Dd A Mood Disorder

MDD is a mood disorder in which one would persistently feel sad and unable to find pleasure in formerly enjoyed activities (American Psychiatric Association, 2013). It affects patients’ physical condition, day-to-day functioning, and quality of life (American Psychiatric Association, 2013). According to American Psychiatric Association (as cited in Scrandis & Watt, 2013), diagnosis of MDD is made when patients present with depressed mood or absence of interest in daily activities for a minimum of two weeks and at least five other symptoms as explained in Appendix C, as well as alterations in prior functioning. MDD is considered a chronic illness and therefore require certain amount of time for treatment (American Psychiatric Association, 2013).

Corticotropin-releasing hormone (CRH) is produced by hypothalamus in response to psychological stress, which then signals the secretion of corticotropin from pituitary, which causes the release of cortisol hormone from the adrenal gland into the plasma (Hasler, 2010). CRH is found to cause some physiological and psychosocial changes that resemble depressive symptoms (Hasler, 2010). In addition, cytokines and inflammation may play a part in the development process of some MDD patients with physical comorbidities (Dantzer, O’Connor, Freund, Johnson, & Kelley, 2008). The symptoms of active inflammatory response overlap with symptoms of MDD, including anhedonia, fatigue, psychomotor delay, and cognitive deficiency (Dantzer et al., 2008). Sickness symptoms are the results of interaction between pro-inflammatory cytokines, such as tumor necrosis factor-α, interleukin-1α, and interleukin-6, which damage the fundamental serotonin mechanism (Dantzer et al., 2008). The last theory of depression is the monoamine-deficiency theory. It simply believes that depressive symptoms are caused by depletion of neurotransmitters, such as serotonin, norepinephrine, or dopamine, in the brain (Hasler, 2010). Monoaminergic systems participate in the organization of extensive cognitive functions, such as reward processing, attention, mood, sleep, and appetite (Hasler,

Even though depression is a common issue among primary care patients, only few communicate openly with their primary care providers (Williams & Nieuwsma, 2016). Moreover, two-thirds of depressed patients at the clinic setting are present with only bodily symptoms, such as back pain and headache (Williams & Nieuwsma, 2016). The United States Preventive Services Task Force [USPSTF] (2009) commends general depression screening for adults aged 18 and older. However, this takes place only when there are some staff-assisted depression care supports, such as clinical evaluation, patient education, and follow-up calls. Otherwise, routine screening is not recommended, unless in a case where an individual is suspected of having depression based on self-report, clinical scrutiny, or risk factors for depression (USPSTF, 2009). Some established screening instruments include the PHQ-9, the PHQ-2, the Beck Depression Inventory for Primary Care, and the WHO-5 (Williams & Nieuwsma, 2016). The PHQ-9 is the most widely utilized and accurate screening tool compared to the others (Williams & Nieuwsma, 2016). It is scored 0 to 27, with scores ≥10 indicating a possible depressive disorder (Williams & Nieuwsma,