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Major depressive disorder MDD is one of the most common mental health disorders in New Zealand both in of terms prevalence in the past year 6 Wells et al 2006 and lifetime prevalence 16 Browne Wells Scott McGee 2006 More than half of these diagnoses were of moderate severity while 35 were severe Wells et al 2006 MDD is rated to have a moderate mean interference with life Wells et al 2006 There is also evidence to suggest that depression is the best predictor of suicide ideation Nock Hwang Sampson Kessler 2010 In fact up to 15 of those with severe MDD complete suicide American Psychiatric Association 2000 The World Health Organisation WHO 2008 ranks MDD as a top three contributor to the global burden of disease with this burden ranked first in middle- to high-income countries However WHO suggests that because of the availability of effective treatments this burden can be reduced Indeed there are a variety of treatments available for MDD which arise from different aetiological perspectives The biological psychodynamic and cognitive-behavioural perspectives are three major paradigms The aetiology and efficacy of these treatments must be examined critically to establish their effectiveness in treating MDDThe DSM-IV-TR APA 2000 characterises major depressive disorder with one or more major depressive episodes Acknowledging that sadness is an innate human emotion a major depressive episode must reflect at least a two-week change from previous functioning and not be a physiological result of drug or medicine intake Symptoms such as depressed mood and feelings of worthlessness and guilt decreased concentration loss of interest or pleasure in previously enjoyable activities as well as changes in appetite weight sleep patterns and psychomotor activity must be present for most of the time during this period Suicidal ideation or attempts may occur although like MDD these vary in frequency and intensity For symptoms to reach clinical diagnosis they must cause significant distress and interference with daily functioning If left untreated
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