Major depression is a severe progressive stage of depression that carries many risks to health and life. It is necessary to persevere in treatment according to the instructions of the doctor to control the disease as soon as possible.
What is major depression?
Major depressive disorder (MDD) is the term used to describe a severe progressive stage of depression. It is diagnosed when a person has persistent depressed or depressed mood, decreased interest in enjoyable activities, guilt, hopelessness, poor concentration, psychomotor retardation, agitation. , sleep disturbance and suicidal ideation.
The etiology of MDD has been identified as multifactorial, including biological, genetic, environmental, and psychosocial factors. In which, mild and moderate depression that is not treated in time, which can progress to severe, is the main and most direct cause.
Major depression is a common mental disorder. It has a lifetime prevalence of 5–17%, with the incidence in women almost twice that of men. This difference is thought to be due to hormones, the effects of childbirth, and stressors.
The average age of onset of major depression is around 40. However, recent surveys show an increasing trend in the incidence among young people. It is usually caused by alcohol and drug abuse.
The World Health Organization (WHO) has ranked major depression as the third leading cause of disease burden worldwide in 2008. In addition, WHO also predicts that the disease will reach 2030. will rank first.
Signs of major depression
Major depression is characterized by symptoms that last longer and are somewhat worse than those of mild to moderate depression. Symptoms of MDD can include:
- Emotions depressive: About 90% of sufferers complain of feeling sad, depressed, and hopeless. Some patients say they cannot cry. Meanwhile, many others were crying for no reason. Particularly in children, irritability and irritability are common.
- Loss of interest: This symptom is experienced in most patients with MDD. The patient seems to have lost interest or enthusiasm for any form of activity. Including sexual activity, hobbies or routine tasks.
- Loss of appetite: About 70% of patients have this condition and it is accompanied by weight loss. A few others have cravings, especially for sweets, and tend to gain weight.
- Sleep disorders: About 80% of patients experience some kind of sleep disorder. The most uncomfortable and severe symptom is when waking up early around 4-5 am. There are also some patients who complain that they sleep a lot instead of having insomnia.
- Psychomotor disorders: About 50% of patients with major depression become sluggish and sluggish. Slowness manifests in thought, speech, and bodily movements. Many people also experience anxiety along with psychomotor agitation symptoms. For example, often pacing or not being able to sit still.
- Loss of Energy: It manifests as fatigue and feeling drained despite not having to do much. Moreover, many patients also feel exhausted.
- Depression, low self-esteem, and guilt: These symptoms are often much worse as depression progresses. Patients often underestimate themselves, blame themselves and exaggerate their small mistakes.
- Anxiety: Most patients with anxiety symptoms are inner tension, palpitations, stomach rumbling, and rapid pulse.
- Suicidal thoughts: Severe depression causes the person to think about death frequently. At first, it felt like it would be better to be around without me. Then there is planning to commit suicide.
- Physical symptoms: May be headache, cramps, back pain, nausea, chest pain, rapid breathing, deep breathing, etc.
- Psychotic: Refers to symptoms of delusions and hallucinations. Major depression with psychotic features is often difficult to respond to treatment and has a higher risk of relapse.
The dangers of major depression
As mentioned, major depression is an advanced stage of depression. Therefore, it is very risky. If not treated seriously and promptly, it is one of the leading causes of disability worldwide.
Severe depression can cause severe functional impairment. Moreover, it also adversely affects the relationship between people and reduces the quality of life of patients.
Serious complications of MDD can include:
- People with MDD are at increased risk of developing anxiety disorders and comorbid stimulant use disorders. This will further increase the risk of suicide.
- Major depression can exacerbate comorbidities such as hypertension, diabetes, coronary artery disease, and chronic obstructive pulmonary disease.
- People with MDD are at increased risk of developing self-destructive behaviors as a coping mechanism.
- MDD causes severe weakness and exhaustion if left untreated.
Statistics show that about two-thirds of people with MDD have suicidal thoughts, about 10-15% of these people seek suicide.
MDD is a chronic and highly relapsing mental disorder. Relapse rates are about 50% after episode 1, 70% after episode 2, and up to 90% after episode 3. About 5 to 10% of MDD patients will eventually develop bipolar disorder.
The prognosis of MDD is considered good in patients without psychotic symptoms, adherence, strong support system, and good response to disease. Prognosis is poor in the presence of comorbid psychiatric disorders, repeated hospitalizations, and high age of onset.
Treatments for major depression
For mild to moderate depression, lifestyle changes and psychotherapy can help resolve symptoms without resorting to medication. However, if depression has progressed, it is often difficult to treat.
With severe depression, many different methods will be combined to help patients improve their effectiveness early. The methods mentioned may include:
Psychotherapy (talk therapy) is the preferred treatment for depression of any stage, including mild, moderate, and severe. This method involves meeting with a psychologist regularly to talk about the patient’s condition and related issues.
Psychotherapy will help you get rid of negative thoughts, feelings, and behaviors. Instead, always aim for the positive. In addition, you will be provided with skills to deal healthily with stressful situations in your life.
There are many psychotherapeutic therapies used in the treatment of mental disorders. For major depression, your doctor may use cognitive behavioral therapy, interpersonal therapy, psychodynamic therapy, or group therapy.
2. Drug use
Antidepressants are the preferred treatment in cases of major depression. The use of medication will help to quickly relieve the symptoms of the disease. Thereby limiting the impact on health and quality of life.
Medications prescribed by your doctor may include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants (TCAs)
- Monoamine Oxidation Inhibitors (MAOIs)
- Atypical antidepressants
- New Antidepressant Esketamine (Spravato)
- Mood stabilizers
- Psychotic drugs
Taking medication can help relieve symptoms of major depression. However, it cannot solve the fundamental problems. And this is by no means a permanent solution.
Furthermore, antidepressants come with side effects and safety concerns. It should be used exactly as prescribed by the doctor. Make sure to take the correct dose and never stop taking it suddenly.
3. Anticonvulsant Therapy (ECT)
Anticonvulsant therapy (ECT) is also known as electroconvulsive therapy. This is a commonly used method for major depression. Especially in case the patient has applied other methods but does not respond.
Statistics show that anticonvulsant therapy (ECT) works for nearly 75% of patients with severe depression, mania, psychosis or persistent agitation, unable to care for themselves and hospitalized. .
However, the effects of ECT will tend to decrease over time. Therefore, patients still need to use drugs and other combined methods to better control the disease.
ECT can pose health risks. Common side effects include: temporary memory loss, muscle pain, headache, nausea, blood pressure disturbances, rapid heart rate, temporary confusion, etc.
4. Transcranial Magnetic Stimulation (TMS)
If you have major depression that is resistant to psychotherapy and medication, transcranial magnetic stimulation (TMS) may be considered. This is a non-invasive treatment that directs pulses of magnetic energy into areas of the brain associated with mood.
The process of applying this method of treatment will not cause pain to the patient. It can stimulate nerve cells improving communication between different parts of the brain. Thereby reducing the symptoms of depression.
Although TMS can improve symptoms of major depression, it does not mean that it will completely cure the disease. However, it will provide an improvement in energy and motivation for you to continue with your treatment plan.
Currently, in addition to being used to treat severe depression, TMS is also applied to a number of other mental illnesses. Examples include obsessive-compulsive disorder, autism spectrum disorder, post-traumatic stress disorder, schizophrenia, or eating disorders.
TMS is contraindicated with other epileptic or convulsive diseases. In addition, people with metal implants in the skull, women who are pregnant or want to become pregnant, drug addicts are also not allowed to apply this treatment.
5. Vagus nerve stimulation (VNS)
Vagus nerve stimulation (VNS) has been approved by the FDA as a long-term adjuvant treatment for treatment-resistant major depression. This method is indicated for patients who have failed at least 4 attempts at drug therapy.
VNS uses a device that looks like a pacemaker and is implanted in the body through surgery. The electric current in this machine helps stimulate the nerves that send signals up the neck and into the brain. Thereby helping to improve the symptoms of depression more effectively.
6. Lifestyle Adjustment
Lifestyle changes are thought to be simple tools that are crucial to a treatment plan for major depression. Even if you are taking other treatments, lifestyle changes are essential.
The right lifestyle adjustments will help you fight depression faster. Also prevent it from coming back in the future.
Support measures may include:
- Physical activity: Regular exercise is effective in treating major depression. Exercise increases serotonin, endorphins, and other feel-good brain chemicals. You should stay physically active for 30 to 60 minutes most days.
- Social Support: Strong social support can reduce isolation. You should stay in regular contact with family and friends. Alternatively, join a class or a club when you have time. Volunteering is also a great way to gain better social connections.
- Nutrition: Eating well is important for both physical and mental health. Especially for those who are suffering from major depression. Eating small, well-balanced meals throughout the day will help maintain energy and reduce mood swings. Pay attention to foods such as fresh fruits and vegetables, healthy proteins and complex carbohydrates.
- Sleep: Sleep has a very strong influence on mood. When you don’t get enough sleep, your symptoms of depression will get worse. Lack of sleep aggravates sadness, moodiness, irritability and fatigue. Make sure you get 7-9 hours of sleep every night.
- Manage stress: Too much stress can make depression worse. It also increases the risk of recurrence of the disease in the future. Try to find ways to deal with stressful issues. Take time to rest instead of working too much.
Severe depression can have a lot of negative effects on health and quality of life. You need to try and stick with the treatment plan your doctor prescribes. In addition, incorporating healthy lifestyle adjustments is essential.