Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD) is a very severe and disabling condition that can result in death (normally by suicide). There is no known cure for MDD, though medical science is developing more and better treatment methods. The Selective Serotonin Re-Uptake Inhibitor (SSRI) class of medications have been effective, often more effective than the prior medications that were commonly used, which included Monoamine Oxidase Inhibitors and Tricyclic medications. A new class of medications is now being considered, which are known as hallucinogens. Specifically, Psilocybin and Ketamine are making news in terms of showing promise as treatments for MDD. Historically, 3,4-methylenedioxy-methamphetamine (MDMA) was used by psychotherapists as an effective medication before it was banned by the Federal government. MDMA is currently being re-examined as a treatment for various mental health issues.

Interestingly, ECT (Electro-Convulsive Therapy) is still used to treat just one condition…MDD. ECT is reportedly so effective at treating severe cases of MDD that some patients really need to have a course of several ECT treatments in order to feel any semblance of normalcy, and to reduce the likelihood of suicide.

Overall, the science surrounding the treatment of MDD is an ongoing process.

I prefer to treat MDD through a stepwise process of minimal intensity at first, with increasing levels of intervention if needed. These increasing levels of intervention include examination of the patient’s daily routine, habits, and socio-cultural environment. New patterns of behavior and activity are recommended, as well as trials on medication if needed, activity level changes, and integration of other specialists as appropriate. The effective treatment of MDD is usually an ongoing process, and requires periodic treatment plan reviews and changes.

Matthew Brittain