Major Depressive Disorder

Introduction

This assignment is a discussion on the topic of Major Depressive Disorder (MDD).The discussion is based on the definition of Major Depressive Disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

The purpose of the discussion is to analyze the definition of MDD and identify any gaps based on the social and biomedical perspectives, after which it gives the recommendations to fill the gaps in the definition so as to inform the definition of the MDD in the next edition of the Diagnostic and Statistical Manual of Mental Disorders. The discussion starts with a definition of MDD, then goes on to identify the gaps and the recommendations to fill the gaps. At the end is a conclusion which sums up the main arguments of the discussion.

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Discussion

The Diagnostic and Statistical Manual of Mental Disorders Criteria for Defining MDD

The Diagnostic and Statistical Manual of Mental Disorders bases its definition of MDD majorly on the criteria of consistence and persistence of symptoms. The criteria distinguish MDD from depression by describing MDD as occurring in a prolonged manner, usually for a period of two weeks.

It defines MDD as a form of depression in which the patient experiences feelings of disturbed moods in a recurrent manner. The mood disturbance cause disruption of the patient’s normal mood and makes him or her unable to adjust or behave accordingly in school, family setting as well as in work.

The criteria of Diagnostic and Statistical Manual of Mental Disorders does not have any kind of diagnosis for MDD but relies on observation of the patient, the patient’s own account of changes in mood as well as reports by close friends or relatives on the observed changes in mood in the patient.

The most notable symptoms which are relied on in diagnosing for MDD include day to day mood changes lasting for more than two weeks, lack of interest in virtually all daily activities even those which are very interesting, instances of daytime sleep (hypersomnia), loss of appetite which leads to loss of body weight, or a weight gain by more than 5 kilograms, inability to concentrate or think aptly, fatigue which leads to feelings of tiredness even after waking up, occasional thoughts about death which are accompanied by feelings of worthlessness, and suicidal or homicidal tendencies.

On the symptom of depressed mood however, the Diagnostic and Statistical Manual of Mental Disorders criteria does not categorize depressed moods caused by things like drug and alcohol use or misuse, or depressed mood caused by other medical illnesses or conditions as MDD.

It does not also diagnose MDD for patients who are believed to have histories of mixed episodes, mania, bipolar disorder or hypomanic. Similarly, the Diagnostic and Statistical Manual of Mental Disorders criteria do not attribute the symptoms of depression caused by stress and bereavement in the criteria for diagnosing for MDD.

The treatment and management of MDD under the criteria of Diagnostic and Statistical Manual of Mental Disorders mainly constitutes of three major interventions namely psychotherapy, electroconvulsive therapy and the use of antidepressants. For psychotherapy, the criteria recommend cognitive behavioral therapy both to the victim and his or her family members as well as close friends.

It also recommends the method of psychoanalysis which was proposed by Sigmund Freud as a way of reconciling the past experiences with the present so as to help the patient get rid of the traumatic experiences of the past and live in a new orientation. According to the criteria, psychotherapy is recommended for patients with mild forms of MDD.

The Diagnostic and Statistical Manual of Mental Disorders recommends antidepressant intervention for the severe cases of MDD which are accompanied by other mental illnesses. The commonly used antidepressant is the Selective Serotonin Reuptake Inhibitors (SSRIs), which is known to be effective especially for those patients who have recurrent episodes of MDD as well as those who respond negatively to psychotherapy.

Electroconvulsive therapy is recommended for those patients who do not respond positively to both psychotherapy and antidepressants. It is also recommended for those patients who have suicidal tendencies, or those who are faced with the threat of dying due to their inability to eat or drink. It involves the generation of seizures in the patient’s brain through the use of electric waves especially when the patient is in a state of anesthesia.

The Gaps in the Definition and Recommendations

One major gap in the above definition of MDD is that the Diagnostic and Statistical Manual of Mental Disorders does not consider social factors such as stress, stigma, criticism from other people, isolation and other relationship problems and challenges in its definition of MDD.

According to a study done by Kleinman in 2004, negative criticism especially from family members is a major cause of MDD especially among women (Kleinman, 2004. pp.951-953). Other researchers have found out that grieve may be a cause of MDD, especially if the patient loses loved ones in a series of episodes. The prolonged stress as a result of bereavement may precipitate MDD in the patients, especially if the patients had strong emotional attachment to the deceased.

The next edition of the Diagnostic and Statistical Manual of Mental Disorders should therefore consider including in its criteria of the causes of MDD the social factors mentioned above. This would allow for wider conceptualizations of the disorder, consequently leading to a wider conceptualization of its treatment and management. This would also widen the scope, especially with regard to counseling approaches involved. Such a move may see the inclusion of bereavement counseling as a way of dealing with or managing MDD.

Going by the Diathesis-Stress perspective of mental illness, the criteria for Diagnostic and Statistical Manual of Mental Disorders has got some other gaps in its definition and conceptualization of MDD. According to this perspective, individuals are born with certain predispositions, which are nurtured by environmental interactions into specific thought patterns and or personalities, some of which may manifest themselves as MDD.

The diathesis stress perspective identifies various predispositions which may shape the future personalities of young children. Such predispositions include genetics, neurotransmitters, neurobiology and the hypothalamic pituitary adrenal (HPA) axis (Martinowich & Lu, 2008. pp.342-348). The next edition of the Diagnostic and Statistical Manual of Mental Disorders should therefore comprise the above mentioned predispositions in its definition and conceptualization of MDD.

This is because with such a gap in a definition of an important concept like MDD, it can make the diagnosis and treatment too narrow, biased and consequently inappropriate and inadequate in dealing with the disorder. The idea of the current edition of ignoring symptoms linked to personalities is tantamount to ignoring a very important aspect of mental illnesses. MDD should therefore be contextualized not only in terms of the duration in which it occurs but also on the history of the individual especially in regard to the above predispositions.

The other gap which is found in the definition and conceptualization of MDD in the Diagnostic and Statistical Manual of Mental criteria is the role of sleep patterns in MDD. According to Krishnan, both ‘decreased REM latency’ and ‘decreased slow wave sleep’ are known to be major contributors of MDD. This is because upon the necessary intervention to deal with them, most patients show improvement in the severity of symptoms of MDD.

Based the findings by Krishnan, the next edition should include the sleep patterns in the diagnosis for MDD. This would make the treatment of MDD more inclusive and consequently effective, as opposed to the current situation in which the sleep disorders and patterns are completely ignored in the diagnosis and treatment of MDD.

Conclusion

This assignment was a discussion on the topic of major depressive disorder. The discussion was based on the current edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and how it defines MDD. From the discussion, it has emerged that the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria is perhaps the most comprehensive approach in defining MDD as well as other mental illnesses.

The criteria for Diagnostic and Statistical Manual of Mental Disorders defines MDD based on the criteria of the duration of the symptoms, which it puts at two weeks. In the diagnosis of MDD, the criteria rely on observations of symptoms like suicidal tendencies and lack of concentration in the patients. These symptoms may be reported by the patient or his or her close friends or family members.

One of the gaps which have been identified in the definition is the ignorance of some predispositions like genetics as well as social factors like stigma, isolation and criticisms. One of the recommendations is that the next edition of the Diagnostic and Statistical Manual of Mental Disorders should factor in the issues identified above so as to fill the gap in the definition and make the diagnosis and treatment of MDD more inclusive and effective.

References

Kleinman, A. (2004).Culture and Depressions. The New England Journal of Medicine, (351) 10, pp.951-953.

Krishnan. (2010). Epidemiology, Pathogenesis & Neurobiology of Depression. Retrieved on October 27th, 2011 fromhttp://www.uptodate.com/online/content/topic.do?topicKey=depress/710&selected Title=9%7E150&source=search_result.

Martinowich, K., & Lu, B.(2008). Interaction between BDNF and Serotonin: Role in Mood Disorders. Neuropsychophamacology: Official Publication of the American College of Neuropsychophamacology, 12(3), pp.342-348.

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