Major Depressive Disorder, Research Paper Example

By definition, major depressive disorder is an abnormal emotional state characterized by “exaggerated feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness that are inappropriate and out of proportion to reality.” The major manifestations which can vary greatly range from a “slight lack of motivation and inability to concentrate to severe physiologic alterations of body functions” and often produces symptoms related to other mental and physical disorders (Glanze, 2010, p. 354). Overall, major depressive disorder usually occurs during a neurotic state when the underlying cause is due to “an intrapsychic conflict, or a traumatic event” but when the condition is psychotic, severe physical and mental functional impairment occurs, due to an “unidentifiable intrapsychic conflict” which is characterized by hallucinations, delusions, and mental confusion related to time, place, and self-identity (Glanze, 2010, p. 355). Due to the fact that the causes of major depressive disorder are not truly known at this time, it has been ascribed to genetic (i.e., an inherited disorder), pharmacological, endocrinal, infectious, nutritional, and neurological malfunctions in either the human brain, the human body, or both.

Major Depressive Disorder Criteria–DSM-IV-TR

According to the DSM-IV-TR 2000 edition (Diagnostic and Statistical Manual of Mental Disorders), in order for a person to be diagnosed as suffering from a major depressive disorder, sometimes referred to as clinical depression, he/she must meet at least five of the following criteria that “have been present during a two week period and represent a change from previous functioning”–

1. The person must experience a depressed mood that endures for either most of the day or nearly every day, based on either a subjective report (i.e., given to one’s physician or psychiatrist) or “observations made by others,” such as immediate family members.
2. A clear diminishment in interests or pleasure related to all activities for most of the day or nearly every day based on subjective reports and observations.
3. Significant weight loss outside of dieting or significant weight gain or a “decrease or increase in appetite nearly every day.”
4. Problems associated with sleeping, such as insomnia or hyperinsomnia, nearly every day.
5. “Psychomotor agitation or retardation nearly every day” or problems associated with being restless or unable to function physically.
6. Problems related with “fatigue or loss of energy nearly every day.”
7. “Feelings of worthlessness or excessive or inappropriate guilt” almost every day.
8. Problems associated with a “diminished ability to think or concentrate, or indecisiveness” almost every day based on subjective accounts or observations made by immediate family members.
9. Recurring thoughts about dying or recurring “suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide” (DSM-IV-TR, 2000, p. 231).

Overall, these nine specific criteria or at least five of them must be causing “significant distress or impairment in social, occupational, or other important areas of functioning,” such as being unable to work or hold a job, or to interact with family members or friends. Also, these criteria cannot be related to the effects of substance abuse, such as excessive drinking or using drugs, or to taking prescribed medication for another medical disorder. In addition, at least five of these criteria or symptoms must persist for at least two months and be “characterized by marked functional impairment, a morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation” (DSM-IV-TR, 2000, p. 232).

The Complexities of Major Depressive Disorder

Much like other types of mental disorders, such as bipolar disorder and schizophrenia, the symptoms associated with clinical depression vary considerably from one individual to another. Kanter, Busch, Weeks, and Landes refer to this variability as a constellation of symptoms that are present in some patients but non-existent in others, due mostly to differences in brain chemistry (2008, p. 4). As per the DSM-IV-TR, these various categories and/or symptoms possess “similar and overlapping characteristics” which are due to an “increasing number of diagnostic categories of depressive disorders” or issues related to the complexities involved in diagnosing true depression as contrasted with simple feelings of sadness and melancholy which most people experience at some point in their lives (Kanter, Busch, Weeks, and Landes, 2008, p. 4).

The DSM-IV-TR also includes a list of seventeen other disorders that are closely related to true clinical depression with six of these referencing specific disorders of mood. Thus, as Kanter, Busch, Weeks, and Landes explains it, clinical depression is a phenomenon with “great variability in time course, symptom severity, and correlated conditions” and exhibits disorders related to “a depressed mood” that only differ “in duration or the number of symptoms” (2008, p. 4).

Problems for the Clinician/Psychiatrist

As noted by Williams, Hitchcock, Cordes, Ramirez, et al., in a clinical study conducted in 2009, although major depressive disorders “are highly prevalent in the general population within the United States,” recognizing and accurately diagnosing clinical depression has been made difficult because of the absence of a “simple confirmatory test” (p. 1160) or exam that would determine if an individual is suffering from a major depressive event or is experiencing symptoms associated with the stress and anxieties of everyday living. Thus, for the professional mental health clinician or psychiatrist, diagnosing true clinical depression can be a very daunting task.

One specific issue is related to the fact that clinical depression is now considered as a major health problem in the United States with approximately 9% of the population afflicted with some form of depression. Although this number may appear relatively low, this percentage equals out to about 20 million Americans spread across a wide spectrum of society. According to the World Health Organization (WHO), clinical depression is currently the fourth leading cause of physical and mental disability worldwide and will soon eclipse heart disease as the second cause of disability (Williams, Hitchcock, Cordes, Ramirez, et al., 2009, p. 1161).

Therefore, since the diagnosis of clinical depression is based on symptoms and can manifest itself in a variety of ways, mental health professionals and psychiatrists must rely upon clinical interviews in order to “determine if a patient meets the established criteria” set up by the American Psychiatric Association and the American Medical Association as of 2010. In other words, a mental health clinician or psychiatrist cannot rely upon “physiological or laboratory tests, radiological examinations, or tissue diagnosis to definitely establish” the existence of clinical depression (Williams, Hitchcock, Cordes, Ramirez, et al., 2009, pp. 1162-1163).

Clinical Depression: A Multi-Societal Manifestation

As previously mentioned, major depressive disorder is currently widespread in the United States and affects an estimated 20 to 25 million Americans on a daily basis with perhaps a third of this number being so affected that they are diagnosed as disabled. Most of these Americans are over the age of thirty and as adults possess a variety of coping mechanisms or ways to live with the disorder without it severely affecting their livelihoods. However, there are three distinct groups in the United States that suffer from clinical depression in ways that may be difficult to imagine for ordinary Americans–individuals that are infected with the HIV/AIDS virus, those with Type 2 diabetes, and pre-schoolers under the age of five.

As discussed by J.M. Adriote, clinical depression is currently one of the most prevalent psychiatric complications associated with individuals afflicted with the HIV/AIDS virus, and although a number of clinical studies have shown that clinical depression “is no more common among HIV+ people than in those at risk for HIV infection,” a 2012 study conducted by the APA Commission on AIDS concluded that individuals afflicted with the HIV/AIDS virus “had twice the risk for depression than those who were at risk for HIV but were not actually infected” (2013). Exactly why this particular group of Americans are more prone to clinical depression is not clear, but Adriote suspects that because of being infected with the HIV/AIDS virus, specific chemicals within the human brain that have been linked to depression are “turned on” by stress and anxiety associated with having to live with the disease (2013). Adriote also notes that some researchers believe than an “HIV+ diagnosis naturally results in depression, sometimes so severe that it impairs functioning and leads to suicide” (2013).

Similarly, some 30% of Americans that currently suffer from Type 2 diabetes appear to be more prone to acquiring clinical depression. As Fisher, Skaff, Mullan, Arean, et al. relate, individuals with Type 2 diabetes and those who exhibit symptoms or criteria that meet the requirements of the DSM-IV-TR manual, “have increased functional impairment,” both physical and mentally, spend more time in the hospital and less time at their place of employment, have “poorer glycemic control and self-management behavior, increased health care use and costs, and a higher risk of morbidity and mortality” (2007, p. 542).

Once again, much like those that suffer from the HIV/AIDS virus and clinical depression, exactly why this particular percentage of Americans are more susceptible to clinical depression is not known; however, according to Fisher, Skaff, Mullan, Arean, et al., even with the assistance of the so-called “gold standard for assessment of clinical depression” in the form of standardized patient interviews via the Structured Clinical Interview, the Composite International Diagnostic Interview (CIDI), and the Mini International Neuropsychiatric Interview, it remains unclear why this percentage with Type 2 diabetes experiences various forms of clinical depression (2007, p. 542).

The data related to the third group is perhaps the most disturbing, due to the fact that they are for the most part under the age of five. These are pre-schoolers or children who have not yet attended public school nor even kindergarten. In the past, this group was considered as not being at risk for developing clinical depression because “it was believed that pre-pubertal children were too immature cognitively and emotionally to experience core depressive affects” (Luby, Heffelfinger, Mrakotsky, Brown, et al., 2003, p. 340).

But unfortunately, recent studies have demonstrated that at least 30% of pre-school children in the United States suffer from some form of clinical depression with about half of this percentage affected with full-blown clinical depression that meets at least five of the criteria set up by the APA. But what is more profound in relation to these studies is that “children as young as preschool age displayed a far more sophisticated understanding and experience of depressive affects than previously recognized” (Luby, Heffelfinger, Mrakotsky, Brown, et al., 2003, p. 340). Possibly, as contrasted with those afflicted with the HIV/AIDS virus and Type 2 diabetes (i.e., adults), the overarching cause for clinical depression in pre-school children is more closely linked to genetics and perhaps to how these children are raised in their own households.

Conclusion

The most important aspect in relation to major depressive disorder or clinical depression is how it manifests itself within the population of the United States as a disruptive and disabling condition for not only adults but also children as young as five years of age. But thanks to advancements in treating and diagnosing clinical depression, the future seems rather bright, especially considering that new drugs and medications are now being developed to help those with the disorder to live more productive lives.

References

Adriote, J.M. (2013). HIV and clinical depression. APA Commission on AIDS. The Journal of the American Psychiatric Association. Retrieved from www.psychiatry.org/AIDS

DSM-IV-TR. (2000). DSM Library. Retrieved from http://dsm.psychiatryonline.org/book.aspx?bookid=22

Fisher, L., Skaff, M.M., Mullan, J.T., Arean, P., et al. (2007). Clinical depression versus distress among patients with type 2 diabetes. Diabetes Care, 30(3), 542-548.

Glanze, W.D. (2010). Mosby’s mental health dictionary. St. Louis, MO: C.V. Mosby.

Kanter, J.W., Busch, A.M., Weeks, C.E., and Landes, S.J. (2008). The nature of clinical depression: Symptoms, syndromes, and behavior analysis. The Behavioral Analyst, 31(1), 1-21. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395346

Luby, J.L., Heffelfinger, A.K., Mrakotsky, C., Brown, K.M., et al. (2003). The clinical picture of depression in pre-school children. American Academy of Child & Adolescent Psychiatry, 42(3), 340-348.

Williams, J.W., Hitchcock, P.N., Cordes, J.D., Ramirez, M., et al. (2009). Is this patient clinically depressed? Journal of the American Medical Association, 287(9), 1160-1171.