Depression

About Depression

Major depressive disorder MDD affects approximately 280 million people worldwide according to WHO and is a leading cause of disability. Symptoms include persistent sad, anxious, or empty mood, loss of interest in activities anhedonia, significant weight change, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, difficulty concentrating, and recurrent thoughts of death or suicide. Diagnosis requires at least 5 symptoms for at least 2 weeks. A substantial share of people experience depression at some point in life. Risk factors include female sex, family history, chronic medical conditions, substance abuse, stressful life events, and certain medications. The disease involves dysregulation of neurotransmitters serotonin, norepinephrine, dopamine, neuroendocrine dysfunction HPA axis, and neuroplasticity. Treatment begins with psychotherapy cognitive behavioral therapy CBT, interpersonal therapy IPT and or medications. First line antidepressants are SSRIs fluoxetine Prozac, sertraline Zoloft, escitalopram Lexapro, citalopram, paroxetine. SNRIs venlafaxine, duloxetine are alternatives. Many people improve with the first treatment tried, while others need adjustments or alternative approaches. Treatment resistant depression may be managed with augmentation using atypical antipsychotics aripiprazole, quetiapine, or newer therapies esketamine Spravato nasal spray, dextromethorphan bupropion Auvelity. Electroconvulsive therapy ECT is highly effective for severe depression. Anyone having thoughts of suicide, or at immediate risk of harm, can get urgent help through local emergency numbers or crisis support lines.