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What is Major Depressive Disorder?

Feelings of sadness and sorrow is expected in response to a significant life stressor, such as following the loss of a loved one or the loss of an important job. However, when certain symptoms of Major Depressive Disorder persist for 2 weeks, and represent a drastic change from prior functioning, the diagnosis of Major Depressive Disorder should be considered.

What are the common symptoms of Major Depressive Disorder?

For the diagnosis of Major Depressive Disorder, five or the following symptoms of Major Depressive Disorder must present for at least 2 weeks are:


Depressed mood most of the day
Significantly decreased interest or pleasure in all or almost all activities almost every day
Insomnia (trouble falling and/or staying asleep) or hypersomnia (sleeping too much) almost every day
Decrease or increase in appetite, that result in significant weight loss or weight gain
Excessive or inappropriate guilt
Feeling helpless, worthless, or hopeless
Inhibited ability to think, concentrate, or make decisions
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a Suicide attempt without a specific plan, a suicide attempt, or a specific plan for carrying out suicide

For a patient to be diagnosed with major depression they must experience at least five of these symptoms for a minimum of two weeks.

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What are the treatments available for Major Depressive Disorder?

There is a myriad of effective treatments available for Major Depressive Disorder. The most conservative treatments of Major Depressive Disorder include Cognitive Behavioral Therapy and other types of psychotherapy. If psychotherapy is not adequate enough to treat a patient’s Major Depressive Disorder, then, certain psychiatric medications can effectively treat Major Depressive Disorder. 


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What Are SSRI's?

The “gold standard” psychiatric medications that is prescribed for treatment of Major Depressive Disorder are SSRI’s (selective serotonin reuptake inhibitors). Commonly prescribed SSRI’s include: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), and Lexapro (escitalopram). Patients with Major Depressive Disorder often are inadequate in the normal amount of serotonin (aka the “happiness” chemical”) in the neurosynaptic cleft. SSRI’s function by increasing the amount the serotonin in the neurosynaptic cleft. Most SSRI’s are FDA-approved for treatment of Major Depressive Disorder, but also Generalized Anxiety Disorder and Panic Disorder. 

However, one of Dr. Wu’s “go-to” psychiatric medications that are used to treat Major Depressive Disorder are SNRI’s (serotonin-norepinephrine reuptake inhibitors). Commonly prescribed SNRI’s includes: Effexor XR (Venlafaxine Hydrochloride Extended-Release), Cymbalta (Duloxetine), and Fetzima (Levomilnacipran). SNRI’s increase the amount of serotonin and norepinephrine in the neurosynaptic cleft. 

The additional benefit of the increase of norepinephrine in the neurosynaptic cleft is often an increase in physical energy and alertness, compared to just taking SSRI’s on their own. This is particularly helpful in patients with Major Depressive Disorder, who struggle with physical fatigue and decreased mental alertness

Other personal problems, like stress at work or traumatic situations, can contribute to depression in individuals who are predisposed to the condition.

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How About Other Antidepressants?

Another class of antidepressants to consider are norepinephrine-dopamine reuptake inhibitors. A commonly prescribed norepinephrine-dopamine reuptake inhibitor is Wellbutrin (Bupropion). This medication is very effective in treating melancholic depression and Seasonal Affective Depression.

This class of medications increases the amount of norepinephrine and dopamine in the neurosynaptic cleft. The benefit of the increased dopamine in the neurosynaptic cleft results in improved concentration and focus. This is why Wellbutrin is also FDA-approved for the treatment of ADHD.

In summary, there is a myriad of treatment options that can effective treat Major Depressive Disorder. Please set up a consultation with Dr. Wu to discuss which treatment would be best suited for you.

Treatment is customized based on the unique circumstances of each patient.

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