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Major Depression (Major Depressive Disorder)

A pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities.

PubMed Health Glossary
(Source: Wikipedia)

About Major Depression

Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness.

Many people with a depressive illness never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with depression.

There are several forms of depressive disorders.

Major depression—severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person's lifetime, but more often, a person has several episodes....Read more about Major Depression NIH - National Institute of Mental Health

What works? Research summarized

Evidence reviews

Depression: The Treatment and Management of Depression in Adults (Updated Edition)

This clinical guideline on depression is an updated edition of the previous guidance (published in 2004). It was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage depression in adults.

Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care

This guideline has been developed to advise on the identification and management of depression in children and young people in primary, community and secondary care. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, carers, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high-quality care for children and young people with depression while also emphasising the importance of the experience of care for patients and their families.

Second‐generation antipsychotic drugs for major depressive disorder 

This review found 28 studies on five second‐generation antipsychotic drugs (amisulpride, aripiprazole, olanzapine, quetiapine and risperidone) comparing the effects of the drugs alone or adding them or placebo to antidepressants for major depressive disorder and dysthymia. There is evidence that amisulpride might lead to symptom reduction in dysthymia, while no important differences were seen for major depression. There is limited evidence that aripiprazole leads to symptom reduction when added to antidepressants. Olanzapine had no beneficial effects for treatment of depression when compared to antidepressants or compared to placebo but there was limited evidence for the benefits of olanzapine as additional treatment. Data on quetiapine indicated beneficial effects for quetiapine alone or as additional treatment when compared to placebo; data on quetiapine versus duloxetine did not show beneficial effects in terms of symptom reduction for either group, but quetiapine treatment was less well tolerated. The data, however, are very limited. Slight benefits of risperidone as additional treatment, in terms of symptom reduction, are also based on a rather small number of randomised participants. Generally, treatment with second‐generation antipsychotic drugs was associated with worse tolerability, mainly due to sedation, weight gain or laboratory values such as prolactin increase.

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Summaries for consumers

Second‐generation antipsychotic drugs for major depressive disorder 

This review found 28 studies on five second‐generation antipsychotic drugs (amisulpride, aripiprazole, olanzapine, quetiapine and risperidone) comparing the effects of the drugs alone or adding them or placebo to antidepressants for major depressive disorder and dysthymia. There is evidence that amisulpride might lead to symptom reduction in dysthymia, while no important differences were seen for major depression. There is limited evidence that aripiprazole leads to symptom reduction when added to antidepressants. Olanzapine had no beneficial effects for treatment of depression when compared to antidepressants or compared to placebo but there was limited evidence for the benefits of olanzapine as additional treatment. Data on quetiapine indicated beneficial effects for quetiapine alone or as additional treatment when compared to placebo; data on quetiapine versus duloxetine did not show beneficial effects in terms of symptom reduction for either group, but quetiapine treatment was less well tolerated. The data, however, are very limited. Slight benefits of risperidone as additional treatment, in terms of symptom reduction, are also based on a rather small number of randomised participants. Generally, treatment with second‐generation antipsychotic drugs was associated with worse tolerability, mainly due to sedation, weight gain or laboratory values such as prolactin increase.

Antidepressants plus benzodiazepines for major depression

The reviewers report that a combination of benzodiazepines with antidepressants works in favour for the treatment of depression, because it decreases drop outs from treatment and it increases short‐term response up to four weeks. However, there are downsides to this combination therapy because benzodiazepines can induce dependence, which is estimated to occur in one third of patients, as well as a decline in the drug's effect over time. Benzodiazepines have been associated with an increase in accident proneness.

Fluvoxamine versus other anti‐depressive agents for depression

Major depression is a severe mental illness characterised by a persistent and unreactive low mood and loss of all interest and pleasure, usually accompanied by a range of symptoms including appetite change, sleep disturbance, fatigue, loss of energy, poor concentration, psychomotor symptoms, inappropriate guilt and morbid thoughts of death. Although pharmacological and psychological interventions are both effective for major depression, antidepressant (AD) drugs remain the mainstay for treatment of moderate or severe depression. Fluvoxamine is one of the oldest selective serotonin reuptake inhibitors (SSRIs) and is prescribed to patients with major depression in many countries. This review reports trials comparing fluvoxamine with other antidepressants for treatment of major depression. We found no strong evidence that fluvoxamine was either superior or inferior to any other antidepressants in terms of efficacy and tolerability in the acute phase treatment of depression. However, there is evidence of differing side‐effect profiles, especially when comparing gastrointestinal side effects between fluvoxamine and tricyclic antidepressants (TCAs). Based on these findings, we conclude that clinicians should focus on practical or clinically relevant considerations including these differences in side effect profiles.

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More about Major Depression

Photo of an adult woman

Also called: Unipolar depression, Unipolar disorder, Clinical depression, MDD

Other terms to know:
Chronic Depression (Dysthymia), Depression

Related articles:
Signs of Depression
Types of Depression
Depression: Strategies for Family and Friends

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