Depressive disorder is the one of the most common mental illnesses that any person can develop, regardless of gender, age or socioeconomic status.
Around the world about 350 million people struggle with depressive disorder
In Poland in 2021 about 205,000 of women and 68,000 of men were treated for depression – however,it doesn’t mean that women are often ill, but that men are less likely to ask for help.
Depressive disorder is most often diagnosed between the ages of 20 and 40, but can also affect about 2% of minors.
At the same time , it is estimated for depressive disorder to be responsible for the largest numbers of deaths in the 15-29 age group.
Causes and risk factors
The exact mechanism of depressive disorder iis complex and not fully understood, but research confirms that it’s the result of chemical changes in the brain with a genetic basis.
These changes might be impacted by stressful events, cognitive and environmental factors, or a combination of unknown causes.
In depression, neuronal circuits in the brain responsible for regulating mood,thinking, sleep, appetite and behaviour don’t function properly and critical neurotransmitters are out of balance.
Depression may occur when low levels of serotonin favour low levels of norepinephrine.
Risk factors include previous suicide attempt or episodes, substance-related disorders, death of a close family member, lack of social support and other stressful events.
Symptoms
Depressive disorder is a mood disorder, in which there are so-called depressive episodes, that last a minimum of two weeks.
Person with depression exhibits symptoms that affect the relationships with family members, friends, work or school.
The most common symptoms are a drop in a mood, tiredness, anhedonia(not feeling pleasure), changes in weights, changes in amount of sleep(sleepless or excessive sleepiness) and many feelings that lower concentration and general well – being.
Often the disease is accompanied by self-destructive and suicidal thoughts. In severe depressive episodes, hallucinations, stupor or delusions may be present.
Diagnosis and treatment
The main purpose of depressive disorder treatment is full remission of the disease.
Most often, people with depression are offered treatment in the form of antidepressants and psychological counselling or psychotherapy.
Drugs used to treat depression include: selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TLDs), monoamine oxidase inhibitors (MAOIs), central alpha2 receptor antagonists, and norepinephrine and dopamine reuptake inhibitors.
Selective serotonin reuptake inhibitors (SSRIs) are usually the first-line treatment for depression. Drugs in this group inhibit the reabsorption of serotonin molecules by neurons, thereby increasing the concentration of serotonin in the brain. SSRIs also have an anti-anxiety effect, often occurring during depression. SSRIs include citalopram, escitalopram, dapoxetine, fluoxetine, fluvoxamine, paroxetine and sertraline. Side effects mainly include gastrointestinal problems (nausea, lack of appetite), insomnia or excessive sleepiness, decreased libido and potency disorders.
Selective serotonin-norepinephrine reuptake inhibitors (SNRIs) work on a similar principle to SSRIs, also increasing the concentration of norepinephrine in the brain. Norepinephrine reuptake inhibition also inhibits dopamine reuptake in the forebrain, improving antidepressant effects and acting on anxiety and neurotic disorders. SSRIs include desvenlafaxine, duloxetine, milnacipran and venlafaxine. Side effects are similar to those when taking SSRIs, but can also cause elevated blood pressure.
Tricyclic antidepressants (TCAs) belong to a group of psychotropic drugs that block the reuptake of serotonin, norepinephrine, and some also block dopamine. Because of their persistent side effects and other treatment options, their use is being abandoned. They are usually used when other treatments have not been effective. TLDs include amitriptyline, desipramine, doxepin, imipramine, clomipramine and nortriptyline.
Monoamine oxidase inhibitors (MAOIs) were the first drugs discovered to treat depression. The mechanism of MAOIs involves the breakdown of neurotransmitters such as serotonin, norepinephrine and dopamine via reversible type A monoamine oxidase inhibitors.
However, due to the many side effects, the additional patient care needed when using MAOs, and interactions with other drugs, their use is being abandoned. Currently, the only drug used from this group of drugs is moclobemide. Other drugs used to treat depression work on a similar basis to the above-discussed drug groups. Currently, many drugs are at the stage of clinical trials focusing on finding a suitable therapeutic method that is both effective in treatment and at the same time reduces the side effects that occur.