Educational Qualifications:
A bachelors degree, or two to four years of pre-medical school.
Four years of medical school.
A internship of 12-16 months.
A license to practice psychiatric medicine.
3. Psychologist
The field of psychology is broad and growing. In the treatment of both Major and Bipolar Depressive Disorder, a clinical psychologist will analyze, diagnose, and assess the disorder in an affected patient. Also, a psychologist may conduct psychotherapy with an affected patient.
Duties and Working Conditions:
Psychiatric ward or hospital to diagnose and assess the disorder in individuals.
Private practice to treat affected patients and family members.
Research of the disorder’s basis, causes, prevention and possible treatments.
Educational Qualifications:
Four years of undergraduate study in clinical psychology at university.
Four years of graduate study in clinical psychology at university.
A internship of 12-16 months.
A license to practice psychological analysis and therapy.
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Conclusion
Up to 15% of patients with severe Major Depressive Disorder die by suicide. Over age 55, there is a quadruple increase in death rate.
10-25% of patients with Major Depressive Disorder have preexisting Dysthymic Disorder. These “double depressions” (i.e., Dysthymia + Major Depressive Disorder) have a poorer prognosis.
There are no laboratory findings that are diagnostic for this disorder.
Males and females are equally affected by Major Depressive Disorder prior to puberty. After puberty, this disorder is twice as common in females as in males. The highest rates for this disorder are in the 25- to 44-year-old age group.
The lifetime risk for Major Depressive Disorder is 10% to 25% for women and from 5% to 12% for men. At any point in time, 5% to 9% of women and 2% to 3% of men suffer from this disorder. Prevalence is unrelated to ethnicity, education, income, or marital status.
Onset And Course:
Average age at onset is 25, but this disorder may begin at any age.
Stress appears to play a prominent role in triggering the first 1-2 episodes of this disorder, but not in subsequent episodes. (An average episode lasts about 9 months.)
Recurrence:
The risk of recurrence is about 70% at 5 year follow up and at least 80% at 8 year follow-up.
After the first episode of Major Depressive Disorder, there is a 50%-60% chance of having a second episode, and a 5-10% chance of having a Manic Episode (i.e., developing Bipolar I Disorder). After the second episode, there is a 70% chance of having a third. After the third episode, there a 90% chance of having a fourth.
The greater number of previous episodes is an important risk factor for recurrence.
Recovery:
For patients with severe Major Depressive Disorder, 76% on antidepressant therapy recover, whereas only 18% on placebo recover.
For these severely depressed patients, significantly more recover on antidepressant therapy than on interpersonal psychotherapy. For these same patients, cognitive therapy has been shown to be no more effective than placebo.
Familial Pattern And Genetics:
Individuals who have parents or siblings with Major Depressive Disorder have a 1.5-3 times higher risk of developing this disorder.
The concordance for major depression in monozygotic twins is substantially higher than it is in dizygotic twins. However, the concordance in monozygotic twins is in the order of about 50%, suggesting that factors other than genetic factors are also involved.
Children adopted away at birth from biological parents who have a depressive illness carry the same high risk as a child not adopted away, even if they are raised in a family where no depressive illness exists.
Interestingly, families having Major Depressive Disorder have an increased risk of developing Alcoholism and Attention-Deficit Hyperactivity Disorder.
Bibliography
British Medical Journal (abstract on the effectiveness of Hypericum Perforatum) No.7052 Volume 313, August 1996.
Judith Michelsen, notes by Abbey Strauss, M.D., A Layperson’s Short Classification Of Psychotherapeutic Drugs, Online Psychological Services.
Stuart Yudofsky, Psychiatric Drugs, American Psychicatric Press, 1991.
D.F. Klien and P.F. Wender, Understanding Depression: A Complete Guide To It’s Diagnosis And Treatment, 1993.