Introduction to Depression Depression is divided into two general types: primary and secondary type. Under the primary type, the most dominant disorder is Major Depressive Disorder (MDD), also known as clinical depression. MDD is divided into three subtypes: (1) melancholia or classic depression, (2) atypical or non-classic depression, and (3) psychotic depression. Major subtypes of MDD Melancholia is a type of depression where the essential feature is the loss of interest or pleasure in all, or almost all activities, or a lack of reactivity to usually pleasurable stimuli. Your depressed mood does not improve, even temporarily, when something good happens to you. In addition, you experience at least three of the following symptoms: a distinct quality of the depressed mood, depression that is regularly worse in the morning, early morning awakening, psychomotor retardation or agitation, significant anorexia or weight loss, or excessive and inappropriate guilt.  In atypical depression, there is mood reactivity and the presence of at least two of the following features: Increased appetite or weight gain Hypersomnia Leaden paralysis The long-standing pattern of extreme sensitivity to perceived interpersonal rejection. These features predominate during the most recent 2-week period.When you manifest mood reactivity, it means that you cheer up when you are presented with positive events, like a visit from your children, or brothers and sisters, or receiving compliments from others.

Major Depressive Disorder is a primary type and the most dominant type of depression. If you suffer from MDD, it is possible that other members of your family have the disease too. The reason is that the predisposition to have the disease is programmed in the genes. It is a familial disease—that is, it runs in the family. If you are predisposed to have the disease and at the same time are exposed to severe stresses of life, such as financial woes, marital and work-related problems, then very likely you will suffer from it. Main Causes of Depression Role of genes and serotonin The cells in your brain are called neurons and they communicate to each other through chemical substances medically known as neurotransmitters, which move and travel in between them. One of these neurotransmitters is serotonin, which serves as the pivotal substance to which all the manifestations of MDD are attributed to. It was initially thought that when your serotonin level was low that you manifest MDD. However, in some instances, that observation did not happen. It took place only when the individual concerned happened to have a positive family history of MDD. In another saying, it is not enough that your serotonin level needs to be low so that MDD could take place.

Major Depressive Disorder, also known as clinical depression, is the most dominant type of depression. You are suffering from MDD if you have been experiencing one or more Major Depressive Episode (MDE) that has taken place during the last two weeks of your life. An MDE has taken place if you experienced five or more of the symptoms. Symptoms of Major Depressive Disorder You have depressed mood most of the day, nearly every day, which is either reported by you or observed by others. You have markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day, as reported by you or observed by others. You have significant weight loss even if you are not dieting or weight gain, such as increase of 5% in your body weight in a month, or decrease or increase in your appetite nearly every day. You experience insomnia (failing to sleep) or hypersomnia (excessive sleeping) nearly every day. You show psychomotor agitation or retardation nearly every day, as reported by you and observed by others. You experience fatigue or loss of energy nearly every day. You feel worthless or excessively or inappropriately guilty nearly every day. You have diminished the ability to think or concentrate, or are indecisive, nearly every day, either reported by you or observed by others.

Major Depressive Disorder is a primary type and the most dominant type of depression. If you suffer from MDD, your management will be a two-pronged approach: (1) intake of medications or drugs (2) psychotherapy. In some occasions, depending on your response to the first two modes of treatment, you could be subjected to electroconvulsive therapy (ECT). Medications and Treatment for Major Depressive Disorder: Selective serotonin reuptake inhibitors (SSRIs) In the preceding discussion, it was mentioned that the low level of serotonin in your brain causes the manifestation of MDD symptoms. For this reason, a group of anti-depressants was developed and was called the selective serotonin reuptake inhibitors (SSRIs) because they inhibit the recycling of serotonin. Thus maintaining its high level in your neurons and preventing the appearance of MDD symptoms. Examples of SSRIs are the following: · Citalopram (Celexa) · Escitalopram (Lexapro) · Fluoxetine (Prozac) · Paroxetine (Paxil, Pexeva) · Sertraline (Zoloft) · Vilazodone (Viibryd) It has been determined that 30-50% of MDD patients do not respond to this class of drugs. Serotonin/norepinephrine reuptake inhibitors (SNRIs) Sometimes, you do not fully respond to the SSRIs. If this happens, it is possible that you manifest more of the positive effect. Thus, you need to take a norepinephrine reuptake inhibitor.

Although MDD is treated with drugs and medication, there are times when your symptoms are not totally cured or treated. Thus, there is a need to add another mode of therapy, such as psychotherapy. Interpersonal psychotherapy Interpersonal psychotherapy (IPT) is a method of treating you through an interaction with your therapist, be it a medical doctor or a psychologist. It is a one on one engagement where the therapist talks to you and will try to uncover the root of your problem. This method is time limited—that is, it will run a certain length of time, usually 12-16 weeks, and it is a present-focused treatment which encourages you to regain control of your mood and functioning. It is a treatment alliance between your therapist and you. He emphatically engages you and helps you feel that you are being understood. He arouses your emotions so that again you will start to feel things. Based on the preceding, IPT generates two basic principles: That depression is a medical illness and it is not the patient’s fault or defect. Furthermore, it is highly treatable. That mood and life situations are related and that IPT connects your mood. Also that any disturbing events in your life that either trigger or follow from the onset of the mood disorder.