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Major Depressive Disorder Treatments

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What Causes Major Depressive Disorder?

Major depressive disorder (MDD) has been ranked as the third cause of the burden of disease worldwide by WHO and is one of the most common mental disorders in the United States [1]. In 2020, an estimated 14.8 million U.S. adults aged 18 or older had at least one major depressive episode with severe impairment in the past year. This number represented 6.0% of all U.S. adults [2]. Moreover, 66.0% of U.S. adults aged 18 or older with major depressive episodes received major depressive disorder treatments in the past year.

MDD is diagnosed when an individual has a persistently low or depressed mood, anhedonia or decreased interest in pleasurable activities, feelings of guilt or worthlessness, lack of energy, poor concentration, appetite changes, psychomotor retardation or agitation, sleep disturbances, or suicidal thoughts. Per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), an individual must have five major depressive disorder symptoms, one of which must be a depressed mood or anhedonia causing social or occupational impairment, to be diagnosed with MDD.

major depressive disorder treatments
Major depressive disorder is a highly treatable mental health condition, whether the mental illness exists by itself or with a co-occurring condition.

The potential causes and risk factors for depression include:

  • Biochemistry: Differences in the levels of certain brain chemicals can make you more prone to depression.
  • Genetic factors: Genes can play a role in depression. Having a relative with depression can increase your chances of developing depression.
  • Personal medical history: You may be more likely to develop depression if you have had it before.
  • Gender: Women may be twice as likely to develop depression than men.
  • Life events: Trauma, the death of a loved one, major life changes, and other upsetting events can cause depression.
  • Stress can affect you physically and mentally, increasing your risk of developing depression.
  • Isolation: Lack of support and social isolation can increase the chances of developing depression.
  • Medical conditions: Depression may occur along with chronic or serious medical conditions like cancer, heart disease, diabetes, and Parkinson’s disease. Having depression can worsen these conditions.
  • Medication: Some medicines can cause depression as a side effect.
  • Substances: Substances such as alcohol or drugs can cause or exacerbate depression.
  • Personality: People who have difficulty coping with various life events may be more prone to developing depression.

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Major Depressive Disorder Symptoms

If you have been experiencing some of the following major depressive disorder symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness or pessimism
  • Feelings of irritability, frustration, or restlessness 
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy, fatigue, or feeling “slowed down”
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early morning awakening, or oversleeping
  • Changes in appetite or unplanned weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment
  • Suicide attempts or thoughts of death or suicide

Not everyone who is depressed experiences every symptom. Some people experience only a few major depressive disorder symptoms while others may experience many. Several persistent symptoms and low mood are required for a diagnosis of major depression, but people with only a few – but distressing – major depressive disorder symptoms may also benefit from major depressive disorder treatments. The severity and frequency of major depressive disorder symptoms and how long they last will vary depending on the individual and their particular illness. Major depressive disorder symptomsmay also vary depending on the stage of the illness.

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How Is Major Depression Treated?

There are many major depressive disorder treatments that a doctor may recommend depending on the individual and the severity of their symptoms.

Antidepressants for Major Depressive Disorder Treatments

Studies have shown antidepressant medication treatment for major depressive disorder can dramatically reduce suicide and hospitalization rates. But unfortunately, very few suicide victims receive antidepressants in acceptable doses, and – even worse – most receive no major depressive disorder treatment.

The selective serotonin reuptake inhibitors (SSRIs) are typically tried first in major depression treatment and include:

  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
major depressive disorder treatments
Major depressive disorder is a treatable mental health condition that should be taken seriously by the person with the disorder and their loved ones. 

Psychotherapy for Treatment of Major Depression

In general, psychiatrists agree severely depressed patients do best with a combination of psychotherapy and antidepressant medications. Medications treat the symptoms of depression relatively fast, while psychotherapy can help the patient deal with the condition and ease some potential stresses that can trigger or exacerbate the disease.

Psychodynamic Therapy

Psychotherapy for major depressive disorder treatments is based on the premise human behavior is determined by one’s past experience (particularly in childhood), genetic endowment, and current life events. It recognizes the significant effects of emotions, unconscious conflicts, and drives on human behavior.

Interpersonal Therapy

Interpersonal therapy is a short-term psychotherapy, usually consisting of 12-16 weekly sessions. It was developed specifically for treating major depression and focused on correcting current social dysfunction. Unlike psychoanalytic psychotherapy, it does not address unconscious phenomena, such as defense mechanisms or internal conflicts. Instead, interpersonal therapy focuses primarily on the “here-and-now” factors that directly interfere with social relationships.

Behavior Therapy

Behavior therapy involves activity scheduling, self-control therapy, social skills training, and problem-solving. Behavior therapy has been reported to be effective in the acute treatment of patients with mild to moderate depression, especially when combined with antidepressant medication.

Is MDD a Disability?

Depression can interfere with your life making you dysfunctional to some extent. That is why it can be regarded as a disability. In that effect, a lot can be done to mitigate it as long as it is correctly diagnosed under the right criteria. The SSDI, a perfect certified program, is the criteria used to diagnose depression as a disability and to guarantee assistance, benefits, and rights to the individuals that qualify.

According to the ADA (Americans With Disabilities Act), clinical depression is covered as a disability. However, not every depressed individual qualifies for the benefits. The SSDI (Social Security Disability Insurance) is a certified program to support individuals going through the tough phase. The program doesn’t cater to every person battling depression, not unless you fit the criterion used.

The requirements for enrollment in disability programs include:

  • Inability to work due to depression.
  • Low-income.
  • Assets are lower than $2000 worth.
  • Spouses also have insufficient support, and combining you and your spouse’s assets should be lower than $3000 in total. 
  • Your depression should be considered severe to be a disability.
  • You cannot work based on your current condition, age, disability, and work history.

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Major Depressive Disorder Treatment Plan

What is a treatment plan? Think of it as your roadmap to better mental health. Treatment is more successful when you work with your doctor to organize your plan. It can change as your condition changes, but it’s often broken down into three parts:

  • The acute or first phase. This often lasts between 6 and 12 weeks and aims to ease symptoms.
  • The continuation phase. This lasts for several more months and aims to get the most improvement.
  • The maintenance phase. This is ongoing. The goal is to keep your symptoms from coming back.

What is the role of medication? Antidepressants target problems with chemicals in the brain that could be behind your depression. Several things help your doctor decide which drug may work best. These include:

  • Your specific symptoms 
  • Medications you take for other conditions
  • What’s likely to cause the fewest side effects

Antidepressants can help, but not always as quickly as you might hope. Several factors determine how well a drug works, including your genes. The symptoms may ease in a week, but you may not feel the full effects for 2 or 3 months. 

How to manage side effects? Some individuals quit taking their medication because of side effects. These vary from one medication to another. But you should speak to your doctor. That’s because there are usually ways to manage side effects. They include:

  • A lower dose
  • A different antidepressant
  • Another drug to control the side effect

Do not just try to disregard them. The stronger the side effects are, the more tempted you might be to give up on treatment. That can set back your recovery.

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Evidence Based Treatment for Major Depressive Disorder

What is an evidence-based practice for depression? Evidence-based practice means the therapist takes three important factors into consideration:

  • Their own expertise
  • The patient’s preferences and values,
  • Scientific evidence to guide which treatments they use

Depression treatments that have research showing they are effective are called evidence-based treatments. Evidence-based treatments for major depressive disorder include:

CBT treatment for Major Depressive Disorder 

Cognitive Behavioral Therapy (CBT treatment for major depressive disorder) is a well-established treatment for individuals with depression that blends two types of therapies: cognitive therapy and behavioral therapy. CBT treatment for major depressive disorder focuses on identifying a person’s thoughts and beliefs so they can learn how those beliefs influence their mood and actions. CBT treatment for major depressive disorder aims to change a person’s thinking to be more adaptive and healthier.

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Major depressive disorder treatment should be individualized based on symptom severity, co-occurring disorders and the patient’s history of mental illness.

Adjunctive Treatment of Major Depressive Disorder 

About half of patients who receive treatment with antidepressant drugs for major depressive disorder (MDD) do not achieve full remission of symptoms. Despite treating depression effectively with short-term antidepressant drugs, the problem of relapse/recurrence remains. Treatment of depression by pharmacological means is likely to leave residual symptoms in most patients. Such symptoms produce impairment and are important risk factors for relapse.

Researchers continue to seek complementary treatments that may improve residual symptoms of depression safely and sustain remission. Physical exercise may be a useful resource. According to the National Center for Biotechnology Information (NCBI), exercise is one potential treatment for MDD in which there are positive research findings. The use of exercise in the treatment of MDD has gained support, as evidenced by the inclusion of exercise treatment in the American Psychiatric Association’s most recent treatment guidelines. 

Depressive symptoms are temporarily reduced immediately following acute bouts of aerobic exercise. Patients may experience improvements in depressive symptoms in as little as four weeks; however, continued exercise for at least 10–12 weeks is necessary for the greatest antidepressant effect. Psychosocial strategies should be implemented to promote adherence to the exercise program. Aerobic exercise can include walking/running outside or on a treadmill, cycling, or using an elliptical machine. 

Biological Treatment for Major Depressive Disorder

Compared with the earlier generation of antidepressants exemplified by the tricyclics, the selective serotonin reuptake inhibitors (SSRIs) have comparatively few side effects and lower cardiotoxicity so they are safer in overdose. The combination of safety, tolerability because of low side effects, and efficacy has undoubtedly contributed to a steadily rising number of prescriptions for SSRIs in recent years.

The SSRIs include fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, and escitalopram (the active enantiomer of citalopram). As a class, they are nonsedative (apart from fluvoxamine) and are not associated with an increased appetite or weight gain. Indeed, they can have an appetite-suppressing effect, and nausea and vomiting may be provoked, particularly at high doses.

An activating effect with restlessness in the first week or two and an increase in anxiety may be reported, but this does not usually persist. More controversially, the SSRIs in general and fluoxetine and paroxetine, in particular, have been associated with increased suicidal ideation and an increased risk of suicide. As with restlessness and anxiety, suicidal ideation and behavior is said to occur most commonly in the early stages of treatment.

Medical Treatment for Major Depressive Disorder

Major depressive disorder can be managed with various treatment modalities, including pharmacological, psychotherapeutic, interventional, and lifestyle modifications. The initial treatment of MDD includes medications or/and psychotherapy. Combination treatment, including both medications and psychotherapy, is more effective than either of these treatments alone. 

FDA-approved medications for the treatment of MDD are as follows: All antidepressants are equally effective but differ in side-effect profiles.

  • Selective serotonin reuptake inhibitors (SSRIs) include fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine. They are usually the first line of treatment and the most widely prescribed antidepressants.
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) include venlafaxine, duloxetine, desvenlafaxine, levomilnacipran, and milnacipran. They are often used for depressed patients with comorbid pain disorders.
  • Serotonin modulators are trazodone, vilazodone, and vortioxetine.
  • Atypical antidepressants include bupropion and mirtazapine. They are often prescribed as monotherapy or as augmenting agents when patients develop sexual side-effects due to SSRIs or SNRIs.
  • Tricyclic antidepressants (TCAs) are amitriptyline, imipramine, clomipramine, doxepin, nortriptyline, and desipramine.
  • Monoamine oxidase inhibitors (MAOIs) available are tranylcypromine, phenelzine, selegiline, and isocarboxazid. MAOIs and TCAs are not commonly used due to the high incidence of side-effects and lethality in overdose.
  • Other medications include mood-stabilizers, antipsychotics which may be added to enhance antidepressant effects.

Non Pharmacological Treatment for Major Depressive Disorder 

Non-pharmacological interventions include formal psychological therapies such as cbt treatment for major depressive disorder and interpersonal psychotherapy (IPT), as well as less formal supportive therapies such as counseling within primary care, mindfulness-based therapy, behavioral activation and self-help strategies. 

Lifestyle and Depression

Lifestyle changes to improve diet, exercise, relaxation, and sleeping habits should also be part of a broader management plan. These changes can help prevent relapse after recovery.

Many lifestyle factors such as exercise, diet, smoking, and drinking alcohol are involved in the pathogenesis of depression yet are given little consideration in managing depression.

Exercise

A recent study suggests a moderate effect of exercise in reducing symptoms of depression over no intervention or placebo among patients with any severity of depression. Exercise appears to elevate mood and boost self-esteem.

Sleep

There is a bidirectional relationship between sleep and depression. Research has shown that insomnia can increase the risk of depression. Sleep disturbance has an impact on mood, cognitive function, and motivation. Alleviating sleep disturbance symptoms can motivate patients to engage in other treatments for depression and help with stress management.

Residential Treatment for Major Depressive Disorder 

Major depressive disorder can at times, seem like a challenge that is too much and will never be overcome. Still, residential treatment for major depressive disorder can be effective and proven to help people feel better, reduce symptoms, and regain control over life. With the right combination of treatments that work for an individual, major depressive disorder is a disease that can be managed over a lifetime. 

Treatment goals are most effective when clients commit to them, are consistent with each element of their treatment plan, engage socially and rely on others for support, and use self-care strategies at home to be proactive about symptoms and negative thoughts and behaviors.

How Is Major Depression Diagnosed? 

Your doctor may determine a diagnosis of depression based on:

  • Physical exam. Your doctor may do a physical exam and ask questions about your health. In some cases, depression may be linked to an underlying physical health problem.
  • Lab tests. For example, your doctor may do a blood test called a complete blood count or test your thyroid to make sure it’s functioning properly.
  • Psychiatric evaluation. Your mental health professional asks about your symptoms, thoughts, feelings, and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.
  • DSM-5. Your mental health professional may use the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

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Major Depressive Disorder Treatments Near Me

Major depressive disorder (MDD) is often accompanied by substance abuse or dependence. The mental health field has long discussed whether these conditions are independently occurring disorders or are overlapping illnesses intertwined by common etiologic and vulnerability factors. The initial presentation of major depressive disorder can be obscured by the overriding symptoms or side effects of a substance use disorder (SUD).

In the general population, the prevalence of a current substance use disorder in persons with Major depressive disorder (MDD) ranges from 8.5 to 21.4%, with a lifetime prevalence of comorbid SUDs ranging from 27 to 40% [6]. Co-occurring depression has an adverse effect on the course of SUDs. Current depression predicted poorer treatment response and higher rates of relapse.

People who suffer from major depressive disorder can experience severe sadness that lasts weeks or even months at a time. It’s common for those battling mental illness to also struggle with substance abuse. Sometimes it can be difficult to determine which condition came first. People with prolonged periods of profound sadness may reach for drugs or alcohol to ease the pain, feelings, and other symptoms.

However, substance use can make major depressive disorder symptoms more severe. Major depressive disorder increases the risk of accidental injury, suicide, and other forms of self-harm. Add in drugs or alcohol, and the threats to the person’s mental and physical health can be extreme.

To determine the most effective ways for major depressive disorder treatments, it’s crucial first to get an accurate assessment of all the symptoms. When the symptoms have been evaluated by a mental health professional, it may be determined that another form of mental condition is present and needs a particular type of treatment. 

Detox Treatment

The first step in treatment is medical detox. It will help you navigate the complicated withdrawal process but doesn’t address patterns of thought and behavior contributing to substance abuse. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.

Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care during your stay in a residential treatment center helps prevent relapse. Clinicians can give necessary medication and medical expertise to lessen cravings and the emotional effects of alcohol withdrawals.

Psychotherapy

Several different modalities of psychotherapy have been used in major depressive disorder treatments, including:

  • CBT treatment for major depressive disorder (CBT) – is an effective treatment that involves changing both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person for various forms of depression. 
  • Dialectical Behavior Therapy – is a comprehensive mental health and substance abuse treatment program whose ultimate goal is to aid patients in their efforts to build a life worth living. The main goal of DBT is to help a person develop what is referred to as a “clear mind.” 
  • Person-Centered Therapy – is a strategy that allows and encourages clients to understand and resolve their concerns in a safe, supportive environment.

Dual Diagnosis Treatment

Substance abuse and mental health disorders often co-occur. In many cases, traumatic experiences can result in a mental health disorder and substance abuse. Dual diagnosis programs treat both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. This strategy treats both the substance abuse problem and the mental disorder simultaneously. Regardless of which diagnosis (mental health or substance abuse problem) came first, long-term recovery will depend largely on the treatment for both disorders done by the same team or provider.

Medication-Assisted Treatments

Medication-Assisted Treatments (MAT) for mental health disorders are commonly used in conjunction with psychotherapy. This includes the use of medications and other procedures. During the major depressive disorder treatments, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.

If you or your loved one suffers from alcohol and major depressive disorder, help is just a phone call away. Professional addiction treatment is necessary for fast and effective recovery. Contact us today at We Level Up treatment facility. We provide utmost care with doctors and medical staff available 24/7 for life-changing and lasting recovery. We offer an enhanced opportunity to return to a fulfilling and productive life.

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The road to recovery can be difficult for those who are dealing with major depressive disorder and substance use disorder, but effective treatments are available that can help these individuals find relief from symptoms as they rebuild their lives in sobriety.

Sources:

[1] NIMH – https://www.nimh.nih.gov/health/topics/depression
[2] NIMH – https://www.nimh.nih.gov/health/statistics/major-depression
[3] NCBI – https://www.ncbi.nlm.nih.gov/books/NBK559078/
[4] Depression Treatment – https://welevelupfl.com/behavioral-health/depression-treatment/