The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression. Proposed causes include psychological, psychosocial, hereditary, evolutionary, and biological factors. Risk factors include female gender, prior episode or suicide attempts, comorbid medical or substance-related disorder, death of a close family member, lack of social support, and other stressful events. 15,16 In depression, neural circuits in the brain responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and critical neuro-transmitters are out of balance. The precise cause of depression is unknown, but it is believed to result from chemical changes in the brain due to a genetic problem triggered by stressful events, cognitive and environmental factors, or a combination of unknown causes. 11 Interestingly, depression appears to be less likely to occur, as well as quicker to remit, among individuals who have strong religious beliefs. 9,10 Depression often co-exists with physical disorders such as stroke and other cardiovascular diseases, Parkinson’s disease, chronic obstructive pulmonary disease (COPD), and pain, especially if it is chronic or uncontrollable moderate-to-severe pain. In the elderly, depressed persons may have cognitive symptoms such as forgetfulness and a more noticeable slowing of body movements. 8 A depressed person may also report multiple somatic complaints such as fatigue, headaches, or digestive problems. 7 In severe cases, depressed people may have symptoms of psychosis that include delusions or, less commonly, hallucinations that are usually unpleasant. Signs and symptoms include a depressed mood, anhedonia, weight loss/gain, insomnia/hypersomnia, fatigue/loss of energy, obsessing over thoughts, feelings of worthlessness, inappropriate guilt or regret, feelings of helplessness and hopelessness, diminished ability to think or concentrate, withdrawal from social activities, reduced sex drive, and thoughts of death or suicide. 6Ī person with a major depressive episode usually exhibits signs and symptoms that significantly affect a person’s personal relationships, family, work, or school life. 6 Before puberty, boys and girls are equally likely to develop depressive disorders, but after age 14, females are twice as likely to have major depression or dysthymia. In children aged 9 to 17 years, it is estimated that the prevalence of any depressive disorder is more than 6% in a 6-month period, with 4.9% having major depression. 5 According to the World Health Organization (WHO), major depression is currently the leading cause of disease burden in North America and the fourth leading cause worldwide. 3 MDD usually has an onset between the ages of 20 and 30 years and peaks between 30 and 40 years, 4 with a prevalence more common in women than in men. 2 Depression is the leading cause of disability in the U.S. MDD is a significant health problem that affects approximately 15 million American adults yearly and about 6.7% of the U.S. The scope of this article focuses on the pharmacotherapy of MDD. 1 Subtypes of major depression include psychotic, atypical, seasonal, postpartum, melancholia, and catatonic. Major depressive disorder (MDD) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem and loss of interest or pleasure in normally enjoyable activities (anhedonia). Depression can strike anyone regardless of age, ethnic background, socioeconomic status, or gender.
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