Clinical Depression (Major Depression)

Clinical Depression

Clinical depression is also know as major depression, it is the most severe category of depression. It is normal for people to feel depressed when something bad happens, such as the death of a loved one. This type of depression normally goes away after a couple of weeks; but sometimes it persists. It can last for periods of six months or more, and then it is classified as clinical depression. Without treatment, symptoms of clinical depression can last for weeks, months, or years. Appropriate treatment for clinical depression, however, can help most people who suffer from clinical depression.

Signs and Symptoms of Clinical depression

In a clinical depression, more of the symptoms of depression are present, and they are usually more intense or severe. However, each individual may experience symptoms differently. Symptoms may include:

  • Inability to experience pleasure
  • Hopeless about the future, excessive pessimistic feelings
  • Insomnia or excessive sleeping
  • Fatigue or loss of energy nearly every day
  • Drug or alcohol abuse
  • Thoughts of suicide
  • Feelings of guilt, worthlessness, helplessness
  • Significant weight loss or gain

What are the Causes of Clinical Depression?

Current theory suggests those clinical depression results from complex interactions between brain chemicals and hormones that influence a person’s energy level, feelings, sleeping and eating habits. These chemical interactions are linked to many complex causes–a person’s family history of illness, biochemical and psychological make-up, prolonged stress, and traumatic life crisis such as death of a loved one, job loss, or divorce. Sometimes no identifiable cause triggers an episode of clinical depression; usually one or more stresses are involved. Medical research has found that people who suffer from clinical depression have changes in important brain chemicals, such as serotonin and norepinephrine. New medications are available that restore these brain chemicals to their proper balance and relieve symptoms of clinical depression.


Major depression can profoundly alter social, family, and occupational functioning. However, suicide is the most serious complication of major depression, resulting when the patient’s feelings of worthlessness, guilt, and hopelessness are so overwhelming that he no longer considers life worth living.

Note: If specific plans for suicide are uncovered or if significant risk factors exist (previous history, profound hopelessness, concurrent medical illness. substance abuse, social isolation), refer the patient to a mental health specialist for immediate care. Nearly 15% of patients with untreated depression commit suicide, and most of these patients sought help from a doctor within 1 month of their deaths.

Diagnostic criteria

A patient is diagnosed with a major depressive episode when he fulfills the criteria documented in the DSM-IV.

  • At least five of the following symptoms must have been present during the same 2-week period and represent a change from previous functioning; one of these symptoms must be either depressed mood or loss of interest in previously pleasurable activities (Don’t include symptoms that are due to a general medical condition, delusions, or hallucinations):

– depressed mood (irritable mood in children and adolescents) most of the day. nearly every day, as indicated by either subjective account or observation by others

– a markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

-significant weight loss or weight gain (greater than 5% of the patient’s body weight in a month) when not dieting or a change in appetite nearly every day

– insomnia or hypersomnia nearly every day

– psychomotor agitation or retardation nearly every day

– fatigue or loss of energy nearly every day

Рfeelings of worthlessness and excessive or inappro­priate guilt nearly every day

– diminished ability to think or concentrate or indecisiveness, nearly every day

– recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide.

  • The symptoms aren’t due to a mixed episode.
  • The symptoms aren’t due to a medical condition (such as hypothyroidism) or the effects of a medication or other substance (drug abuse, for example).
  • The symptoms aren’t better accounted for by bereavement (for example, symptoms persist for more than 2 months after a loved one’s death or are characterized by marked functional impairment, morbid thoughts of worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).

Psychological tests such as the Beck Depression Inventory can be used to determine the onset, severity, duration, and progression of depressive symptoms. The dexamethasone suppression test may show a failure to suppress cortisol secretion; however, this test has a high false-negative rate. Toxicology screening may suggest a drug-induced depression.

Treatments for Clinical Depression

The first step to getting appropriate treatments for clinical depression is a physical examination by a physician. If a physical cause for the clinical depression is ruled out, a psychological evaluation should be done by referral to a psychologist or psychiatrist. Physical treatments have several options including antidepressant medication therapy, psychotherapy or electroconvulsive therapy or ECT.

  1. Antidepressant medication therapy, it takes about 5 or 6 weeks to find out if that antidepressant medication is appropriate – that is it is working and does not have untoward side effects – and then it takes 6 months or more of continuation treatment to ensure that the medication remains effective.
  2. Psychotherapy – most often cognitive-behavioral and/or interpersonal therapy) for the individual. Cognitive-behavioral focused on the negative thinking and behavioral patterns associated with depression, and teaches the individual to recognize and target the self-defeating behavioral patterns that contribute to their depression.
  3. Electroconvulsive therapy (or ECT). This usually involves 8 to 10 treatments over a 3 to 4 week period. One can consider ongoing treatment once every 2 weeks to once every 4 weeks over a several month period if this treatment has been successful. (ECT)

The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control he or she has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.

While treatment is generally effective, there are some cases where the condition fails to respond. Treatment-resistant depression requires a full assessment which may lead to the addition of psychotherapy, higher medication doses, changes of medication or combination therapy, a trial of ECT /electroshock, or even a change in the diagnosis with subsequent treatment changes. Although this process helps many, some people’s symptoms continue unabated.



Bulimia Nervosa

bulimia nervosa

Bulimia (buh-LEE -me-ah) nervosa, typically called bulimia, is a type of eating disorder. The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self-deprecation. These feelings precipitate the patient’s engaging in self-induced vomiting. the use of laxatives or diuretics, or strict dieting or fasting to overcome the effects of the binges. Unless the patient devotes an excessive amount of time to binging and purging, bulimia nervosa seldom is incapacitating.

Most people with bulimia nervosa are females, ranging in age from the teens to early 20s, who are preoccupied with their weight and body image. Bulimia nervosa affects all races, but is most often diagnosed in Caucasian women.


The exact cause of bulimia is unknown, but various psychosocial factors are thought to contribute to its development. Such factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is strongly associated with depression.

Signs and symptoms

  • self-induced vomiting (usually secretive)
  • depression
  • inappropriate use of diuretics or laxatives
  • overachieving behavior
  • persistent preoccupation with eating and an irresistible craving for food.
  • anxiety


Treatment of bulimia nervosa may continue for several years. Interrelated physical and psychological symptoms must be treated simultaneously. Merely promoting weight gain isn’t sufficient to guarantee long-term recovery. A patient whose physical status is severely compromised by inadequate or chaotic eating patterns is difficult to engage in the psychotherapeutic process.

Psychotherapy focuses on breaking the binge-purge cycle and helping the patient regain control over eating behavior. Treatment may occur in either an inpatient or outpatient setting. It includes behavior modification therapy, possibly in highly structured psychoeducational group meetings. Individual psychotherapy and family therapy, which address the eating disorder as a symptom of unresolved conflict, may help the patient understand the basis of her behavior and teach her self­control strategies. Antidepressant drugs such as imipramine may be used to supplement psychotherapy.

The patient also may benefit from participation in self-help groups such as Overeaters Anonymous or in a drug rehabilitation program if she has a concurrent substance abuse problem.


Preventive measures to reduce the incidence of bulimia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.