What is major depression?
Depression is a syndrome that has mental and somatic symptoms. When a person is confronted with socio-psychological stress, he/she may show low moods, reduced energy, insomnia, lack of appetite, difficulty in concentration, guilty feelings, as well as other depressive reactions. If the duration is prolonged and there is an increase in severity of the symptoms, then the individual may have repeated ideas of death, which may precipitate self-harm or suicidal behavior.
 
Etiology:
Depression can be caused by many stressors in life that make the individual feel as if he/she is unable to cope. It may also be related to one’s stress-coping ability or one’s personality or genetic factors. The main reason is the dysfunction or insufficiency of neurotransmitters of the brain, such as serotonin or norepinephrine, which are at lower concentrations than in normal people.
 
Symptoms:
At least five of the following symptoms may occur almost daily for two weeks and may also affect one’s functioning in daily life in social, occupational, and in other important areas. These include a depressive mood, a loss of interest or a sense of happiness, and a lower mood, almost all day and every day, with a feeling of sadness, helplessness, or a sense of emptiness. 
  1. A significant loss of interest or pleasure in all activities.
  2. A significant weight and appetite increase or decrease; for example, a weight change of over 5% within one month.
  3. Lethargy or insomnia.
  4. Psychomotor agitation or retardation.
  5. Tiredness or a lack of vitality.
  6. A feeling of worthlessness or guilt.
  7. A decrease in one’s ability to think and concentrate, which leads to hesitancy.
  8. Repeated ideas about death, attempting to commit suicide, or planning a definite suicide.
The above symptoms are not necessarily linked to depression; however, if you have the above described symptoms, please see your psychiatrist for treatment.
 
Treatment:
  1. Medical treatments: taking antidepressants is the main way. Antidepressants usually need to be taken for 2 to 3 weeks before the benefit starts to be felt. The symptoms of depression should be gradually improved in 6-8 weeks. One may also consider to add mood stabilizers, as prescribed by psychiatrists.
  2. Non-medical treatments: with assessments done by professionals to determine depressive symptoms and causes. Offered treatment may include group therapy, individual psychotherapy, cognitive behavior therapy, mindfulness-based cognitive therapy, individual exercise therapy, phototherapy, and assisting in the learning of new behaviors and coping skills.
  3. Electro-convulsive therapy: must be assessed by physicians and performed in a hospital.
  4. Transcranial Magnetic Stimulation (rTMS): must be assessed by physicians, without hospitalization, and outpatient treatment may be performed. 
 
Prevention of recurrence:
  1. Coordinate with the instructions of medical staff and continue to take medication regularly. The support and encouragement of family and friends are very important for recovery from the disease.
  2. For taking medicine, use small bags or boxes for medicine and put them in a visible place as a reminder to oneself to take medication on time. Do not stop medication or decrease the dosage by yourself.
  3. Patients with depression need to maintain treatment and company. Family and friends should encourage, care for, and listen at appropriate times.
  4. Develop an interest and keep a good habit of regular exercise. For example: walking will eliminate stress and allow relaxation.
  5. When you feel irritated, remind yourself to relax first, take a deep breath, then leave the scene, avoid emotional suppression, and try to change your mood. During appropriate times, try to relieve yourself of psychological stress or guilt feelings, so that one does not accumulate stress. 
  6. Arrange one’s own routine schedule, and keep a regulated lifestyle. Avoid smoking and excessive drinking.
  7. When returning to work or school, start from the adaptation period, and increase the workload in a step-wise manner, in order to avoid overload.
  8. If sleep quality decreases, or the symptoms appear and begin to interfere with your daily life, please visit your psychiatrist as soon as possible, in order to avoid recurrences.
 
Reference
  1. A-Tjak, J. G., Morina, N., Topper, M., & Emmelkamp, P. M.G. (2021). One year follow-up and mediation in cognitive behavioral therapy and acceptance and commitment therapy for adult depression. BMC Psychiatry, 21(1), 1-17. https://doi.org/10.1186/s12888-020-03020-1
  2. Baldwin, D. S., Dang, M., Farquharson, L., Fitzpatrick, N., Lindsay, N., Quirk, A., Rhodes, E., Shah, P., Williams, R., & Crawford, M. J. (2021). Quality of english inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the national clinical audit of anxiety and depression. Comprehensive Psychiatry, 104, 152212.  https://doi.org/10.1016/j.comppsych.2020.152212
  3. Cordner, Z. A., MacKinnon, D. F., & DePaulo Jr, J. R. (2020). The care of patients with complex mood disorders. Focus, 18(2), 129-138.  https://doi.org/10.1176/appi.focus.20200007
  4. Hong, R. H., Murphy, J. K., Michalak, E. E., Chakrabarty, T., Wang, Z., Parikh, S. V., Culpepper, L., Yatham, L. N., Lam, R. W., & Chen, J. (2021). Implementing measurement-based care for depression: Practical solutions for psychiatrists and primary care physicians. Neuropsychiatric Disease and Treatment, 17, 79–90.  https://doi.org/10.2147/NDT.S283731
  5. Kruisdijk, F., Hopman-Rock, M., Beekman, A.T. F., & Hendriksen, I. (2019). EFFORT-D: Results of a randomised controlled trial testing the effect of running therapy on depression. BMC Psychiatry, 19(1), 170. https://doi.org/10.1186/s12888-019-2156-x
  6. McCartney, M., Nevitt, S., Lloyd, A., Hill, R., White, R., & Duarte, R. (2021). Mindfulness based cognitive therapy for prevention and time to depressive relapse: Systematic review and network meta-analysis. Acta Psychiatrica Scandinavica, 143(1), 6-21.  https://doi.org/10.1111/acps.13242
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