ONG Specialist & Counselling Centre
8-G, Lebuh Sungai Pinang 1,
11600 Georgetown, Penang, Malaysia.

Contact No. : +604-283 8178
+604-282 2237

Opening hours : Tue - Sat
10am - 5pm

Major Depressive Disorder (MDD) is an example of depressive disorder (mood disorder category). Its clinical importance cannot be underestimated as it is widely prevalent and carries a high morbidity and mortality. The prevalence of MDD in the community is about 10%, with a lifetime risk of up to 12% in men, and 25% in women. 15% of patients commit suicide. Therefore it is urgent to manage these patients accordingly.

Typically, the patient is in her 20s, 30s or 40s and presents with:
  1. biological symptoms of depression such as poor sleep, lack of appetite, losing weight, lack of energy, “always tired” and “being slowed down”
    A minority may complain of atypical symptoms such as sleeping too much, keeps on eating, putting on weight and agitation.

    In certain cultures and segment of society, the patient may just emphasize on these biological symptoms rather than talk about the emotional component of depression. It is therefore very important to have high index of suspicion of depression in patients (especially the elderly) who repeatedly present with multiple somatic complaints when all the biological/ medical investigations are normal.

  2. Emotional symptoms such as feeling depressed/ low/ sad/ ‘blue’/ unable to cheer up, and loss of interest. Patient usually says, “Things do not interest me anymore”.
    She may have excessive guilt and a sense of worthlessness and hopelessness.
  3. Cognitive symptoms like reduced concentration, indecisive, recurrent thoughts of death, suicidal ideation, suicidal plan and attempt.
    It is important to remember that depressive disorders are highly associated with other mental conditions such as Anxiety Disorders and Substance Misuse.

    Everyone feels sad at one time or another but when a patient has persistent low mood or loss of interest most time of the day, for nearly everyday in a 2 week period, then it must sound the alarm! Look out for signs and symptoms of depression, and other associated conditions. Treatment is warranted to reduce the duration of ‘suffering’, to reduce the risk of suicide and to quickly get the patient back to her normal level of functioning.

    Antidepressants, such as those in the tricyclics, SSRIs, SNRIs and NaSSA groups, are the main line of treatment. Nevertheless it must be prescribed judiciously based on their   side-effects profile, and toxicity in overdose. The duration of treatment is individualized based on a few factors, but generally the patient should be treated for another 6-9 months after complete symptom remission if it is the first/ initial episode of depression. Recurrence is common, especially if not fully treated. Some patients may need long term medication. Studies have repeatedly shown that a combination of pharmacotherapy and psychotherapy (IPT, CBT) is superior than either one alone in managing patients with depression.

    To learn more please click this link.

    To know more about bipolar disorders, please click here.