IndexIntroductionBodyConclusionIntroductionThe focus of this academic work will be on one of the best-known mental illnesses, major depressive disorder (MDD). Its high prevalence in today's society highlights the need to explore available treatments for people with major depressive disorder. Pharmacological and non-pharmacological management of major depressive disorder will be discussed, along with possible community resources that patients with major depressive disorder can rely on. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original EssayBodyMDD, also known as unipolar depression or clinical depression, is a type of mood disorder. People with major depressive disorder are characterized by a constant state of unhappiness (Videbeck, 2010, p281). According to the Diagnostic and Statistical Manual of Mental Disorders V, a person is diagnosed with major depressive disorder when he or she is in a depressed state for a minimum of 2 weeks and exhibits at least 4 or more symptoms (American Psychiatric Association, 2013). Some clinical manifestations of major depressive disorder are feelings of sadness, tiredness and inability to sleep well. Major depressive disorder is the most common mental illness worldwide, so much so that it has been called the “common cold” in mental health (Institute of Mental Health, n.d.). In Singapore, major depressive disorder is so prevalent that it has a lifetime prevalence of 6.3% (Ministry of Health, 2012). Research has also shown that for every sixteen individuals in Singapore, one will suffer from depression at some point in time (Choo, 2018). The etiology of DCS cannot be explained by a single theory. Based on neurochemical theory, MDD occurs when there is a deficiency of neurotransmitters, namely serotonin (5-HT), norepinephrine, and dopamine (Nutt, 2008). These neurotransmitters control an individual's emotional state by transmitting chemical messages in the brain. Dopamine has been found to correlate with happiness, while serotonin controls mood (Baixauli, 2017). The concentration of these neurotransmitters decreases due to reabsorption by receptors at presynaptic nerve endings (Adams, Holland & Urban, 2013, p192), thus causing depressive signs. According to genetic theory, those who have a first-degree relative who has MDD have a two to four times greater risk than the rest of the population (American Psychiatric Association, 2013). Gender also plays a role in the etiology of major depressive disorder as women are at two times the risk of developing major depressive disorder compared to men (Videbeck, 2010, p284). External factors also contribute to major depressive disorder. People with long-term medical illnesses such as cancer or coronary heart disease may consider themselves to have a disability and simultaneously suffer from the pain inflicted by their illness (Turner & Kelly, 2000). Chronically ill patients have been found to be two to three times more likely to develop major depressive disorder than common patients (Katon, 2011). Other stressful life events such as the death of loved ones, divorce, and unemployment can also cause the same depressive symptoms (Jesulola, Micalos & Baguley, 2018). It is important for us to discuss major depressive disorder because a potential but important consequence of major depressive disorder is suicide. . One study showed that among individuals who attempted suicide, 59% to 87% were diagnosed with MDD, and approximately 15% of patients with MDD completed suicide (Gonda,Fountoulakis, Kaprinis & Rihmer, 2007). This high statistic is worrying news since depression, as mentioned, is very common in the world. This means that more people may be inclined to end their lives if effective medical intervention is not provided. Therefore, it is crucial to discuss the medical treatments available for patients with major depressive disorder. Since major depressive disorder has been around for a long time, numerous antidepressants have been invented to deal with the symptoms. The main classes of medications for major depressive disorder are tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs). SSRIs are preferred over TCAs and MAOIs because they are safer to use on older adults and have positive effects with fewer adverse effects, such as cardiovascular risk (Ferguson, 2001). Therefore, SSRI is considered the first-line medication for patients with major depressive disorder (Clevenger, Malhotra, Dang, Vanle & IsHak, 2018). Common SSRIs are fluoxetine (Prozac), Citalopram (Celexa), and paroxetine (Paxil). SSRIs work by blocking serotonin receptors, preventing the reabsorption of serotonin into presynaptic nerve terminals (Adams et al., 2013, p191). This increase in serotonin level then triggers a change in the presynaptic neuron such that it becomes desensitized to serotonin while the postsynaptic neuron undergoes changes that increase its sensitivity (Adams et al., 2013, p192). Then, more serotonin can be transmitted through neurons to transmit signals to the brain to regulate mood. An advantage of SSRI, as the name suggests, is that it only targets serotonin and does not affect other neurotransmitters (Videbeck, 2010, p285). Research has shown that escitalopram has a prophylactic efficacy of 36%, which is the highest compared to other SSRIs. such as fluoxetine and paroxetine (Clevenger et al., 2018). Therefore, escitalopram is the best choice as a drug for the prevention of relapse of major depressive disorder. Although the side effects of SSRIs are more tolerable than TCAs and MAOIs, they include gastrointestinal (GI) problems such as nausea and diarrhea (Ferguson, 2001). This is due to the hyperactivation of 5-HT3 receptors due to the high amount of available serotonin which fortunately, if administered at a lower dosage, can reduce side effects (Ferguson, 2001). Research has found that citalopram shows the least adverse effect, so Ferguson (2001) states that it is the most tolerable SSRI. An adverse consequence of SSRIs is serotonin syndrome, whereby an extremely high level of serotonin is available due to excessive use of SSRIs. or insufficient washout period between taking SSRIs and MAOIs (Videbeck, 2010, p289). With the buildup of serotonin within the body, an individual experiences serotonin toxicity that can be life-threatening (Buckley, Dawson & Isbister, 2014). Manifestations of serotonin toxicity include diarrhea, nausea, and mental changes such as agitation and confusion (Buckley et al., 2014). Therefore, patients should be educated on the right dosage of SSRIs. Like other antidepressants, SSRIs have a black box warning according to the US Food and Drug Administration (Adams et al., 2013, p190) for suicidal ideation, especially in younger populations. (Nischal, Tripathi, Nischal, & Trivedi, 2012). Due to the uplifting nature of SSRIs, clients may gain energy to carry out suicidal behaviors because they are still in a depressed state (Videbeck, 2010, p313). Therefore, it is important to alert friends and family to monitor customers for any behaviorsuicidal. Psychoeducation Psychoeducation is the process of teaching the client and his family about the diagnosed mental illness. A mental health nurse specialist (RMN) is usually the one who conducts training on a hospital ward. A strong therapeutic nurse-patient relationship (TNPR) is essential in psychoeducation to achieve desirable outcomes (Dziopa & Ahern, 2009). To achieve TNPR, the NMR will show understanding of the client by actively listening to and respecting the client's thoughts rather than condemning their behaviors (Dziopa & Ahern, 2009). From the client's perspective, his illness may be a concern because he is unfamiliar with the symptoms it presents. This is where the NMR will come in to share information with the client regarding the possible causes of major depressive disorder, the symptoms, and the treatment available to them (Bamual, Frobose, Kraemer, Rentrop & Pitschel-Walz, 2006). Psychoeducation allows the client to clarify doubts about his condition (Bamual et al., 2006), thus increasing his awareness and involving him in the treatment process. It is important for the MRI to emphasize medication adherence to the client so that their condition improves. For example, a client may assume that his SSRI is not working due to the long waiting time for the drug's effect to peak, causing him to lose hope and give up on his medicine (Videbeck, 2010, p313). This scenario can be avoided when the MRI has provided information on the timing for the SSRI to work. From the perspective of the client's family, they may also be anxious about the client's condition. The pressure of caring for the client can cause stress for the caregiver. When stress is too overwhelming, family members may develop hostility and intolerance toward the client who is defined as having high expressed emotion (EE) (McCann, Songprakun, & Stephenson, 2015). This in turn leads the client to relapse (McCann et al., 2015). From an empathic perspective, NMR supports family well-being by providing advice on how to cope with high EE. In the study Shimazu et al. (2011), families of clients with major depressive disorder were provided four psychoeducation courses on depression and how to cope with high EE scenarios. The study found that the time it took clients with major depressive disorder to relapse was longer for clients whose family had received psychoeducation compared to the control group. After a nine-month follow-up of clients, the psychoeducation group had a 42% lower recidivism rate than the control group (Shimazu et al., 2011). Therefore, family psychoeducation is useful to prevent relapse of patients with major depressive disorder. When preparing for the client's discharge, the RMN should also provide the family with instructions on what to look out for, such as symptoms of major depressive disorder recurrence and medication side effects (Videbeck, 2010, p298). For example, it is critical that the NMR instructs the family to consistently observe the client's behavior for any signs of suicidal intent as antidepressant use can trigger suicidal thoughts (Adams et al., 2013, p190). Therefore, with psychoeducation, clients can take charge of their illness and their families can understand them better and help them cope with their condition Interpersonal PsychotherapyInterpersonal Psychotherapy (IPT) is a psychotherapy developed in the 1970s for the treatment of major depressive disorder. According to Wilfley (2001), IPT suggests that major depressive disorder develops due to changes in interpersonal relationships surrounding thecustomer. The death of a loved one is an example of the change in interpersonal relationships. Wilfley (2001) also argues that IPT aims to decrease symptoms of depression by improving the client's interpersonal relationships. This is done by targeting one of four possible interpersonal problems which are pain, interpersonal role disputes, social role change, and lack of social interaction (Wilfley, 2001, p7863). There are 3 main phases in IPT, the beginning (three weeks), middle (six weeks) and end (three weeks). The overall duration of IPT is twelve to sixteen weeks for acute major depressive disorder, as IPT revolves around a structured treatment plan (Markowitz & Weissman, 2004). A therapist may be the one who conducts IPT in an outpatient clinic. The client will then visit the clinic every week for each IPT session. Initially, the therapist will gather information from the client regarding all of his or her current interpersonal relationships (Markowitz & Weissman, 2004). After a detailed assessment, the therapist will identify the most appropriate interpersonal issue affecting the client (Markowitz & Weissman, 2004). Therefore, the selected interpersonal issue will be the main focus of the next sessions. It is important that the therapist establishes with the client the idea that the relationship between his depression and life changes is “practical, not etiological” as stated by Markowitz and Weissman (2004). This means that the client should not blame himself for the cause of his depression. During this period the therapist entrusts the client with the role of a sick person, to take away all burdens and allow him to feel more at ease (Lipsitz & Markowitz, 2013). Markowitz & Weissman (2004) suggest that in the middle phase, the therapist advises the client on ways to resolve the interpersonal relationship. For example, if the client is grieving the death of his wife, then the therapist can help him with the grief (Markowitz & Weissman, 2004). If the interpersonal issue is a change in social role such as a divorce, then the therapist can also help the client grieve, but at the same time encourage him or her to accept the new social role (Markowitz & Weissman, 2004). Therefore, the client learns from the therapist new interpersonal skills that are applicable to him to solve his interpersonal problem. In the final stage, the therapist informs the client of the end of therapy and both can look back on the client's progress. interpersonal relationship (Lipsitz & Markowitz, 2013). If the outcome is not satisfactory, the therapist will reevaluate the problem that occurred and allow the client to try new interpersonal skills again (Markowitz & Weissman, 2004). The therapist may praise the client's efforts to resolve his interpersonal relationship when he shows improvement. Therefore, Markowitz and Weissman (2004) define the therapist as a “cheerleader,” because by doing so the client is encouraged to resolve his interpersonal relationship. Finally, the therapist discusses with the client to schedule future sessions less frequently in order to maintain the optimal state he or she is in (Markowitz & Weissman, 2004). Based on a meta-analysis, Cuijpers et al. (2011) states that IPT is “one of the most empirically validated management methods” for MDD. Various clinical studies also demonstrate that outcomes of IPT include remission and improvement of symptoms of major depressive disorder (Feijo, Mari, Bacaltchuk, Verdeli & Neugebauer, 2005). Therefore, IPT is a good approach for MDD. However, one disadvantage is the time-limiting part of IPT. Clients who are more accustomed to therapies that have no time limits may find IPT too short, so they might.