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Major depressive disorder recurrent severe symptoms, chronic fatigue immune dysfunction syndrome - Within Minutes

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Current nosologies of depressive illnesses do not, however, do a very good job of categorizing chronic depression.
When the validity of these distinctions is examined, it becomes apparent that this multitude of diagnoses does not reflect the clinical reality of chronic depressive illnesses.
The natural history of chronic depression was well described in the work of the NIH Collaborative Study on the Psychobiology of Depression. McCullough and colleagues4 compared 681 outpatients with chronic depression for a broad range of demographic, clinical, psychosocial, family history, and treatment response variables. Those who had suffered at least 2 major depressive episodes but without full interepisode recovery. Had at least 2 weeks of a major depressive episode which caused significant distress or disability. Major Depressive Disorder is a condition characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes. Completed suicide occurs in up to 15% of individuals with severe Major Depressive Disorder. Disorder, Obsessive-Compulsive Disorder, Anorexia Nervosa, Bulimia Nervosa, and Borderline (Emotionally Unstable) Personality Disorder.
There is a greater likelihood of developing additional episodes of this disorder if: (1) there was pre-existing Persistent Depressive Disorder, (2) the individual has made only a partial recovery, (3) the individual has a chronic general medical condition.
Manic Episode never disappears completely, however many Major Depressive Episodes have been experienced.
Stressors may play a more significant role in the precipitation of the first or second episode of this disorder and play less of a role in the onset of subsequent episodes. First-degree biological relatives of individuals with this disorder are 2-4 times more likely to develop Major Depressive Disorder.
Treatment refractory depressions may respond to a combination of an antidepressant plus lithium or electroconvulsive therapy (ECT). Although almost two-thirds of individuals with major depressive disorder respond to current therapies; at least one-third of those entering remission relapse back into depression 18 months posttreatment. In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity.
Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities. An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt.
A disorder characterized by repeated episodes of depression as described for depressive episode (F32.-), without any history of independent episodes of mood elevation and increased energy (mania).
A disorder characterized by repeated episodes of depression, the current episode being mild, as in F32.0, and without any history of mania.
A disorder characterized by repeated episodes of depression, the current episode being of moderate severity, as in F32.1, and without any history of mania. A disorder characterized by repeated episodes of depression, the current episode being severe without psychotic symptoms, as in F32.2, and without any history of mania. A disorder characterized by repeated episodes of depression, the current episode being severe with psychotic symptoms, as in F32.3, and with no previous episodes of mania.
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
Over 5 years (2005-2011) I studied my outpatient psychiatric patients that had a DSM-IV diagnosis of Major Depressive Disorder. Fatigue, sleep disturbance, appetite disturbance, occupational impairment and social impairment are all part of the diagnostic criteria for major depressive disorder.
Depressed mood, guilt, self-harm, agitation, distractibility, apathy, and impaired executive functioning are all part of the diagnostic criteria for major depressive disorder. The most striking finding was the extent to which depression had impaired my patients' social functioning. Fortunately, on the seventh day of starvation, the four group members that still had the energy and optimism to hunt, actually killed an elk using their caveman spears.
When you watch the video of this caveman experiment, you can see practically all of the symptoms of major depressive disorder appear.
This disorder can be triggered by exposure to any major physical, psychological, or social adversity. When severely depressed, people often become socially withdrawn, and stop their usual social activities. The average major depressive episode lasts less than one year, but up to 15% of severely depressed individuals commit suicide because they prematurely give up any hope of recovery.
During a depression, self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present.
Summary Of Practice Guideline For The Treatment Of Patients With Major Depressive Disorder. Patients should also be told about the need to taper antidepressants, rather than discontinuing them precipitously, to minimize the risk of withdrawal symptoms or symptom recurrence [I]. An antidepressant medication is recommended as an initial treatment choice for patients with mild to moderate major depressive disorder [I] and definitely should be provided for those with severe major depressive disorder unless ECT is planned [I].
Bright light therapy might be used to treat seasonal affective disorder as well as nonseasonal depression [III].
In women who are pregnant, wish to become pregnant, or are breastfeeding, a depression-focused psychotherapy alone is recommended [II] and depending on the severity of symptoms, should be considered as an initial option [I].
Marital and family problems are common in the course of major depressive disorder, and such problems should be identified and addressed, using marital or family therapy when indicated [II].
The combination of psychotherapy and antidepressant medication may be used as an initial treatment for patients with moderate to severe major depressive disorder [I]. Combining psychotherapy and medication may be a useful initial treatment even in milder cases for patients with psychosocial or interpersonal problems, intrapsychic conflict, or co-occurring personality disorder [II]. Onset of benefit from psychotherapy tends to be a bit more gradual than that from medication, but no treatment should continue unmodified if there has been no symptomatic improvement after 1 month [I]. For patients whose symptoms have not responded adequately to medication, ECT remains the most effective form of therapy and should be considered [I].
For MDD, symptoms must be present continuously for 2 weeks and may be characterized by a single episode or be recurrent. The term "double depression" was introduced by Keller and colleagues3 in 1982 to describe patients with MDD and a preexisting chronic minor depression (now called dysthymic disorder). These Major Depressive Episodes are not due to a medical condition, medication, abused substance, or Psychosis.

Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment. There is a fourfold increase in deaths in individuals with this disorder who are over age 55.
Persistent Depressive Disorder often precedes the onset of this disorder for 10%-25% of individuals.
These vascular depressions are associated with greater neuropsychological impairments and poorer responses to standard therapies. About 5%-10% of individuals with Major Depressive Disorder eventually convert into Bipolar Disorder. Major Depressive Disorder, particularly with psychotic features, may also convert into Schizophrenia, a change that is much more frequent than the reverse.
St John's wort and regular exercise appear mildly effective in the treatment of depression (but their effect size is small).
Depending upon the number and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe.
Suicidal thoughts and acts are common and a number of "somatic" symptoms are usually present. If such an episode does occur, the diagnosis should be changed to bipolar affective disorder (F31.-). During major depressive disorder, individuals lack the essential social skills of self-confidence, optimism, belonging, and sociability. Unlike emotions, these 4 problems are not adaptive, but are symptoms of brain malfunctioning. In this way, I could statistically determine which symptoms were elevated in major depressive disorder. As expected, these classical symptoms of major depression decreased as my patients recovered. Thus suicide is a tragic waste of life; especially when major depressive disorder is so time-limited. By the fourth day of starvation, the entire group suffered from severe fatigue, insomnia and apathy. So depression can be triggered by a physical illness or stress, an addiction to alcohol or drugs, or a significant psychological or social stress. The following shows which items on this scale would be rated as abnormal for Major Depressive Disorder. Although this term appears commonly in the clinical literature and comes closest to reflecting the clinical reality of chronic depression, it is not a DSM diagnosis and must be captured in DSM-IV by assigning 2 diagnoses (MDD and dysthymia).
For dysthymic disorder, symptoms must present for 2 years (1 year in children and adolescents) with no absence of symptoms lasting more than 2 months. Also, there can be no major depressive episode during the first 2 years of the disturbance (1 year for children and adolescents).
Malfunctioning of this self-control function is seen in Eating Disorders and Substance Use Disorders. In Schizophrenia and related disorders, there is malfunctioning of the brain's "detachment" function.

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