মেজর ডিপ্রেসিভ ডিজঅর্ডার (Major Depressive Disorder, MDD)
সংজ্ঞা (Definition)
মেজর ডিপ্রেসিভ ডিজঅর্ডার (MDD) হলো একটি গুরুতর মানসিক রোগ যেখানে রোগী কমপক্ষে ২ সপ্তাহ বা তার বেশি সময় ধরে গভীর দুঃখবোধ, আগ্রহহীনতা (loss of interest), শক্তিহীনতা এবং দৈনন্দিন কাজকর্মে অক্ষমতা অনুভব করে।
DSM-5 অনুযায়ী এটি একটি Mood Disorder।
Causes / Etiology (কারণ)
MDD এর কারণ multifactorial।
1. Biological Causes
Neurotransmitter imbalance
- Serotonin ↓
- Norepinephrine ↓
- Dopamine ↓
2. Genetic Factors
- Family history থাকলে ঝুঁকি বেশি
- First-degree relatives এ risk ↑
3. Psychological Factors
- Childhood trauma
- Abuse
- Low self-esteem
- Chronic stress
4. Social Factors
- Divorce
- Financial crisis
- Unemployment
- Social isolation
5. Medical Causes
Secondary depression হতে পারে:
- Hypothyroidism
- Stroke
- Parkinson disease
- Cancer
- Chronic kidney disease
6. Drug-induced
- Steroid
- Alcohol
- Interferon
- Isotretinoin
Clinical Features (লক্ষণ)
Core Symptoms
1. Depressed mood
- সারাদিন মন খারাপ
2. Anhedonia
- আগে ভালো লাগত এমন কাজেও আগ্রহ না থাকা
Associated Symptoms
- Fatigue
- Insomnia / hypersomnia
- Appetite ↓ বা ↑
- Weight change
- Poor concentration
- Feelings of worthlessness
- Excessive guilt
- Psychomotor retardation/agitation
- Suicidal thoughts
DSM-5 Diagnostic Criteria
≥5 symptoms থাকতে হবে
কমপক্ষে ২ সপ্তাহ ধরে, এবং নিচের মধ্যে একটিঃ
- Depressed mood
অথবা - Loss of interest
SIGECAPS mnemonic
| Letter | Meaning |
| S | Sleep change |
| I | Interest loss |
| G | Guilt |
| E | Energy low |
| C | Concentration poor |
| A | Appetite change |
| P | Psychomotor change |
| S | Suicidal ideation |
Clinical Diagnosis
History Taking
Important Questions
- Mood কতদিন ধরে খারাপ?
- ঘুম কেমন?
- Appetite change?
- Suicidal thought আছে?
- Hallucination আছে?
- Drug/alcohol history?
- Past psychiatric illness?
Mental Status Examination (MSE)
Findings
- Depressed affect
- Slow speech
- Poor eye contact
- Psychomotor retardation
- Hopelessness
Severity Assessment
| Severity | Features |
| Mild | Few symptoms |
| Moderate | Functional impairment |
| Severe | Suicidal risk / psychosis |
Investigations (তদন্ত)
MDD diagnosis মূলত clinical।
Routine Investigation
কারণ exclude করার জন্যঃ
Blood Tests
- CBC
- ESR
- Blood glucose
- Thyroid function test (TSH)
- Vitamin B12
- Serum electrolytes
- Liver function
- Renal function
If indicated
- CT/MRI brain
- Urine toxicology
- ECG (before TCA)
Differential Diagnosis
- Bipolar disorder
- Hypothyroidism
- Adjustment disorder
- Schizophrenia
- Dementia
- Substance abuse
Treatment & Management:-
1. Psychotherapy
Cognitive Behavioral Therapy (CBT)
সবচেয়ে effective psychotherapy।
Other therapies
- Interpersonal therapy
- Supportive psychotherapy
- Family therapy
2. Pharmacotherapy (Drug Treatment)
First-line Drugs = SSRIs
| Generic Name | Starting Dose |
| Fluoxetine | 20 mg daily |
| Capsule 1.Prolert 20 mg AS A Fluoxetine Hydrochloride Sertraline | 50 mg daily |
| Tablet 1.Repose 100 mg AS sertraline Hydrochloride | 200 mg daily |
| Citalopram Tablet 1.Citapram 10 mg AS A Citalopram Hydrobromide | 20 mg daily |
| Paroxetine Tablet 1.Panirid 20 mg AS A Paroxetine Hydrochloride | 20 mg daily |
SNRI
| Drug | Dose |
| Venlafaxine | 75 mg/day |
| Tablet 1.Venlax 75 mg AS A Venlafaxine Hydrochloride | |
| Duloxetine Tablet 1.Diliner-DR 60Mg AS A Duloxetine Hydrochloride. | 30–60 mg/day |
Atypical Antidepressants
| Drug | Feature |
| Mirtazapine | Good for insomnia |
| Tablet 1.Mirapro 7.5 mg Bupropion | AS A Mirtazapine Less sexual dysfunction |
| Tablet 1.Depnox -SR 150 mg AS A | Bupropion Hydrochloride. |
Tricyclic Antidepressants (TCA)
| Drug | Important |
| Amitriptyline | Sedative |
| Tablet 1.Amilin | 10 mg |
| Imipramine Tablet 1.Depram 25 Mg AS A Imipramine Hydrochloride. | Older drug |
⚠ Overdose risk বেশি।
MAOI
Rarely used।
- Phenelzine
Tablet 1.N/A
Severe Depression Treatment
Electroconvulsive Therapy (ECT)
Indications:
- Severe suicidal depression
- Psychotic depression
- Catatonia
- Drug-resistant depression
Emergency Admission Indications
- Suicidal attempt
- Psychosis
- Refusing food
- Severe self-neglect
Follow-up
- Antidepressant effect আসতে 2–6 সপ্তাহ লাগে
- Treatment continue:
- First episode → কমপক্ষে 6–12 months
- Recurrent → longer duration
Important Side Effects of SSRIs
| Drug Group | Side Effects |
| SSRI | Nausea, sexual dysfunction |
| SNRI | Hypertension |
| TCA | Dry mouth, constipation |
| MAOI | Hypertensive crisis |
Suicide Risk Assessment
সব MDD patient এ assess করতে হবেঃ
- Suicidal thought?
- Plan?
- Previous attempt?
- Access to weapon/drug?
Real Clinical Example
Example
২৫ বছর বয়সী মহিলা, ১ মাস ধরে:
- মন খারাপ
- ঘুম কম
- খেতে ইচ্ছা করে না
- পড়াশোনায় মনোযোগ নেই
- নিজেকে worthless মনে হয়
DSM-5 criteria অনুযায়ী MDD diagnosis হবে।
Overview / Summary
Major Depressive Disorder একটি common কিন্তু serious psychiatric disorder। Diagnosis মূলত clinical এবং DSM-5 criteria ভিত্তিক। Treatment এ psychotherapy + SSRI হলো first-line management। Suicide risk সবসময় evaluate করতে হবে।
Actionable Plan / Steps
Suspected MDD হলে:
- Detailed psychiatric history নিন
- Suicide risk assess করুন
- DSM-5 criteria মিলান
- Secondary causes exclude করুন
- Mild → CBT
- Moderate-Severe → SSRI শুরু করুন
- Follow-up 2–4 weeks
- Emergency হলে psychiatric admission দিন
References
Textbooks
- Harrison’s Principles of Internal Medicine, 21st Edition
- Kaplan & Sadock’s Synopsis of Psychiatry, 12th Edition
- Davidson’s Principles and Practice of Medicine, 24th Edition
Guidelines
- NICE Guideline: Depression in Adults (2022)
- APA Practice Guideline for Major Depressive Disorder (2020)
- WHO Mental Health Gap Action Programme (mhGAP)
Journal References
- Cipriani A, et al. Comparative efficacy of antidepressants. Lancet. 2018.
DOI: 10.1016/S0140-6736(17)32802-7 - Malhi GS, Mann JJ. Depression. Lancet. 2018.
DOI: 10.1016/S0140-6736(18)31948-2
Md.Rafiqul Islam Lipu Date:-08-05-2026 Friday Time:-09-02-45 Pm