Table of ContentsIntroductionBodyConclusionIntroductionThis academic work will focus on one of the well-known mental illnesses, major depressive disorder (MDD). Its high prevalence in today's society highlights the need to explore available treatments for people with MDD. Pharmacological and non-pharmacological management of MDD will be discussed, as well as possible community resources that MDD clients can rely on. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essayBodyUnipolar depression or clinical depression, also known as clinical depression, is a type of mood disorder. People with MDD 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 MDD when they have been in a depressed state for at least 2 weeks and have at least 4 or more symptoms (American Psychiatric Association, 2013). Some clinical manifestations of MDD include feelings of sadness, fatigue, and an inability to sleep well. MDD is the most common mental illness in the world, so much so that it is called the “common cold” in mental health (Institute of Mental Health, nd). In Singapore, MDD is so prevalent that it has a lifetime prevalence of 6.3% (Ministry of Health, 2012). Research has also shown that out of every sixteen individuals in Singapore, one will suffer from depression at some point (Choo, 2018). The etiology of MDD cannot be explained by a single theory. Based on neurochemical theory, MDD occurs when there is a deficiency in 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 is correlated with happiness, while serotonin controls mood (Baixauli, 2017). The concentration of these neurotransmitters becomes low due to reabsorption by receptors on presynaptic nerve endings (Adams, Holland & Urban, 2013, p192), thus leading to depressive signs. According to genetic theory, a person with a first-degree relative who has the risk of MDD is two to four times higher than that of the rest of the population (American Psychiatric Association, 2013). Gender also plays a role in the etiology of MDD, as women are twice as likely to develop MDD as men (Videbeck, 2010, p284). External factors also contribute to MDD. People with long-term illnesses such as cancer or coronary heart disease may view themselves as a liability and simultaneously suffer from the pain inflicted by their illness (Turner and Kelly, 2000). It has been found that patients with chronic illnesses have two to three times higher incidences of developing MDD than patients in general (Katon, 2011). Other stressful life events, such as the death of loved ones, divorce, and unemployment, can also lead to the same depressive symptoms (Jesulola, Micalos, & Baguley, 2018). It is important for us to discuss MDD because a potential but major consequence of MDD is suicide. . One study showed that among people who have attempted suicide, 59-87% are diagnosed with MDD, and approximately 15% of patients with MDD have committed suicide (Gonda, Fountoulakis, Kaprinis, & Rihmer, 2007). This high figure is worrying news because depression, as mentioned, is very common around the world. This means that a greater number ofPeople might be inclined to end their lives if effective medical intervention is not provided. Therefore, it is essential to discuss the medical treatment available to MDD clients. Since MDD has been around for a long time, a variety of antidepressants have been invented to deal with the symptoms. The main classes of medications for MDD 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 in older people and have fewer adverse effects, for example cardiovascular risk (Ferguson, 2001). Therefore, SSRIs are considered the first-line medication for clients with MDD (Clevenger, Malhotra, Dang, Vanle & IsHak, 2018). Common SSRIs include fluoxetine (Prozac), citalopram (Celexa), and paroxetine (Paxil). SSRIs work by blocking serotonin receptors, thereby preventing the reabsorption of serotonin into presynaptic nerve terminals (Adams et al., 2013, p191). This increased level of serotonin 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). So more serotonin can be transmitted through neurons to transmit signals to the brain to regulate mood. An advantage of SSRIs, as the name suggests, is that they only target serotonin and do not affect other neurotransmitters (Videbeck, 2010, p285). Research has shown that escitalopram has a prophylactic effectiveness of 36%, which is the highest compared to other SSRIs. such as fluoxetine and paroxetine (Clevenger et al., 2018). Thus, escitalopram is the best drug choice for the prevention of MDD relapse. Although the side effects of SSRIs are more tolerable than those of TCAs and MAOIs, they include gastrointestinal (GI) problems such as nausea and diarrhea (Ferguson, 2001). This is due to the overactivation of 5-HT3 receptors due to the large amount of serotonin available which, fortunately, if given at a lower dose, can reduce side effects (Ferguson, 2001). Research has shown that citalopram has the fewest adverse effects, thus Ferguson (2001) states that it is the most tolerable SSRI. An undesirable consequence of SSRIs is serotonin syndrome, in which there is an extremely high level of available serotonin due to excessive use of SSRIs. or insufficient washout period between taking SSRIs and MAOIs (Videbeck, 2010, p289). With the accumulation of serotonin inside the body, an individual experiences serotonin toxicity which 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, clients should be informed of the correct dosage of SSRIs. Like other antidepressants, SSRIs carry a black box warning from the United States Food and Drug Administration (Adams et al., 2013, p190) for suicidal ideation, particularly in the younger population. (Nischal, Tripathi, Nischal, & Trivedi, 2012). Due to the uplifting nature of SSRIs, clients may gain energy to engage in suicidal behaviors because they are still in a depressed state (Videbeck, 2010, p313). Thus, it is important to advise friends and relatives to monitor clients for suicidal behavior. PsychoeducationPsychoeducation is theprocess of teaching the client and family about the diagnosed mental illness. A Registered Mental Health Nurse (RMN) is usually the one providing training in a hospital ward. A strong therapeutic nurse-patient relationship (TNPR) is essential in psychoeducation in order to achieve the desired results (Dziopa and Ahern, 2009). In order to achieve TNPR, the RMN will demonstrate understanding towards the client by actively listening to them and respecting their thoughts rather than condemning their behaviors (Dziopa & Ahern, 2009). From a client's perspective, their illness may worry them because they are unfamiliar with the symptoms they are experiencing. This is where the NMR will come into play to share information with the client regarding the possible causes of MDD, the symptoms, and the treatment available to them (Bamual, Frobose, Kraemer, Rentrop & Pitschel-Walz, 2006). Psychoeducation allows the client to clarify doubts about their condition (Bamual et al., 2006), thus increasing their awareness and involving them in the treatment process. It is important that the RMN insists to the client on compliance with drug treatment so that their condition improves. For example, a client may assume that their SSRIs are not working due to the long wait time for the medication's effect to peak, causing them to lose hope and abandon their medication (Videbeck, 2010, p313 ). This scenario can be avoided when the NMR has provided information on the timing of action of SSRIs. From the perspective of the client's family, they may also be worried about the client's condition. The pressure of caring for the client can lead to stress for the caregiver. When stress is too overwhelming, family members may develop hostility and intolerance toward the client, which is referred to as elevated expressed emotion (EE) (McCann, Songprakun, & Stephenson, 2015). This in turn leads the client to relapse (McCann et al., 2015). From an empathetic perspective, the RMN advocates for the well-being of the family, providing advice on ways to cope with high EE. In the study by Shimazu et al. (2011), families of clients with MDD received four sessions of psychoeducation about depression and how to cope with high EE scenarios. The study found that the time it took for MDD clients to relapse was longer for clients whose families received psychoeducation than for the control group. After nine months of client follow-up, the psychoeducation group had a 42% lower relapse rate than the control group (Shimazu et al., 2011). Therefore, family psychoeducation is beneficial in preventing relapse for clients with MDD. When preparing for the client's discharge, the RMN should also provide the family with instructions on what to watch for, such as symptoms of MDD relapse and medication side effects (Videbeck, 2010, p298). For example, it is crucial that the NMR asks the family to constantly observe the client's behavior for signs of suicidal intent, as antidepressant use can trigger suicidal thoughts (Adams et al., 2013, p190 ). Therefore, through psychoeducation, clients can take charge of their own illness and their families can better understand them and help them cope with their condition. Interpersonal psychotherapy Interpersonal psychotherapy (IPT) is a psychotherapy developed in the 1970s to treat MDD. According to Wilfley (2001), IPT suggests that MDD develops due to changes in the interpersonal relationships surrounding the client. The death of a loved one is an example of a change in interpersonal relationships. Wilfley (2001) also states that IPT aims to reduce the symptoms ofdepression by improving the client's interpersonal relationships. This is done by targeting one of four possible interpersonal problems which are bereavement, interpersonal role conflicts, social role change and lack of social interaction (Wilfley, 2001, p7863). There are 3 main phases in IPT, the beginning (three weeks), the middle (six weeks) and the end (three weeks). The overall duration of IPT takes twelve to sixteen weeks for acute MDD because IPT is built around a structured treatment plan (Markowitz and Weissman, 2004). A therapist may be the one performing IPT in an outpatient clinic. The client will thus come to the clinic every week for each IPT session. Initially, the therapist will gather information from the client regarding all current interpersonal relationships (Markowitz & Weissman, 2004). After a detailed assessment, the therapist will identify the most appropriate interpersonal problem affecting the client (Markowitz and Weissman, 2004). Therefore, the selected interpersonal question will be the focus of the next sessions. It is important for the therapist to make the client understand that the relationship between their depression and life changes is “practical and not etiological,” as Markowitz and Weissman (2004) state. This means that the client should not blame themselves for the cause of their depression. The client is given the role of a sick person by the therapist during this time, to remove any burdens to allow them to feel more comfortable (Lipsitz & Markowitz, 2013). Markowitz & Weissman (2004) suggest that in the middle phase, the therapist advises the client on methods to resolve the interpersonal relationship. For example, if the client is grieving because of the death of his wife, then the therapist can help him grieve (Markowitz & Weissman, 2004). If the interpersonal problem is social role change such as divorce, then the therapist can also help the client grieve, while simultaneously encouraging acceptance of the new social role (Markowitz & Weissman, 2004). Thus, the client acquires new interpersonal skills from the therapist that are applicable to him in resolving his interpersonal problem. In the final phase, the therapist informs the client of the end of therapy, and both can review the client's progress. interpersonal relationship (Lipsitz & Markowitz, 2013). If the outcome is not satisfactory, the therapist will then reassess the problem that has arisen and allow the client to try new relationship skills again (Markowitz & Weissman, 2004). The therapist can praise the client's efforts to resolve their interpersonal relationship when it shows improvement. Thus, the therapist is referred to as a “cheerleader” by Markowitz and Weissman (2004), because in doing so, the client is encouraged to resolve their interpersonal relationship. Finally, the therapist discusses with the client to schedule less frequent future sessions in order to maintain the optimal state they are in (Markowitz & Weissman, 2004). Based on a meta-analysis, Cuijpers et al. (2011) states that IPT is “one of the most empirically validated management” of MDD. Various clinical studies also prove that IPT outcomes include remission and improvement of MDD symptoms (Feijo, Mari, Bacaltchuk, Verdeli & Neugebauer, 2005). Therefore, IPT is a good approach for MDD. However, one drawback is the time-limited part of the IPT. Clients who are more accustomed to therapies without time limits may find IPT too short and therefore may be unable to adapt to the structured plan (Addiction, n.d.). In Singapore, a major government organization called the Agency for Integrated Care.