Major Depressive Disorder (MDD) is a mental health condition characterized by the presence of at least one Major Depressive Episode (MDE), and the absence of a Manic or Hypomanic episode.
The MDEs are time-periods usually at least 2 weeks long, marked by either depression or loss of pleasure (anhedonia), and other symptoms, which cause great distress and impairment in a person’s daily functioning.
According to the WHO, MDD - or more commonly known among Filipinos as simply “Depression” - is the most common mental health condition in the Philippines. In 2017, there were 3.3 million cases of depressive disorders in the Philippines. While this condition can be seen from adolescents to the elderly, it is especially common among younger adults. In a study by Flores (2018), 1203 participants from the Philippines showed that 29% had depression, 39% had anxiety, and 82% had some degree of distress. In a more recent local study by Puyat et al (2021), data on depression was collected from 19,017 young adults using the Center for Epidemiological Studies - Depression scale. The results of this study showed that almost 1 in every 10 young adult Filipinos suffer from Major Depressive Disorder. This creates a serious economic burden, as a significant amount of the country’s workforce are composed of these young Filipinos.
There is no single cause of developing Major Depressive Disorder (MDD). This condition is brought about by a combination of genetic factors, developmental factors, and even social factors.
However, certain events and conditions increase one’s risk of developing MDD, such as:
Having first-degree family members who have Depression
Having multiple, diverse, adverse childhood experiences
Having experienced physical or sexual abuse as a child
Having a low-income socioeconomic status
Having limited formal education
Experiencing racism or discrimination
These conditions may bring about high levels of stress that create changes in the developing brain. These changes may lead to imbalances of neurotransmitters, which are brain chemicals that are responsible for the brain’s daily functions. In particular, deficiencies in the neurotransmitters serotonin and norepinephrine are thought to lead to symptoms of depression. Newer research however, suggests that imbalances in other neurotransmitters such as Glutamate and GABA may also be related to depression. Over time, these changes in neurotransmitters may affect not only the function, but also the actual structure of the brain itself, which leads to further imbalances and further impairment in normal functions.
It is important to understand then that MDD, or Depression, is not something that is simply made up in one’s head, or as Filipinos would say ‘gawa-gawa lang’. Nor is it a fad that people actively choose to have, or ‘kaartehan lang’. MDD is a serious, chronic, and life-threatening disorder based on brain changes, that significantly impairs and debilitates the people suffering from it.
The 2 core symptoms of MDD are depression and anhedonia
Depression may be experienced as feelings of sadness, hopelessness, emptiness, irritability, and sometimes even bodily aches or pains. Anhedonia on the other hand, is described as feeling decreased interest or pleasure in activities that were previously considered by the person as interesting or pleasurable.
Besides these 2 core symptoms, there are other commonly associated symptoms of Depression. These symptoms are:
Sleep disturbances - too much or too little, poor quality, sleep
Feelings of worthlessness
Feelings of inappropriate, excessive guilt
Fatigue and loss of energy
Decreased ability to think, concentrate, or make decisions
Significant weight loss or weight gain, or changes in appetite
Psychomotor agitation or retardation
Thoughts of death or dying, or suicidal thoughts, intentions, or plans
In an episode of depression, these symptoms happen everyday or nearly everyday
Before diagnosing a person with Major Depressive Disorder, mental health professionals usually determine whether he/she meets the core symptoms and other associated symptoms. Additionally, professionals determine the duration of the condition, the degree of impairment caused by the condition, and whether or not the patient’s symptoms are caused by another medical condition or by substance use.
As Major Depressive Disorder is brought about by multiple factors, multiple modes of treatment are also needed. These include medications and various forms of psychotherapy.
The most commonly used medications for Major Depressive Disorder in the Philippines are Selective Serotonin Reuptake Inhibitors (SSRIs), which include generics such as Escitalopram, Fluoxetine, Sertraline, Paroxetine. These drugs work by increasing the levels of Serotonin in the brain.
Psychotherapy for Depression comes in many different forms, such as Supportive Psychotherapy, Psychodynamic Psychotherapy, or Cognitive Behavioral Therapy, which are usually chosen by therapists based on the individual needs of the patient.
In general, the treatment of MDD should be centered on the patient as a person, and should resolve not only his/her symptoms, but also improve strengths, adaptive skills, and overall functioning.
Major Depressive Disorder develops from an interplay of genetics, childhood development, adverse life events, stressors, and the environment. While many of these factors are difficult, if not impossible, to control, we can still minimize the impact of these factors on our daily functioning by trying to keep our brains healthy.
Keeping our brains healthy involves:
1. Sleeping adequately every day
Eating healthy
Drinking enough water
Engaging in exercise
Engaging in mindfulness or meditation
Engaging in prosocial behavior
Lastly, we can also help prevent the debilitating effects of MDD by being aware of this condition, knowing its signs and symptoms, and spreading our knowledge to others.
The more we share our knowledge, the more we create awareness in other people, and the more society will understand this condition and the plight of the people suffering from it.
References:
DSM-5-TR
Duman, Ronald S., et al. ‘Altered Connectivity in Depression: GABA and Glutamate
Neurotransmitter Deficits and Reversal by Novel Treatments’. Neuron, vol. 102, no. 1, Apr. 2019,
pp. 75–90. DOI.org (Crossref), https://doi.org/10.1016/j.neuron.2019.03.013.
Flores JL, Hernandez MA, Leyva EW, Cacciata M, Tuazon J, Evangelista L. PREVALENCE AND
CORRELATES OF DEPRESSION, ANXIETY, AND DISTRESS AMONG FILIPINOS FROM LOW-INCOME COMMUNITIES IN THE PHILIPPINES. Philipp J Nurs. 2018 Jul-Dec;88(2):8-13. PMID: 33935304; PMCID: PMC8088195.
John, R. L., & Antai-Otong, D. (2016). Contemporary Treatment Approaches to Major Depression and Bipolar Disorders. Nursing Clinics of North America, 51(2), 335–351. doi:10.1016/j.cnur.2016.01.015
Parmentier FBR, García-Toro M, García-Campayo J, Yañez AM, Andrés P, Gili M. Mindfulness and Symptoms of Depression and Anxiety in the General Population: The Mediating Roles of Worry, Rumination, Reappraisal and Suppression. Front Psychol. 2019 Mar 8;10:506. doi: 10.3389/fpsyg.2019.00506. PMID: 30906276; PMCID: PMC6418017.
Puyat, Joseph H., et al. ‘Depressive Symptoms among Young Adults in the Philippines: Results from a Nationwide Cross-Sectional Survey’. Journal of Affective Disorders Reports, vol. 3, Jan. 2021, p. 100073. DOI.org (Crossref), https://doi.org/10.1016/j.jadr.2020.100073.
Raposa, E. B., Laws, H. B., & Ansell, E. B. (2016). Prosocial Behavior Mitigates the Negative Effects of Stress in Everyday Life. Clinical Psychological Science, 4(4), 691–698. doi:10.1177/2167702615611073
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