in-depth analysis of the diagnosis and treatment of major depressive disorder (MDD)

The study included a thorough examination of the diagnosis and therapy of major depressive illness (MDD). To further understand the condition, an exploratory study using qualitative analysis was conducted. It is a condition that causes people’s typical behavior to change, resulting in symptoms such as anxiety and panic attacks. It affects people of all ages, but it is increasingly prevalent among young people today. Antidepressants, placebo, and psychotherapy were recognized as treatments. To achieve better results, it was suggested that antidepressants be used with psychotherapy. The treatment of MDD has been hampered by assumptions such as stereotyping the condition and a lack of understanding of the disease, resulting in little research.

Keywords: Major Depression, psychotherapy, antidepressants, depression symptoms

Diagnosis and treatment of major depression

Major depression disorder (MDD) is a condition that is common today that causes cognitive problems and the ability to function normally. There is a vast number of causes of MDD ranging from personal experiences or going through a traumatic experience. The diagnosis and treatment of MDD have been a challenge to doctors and patients with the problem due to its complexity. The study will look into various ways the condition could be treated to generate positive health outcomes and increase the chances of remission. There will be an in-depth analysis of research done on the illness and the results experienced. There are vast ways that people have recommended in the treatment of MDD that will be reviewed to understand one that has worked efficiently and could be adopted in future. The study will conclude with recommendations for best treatment and a follow-up plan in a bid to ensure the patient has adequate care on their own.

Literature Review on Diagnosis and Treatment

Diagnosis of MDD has been a challenge over the years as research indicates that people tend to compare it with weakness and inability to manage normal life challenges. Yet, it is predicted by the World Health Organization (WHO) that in time, depression could be the second most rampant condition after heart problems (WHO, 2012). It impacts the person with the illness, their families and the economy. Their ability to be productive is limited by the number of days they have to be away from work coupled with reduced work productivity. It is, therefore, fundamental in nursing to understand the symptoms of depression to enhance the ability to give adequate treatment. Early depression could be identified through a loss of interest in activities that one was interested in the past. Depressed persons tend to have feelings of guilt and blaming themselves for what happened to them and others around them. There is a tendency to lose appetite or gain too much appetite and therefore high variation in weight. They are unable to concentrate on tasks they are expected to perform and tend to have suicidal thoughts (Batterham, Christensen, & Calear, 2013).

All persons have the prevalence of MDD with younger persons today being the most affected. People below the age of thirty years have high levels of anxiety resulting in depression. It is more rampant in young women between the ages of 27 to 31 who have up to a 77% change of MDD compared to the men of the same age (Schuch, Roest, Nolen, Penninx, & de Jonge, 2014). Persons with lower level incomes are also prone to MDD compared to those with moderate incomes (Lee et al., 2016).

However, one cannot rule out the presence of MDD without a proper medical diagnosis. First (2014) proposed a six-step diagnostic process. The process entails ruling out of fictitious disorders, use of substances, existing medical conditions, and the establishment of the particular disorder that a person may be suffering. The final step in diagnosis understanding the level of the depression. The use of an accurate diagnosis rules out the probability of treating a non-existent condition. The Diagnostic and Statistical Manual (DSM-5) has proven to be a successful technique in the diagnosis of mental conditions such as depression.

Diagnosis of MDD could be made through physical examinations in which case the condition is linked to the existence of another health issue such as cancer. Lab tests are a key way to recognise the existence of MDD as they are an indication that the body is performing normally and parts of the body that are well. Lab tests rule out the presence of illnesses in the body that could exhibit symptoms similar to depression. The tests provide an opportunity for individualized treatment and provide an analysis that could be separated from other existing medical conditions (Redei et al., 2014). Hospitals today have been seen to conduct psychological evaluations to establish abnormal behavioural patterns. It could be done through answering oral questions or filling out questions that would determine the feelings and thoughts of individuals. Persons with depression tend to exhibit a reinforced avoidance behaviour that nurses could detect during the examination (Polenick, & Flora, 2013).

MDD is a treatable condition and research has been thoroughly done to establish different ways of dealing with the condition. However, it is coupled with significant challenges with people remaining untreated for extended periods of time and those under treatment being undertreated (Rothschild, 2013). The fact the condition is associated with the existence of other conditions means that it may be missed out for extended periods of time. Another key challenge is a determination of the severity of the condition on the onset of treatment. Some people may be treated for MDD, yet they are suffering from bipolar conditions.

Treatment is dependent on the ability to identify symptoms and diagnose the patient correctly. Culpepper, Muskin, & Stahl (2015) call for the treatment of all symptoms to the level that they can no longer be seen in a person. However, their research indicates that patients have been seen to exhibit lingering symptoms even after treatment that open the leeway for resistance in use of therapy. They call for individualized treatment for patients as people suffer depression in different levels and caused by various circumstances.

Approaches to treatment of major depression

There is an enormous number of ways of treating and managing major depression that includes using the pharmacological approach or handing patients without using medication. Medically, patients have been treated through the use of antidepressants that alter the functioning of the brain cells. The effectiveness of antidepressants is based on the fact that the DSM manual categorized the condition as neural and therefore the drugs would be useful in handling the situation (Davey, & Chanen, 2016). However, their use has been criticized over the years for their inability to treat the condition to levels that remission is permanent. Their reduced effectiveness has been related to the release of wrong research reports on the drug trials. The antidepressants that are on the rise in usage by children and adolescents have been criticized for being ineffective. However, the combination of antidepressants with other medical treatments has been seen to yield positive results (Davey, & Chanen, 2016). The variation in the number of existing antidepressants brings the challenge of the choice of medication that one patient should take compared to another. Nurses are burdened with the role of ensuring adherence to the patients to ensure positive health outcomes. They are expected to ensure dosages are adhered to, and there is adequate education to patients medicating themselves on the use of antidepressants. Another key challenge in the use of antidepressants is that patients have been forced to try different drugs until they could find one the works for them and presents manageable side effects on it use (Plotnik, & Kouyoumdjian, 2013).

Placebo has been identified through clinical trials as having the ability to treat major depression. Though not as effective as antidepressants it has been seen to generate positive health outcomes for patients under treatment (Marchesi, De Panfilis, Tonna, & Ossola, 2013). Placebo entails the use of non-medical substances such as pills that contain no real drug. The logic behind their use is that the mind is tuned to believe that it can be healed without active medication. There is no actual relationship between the pill and the depression as people improve their condition due to the expectation that the medicine will generate positive results. However, the use of placebo in the treatment of medical conditions is done with care depending on the severity of the ailment. Marchesi, De Panfilis, Tonna, & Ossola, (2013) in their research call for a proper diagnosis to separate patients that would be eligible to receive placebo. The challenge comes primarily in the relationship between the patient and the nurse where the nurse would have to deceive the patient that they are receiving medical treatment whereas there is no pharmaceutical component in it. The ability to use the placebo effectively without deception has proven a challenge because the essence lies in lying to the mind of the depressed person. Individuals with the knowledge that they are not taking something that is not may not respond positively as they work through classical conditioning. However, they could be used in the treatment of depression after the consumption of antidepressants, and an individual has shown improvement through the depression reducing to mild. Marchesi, De Panfilis, Tonna, & Ossola, (2013) recommend medical practitioners to advise patients suffering from MDD to explore the use of placebos for patients with mild depression.

The use of therapy has been widely employed in the treatment of major depression. Psychotherapy entails talking to the patients to understand the inherent cause of their depression. The person providing the therapy has to be a licensed practitioner to ensure they provide evidence-based care. Therapy could be presented in different ways including cognitive behavioural therapy (CBT). CBT entails purports that depression could be a result of an individuals’ cognition of their current or past situations. Such thoughts tend to be rigid and negative leading to a negative view of one’s life resulting in depression. The therapy calls for the creation of a relationship between the patient and the therapist to foster a change in thoughts of an individual. Various experimental aspects are applied that require the patient to modify the way they perceive the occurrences in their lives. The treatment could be short term or long term depending on the condition of the patient with up to 12 sessions. Studies have revealed that CBT is effective for major depression especially when implemented by practitioners such as nurses who have undergone training in advance (Plotnik, & Kouyoumdjian, 2013).

MDD patients could explore the use of interpersonal therapy to deal with their illness. A principal cause of MDD was identified to be personal experiences in the past that could lead one to adopt depressive behaviours. The therapy focusses on dealing with actual issues that influence the behaviour of a person. The sessions have to be limited to a given duration of time with the health practitioner focusing on the cause of the illness as opposed to the behaviour that the person is exhibiting. The diagnosis that warrants this treatment is based on accurately determining the cause of the depression. Treatment takes places in phases starting with the patient accepting that a particular condition is causing depression. It is followed by dealing with the problem to enable the patient to function at full capacity. Finally, there is preparation for termination of the program and allowing the patient to be independent and knowing they can go through issues on their own even after therapy.

Patients with depression to the levels of having suicidal thoughts have been introduced to the use of electroconvulsive therapy (ECT). It is considered the last option to explore in the event of depression (Rothschild, 2013). ECT entails passing a current through the brain when an individual is under full anaesthesia. It has been proven to provide an instantaneous reprieve to persons with MDD. People with depression have been known to seek alternative modes of treatment including herbal medicine. They are not as effective as the demonstrated methods of medication but have been known to improve one’s depressive state. Knowledge of treatment and handling of MDD has been increasing over the years with research continually providing ways to better diagnosis and treatment. Clinical trials will bring the medical field to a place where they can determine whether to give patients first line, second line or third line option of drugs depending on the degree of depression.

Recommendation for treatment

The studies above indicate various modes of treatment available to patients suffering from MDD. The research would recommend the combination of the use of antidepressants combined with the use of psychotherapy. Cuijpers et al., (2014) in their research indicated that it was evident that combining the two provides superior results in handling major depression. The study was done through meta-analysis and proved that a combination of the two treatments is more effective working together as opposed to working with individual treatments.

The ability of medical practitioners to work with both ensures that the underlying issues are met through therapy. Persons get an opportunity to talk to a qualified person to get rid of behaviour leading to depression. The antidepressants, on the other hand, play the role of providing immediate relief to the patient and to handle anxiety, panic attacks and suicidal thoughts. Based on the studies done and an understanding of the topic, the recommendation provides positive outcomes for the patients which are fundamental to the practice of nursing.

Assumption in diagnosis and treatment of major depression

Diagnosis of MDD is a challenge for medical practitioners given the ability to have symptoms that could be confused with other conditions. Depression is a condition that the individual suffering may not be aware due to the discretion of the symptoms. The challenge is coupled by the interchangeability of symptoms that could be confused with other illnesses (Fried, 2015). Physicians have the tendency to assume that depression is as a result of the existence of other medical conditions such as diabetes. The assumption has made limited the scope of research done on MDD as there is a lack of direction on the dynamism through which specific symptoms could lead to depression. Fried (2015) indicates that people have the tendency to stereotype the occurrence of depression to particular groups of persons such as the aged, the sick and worldly people. Such an assumption leaves people, not in the category unable to decipher symptoms and acquire treatment adequately. The biases that people create do not reflect the reality as any person has the capability to acquire MDD.

Another fundamental assumption that has been researched on is the causation of depression and its symptoms. People believe that MDD results in a set of symptoms which is not an assumption made in other medical conditions. Symptoms are the leeway to an illness and not the vice versa, and such should not be assumed in MDD. Depression has a cluster of symptoms such as fatigue, lack of sleep and moodiness. The ability to determine the root cause of MDD is fundamental towards treatment and management of the condition (Fried, 2015).

Treatment of MDD is coupled by further assumptions that the symptoms exhibited by depression are standard and could, therefore, be handled in primary care as opposed to seeking mental health care. Patients are therefore treated with antidepressants with referrals for further care such as therapy being provided in critical situations where the person may already have high suicide risks.

Follow-up treatment and referrals

Patients suffering from MDD require regular follow-up after treatment to ensure they do not relapse to their initial conditions. Follow up for patients will be done within the periods of three months on clearance from medication to a period of 24 months. As a family nurse, follow-up will entail collaborating efforts with physicians to ensure access to examination within the follow-up duration to establish whether the persons under treatment have improved or required further medical attention. The collaboration of efforts with require identification of a place that consists of people that understand mental health and have the ability to handle cases presented to them.

Follow up will require adequate documentation of the patients’ details to allow the analysis of progress and the treatment received throughout the period. It will ensure that all persons working with the patient have the ability to understand the underlying condition and to make decisions to improve the status of the patient.

Finally, the follow-up will entail education to the patient and the caregivers. A detailed understanding of the condition and treatment ensures the success of the intended outcomes. It ensures that both the medical and non-medical teams provide care with a common goal.

Methodology

Data collection in the study was done with the utilization of internet search. The data collection method explored was qualitative analysis. An explorative data collection was used to understand the concept of diagnosing and treating MDD. Various opinions were sought from the work of other authors.

Data was collected by first understanding the topic and the keywords and phrases to the study. The goal of the study was set out to ensure that there was no deviation from the core of the topic. Finally, data was collected and a report done to bring out the underlying issues in MDD. Various databases were essential in the research including CINAHL, EBSCOhost, Medline and the Web of Science. The databases were critical in the provision of journals and books with relevant information for the study.

References

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Cuijpers, P., Sijbrandij, M., Koole, S., Andersson, G., Beekman, A., & Reynolds, C. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry, 13(1), 56-67. http://dx.doi.org/10.1002/wps.20089

Culpepper, L., Muskin, P., & Stahl, S. (2015). Major Depressive Disorder: Understanding the Significance of Residual Symptoms and Balancing Efficacy with Tolerability. The American Journal Of Medicine, 128(9), S1-S15. http://dx.doi.org/10.1016/j.amjmed.2015.07.001

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Marchesi, C., De Panfilis, C., Tonna, M., & Ossola, P. (2013). Is placebo useful in the treatment of major depression in clinical practice?. Neuropsychiatric Disease And Treatment, 9, 915-920. http://dx.doi.org/10.2147/ndt.s44519

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