The major depressive episode

The major depressive episode

Mood disorders are common, potentially fatal and highly treatable conditions in which patients experience abnormally high or low mood. Depression is probably the most common mental disorder, being encountered, but less diagnosed, in all types of medical services. According to the WHO, depression will be the second leading cause of morbidity in the world by 2020. Lifetime prevalence is 25% for women and 12% for men.

Causes of depression:

  • Biological: serotonin depletion is associated with depression
  • Genetics: first-degree relatives of patients with depression have a 10-13% risk of developing the disease.
  • Cognitive-behavioral: the theory that depression is the inability of the person to control existential events.
  • Stressful life events: the loss of a parent before the age of 11 is the life event most associated with the further development of depression.

Risk factors for depression:

  • Family history of depression, especially in first-degree relatives
  • History of suicide attempts
  • Female sex
  • Sleep disorders
  • Chronic undifferentiated pain
  • Postpartum period - postpartum
  • Other physical diseases: cancer, diabetes, Parkinson's disease
  • Lack of social support, stressful events
  • Consumption of prohibited substances and / or alcohol

Signs and symptoms:

  • Depressed mood - subjective feeling of sadness for a long time
  • Anhedonia - the inability to feel pleasure
  • Social withdrawal
  • Lack of motivation
  • Vegetative signs: weight loss or gain, excessive fatigue with decreased energy, severe insomnia or drowsiness, constipation, headache.
  • Suicidal ideation occurs in 60% of depressed patients and 15% try to commit suicide
  • Feelings of devaluation, guilt, impoverishment of the content of thought and speech
  • Hallucinations and delusional ideas that are congruent with the mood

Specific elements of depression in relation to age:

  • Prepubertal: physical accusations, agitation, auditory hallucinations - one voice, anxiety, phobias
  • Adolescence: substance abuse, antisocial behavior, anxiety, bullying, school difficulties, increased sensitivity to rejection.
  • Elderly: memory disorders, disorientation, confusion, apathy, distractibility.


Major depressive episodes are treatable in 70-80% of patients. The doctor should integrate pharmacotherapy with psychotherapeutic interventions. First-line treatment consists of SSRI-type antidepressants that have increased tolerability and efficacy.

Anxiolytics or benzodiazepines may be added to control anxiety or insomnia. Voting doses should be gradually reduced to avoid tolerance or dependence. If there are hallucinations or delusional ideas, antipsychotic antipsychotics are useful. Antidepressant treatment is recommended for a period of 6 months at the first episode. In case of recurrence the period can be extended.

Medication-associated psychotherapy is more useful than any of these treatments applied in isolation. Cognitive-behavioral therapy: is based on correcting cognitive distortions that lead to depression and associated behaviors. Psychoanalytic therapy: understanding the unconscious conflicts and motivations that support and fuel depression. Group therapy: patients can benefit from the support, emotional ventilation and positive reinforcement provided by groups.

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