Anatomy of Illness paper, part 2, 6page, double space
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Anatomy of illness
Major Depressive Disorder
Description
The common name for the Major Depressive Disorder is depression, with other slangs arising. In some contexts, it is known as depressive diseases or illness, mood disorder, etc.
Major depressive disorder is one of the most prevalent and common mental disorders in the United States. According to the 2017 National Survey on Drug Use and Health (NSDUH) data, at least 17.3 million adults had a minimum of one major depressive episode in the United States (National Institute of Mental Health (NIMH), 2019). It is more evident in females with an 8.7 percent prevalence and 5.3 percent in males. A major depressive episode was noticeable and higher among the 18 to 25 years adults with a 13.1 percent prevalence.
The statistics indicate at least 3.2 million adolescents of 12 to 17 years had a minimum of one major depressive episode representing at least 13.3 percent of the adolescents in the United States (National Institute of Mental Health (NIMH), 2019). The adolescent females are highly prone to significant depressive with at least 20 percent, lower in male adolescents with 6.8 percent, and high among those reporting two or more races. It estimated at least 400,000 suicides in the world occur with a depressive episode. The statistics establish that females represent the highest population with major depressive disorder in the United States every year.
According to the center for disease control and prevention, major depressive disorder in the United States is a leading factor for suicides: ranking the 10th cause of death and accounting for over 36,909 deaths in 2009 (Halverson, 2019). Additionally, at least 70 to 80 percent of the persons with major depressive disorder can attain reduced symptoms of the disease with appropriate or excellent treatment (Halverson, 2019). However, 50 percent of these individuals may not respond to the initial therapeutic trials.
There is a typical age of major depressive disorder: it can develop at any age. However, the median age at onset is 32.5 years and more prevalent in women than men. The neuroendocrinological mechanisms, hormonal, genetic, and immunological mechanisms steer significant depressive disorder development. Additionally, personal vulnerabilities like stress trigger depression, and environmental factors like childhood exposure to adversity and adverse events lead to substantial depressive disorder development. The etiology of major depressive disorder’s heritability is approximated to be 35 percent and is multifactorial. It is caused by environmental factors related to emotional, sexual, and physical abuse. Cognitive personality, interpersonal factors, and concurring disorders like substance abuse, anxiety, and behavioral disorders lead to significant depressive disorder development.
The major depressive disorder's contributing factors include treatment-related elements like patient setting and social support, pain, and being aware of a cancer diagnosis. Additionally, patient-related factors such as a history of depression in the family contribute to major depressive disorder. Also, risk factors include personality traits such as dependency, low self-esteem, pessimism, traumatic events, sexuality, etc. Healthy behaviors are significantly positive in diagnosis since it leads to a faster recovery and avoidance of risk factors. Thus, it would influence my diagnosis positively through effects reduction. Essentially, cognitive behaviors are critical elements to counter-attack significant depressive disorder challenges in the future. Health behaviors are optimizing factors to the existing treatment or therapeutic strategies.
Major depressive disorder (MDD) is associated with changes in behavior, cognition, and emotions. Additionally, MDD can relate to some of the physical symptoms, such as headache and back pain. The psychological factors include a feeling of sadness and hopelessness, angry outbursts, and quickly getting irritated, agitation, anxiety, and a problem concentrating.
According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the MDD diagnosis relied on the mania or hypomania represented by mood elevation and irritability with a minimum of one of the following symptoms: increased speech, low self-esteem, and insomnia. After the physical examination and the MDD symptoms or criteria are met within the first two weeks, two diagnoses for MDD and persistent depressive disorder are executed (Otte, Gold, Penninx, Pariante, Etkin, Fava, ... & Schatzberg, 2016). After the MDD diagnoses, various modifiers are used to characterize the condition further.
The major depressive disorder affects the body's various functions, primarily affecting the nervous system, immune system, and the circulatory system. Heart and brain are mostly affected due to the changes in the standard functioning of the systems. The identifiable prevalence of the MDD in the US is based on the socio-demographic correlations. Through the American Medical Association study, the annual and lifetime prevalence in women is 1.4 and 26.1 percent and for the men is 7.2 and 14.7 percent, respectively (Avenevoli, Swendsen, He, Burstein, & Merikangas, 2015). The annual and lifetime prevalence of MDD among US adolescents was 11.0% and 7.5%, respectively. A recent meta-analysis associates MDD with at least 50 percent for the increased mortality rates (Avenevoli, Swendsen, He, Burstein, & Merikangas, 2015). The persons in early adulthood and adolescents have lower chances of survival compared to seniors due to widening comorbidity and health complications.
Social determinants of health significantly influence the MDD diagnosis, ranging from economic stability, social and community context, education, health and healthcare, neighborhood, and built environment. Most poor communities and the unemployed population are prone to depressive disorders due to the economic pressure to meet their needs. Additionally, illiteracy and level of education will influence the ability to adopt healthy behaviors, which affect the mental health of persons. Discrimination increased incarceration, and lack of social cohesion influence MDD because of the lack of community integration and social support that encourages them during challenging moments. Additionally, inaccessibility to quality care and poor environmental condition exposes persons to potential stressors that implicate the body's normal cognitive, physical, and emotional functioning. Like this, it might lead to broad exposure to behavioral changes and dynamics in a person's entire personality.
After establishing these elements, I can integrate the course concepts' distribution, determinants, behavioral and psychological aspects. Therefore, I ascertain that major depressive disorders are associated with various diseases, prevalent mostly in women and economically challenged persons. Educating and empowering the vulnerable population through community and self-health awareness programs is essential to prevent the MDD incidences in the United States.
Treatment, Interventions, and Impact
Before the major depressive disorder treatment, a physician would execute various diagnostic testing such as physical examination, which involves asking the patients questions to probe their health and examine their behavior. Secondly, a lab test called complete blood count, and testing thyroid to ensure they are functional are necessary tests before treatment (Mayo Clinic, 2018). Additionally, the doctor would conduct a psychiatric evaluation and DSM-5 tests to evaluate behavioral patterns, feelings, and thoughts. I need to endure the finance costs, distress, and pain during the diagnostic process before therapies.
The standard treatments for major depressive disorder include medications and psychotherapy (Mayo Clinic, 2018). Additionally, the medicines are essential to suppress the depressive symptoms visible from the patient. Also, whole-body hyperthermia (WBH) is recognizable therapy for the MDD. WBH works to stimulate "warm-sensitive thermo-sensory pathways projecting from the patient's skin to the cortical and subcortical regions to influence behavior and neural activity in an approach appropriate for the MDD treatment" (Janssen, Lowry, Mehl, Allen, Kelly, Gartner, ... & Fridman, 2016). WBH has prolonged therapeutic benefits with rapid-acting and antidepressant modality, which holds safety. If there is no standard treatment, this could further chemical imbalance that can trigger the patient's debilitating effects. It might increase the patient's vulnerability to other diseases and make it challenging to treat these other disorders.
The antidepressants have some common side effects such as weight gain and increased appetite, insomnia, nausea, blurred vision, anxiety, constipation, dizziness, delirium, and sexual desire loss. There is a need to improve the MDD treatment outcomes: currently, there no clinically approved or reliable tools for forecasting outcomes or stratifying subgroups (Kraus, Kadriu, Lanzenberger, Zarate Jr, & Kasper, 2019). However, there are strategies suggested to link the outcomes and the current strategy to improve the processes. The studies ascertain that a shorter duration of the untreated disorder in the first and repetitive episodes promote better therapeutic response and long-term results (Kraus, Kadriu, Lanzenberger, Zarate Jr, & Kasper, 2019). The psychological variables establish that the socio-demographic factors like sex, age, and previous episodes impact the outcomes. For instance, stress related to high levels of occupation impairs the results. The environmental stress and adverse events of life, physical and psychiatric comorbidities impairs the MDD treatment outcomes. Living with MDD is encompassed with relationship challenges, low emotional intelligence, and the possibility of self-harm.
Several studies indicate socio-demographic factors like women and young age, and persons who have never been married were at a higher peril of recurrence, but these elements are inconsistent (Lye, Tey, Tor, Shahabudin, Ibrahim, Ling, ... & Badamasi, 2020). The clinical variables such as family history, number, and severity of previous episodes are critical predictors of recurrence. Among the mature women, exacerbation are higher during the menstrual cycle, and generally, when a patient stops the medication, the exacerbation is prevalent. "At the clinical level, progression of MDD is parallel by more advanced pathophysiological dysregulations," (Verduijn, Milaneschi, Schoevers, van Hemert, Beekman, & Penninx, 2015). Disease progression is evident from somatic disorders: it essential for prognosis and therapeutic modality selection. For instance, it is crucial early disease detection and development of particular treatments.
The treatment costs of MDD is widely spread across several aspects of human life. Financially, treatment costs of MDD are relatively high, involving expensive medications and therapies. For instance, the cost of Wellbutrin SR/XL dosage of one month costs an averagely $228/$1,992 (Cherney, 2020). Additionally, MDD impairs one's ability to socialize, which can hinder him/her from creating healthy relationships. It impairs one's ability to work effectively, reducing their productivity since most of the time is spent on therapeutic procedures related to MDD (Cherney, 2020). It suppresses the individuals' emotional intelligence and lowers their relationship with families.
Apart from the pharmacotherapy, interpersonal therapy and behavioral therapy are useful tools for treating MDD (Soleimani, Lapidus, & Iosifescu, 2011). Somatic treatments such as Electroconvulsive therapy (ECT) are other efficient alternatives for MDD treatment. The current research and clinical trials on MDD aim to examine the effectiveness and safety of ketamine and riluzole drugs in treating resistant MDD (U.S. National Library of Medicine, 2019). The same research examines the appropriateness or efficacy of lamotrigine in minimizing the ketamine side effects (U.S. National Library of Medicine, 2019). The hope for future treatment is to devise or develop a combination of drugs to ensure the patient's safety through side effects reduction.
The ethical issue that might arise for me in decision making regarding the treatment is deciding to bear the costs of sacrificing life for future generations. Resource depletion is a significant concern in this scenario. The treatment procedures' cultural issues might entail living different from what is expected and engaging in what is perceived as wrong during therapeutic processes, such as substance abuse. Ignorance may arise due to the diversity issues and differences regarding the condition. When making treatment choices, I will consider therapy's goal, the alternatives available, and the financial implication on my future generations.
Reflection as a Patient (perceive me as the patient own it)
After receiving the diagnosis, I lost the meaning of life, and I felt worthless and with diminished interest in life. I believed that I had a short time to live or accomplish my life goals. As I began this assignment, I believed the product of MDD is death, but this information has much enlightened me. After my diagnosis and learning possible treatment plans, I feel re-energized and hopeful of resolving my irritating moods and fears. My thoughts are that MDD is like any other mental illness with few escalated impacts, and if treated entirely, it is possible to eradicate. However, my fears are it would take a prolonged period to restore my previous life, and I will experience the treatment's disgusting side effects.
Additionally, I hope researchers will complete the clinical trials on drugs that fully cure MDD and seek a practical solution by combining several drugs. My concerns are the excessive weight and possibility of obesity due to antidepressants that can lead to diabetes and heart disease. My questions are; is MDD a disability? What personal factors that trigger MDD? What individual initiatives am I incorporating to solve the MDD issues? At this moment, my family and I need a family therapist due to frequent quarrels and feeling abandoned. Besides, we need a post-treatment caregiver to watch on my progress and educate the family on patient care at home.
References
Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the National Comorbidity Survey–Adolescent Supplement: prevalence, correlates, and treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 37-44.
Cherney, K. (2020). The cost of depression: Medications, therapy, and more. Healthline. https://www.healthline.com/health/depression/how-much-does-depression-cost#medication-cost
Halverson, J. L. (2019, November 27). What is the suicide rate among persons with depressive disorder (clinical depression)? Latest Medical News, Clinical Trials, Guidelines - Today on Medscape. https://www.medscape.com/answers/286759-14675/what-is-the-suicide-rate-among-persons-with-depressive-disorder-clinical-depression
Janssen, C. W., Lowry, C. A., Mehl, M. R., Allen, J. J., Kelly, K. L., Gartner, D. E., ... & Fridman, A. (2016). Whole-body hyperthermia for the treatment of major depressive disorder: a randomized clinical trial. JAMA psychiatry, 73(8), 789-795.
Kraus, C., Kadriu, B., Lanzenberger, R., Zarate Jr, C. A., & Kasper, S. (2019). Prognosis and improved outcomes in major depression: a review. Translational psychiatry, 9(1), 1-17.
Lye, M. S., Tey, Y. Y., Tor, Y. S., Shahabudin, A. F., Ibrahim, N., Ling, K. H., ... & Badamasi, I. M. (2020). Predictors of recurrence of major depressive disorder. PloS one, 15(3), e0230363.
Mayo Clinic. (2018, February 3). Depression (major depressive disorder) - Diagnosis and treatment - Mayo Clinic. Mayo Clinic - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013
National Institute of Mental Health (NIMH). (2019). major depression. NIMH » Home. https://www.nimh.nih.gov/health/statistics/major-depression.shtml
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., ... & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2(1), 1-20.
Soleimani, L., Lapidus, K. A., & Iosifescu, D. V. (2011). Diagnosis and treatment of major depressive disorder. Neurologic clinics, 29(1), 177-193.
U.S. National Library of Medicine. (2019). Research study for major depressive disorder: Investigation of glutamate medications. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00419003
Verduijn, J., Milaneschi, Y., Schoevers, R. A., van Hemert, A. M., Beekman, A. T., & Penninx, B. W. (2015). Pathophysiology of major depressive disorder: mechanisms involved in etiology are not associated with clinical progression. Translational psychiatry, 5(9), e649-e649.