Major Depressive Disorder
Major depressive disorder or “unipolar depression” is a common condition likely related to several etiologies. Recent research has focused on the biological underpinnings of major depressive disorder as well as treatment advances, involving both pharmacotherapy and psychotherapy. In this chapter, the epidemiology, clinical picture, biological theories regarding etiology, clinical presentation in primary care and mental health settings, and treatment of major depressive disorder are reviewed. Advances in genetic approaches to understanding the pathogenesis of major depressive disorder will likely result in better and more precise treatments in the future.
The term “unipolar depression” evolved from the concept of a primary affective disorder. Primary affective disorder referred to patients whose first psychiatric disorder was depression and who did not evidence manic or bipolar symptoms. Support for the classification of primary affective disorder derived from the classic study of Cassidy et al (1), and symptoms differentiating depressed patients from controls formed the basis of the disorder. Symptoms which occurred in more than 50% of depressed patients included reduced energy, impaired concentration, anorexia, initial insomnia, loss of interest, difficulty starting activities, worrying, subjective agitation, slowed thinking, difficulty making decisions, terminal insomnia, suicidal ideation or plans, weight loss, tearfulness, slowed movements, irritability, and feeling one will never get well (2). These symptoms continue to form the basis for the diagnosis of depressive states.
KeywordsMajor depressive disorder Pharmacotherapy Psychotherapy Biology of depression Epidemiology Genetic studies
- 7.Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R, Thase ME, Kocsis JH, Keller MB. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 2003;54:573–583.CrossRefPubMedGoogle Scholar
- 8.Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS, National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003;289:3095–3105.CrossRefPubMedGoogle Scholar
- 29.Schulberg HC, Katon W, Simon GE, Scott CP, Rodriguez E, Imber SD, Perel J, Lave J, Houck PR, Coulehan JL. Treating major depression in primary care practice: an update for the Agency for Health Care Policy and Research Practice Guidelines. Arch Gen Psychiatry 1996;53:1121–1127.CrossRefGoogle Scholar
- 31.Keller MB, Gelenberg AJ, Hirschfeld RM, Rush AJ, Thase ME, Kocsis JH, Markowitz JC, Fawcett JA, Koran LM, Klein DN, Russell JM, Kornstein SG, McCullough JP, Davis SM, Harrison WM. The treatment of chronic depression, part 2: a double-blind, randomized trial of sertraline and imipramine. J Clin Psychiatry 1998;59:598–607.CrossRefPubMedGoogle Scholar
- 33.Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, Norquist G, Howland RH, Lebowitz B, McGrath PJ, Shores-Wilson K, Biggs MM, Balasubramani GK, Fava M; STAR*D Study Team. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006;163:28–40.Google Scholar
- 34.Cuijpers P, Berking M, Andersson G, Nierenberg AA, Warden D, Ritz L, Norquist G, Howland RH, Lebowitz B, McGrath PJ, Shores-Wilson K, Biggs MM, Balasubramani GK, Fava M, STAR*D Study Team. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry 2013;58:376–385.PubMedGoogle Scholar
- 36.Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, Gallop R, McGlinchey JB, Markley DK, Gollan JK, Atkins DC, Dunner DL, Jacobson NS. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol 2006;74:658–670.CrossRefPubMedGoogle Scholar
- 38.Gelenberg AJ, Trivedi MH, Rush AJ, Thase ME, Howland R, Klein DN, Kornstein SG, Dunner DL, Markowitz JC, Hirschfeld RM, Keitner GI, Zajecka J, Kocsis JH, Russell JM, Miller I, Manber R, Arnow B, Rothbaum B, Munsaka M, Banks P, Borian FE, Keller MB. Randomized, placebo-controlled trial of nefazodone maintenance treatment in preventing recurrence in chronic depression. Biol Psychiatry 2003;54:806–817.CrossRefPubMedGoogle Scholar
- 41.Citrome L. Levomilnacipran for major depressive disorder: a systematic review of the efficacy and safety profile for this newly approved antidepressant—what is the number needed to treat, number needed to harm and likelihood to be helped or harmed? Int J Clin Pract 2013;67:1089–1104.CrossRefPubMedGoogle Scholar
- 43.Laughren TP, Gobburu J, Temple RJ, Unger EF, Bhattaram A, Dinh PV, Fossom L, Hung HM, Klimek V, Lee JE, Levin RL, Lindberg CY, Mathis M, Rosloff BN, Wang SJ, Wang Y, Yang P, Yu B, Zhang H, Zhang L, Zineh I. Vilazodone: clinical basis for the US Food and Drug Administration’s approval of a new antidepressant. J Clin Psychiatry 2011;72:1166–1173.CrossRefPubMedGoogle Scholar
- 54.Shelton RC, Keller MB, Gelenberg A, Dunner DL, Hirschfeld R, Thase ME, Russell J, Lydiard RB, Crits-Cristoph P, Gallop R, Todd L, Hellerstein D, Goodnick P, Keitner G, Stahl SM, Halbreich U. Effectiveness of St John’s wort in major depression: a randomized controlled trial. JAMA 2001;285:1978–1986.CrossRefPubMedGoogle Scholar