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According to Wikipedia;” Major depressive disorder (MDD), also known simply as depression, is a mental disorder characterized by at least two weeks of low mood that is present across most situations” .Any body can be victim of depression. Depression bring low esteem with it. A person can have a very good day and next movement there is a period, full of anxiety, thinking what can never happen, negativity. It can also change one’s mood, eating habits and effecting day to day activity. There is no specific age that it can happen to 25 year old men women and not to that of 70 years of age. There is no specific reason of depression but there can be certain factors that can increase the chances of depression and it include following:-

Family History :              Sometimes because of family history and or genes some disease are passed on   to the Kids. A family history can increase the chances of depression.

Medications     :              Sometimes, side effect of a medication can result in depression. For example:    Anticholinergic drug. This drug is usually used for the treatment of Irritable                                                          bowel syndrome but at the same time it affects the central nervous system and can cause depression.

Besides the above mentioned facts, there can be other additional reasons that can accelerate depression such as Sudden death of a loved one, Conflict with family member and or at workplace. Major Symptoms of Depression are as follow:-

1)     Sad or irritable day

2)     Lack of energy

3)     Change in eating habits and   Lose, gain weight

4)     Sleeping problem

5)     Low energy to do normal life activities

6)     Feeling guilty of things that will never or can happen.

7)     Problem in making decisions.

The Great comedian “Robin Williams” died in the year 2014  because of Severe depression and because of his battle with drinking problems. It can happen to anybody i.e. from Famous personalities to Common man. Depression symptoms vary from age to gender. Depression in women can be different from that of men. Men’s in depression will be angry, reckless behaviour and substance use. Where as in women, they will feel guilty, over reacting. During their menstruation, pregnancy period etc due to Harmon   changes the depression can be accelerated. Depression in adults will be entirely different they will have headache, Physical pain etc. If you see these signs and warning in an Individual then it’s point where he/she needs family support and even medical help.

A therapist can analyze a person based on different types of therapies and can tell that the person is struggling with depression or not. There are variety of Theories available but I would like to discuss the Humanistic theory. In this theory, therapist’s goal is to help and realize the person about self acceptance and self awareness. Active listening is the key to solution. If a person is hurt by his/her family member or lost his loved one then his changing behaviour, eating habits, level of angriness, no or little initiative to perform activity etc. all these signs lead to the conclusion that a person is in depression. These symptoms are strong indication that indicates the therapist to make a right decision that which therapy will help to cope with feelings, change behaviour pattern etc.

Depression not only drains you physically, mentally but it also affects one’s Spiritual development as well. When  an Individual is going through depression his Spiritual development initially increases and the at a certain point he couldn’t even get a peace of mind there then he self isolate spiritually as well and this is very normal type of behaviour. In United states; “ the most recent Gallup Poll conducted in late 2011 found that 55% of Americans indicated that religion is very important in their lives and 26% said it is fairly important, leaving only 19% who said it was not important”. On the switch sides, even therapist recommend the mindfulness classes, yoga, regular walking etc to relax your mind and when one’s mind is relaxed, then person think from a different point of view and finding solution for their problem. I would like to quote my example, when I was in rehab, I have taken yoga classes with light music on. It takes you to a different level of relaxation.

Depression can also affect your emotional development and weaken you immune system. Some people don’t feel like making their meals, taking a bath etc and it’s not that the person is lazy but it’s because the energy to take initiative is zero. Some days can be good and some days are worse. I am telling it with my friend’s experience. A person is emotionally drained and don’t enjoy the present enjoyable movements and worried about the future. There  other  sign of Poor emotion health are as follows:-

Insomnia

Sexual Problem

Headaches

High blood pressure etc.

When we think about depression, the thing that generally come to our mind is that an Individual is going through up and down, over reacting etc. but there is more to it when we talk about it when we connect the affects of depression cognitively. Individual struggles the decision making skills. Moreover, it affects your problem solving skills and Higher thinking. Individual can also face problems like poor concentration. He/she might not be aware of what mistake he/she is making and as a result the person is unable to achieve goals which further take him/her to depression as the feeling of failure, unhappiness arise again.

Known/Suspected Causes of MDD

The aetiologies surrounding major depressive disorder (MDD) are unclear, and will likely be unclear for some time to come. However, there are many known causes of MDD and a variety of suspected causes. When discussing the causes of MDD, it is important to keep in mind that it is highly unlikely depression is caused by a single factor. Depression is caused by a multitude of factors, physical, psychological, and sociological, that work together to negatively affect a person’s life.

Causes of MDD:

Genetic – Genes that have been inherited through the family bloodline can play a role in the causation of MDD. If somebody in a family has had depression or is suffering from depression, other family members can be at a higher susceptibility of suffering from MDD. The exact genes that are relative to depression is unknown, however, many genes are suspected to be a part of the equation.

Hormonal – Changes in hormonal states are known to cause depression. Human vulnerabilities like childbirth, menopause, thyroid problems, and other disorders are known to cause unpredictable hormone fluctuation can cause someone to be vulnerable to MDD. Postpartum depression is a good example of this; after childbirth, it is normal for a mother to experience unforeseeable hormone levels and thus, suffer from depression. Postpartum depression is a very serious condition and should be treated as so.

Biochemical – Psychiatrists tend to look at brain chemistry when diagnosing and treating MDD. Depression can cause noticeable changes in the brain. Serotonin, dopamine, and norepinephrine are chemicals in the brain that cause and regulate happiness. These chemicals suffer noticeable changes in the brain of a patient suffering from MDD. While it is known the brain chemistry changes with MDD, how or why they change is yet to be known.

Psychological Factors – Psychological stress can induce a multitude of physiological responses in the nervous, endocrine, and immune systems. Serious changes in someone's life can cause depression. Trauma, life struggle, losing a loved one, being fired from a job, financial troubles, and many other traumatizing events can have a bleeding effect on a person’s psychological health. When the psychological health is damaged or jeopardized, chances of suffering from depression are increased.

Seasonal – When the winter months roll around and the amount of daylight in a day decreases, people receive less sunlight and are at higher risk of suffering from depression. When the days get short, people can suffer from lethargy, tiredness, and loss of interest in activities. These symptoms are directly relevant to symptoms of MDD and can cause MDD. SAD (seasonal affective disorder) is a type of depression that follows seasonal patterns.

There are many causes of depression. There are also many risk factors separate from causes that can leave a person at risk of contracting MDD. Some of these risk factors include;

Being a woman;

Low self-esteem;

Health issues in blood relatives;

Sexuality;

Other mental disorders;

Drug/alcohol abuse;

Serious or chronic illness;

Medications;

And regions with long winter nights and limited sunlight.

(Gabbey, 2017.).

Diagnosing MDD

According to the DSM IV criteria, to be clinically diagnosed with MDD a person must be experiencing five or more of a variety of symptoms throughout the same two-week time-space. At least one of the symptoms should be (1) depressed mood and (2) loss of interest of pleasure to be clinically diagnosed with MDD.

The DSM IV criteria explains the eight symptoms as follows:

1.      Depressed mood most of the day, nearly every day.

2.      Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

3.      Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

4.      A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).

5.      Fatigue or loss of energy nearly every day.

6.      Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

7.      Diminished ability to think or concentrate, or indecisiveness, nearly every day.

8.      Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

(Truschel, 2019.).

To receive a clinical diagnosis of MDD, the aforementioned symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be caused by substance abuse or a medical condition. (Truschel, 2019.).

Psychological Perspectives on MDD

 Psychodynamic Theory (Freud) 

Psychodynamic theory, in its floruit, understood depression in terms of;

Inwardly directed anger;

Intorjection of love object lost;

Severe super-ego demands;

Excessive narcissistic, oral, and/or anal personality needs;

Loss of self-esteem;

And deprivation in the mother-child relationship during the first year of life.

Freud’s psychoanalytic theory believed that depression is highly a result of biological factors, while also believing loss or rejection by parents and close relationships can cause depression because of grief. Psychoanalytic theory explained the cause of depression not by the loss but by the reaction to the loss;

The individual identifies with the loss and thus, repressed anger amongst other emotions is directed inwards at the self. Therefore, the self-esteem of the individual is impacted and heightens susceptibility to depression. Freud identified the difference between losing an actual loss, and a symbolic loss. Freud described an actual loss as the death of a loved one, the loss of a significant relationship, etc. Freud described a symbolic loss as the loss of a job, vehicle, responsibility, etc.

Later, Freud adjusted his theory as he believed that the internalization of lost objects is a normal reaction. Freud believed that depression occurs when the super-ego assumes or is given control over the mind. The super-ego takes control and twists and turns the internalized loss into a reality, whereas depression occurs.

(McLeod, 2015.).

 Cognitive Perspective (Beck) 

The cognitive theory places the blame of depression on the ideology of belief over behaviour. Beck’s theory from a cognitive perspective is built upon the foundation that assumes depressed people appraise events in a negative manner. Beck believed that changes in thinking precede the onset of depressed mood.

Beck believed there to be three mechanisms primarily responsible for depression:

1.      The cognitive triad (negative automatic thinking)

2.      Negative self-schemas

3.      Errors in logic

Cognitive Triad – Beck defined the cognitive triad with three forms of negative thought. Specifically, negative thoughts of the self, negative thoughts of the world, and negative thoughts of the future. Beck believed that a depressed person suffers from automatic thoughts relative to the cognitive triad.

The triad leads people to have negative thoughts of self-worthlessness, thoughts viewing the world in a “negative and defeatist way” (McLeod, 2015), and thoughts of the future being worthless as well.

The trifecta of negative thought will cause impairments in cognitive processing which leads to impairments in memory, perception, and problem-solving. Impairments in these areas feed the fire of obsession with negative thoughts.

Self-Schemas – Beck believed that activating a negative self-schema (a set of beliefs about the self that are fundamentally negative and pessimistic) will predispose an individual to MDD. Therefore, the cognitive triad will not necessarily cause depression on its own. Beck believed that a stressful life event is required to activate the negative self-schema and predispose an individual to depression.

People who are suffering from negative self-schema and cognitive triad are prone to logical errors and selectively focus on negative aspects as opposed to positive aspects of the self, the world, and the future.

Errors in Logic – Beck defines errors in logic with several systematic negative bias’ in information processing. The illogical thought processes are described by Beck as follows, and can cause great negative effects on an individual:

Arbitrary Inference - Drawing a negative conclusion in the absence of supporting data.

Selective Abstraction - Focusing on the worst aspects of any situation.

Magnification and Minimisation - If they have a problem they make it appear bigger than it is. If they have a solution they make it smaller.

Personalization - Negative events are interpreted as their fault.

Dichotomous Thinking - Everything is seen as black and white. There is no in-between.

(McLeod, 2015.).

Beck believed that the cognitive triad, self-schemas, and errors in logic all work together towards the destruction of a healthy mind by inducing an individual's automatic thinking processes to become negative. When the automatic thinking process is negative, depression can be expected. The negative thoughts become very strong and tend to overpower any positive logic or reasoning. Breaking the automatic thinking process is very difficult, thus, explaining the difficulty of treating depression. (McLeod, 2015.).

A Case Example to Illustrate MDD

Helen Martin, a 56-year-old woman was charged with murder and neglect of a dependent resulting in death after allegedly drowning her grandson. Helen Martin allegedly took her grandson for a bath, climbed into the tub fully clothed, and held the child's head underwater until he no longer lived. Brain Martin, Helen’s husband, came home to find the child dead in the bathtub.

Helen Martin allegedly told police that she was depressed. According to authorities, Helen also said that she believed the child was “better off in heaven” (Pruitt, 2020.). She also told police that she suffered from gaps in her memory due to PTSD from “past abusive marriage, depression, anxiety, and bipolar disorder,” (Pruitt, 2020.).

The Importance of Understanding Depression in Policing

It is extremely difficult to relate and approach a person suffering from depression. Everybody experiencing depression differently, thus, it is difficult to properly approach a person suffering from MDD whether or not there is a substantial understanding of depression.

Depressed people, especially in high-pressure situations may:

Be unpredictable,

Be in a place that is difficult/impossible to understand,

Be negatively responsive to help,

Not want any help,

Have a death-wish,

Have a burning hate or desire to damage society.

Without any understanding of depression, an officer will be unable to obtain any trust from a depressed individual in a high or low-pressure situation. Officers find themselves face-to-face with situations that need to be de-escalated as quickly as possible. In order to de-escalate, an officer must be able to establish trust with strangers who may be suffering from extreme mental difficulties. A lack of understanding of depression can result in death and chaos by an individual suffering from MDD.

For an officer to do his/her job by serving the public and protecting the peace, knowledge of major depressive disorders and many other disorders is absolutely essential.

MDD Treatments

-         Psychodynamic therapy treats depression on the grounds that address that the individual in mourning work to separate the self from the lost person. Thus, the inner-directed emotion is reduced (McLeod, 2015.). PDT  is very effective in treating short and long term MDD symptoms. The scientific evidence suggests PDT is at least as effective as other psychotherapies and long-lasting. (Shedler, 2010.).

-         An effect of 0.80 is considered large in medical and psychological studies (Shedler, 2010.).

PDT is quite effective short-term and even more so long term. A major meta-analysis including just shy of 1,500 patients found an effect of 0.97 for overall symptom improvement.

Nine months later, the patients were re re-evaluated and the effect size increased by 50% to 1.51 (Shedler, 2010.).

-         Antidepressant medications affect the release and reuptake of monoamines in the brain like serotonin, noradrenaline and dopamine (Andrade & Rao, 2010.).

Antidepressants have a relatively larger effect size on severe cases as opposed to mild cases (NCBI, 2017.).

About 40-60/100 people who take an antidepressant notice an improvement of symptoms.

20-40/100 people noticed an improvement in symptoms when given a placebo (NCBI,2017.).

50/100 people relapsed after 1-2 years when given a placebo.

23/100 relapsed after 1-2 years after being given antidepressants (NCBI, 2017.).

Side Effects

-         Psychodynamic therapies are lacking research of negative side effects in its practice because it is exceptionally difficult to define and measure (NCBI, 2013.). Thus, the etiology surrounding the side effects of psychodynamic therapies are more unclear than that of major depressive disorder. Some possible unwanted side-effects of PDT include regression and suicide, psychotic episodes, dysphoric emotions, and several more (Rege & Graham, 2017.).

-         Antidepressant medications have had plenty of research done on the side effects. However, it is difficult to deviate between the side effects of the depression itself and that of the medication.

Antidepressant medications are commonly known to cause moderate side effects including dry mouth, headaches, feeling faint, anxiety, decreased sex drive, and more (NCBI, 2015.).

Common side effects of a more severe nature include dizziness and unsteadiness at risk of falls and broken bones, combinations of medications can create an increase and rise in unwanted side effects. (NCBI, 2015.).

Heart problems, epileptic fits and liver damage are believed to be rare side effects of antidepressant medication (NCBI, 2015.).

Studies have shown that teenagers taking antidepressant medications are more like to commit suicide (NCBI, 2015.).

References:-

https://en.wikipedia.org/wiki/Major_depressive_disorder

https://www.healthline.com/health/clinical-depression

https://www.verywellmind.com/drugs-that-can-cause-depression-1067458

https://www.webmd.com/depression/guide/causes-depression#1

hhttps://www.gracepointwellness.org/5-depression-depression-related-conditions/article/13003-psychology-of-depression-psychodynamic-theoriesttps://www.helpguide.org/articles/depression/depression-symptoms-and-warning-signs.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426191/

https://familydoctor.org/mindbody-connection-how-your-emotions-affect-your-health/

https://www.health.harvard.edu/blog/sad-depression-affects-ability-think-201605069551

National Institute of Mental Health. (2019.). Major Depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml

Amber, Gavey. (2017.). Causes of Depression. Retrieved from https://www.healthline.com/health/depression/causes

Yang, Zhao, Wang, Liu, Zhang, Li, & Cui. (2015.). The Effects of Psychological Stress on Depression. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790405/

Jessica, Truschel. (2019.). Depression Definition and DSM-5 Diagnostic Criteria. Retrieved from https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/

Sharon, Pruitt. (2020.). Woman Allegedly Drowned Grandson, Told Officers The 4-Year-Old Boy Was ‘Better Off In Heaven’ Retrieved from https://www.oxygen.com/crime-news/helen-martin-allegedly-drowned-grandson-said-he-was-better-off

“The Efficacy of Psychodynamic Psychotherapy,” Jonathan K. Shedler, PhD, University of Colorado Denver School of Medicine; American Psychologist, Vol. 65. No.2. Retrieved from https://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy

McLeod, S. A. (2015, Jan 14). Psychological theories of depression. Retrieved from https://www.simplypsychology.org/depression.html

NCBI. (2017). Depression: How effective are antidepressants? Retrieved from  https://www.ncbi.nlm.nih.gov/books/NBK361016/ 

Chittaranjan, Andrade & N. Sanjay Kumar Rao. (2010.). How antidepressant drugs act: A primer on neuroplasticity as the eventual mediator of antidepressant efficacy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/

NCBI. (2013.). How to define, find and classify side effects in psychotherapy: from unwanted events to adverse treatment reactions. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22253218

Feldman & Cavanagh. (2019.). Essentials of Understanding Psychology. Canada: McGraw Hill Education.

Authors: Mathew Eardley & Shivani Mehta