MDD, Major depressive disorder entities

Clinic

• MDD also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities

Symptoms / Signs

• Low mood:Thoughts and feelings of worthlessness, Inappropriate guilt or regret, Helplessness or Hopelessness.
• Poor concentration and memory
• Withdrawal from social situations and activities
• Reduced sex drive
• Irritability
• Thoughts of Death / Suicide
• Insomnia is common; in the typical pattern, a person wakes very early and cannot get back to sleep.
• Hypersomnia
• In severe cases, depressed people may have psychotic symptoms including delusions or, less commonly, hallucinations, usually unpleasant.
• Fatigue
• Headaches
• Digestive problems
• Appetite often decreases, resulting in weight loss, although increased appetite and weight gain occasionally occur.
• Older depressed people may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements.
• Depressed children may often display an irritable rather than a depressed mood

Other health problems

Depression can also come secondary to a chronic or terminal medical condition, such as HIV/AIDS or asthma, and may be labeled "secondary depression." It is unknown whether the underlying diseases induce depression through effect on quality of life, or through shared etiologies (such as degeneration of the basal ganglia in Parkinson's disease or immune dysregulation in asthma).

Pathophysiology

Current theories center around

• Monoaminergic systems
• Circadian rhythm
• Immunological dysfunction
• HPA-axis dysfunction and structural or functional abnormalities
• Emotional circuits

Subtypes

• Melancholic depression
  • Loss of pleasure in most or all activities
  • A failure of reactivity to pleasurable stimuli
  • A quality of depressed mood more pronounced than that of grief or loss
  • A worsening of symptoms in the morning hours
  • Early-morning waking
  • Psychomotor retardation
  • Excessive weight loss
  • Excessive guilt
• Atypical depression
  • Mood reactivity (paradoxical anhedonia) and positivity
  • Significant weight gain or increased appetite (comfort eating)
  • Excessive sleep or sleepiness (hypersomnia)
  • Sensation of heaviness in limbs known as leaden paralysis
  • Significant long-term social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.

• Catatonic depression
  • Disturbances of motor behavior and other symptoms
  • Mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements.
• Depression with anxious distress
• Co-occurrence between depression or mania and anxiety, as well as the risk of suicide of depressed individuals with anxiety. Specifying in such a way can also help with the prognosis of those diagnosed with a depressive or bipolar disorder.

• Depression with peri-partum onset
  • Intense, sustained and sometimes disabling depression experienced by women after giving birth or while a woman is pregnant.
• Seasonal affective disorder (SAD)
  • Depressive episodes come on in the autumn or winter, and resolve in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times, over a two-year period or longer.

Entities

	HSV-1	EBV	CMV	HSV-2
Adrenal insufficiency	++	+	+++
Autonomic dys, parasympathetic Hyperactivity	+++	+++	+++	+
Memory weakness		+++	+++
Sleeplessness			+++
Fatigue	++	+++	+
Irritability / Anger	+++		+	+++
Hallucination	+	+		+
Depression	+			+
Ileus		+++	+++
Constipation	++	+		++

Anorexia, Sleepiness and weight loss is covered by all four, so it is deleted from the table.

Points

• HSV-1 , HSV-2 are suggested in Irritable/ Anger, constipation depression
• EBV and CMV are suggested for MDD with Fatigue, Memory weakness and Ileus.