Crippling Depression is also called Major Depressive Disorder. A major depressive disorder is one of the most prevalent psychiatric disorders and estimated that greater than 300 million people suffer from depression. The W-H-O states that depression is the leading cause of disability worldwide. The Centers for Disease Control estimates that approximately seven point six percent of Americans suffer from depression.
Depression occurs throughout a person’s lifetime and generally females at the number of males, and estimated that females outnumber males by about two to one.
So how do we diagnose major depressive disorder MDD while utilizing the DSM-5 criteria the eight criteria, the requirements we need to have to even consider MDD is that there’s an equal to or greater than five of the following symptoms present during the same two-week period.
Crippling Depression-Depresses Mood or Loss of Interest
Represent a change from previous functioning at least one of the symptoms is either one a depressed mood or two a loss of interest or pleasure. So that right there tells us the critical information we need even to consider making a diagnosis of (Crippling Depression) major depressive disorder.
We need either a depressed mood or loss of interest or pleasure or both for at least two weeks, and when we have those we still need to meet at least another three to four of the following symptoms to even say we have the criteria for (Crippling Depression) major depressive disorder.
So what are some of the other symptoms, well two of the signs we have already talked about depressed mood so that print press mood is most of the day near every day has indicated by other subjective reports, so the person states that they feel sad or empty or hopeless?
An observation or an observation made by others someone that knows and that says that they appear tearful that they seem sad and children and adolescents, this can be considered irritable mood, so I’m not a depressed mood but in a grumpy mood.
The second one is that they lost interest in pleasure, so that means it’s markedly diminished interest or desire in all or almost all activities most of the day; hence if we have one or the other of those, we still need at least three or four more of the following symptoms.
Significant Weight Loss
One – A significant weight loss when not dieting or weight gain, usually it’s a change of more than 5% of the body weight in a month or decrease or increase in appetite nearly every day. So it’s what we consider a change in appetite that results in a change in weight and not necessarily having a shift in weight.
We can have a change in weight or a change in appetite, then that would be enough to meet those criteria.
Insomnia or Hypersomnia
The next symptom is insomnia or hypersomnia nearly every day. So some sleep disturbance the next one is psychomotor agitation or retardation almost every day so can be observable by others, and it’s not merely subjective feelings of restlessness or being slow down.
Fatigued or Loss of Energy
Another symptom is that the patient feels fatigued or loss of energy nearly every day; another one is feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Another one is a diminished ability to think or concentrate or indecisiveness nearly every day, so this is an issue with concentration or problems with thinking.
Thoughts of Death
The final one is that the person may have recurrent thoughts of death recurrent suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide.
So if we have either a depressed mood or a loss of interest in our pleasure for at least two weeks with at least three to four, more of these symptoms that we’ve just gone over for more days than not or almost every day during those two weeks. Then we say that we have met the criteria for (Crippling Depression) major depressive disorder.
The B criteria are that the symptoms caused clinically significant distress or weakness and social occupational or other important areas of function.
The C criteria are that the episode is not attributable to the physiological effects of a substance or another medical condition. So if the person’s drinking alcohol heavily, if they’re using other elements that are causing some of these symptoms, we can’t say that it is (Crippling Depression) major depressive disorder.
The D criteria are that the occurrence of the (Crippling Depression) major depressive episode is briefly explained by schizoaffective disorder. Schizophrenia form disorder delusional disorder or other specified or unspecified schizophrenia spectrum or other psychotic disorders, so some of these other disorders such as skin so that it’s ordering have elements of schizophrenia.
And mood components so if they have that already we don’t say that they have MD D you, they have schizoaffective disorder, so we need to exclude MBD if another disorder explains these symptoms.
And then finally, the E criteria are also other exclusion criteria in that if they have had a manic episode or hyper manic or hypomanic episode. They do not have MD D; they have bipolar type 1 for manic episode type 2 for a hypomanic episode, so we need to make sure that they have not had a manic episode or hypomanic episode.
So there are also several specifiers we can use to describe the (Crippling Depression) major depressive episode that the patient is experiencing it can be
- With anxious distress, they can have a component of anxiety that is severe that is significant.
- They can also have mixed features, which means that they have characteristics of both bipolar disorder and major depressive disorder. Still, they don’t meet the criteria or the definition of a manic or hypomanic episode, so they might feel they might have very energetic.
They might be very energetic but also stating that they have a low mood, or they’re very depressed, so these are the types of things that we see with mixed mix features.
- It can also be melancholic features; this is when they wake up in the morning, they feel the press, but as their day goes on, they start to feel a bit better.
- Atypical features are also another specifier we can use.
- There’s also mood-congruent psychotic features, so mu congruent psychotic features are delusions or hallucinations that are associated with the major depressive disorder, and these are when it’s mood-congruent those delusions.
Hallucinations match the mood so if they have a low mood they are those psychotic features are congruent to that mood so they would experience delusions and hallucinations that are more negative that is more depressing
Incongruent Psychotic Features & Catatonia Peripartum
- There are also mood incongruent psychotic features that are the opposite, so if they have a low mood they are experiencing psychotic features that don’t match with that mood. There could be things that they’re seeing or experiencing that are happy and that are more positive that don’t match their mood.
- There’s also the specifier of catatonia peripartum onset if it occurs during pregnancy and seasonal pattern; this used to be called seasonal affective disorder in the sm4. It’s been changed in DSM-5. Now it’s a specifier of MDD you. So it’s MBD with a seasonal pattern. This is what we refer to as seasonal affective disorder previously. Hence, they become depressed during the winter months when it gets dark, and it’s more of a seasonal recurring type pattern.
Crippling Depression Diagnose
So how do we make the diagnosis more easily without trying to memorize all those things in the DSM-5 criteria, well we have the mnemonic device known as M SIGECAPS MCT caps is the mnemonic device we use to make the diagnosis. We need five or more of the following, and we must have at least M and I.
- M means the mood is low so that is our depression.
- S is for sleep disturbances.
- I is for interest loss so that’s the other eight criteria so the other need the mood low.
- G is for the guilt he is for having low energy or fatigue
- C is for concentration difficulties.
- A is for appetite changes.
- P is for psycho psychomotor retardation.
- S is for suicidal suicidality.
So this mcg capsule looks excellent, so again we need five or more of those symptoms, and we need at least M and I, so we need at least mood low and interest loss, and then we need to have other symptoms in this list that add up to at least five or more.
So again, mood low, sleep disturbances, interest loss, guilt, energy low, concentration difficulties, appetite, changes psychomotor retardation, and suicidality.
The question as to why MBD occurs, there are many possible explanations. Some of them are biological; some of them are psychosocial, or there could be a mixture biopsychosocial, and that’s more likely to be the reason.
Some of the biological causes that have been proposed are genetic, so genetic causes are essential because it been found that monozygotic and dizygotic twins have increased risk of MDD if they’re monozygotic twin or dizygotic twin have MD D. It’s they actually have a higher risk of their monozygotic then if their dizygotic.
It shows that there is an actual genetic component involved.
There’s also the neurotransmitter depletion, so that means that there’s decreased five-inch TV offer nephron dopamine. It’s also the belief that there’s an increased HPA access activation, so there is an increased HP active access activation, and this can be thought to be a biological cause of MDD possibly.
Another theory is that there’s an immunological at this function, and it has shown that there is dysfunction in the immune system in patients with (Crippling Depression) major depressive disorder. It’s still not sure if MVD causes immunological dysfunction or immunological dysfunction causes MDD, or they both cause each other.
There also neuroanatomical changes, so it is found that there is a decrease in the hippocampal volume in patients with MD D there are also neurophysiological changes, so it’s shown that patients with MD D have Reduced REM latency decreased.
(SWS) Slow-wave sleep increased REM length, so they have changes in the way they sleep; their sleeping patterns changed.
On the other side of it and the psychosocial side, there are cognitive theories such as baek Beck’s triad, so the patients with MD D are more likely to have Beck’s triad. They have negative views of themselves of the world and their future, and they might have disordered, or kind of pathological schemata.
Psychodynamic theories include patients that have low self-esteem, and attachment disorders may have a propensity of having MD D. Environmental issues include stressors in the person’s life things that they’ve experienced in their life that all ultimately lead to the development of MVD also associations.
With other psychiatric disorders, psychiatric comorbidities, these include anxiety substance abuse, major neurocognitive disorders, so dementia.
We look at the risk factors, so what are some of the risk factors that can increase someone’s risk of getting a (Crippling Depression) major depressive disorder.
One of the first ones is the female gender, so we’ve talked about females outnumber males 2 to 1. There’s also family history, so patients with a family history of (Crippling Depression) major depressive disorder with suicide attempts and completion and with substance abuse all have a higher risk of getting MBD.
Also, having certain past experiences and in someone’s life so things like abuse and neglect losing a parent at a young age all can increase your risk for having (Crippling Depression) major depressive disorder.
Another risk factor stressors in one’s life so these could be financial they could have lost their job they could have gone through divorce these all increase your risk for having (Crippling Depression) major depressive disorder.
People with certain personality traits are more likely to have more likely to develop (Crippling Depression) major depressive disorder.
And other these include being from low socioeconomic status and having a lack of relationships, and our support can increase your risk for developing (Crippling Depression) major depressive disorder.
Crippling Depression Treatment
What are some of the treatments of (Crippling Depression) major depressive disorder, well there are many different treatments
First is lifestyle modification could be increased exercise could also be a mindfulness type meditation can help.
Biological treatments these are the many variety SSRIs SNRIs NDRis SARI and the NaSSa or the NASA.
In the first line generally are the SSRIs (Sertraline or Escitalopram), and we usually use sertraline Zoloft or sits settle up REM and then the faxing, so that’s an SSRI that’s Effexor that could be another first-line. We generally see that used with (Crippling Depression) major depressive disorder in mirtazapine.
Which is it the only NASA, and that’s Remeron, and generally, we use most as opine when the patient has problems with cachexia and with issues with their sleep.
ECT is also a possible treatment modality. Generally, we only use ECT for patients with MDD with psychotic features or treatment-resistant cases, but ECT is very effective in treating (Crippling Depression) major depressive disorder.
There’s also phototherapy is more helpful for specific MDD, especially with MBD with seasonal pattern or any type of issue with sleep dysregulation or shift work anything like that can be helped with phototherapy.