due to both biological and social factors. According to research, almost 50% of all cases of major depression begin before the age of 25.
Genetic predisposition to this disease
Research shows that major depression has a significant genetic component. There are several genes associated with the risk of developing the disorder, particularly genes involved in the functioning of neurotransmitters such as serotonin and dopamine. The following genes and mutations are key:
- Serotonin transporter genes (5-HTTLPR)
- Dopamine receptor-related genes (DRD4, DRD2)
- Genes associated with the inflammatory system (eg, IL-6)
Research also shows that in families with a history of major depression, the risk of close relatives developing the disease increases significantly.
Risk factors for the development of this disease
There are many factors that contribute to the development of major depression. These factors can be divided into several categories:
- Physical factors:
- Chronic diseases (diabetes, asthma)
- Hormonal changes (postpartum depression)
- Neurological disorders (stroke, Alzheimer's disease)
- Social and psychological factors:
- Psychological stress (divorce, loss of a loved one)
- Social isolation
- Family conflicts
- Chemical factors:
- Alcohol and drug abuse
- Long-term use of certain medications
All these factors in combination affect a person's emotional and physical state, increasing the likelihood of developing depressive episodes.
Diagnosis of this disease
Diagnosis of major depression begins with a thorough analysis of the patient's symptoms. The main symptoms include:
- Constantly depressed mood
- Loss of interest or pleasure in usual activities
- Changes in appetite or weight
- Sleep disorders (insomnia or hypersomnia)
- Feelings of guilt or hopelessness
- Problems with concentration
- Suicidal thoughts and intentions
Laboratory tests are usually performed to rule out other conditions, such as thyroid dysfunction or vitamin deficiencies (such as vitamin D and B12). Radiological tests, such as MRI or CT scans, may be recommended to detect underlying neurological problems.
It is important to perform a differential diagnosis to rule out other mental disorders such as bipolar disorder, schizophrenia and anxiety disorders.
Treatment
Treatment for major depression can range from psychotherapy to medication and other methods. Common treatment approaches include:
- General treatment:
- Psychotherapy (cognitive behavioral therapy, humanistic therapy)
- Group therapy
- Educational programs for patients and their families
- Pharmacological treatment:
- Antidepressants (SSRIs, TCAs)
- Mood stabilizers (lithium)
- Surgical treatment:
- Electroconvulsive therapy (ECT) - used in special cases
- Other types of treatment:
- Magnetic resonance stimulation
- Light therapy
List of medications used to treat this disease
The main drugs used in the treatment of major depression include:
- Selective serotonin reuptake inhibitors (SSRIs), such as floxetine and sertraline
- Tricyclic antidepressants (TCAs), such as amitriptyline
- Monoamine oxidase inhibitors (MAOIs) such as phenelzine
- Atypical antidepressants such as bupropion and mirtazapine
- Mood stabilizers, including lithium
The specific choice of drugs depends on the individual characteristics of the patient and his response to treatment.
Disease monitoring
Monitoring of a patient with major depression involves regular visits to the doctor and assessment of the patient's condition using a depression scale. The prognosis may vary depending on the timing of treatment, the presence of social support, and compliance with the doctor's recommendations. Complications include the risk of suicide, the development of other mental illnesses such as anxiety disorders, and physical illnesses such as cardiovascular disorders.
Age-related features of the disease
Major depression can manifest itself differently in different age groups. Children and adolescents tend to exhibit more extreme behaviors, such as irritability and aggression, than adults. In older adults, depression can manifest itself through physical symptoms, such as fatigue and sleep disturbances, and may be misdiagnosed as part of normal aging.
Questions and Answers
- What are the main symptoms of major depression? The main symptoms include depressed mood, loss of interest in life, changes in appetite, sleep disturbances and problems with concentration.
- How is major depression diagnosed? Diagnosis is based on a thorough analysis of symptoms, exclusion of other diseases using laboratory and radiological methods.
- What treatments are used for major depression? The main methods of treatment include psychotherapy, pharmacological treatment, and in some cases, electro- and magnetic resonance therapy.
- Are there genetic risk factors for major depression? Yes, certain genes related to neurotransmitter function may increase the risk of developing this disease.
- What is the prevalence of major depression? The incidence varies from 12 to 20% of the population depending on the region and other factors such as gender and age.
