MAJOR DEPRESSIVE DISORDER (MDD)

Definition of Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD), often simply referred to as depression, is a common and serious mental health condition characterized by persistent and intense feelings of sadness, hopelessness, and a lack of interest or pleasure in most activities. It is considered a mood disorder and can significantly interfere with a person’s daily life, affecting their thoughts, emotions, and behaviors.

Key features of Major Depressive Disorder include:

• Depressed Mood: A pervasive feeling of sadness or a sense of emptiness that persists for most of the day and on most days for at least two weeks.
• Loss of Interest or Pleasure: A marked decrease or loss of interest in previously enjoyable activities, including hobbies, social interactions, and work.
• Additional Symptoms: Individuals with MDD often experience a range of other symptoms, which may include changes in appetite and weight, sleep disturbances (insomnia or hypersomnia), fatigue, difficulty concentrating, feelings of worthlessness or guilt, and recurrent thoughts of death or suicide.
• Duration: To be diagnosed with MDD, these symptoms should persist for a significant portion of each day for at least two consecutive weeks.
• Impairment: The symptoms of MDD typically result in functional impairment, affecting a person’s ability to work, study, socialize, and take care of themselves.

MDD is a complex condition, and its exact causes are not fully understood. A combination of genetic, biological, environmental, and psychological factors is thought to contribute to its development. Diagnosis and treatment of MDD are typically done by mental health professionals, such as psychiatrists and psychologists. Effective treatments often include psychotherapy (talk therapy), medication (such as antidepressants), lifestyle changes, and support from loved ones.

It is important to note that Major Depressive Disorder is a treatable condition, and many individuals with MDD can experience significant improvement in their symptoms and overall quality of life with appropriate care and support. If you or someone you know is experiencing symptoms of depression, it is crucial to seek professional help and support. Depression is not a sign of weakness, and seeking help is a positive and courageous step toward recovery.

History of Major Depressive Disorder (MDD)

The history of Major Depressive Disorder (MDD), also known simply as depression, is a long and complex one. The understanding and classification of depression as a mental disorder have evolved over centuries. Here is an overview of some key developments in the history of MDD:

Ancient Beliefs:

In ancient civilizations, depressive symptoms were often attributed to supernatural or spiritual causes. Many early societies believed that mental and emotional disturbances were the result of evil spirits, divine punishment, or moral failings.

Hippocrates and the Humoral Theory:

In ancient Greece, the renowned physician Hippocrates proposed the humoral theory of mental illness, which suggested that an imbalance in the bodily humors (such as blood, phlegm, black bile, and yellow bile) could lead to melancholia, a term that referred to a state of severe sadness and despair.

Early Medical Understanding:

During the Middle Ages and the Renaissance, the concept of melancholia persisted, but it was increasingly recognized as a medical condition. Some treatments included bloodletting and dietary changes to correct the perceived bodily imbalances.

18th and 19th Centuries:

The 18th and 19th centuries saw advancements in the understanding of depression. The term “depression” began to replace “melancholia.” The emergence of psychiatry as a medical field contributed to a more systematic examination of mental disorders.

Psychodynamic Theories:

In the early 20th century, Sigmund Freud’s psychoanalytic theories played a significant role in shaping the understanding of depression. He proposed that unresolved conflicts and repressed emotions were at the root of depressive symptoms.

Biological and Neurochemical Discoveries:

In the mid-20th century, research into the biological and neurochemical aspects of depression gained prominence. The discovery of antidepressant medications, such as the tricyclic antidepressants and later selective serotonin reuptake inhibitors (SSRIs), revolutionized the treatment of depression.

DSM and Diagnostic Criteria:

The publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the mid-20th century provided standardized diagnostic criteria for mood disorders, including Major Depressive Disorder. This made it easier for mental health professionals to diagnose and treat the condition.

Modern Research and Understanding:

In recent decades, research has continued to advance our understanding of depression. There is now a growing appreciation for the complex interplay of genetic, environmental, and psychological factors in the development of MDD.

Stigma Reduction and Advocacy:

In the late 20th and early 21st centuries, efforts to reduce the stigma associated with depression and other mental health conditions have gained momentum. Advocacy groups, public awareness campaigns, and advancements in mental health care have made it easier for individuals to seek help and support.

The history of MDD reflects the evolving societal, medical, and scientific perspectives on mental health. Today, depression is recognized as a common and treatable mental health condition, and significant efforts are made to provide support and treatment to those affected by it.

DSM-5 criteria of Major Depressive Disorder (MDD)

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a widely used reference for mental health professionals in diagnosing various mental health conditions, including Major Depressive Disorder (MDD). To be diagnosed with MDD according to the DSM-5 criteria, an individual must exhibit a specific set of symptoms that persist for a defined period. Here are the DSM-5 criteria for Major Depressive Disorder:

A. Five (or more) of the following symptoms must be present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure:

• Depressed mood most of the day, nearly every day, as indicated by self-report (e.g., feels sad or empty) or observed by others (e.g., appears tearful).
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation).
• Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or a decrease or increase in appetite nearly every day.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
• Diminished ability to think or concentrate or indecisiveness, nearly every day (either by subjective account or as observed by others).
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or another medical condition.

D. The occurrence of the major depressive episode is not better explained by a psychotic disorder (e.g., schizophrenia, schizoaffective disorder, delusional disorder) or is not superimposed on schizophrenia, schizoaffective disorder, delusional disorder, or other psychotic disorders.

E. There has never been a manic episode or a hypomanic episode.

F. The symptoms are not better explained by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than expected, or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

To be diagnosed with Major Depressive Disorder, an individual must meet all the criteria listed above. The symptoms should be significant, persistent, and not better explained by other medical or psychiatric conditions. It’s important to note that a diagnosis should be made by a qualified mental health professional, such as a psychiatrist or psychologist, based on a thorough assessment and clinical judgment.

Etiology of Major Depressive Disorder (MDD)

The etiology of Major Depressive Disorder (MDD) is complex and not fully understood. MDD is likely the result of multiple interacting factors, including genetic, biological, environmental, and psychological elements. Here are some key factors associated with the development of MDD:

Genetic Factors:

There is evidence to suggest that a genetic predisposition plays a role in MDD. Individuals with a family history of depression are at a higher risk of developing the disorder. Specific genes and genetic variations have been implicated, although the genetic component is not the sole cause of MDD.

Biological Factors:

• Neurotransmitters: Imbalances in neurotransmitters, such as serotonin, norepinephrine, and dopamine, are often linked to MDD. It’s believed that disruptions in the regulation of these chemicals can contribute to the symptoms of depression.
• Brain Structure and Function: Structural and functional brain abnormalities have been observed in individuals with MDD, particularly in areas associated with mood regulation, such as the prefrontal cortex and the limbic system.
• Hormonal Factors: Hormonal changes can influence the development of MDD, particularly in women. For example, hormonal fluctuations during the menstrual cycle, pregnancy, and menopause can contribute to the onset or exacerbation of depressive symptoms.

Environmental Factors:

• Stress: Chronic or acute stress can trigger or exacerbate MDD. Stressful life events, such as the loss of a loved one, financial difficulties, or trauma, can be significant contributing factors.
• Early Life Experiences: Adverse childhood experiences, including abuse, neglect, or family dysfunction, can increase the risk of developing depression in adulthood.
• Social and Environmental Conditions: Factors like social isolation, lack of social support, and exposure to a negative or unsupportive environment can contribute to MDD.
• Psychological Factors: Certain personality traits and cognitive patterns may increase susceptibility to depression. For example, individuals with low self-esteem, a pessimistic outlook, or a history of repeated negative thinking patterns may be more prone to MDD.
• Physical Health Conditions: Chronic medical conditions, such as chronic pain, cancer, and heart disease, can contribute to depression. The psychological and physical burden of dealing with these conditions can lead to the development of MDD.
• Substance Use: Substance abuse, including alcohol and drugs, is often linked to MDD. Substance use can be both a cause and a consequence of depression.
• Medication and Medical Treatments: Some medications, including certain prescription drugs, can induce depressive symptoms as a side effect.

It’s important to note that these factors do not operate in isolation. Instead, they interact with one another, making it difficult to pinpoint a single cause of MDD. Additionally, not everyone exposed to these risk factors will develop depression, and not all individuals with MDD will have experienced all these risk factors. Diagnosis, treatment, and management of MDD often require a comprehensive assessment by mental health professionals who take into account the individual’s unique circumstances.

Treatment for MDD typically involves a combination of psychotherapy, medication (such as antidepressants), lifestyle changes, and social support. Understanding the complex interplay of these factors is essential for effective management and prevention of MDD.

Theories related to Major Depressive Disorder (MDD)

Several theories and models have been proposed to understand the development and manifestation of Major Depressive Disorder (MDD). These theories offer different perspectives on the causes, underlying mechanisms, and treatment approaches for depression. Here are some of the key theories related to MDD:

Biological Theories:

• Neurotransmitter Imbalance Theory: This theory suggests that an imbalance in neurotransmitters (e.g., serotonin, norepinephrine, and dopamine) in the brain plays a crucial role in the development of MDD. Antidepressant medications are often designed to address these imbalances.
• Neuroplasticity Theory: This theory focuses on changes in the structure and function of the brain, suggesting that MDD is associated with disruptions in neural circuits, neurogenesis, and synaptic plasticity. Chronic stress, for example, can negatively impact neuroplasticity.
• Hormonal Theories: Hormonal fluctuations, particularly in women, are linked to the development of MDD. Changes in estrogen and progesterone levels during the menstrual cycle, pregnancy, and menopause can influence mood.

Psychological Theories:

• Cognitive Theory: Developed by Aaron Beck, this theory posits that MDD is characterized by distorted and negative thought patterns. These negative cognitions contribute to depressive symptoms, and cognitive therapy aims to identify and challenge these distorted thoughts.
• Psychodynamic Theory: This theory, rooted in Freudian psychoanalysis, suggests that unresolved conflicts and repressed emotions from early life experiences contribute to depression. Psychoanalytic therapy aims to bring these unconscious conflicts to consciousness.
• Behavioral Theory: Behavioral theories suggest that depression is associated with learned helplessness, where individuals come to believe they have no control over their life circumstances. Behavioral therapies, like cognitive-behavioral therapy (CBT), aim to change these patterns of learned helplessness.
• Interpersonal Theory: This theory emphasizes the role of interpersonal relationships and life events in the development of MDD. It posits that difficulties in relationships, such as social isolation or conflicts, can contribute to depressive symptoms. Interpersonal therapy (IPT) focuses on improving these relationships.
• Biopsychosocial Model: This model takes a comprehensive approach, considering the interaction of biological, psychological, and social factors in the development of MDD. It acknowledges that multiple factors, including genetics, neurobiology, cognitive processes, and life experiences, all contribute to depression.
• Diathesis-Stress Model: This model suggests that individuals have a genetic or biological predisposition (diathesis) to MDD, and the onset of depression is triggered by environmental stressors. The severity and likelihood of depression are influenced by the interplay of these factors.
• Evolutionary Theory: Some evolutionary psychologists propose that certain depressive symptoms, such as social withdrawal and reduced interest in pleasurable activities, may have had adaptive functions in the past. In modern times, these symptoms can become maladaptive and lead to MDD.
• Sociocultural Model: This model emphasizes the role of social and cultural factors in the development of MDD. It highlights how cultural norms, societal expectations, and socioeconomic conditions can influence the expression and experience of depression.
• Neuroinflammatory Theory: Emerging research suggests that inflammation in the brain and body may play a role in MDD. Chronic inflammation can disrupt neurochemical balance and contribute to depressive symptoms.

It’s important to note that these theories are not mutually exclusive, and depression likely results from a combination of multiple factors. The specific causes and manifestations of MDD can vary from one individual to another. Effective treatment and management of MDD often involve a multidisciplinary approach that takes into account the various aspects of these theories.

Risk factors of Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD) is a complex mental health condition influenced by a variety of risk factors, including biological, psychological, and environmental factors. While experiencing one or more of these risk factors does not guarantee that an individual will develop MDD, they can increase the likelihood of its onset. Some common risk factors for MDD include:

Family History:

Having a family history of depression or other mood disorders increases the risk of MDD. There is a genetic component to depression, and individuals with a family history of the condition may be more genetically predisposed.

Genetics:

Certain genes and genetic variations have been associated with an increased risk of MDD. While genetics play a role, they interact with environmental factors.

Biochemical Imbalances:

Imbalances in neurotransmitters (e.g., serotonin, norepinephrine, and dopamine) in the brain have been linked to MDD. Changes in these neurotransmitters can affect mood regulation.

Brain Structure and Function:

Abnormalities in brain structure and function, particularly in regions involved in emotional regulation and mood, can contribute to the development of MDD.

Hormonal Changes:

Fluctuations in hormones, such as during the menstrual cycle, pregnancy, postpartum period, and menopause, can influence mood and increase the risk of depression, especially in women.

Chronic Medical Conditions:

People with chronic medical conditions like cancer, diabetes, heart disease, and chronic pain are at a higher risk of developing MDD due to the physical and emotional burdens associated with these conditions.

Trauma and Stress:

Experiencing significant trauma, such as physical or sexual abuse, emotional trauma, or other major life stressors, can increase the risk of MDD. Chronic stress, including ongoing work-related stress, can also be a contributing factor.

Childhood Adversity:

Adverse childhood experiences, including neglect, abuse, or the loss of a parent, can raise the risk of MDD in adulthood.

Personality Traits:

Certain personality traits, such as high levels of neuroticism, introversion, or perfectionism, may increase vulnerability to depression.

Substance Abuse:

Alcohol and drug abuse can both contribute to and result from MDD. Substance abuse can worsen depression and make it more challenging to treat.

Social Isolation:

Social isolation and a lack of social support are risk factors for MDD. Strong social connections and support systems are protective against depression.

Environmental Factors:

Living in a challenging environment with limited resources, exposure to violence, discrimination, or other adverse social and economic conditions can elevate the risk of MDD.

Recent Loss or Bereavement:

The loss of a loved one, such as through death or divorce, can lead to a specific type of depression called “bereavement-related depression,” which shares similarities with MDD.

It’s essential to recognize that these risk factors often interact and can be cumulative. Additionally, not everyone with these risk factors will develop depression, and many individuals with MDD do not have a clear history of these risk factors. Diagnosis and treatment of MDD should be based on a comprehensive evaluation by a mental health professional who takes into account an individual’s unique circumstances and risk factors. Early intervention and support can be crucial in managing MDD and reducing its impact on an individual’s life.

Treatment of Major Depressive Disorder (MDD)

The treatment of Major Depressive Disorder (MDD) typically involves a combination of approaches aimed at addressing the biological, psychological, and social factors that contribute to depression. It’s important to note that treatment should be individualized, and what works best for one person may not be the same for another. Treatment options for MDD include:

Psychotherapy (Talk Therapy):

• Cognitive-Behavioral Therapy (CBT):CBT helps individuals identify and challenge negative thought patterns and replace them with healthier, more constructive thinking. It also focuses on behavior change and problem-solving.
• Interpersonal Therapy (IPT): IPT is designed to improve interpersonal relationships and address difficulties in social interactions. It helps individuals develop healthier ways of communicating and relating to others.
• Psychodynamic Therapy:This form of therapy explores unconscious conflicts and unresolved issues from the past that may be contributing to depression. It aims to increase self-awareness and insight.

Medication:

• Antidepressants:

These medications, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and others, work to correct imbalances in neurotransmitters in the brain. It may take several weeks for the full therapeutic effects to be realized, and medication should be closely monitored by a healthcare provider.

• Atypical Antidepressants:

Some antidepressants, such as bupropion and mirtazapine, have different mechanisms of action than traditional SSRIs and SNRIs.

• Monoamine Oxidase Inhibitors (MAOIs):

MAOIs are less commonly prescribed due to dietary and drug interaction restrictions, but they may be considered for individuals who do not respond to other treatments.

Brain Stimulation Therapies:

• Electroconvulsive Therapy (ECT):

ECT is typically reserved for severe cases of MDD that do not respond to other treatments. It involves controlled electric currents applied to the brain to induce a seizure. ECT can lead to rapid improvement in symptoms.

• Transcranial Magnetic Stimulation (TMS):

TMS involves the use of electromagnetic coils to stimulate specific areas of the brain. It is an option for individuals who have not responded to medication or psychotherapy.

Lifestyle Changes:

• Physical Activity:

Regular exercise has been shown to have a positive impact on mood and can complement other treatments for MDD.

• Healthy Diet:

A balanced diet with adequate nutrition is essential for overall well-being, including mental health.

• Sleep Management:

Addressing sleep disturbances, which are common in MDD, can improve mood and overall functioning.

• Reducing Alcohol and Drug Use:

Minimizing or abstaining from alcohol and illicit drug use is crucial, as these substances can worsen depression.

• Social Support:

Building and maintaining a strong support network of friends and family can provide emotional support and assistance during treatment.

• Mind-Body Practices:

Techniques such as mindfulness meditation, yoga, and relaxation exercises can help individuals manage stress and improve their overall well-being.

• Self-Help Strategies:

Self-help books, apps, and online resources can provide individuals with tools and information to manage their depression.

It’s essential for individuals with MDD to work closely with a mental health professional, such as a psychiatrist, psychologist, or therapist, to determine the most appropriate treatment plan. Treatment plans may involve a combination of the above approaches, and the effectiveness of treatment may vary from person to person. Early intervention and ongoing support are key to managing MDD, and individuals should communicate openly with their healthcare providers to monitor progress and make adjustments as needed. If you or someone you know is struggling with depression, seeking professional help is a critical step in the path to recovery.

Therapies of Major Depressive Disorder (MDD)

Therapies for Major Depressive Disorder (MDD) aim to help individuals manage and alleviate their depressive symptoms, improve overall well-being, and prevent the recurrence of depressive episodes. Several types of therapy have been shown to be effective in treating MDD. Here are some of the most commonly used therapeutic approaches:

Cognitive-Behavioral Therapy (CBT):

CBT is one of the most widely used and well-researched therapies for MDD. It focuses on identifying and challenging negative thought patterns and beliefs that contribute to depressive symptoms. CBT helps individuals develop healthier thinking and problem-solving skills, as well as improve coping strategies for managing stress and difficult emotions.

Interpersonal Therapy (IPT):

IPT is a time-limited therapy that concentrates on addressing interpersonal problems and conflicts that may contribute to depression. It helps individuals enhance their communication and relationship skills, ultimately reducing depressive symptoms related to social difficulties.

Psychodynamic Therapy:

This therapy explores unconscious conflicts, unresolved issues, and early life experiences that may be influencing the individual’s current depressive symptoms. Psychodynamic therapy aims to increase self-awareness and insight into these underlying issues.

Behavioral Activation:

Behavioral activation is a component of CBT that focuses on increasing engagement in pleasurable and meaningful activities. It helps individuals regain a sense of accomplishment and joy in their lives, which can counteract the lack of interest and pleasure often seen in depression.

Mindfulness-Based Cognitive Therapy (MBCT):

MBCT is a combination of CBT and mindfulness meditation techniques. It is designed to help individuals become more aware of their thoughts and feelings and to prevent the recurrence of depressive episodes.

Dialectical Behavior Therapy (DBT):

DBT was initially developed to treat borderline personality disorder but has been adapted to treat mood disorders, including depression. It combines cognitive-behavioral strategies with mindfulness and acceptance techniques to help individuals manage emotional regulation.

Group Therapy:

Group therapy can be a valuable adjunct to individual therapy. It provides a supportive and structured environment where individuals with MDD can share their experiences, learn from others, and practice social and interpersonal skills.

Family or Couples Therapy:

When depression has a significant impact on family or romantic relationships, involving family members or partners in therapy can be beneficial. Family therapy or couples therapy can help improve communication and address relationship dynamics.

Art, Music, or Expressive Therapies:

These creative therapies can provide individuals with alternative ways to express and process their emotions, which can be particularly helpful for those who find it challenging to verbalize their feelings.

Self-Help and Support Groups:

While not traditional therapies, self-help resources and support groups can provide valuable emotional support and practical advice for managing depression. These groups may be in-person or online.

It’s important to note that the choice of therapy depends on the individual’s preferences, the severity of their depression, and their specific needs. Many individuals benefit from a combination of therapies, medication, and lifestyle changes. A qualified mental health professional, such as a psychiatrist, psychologist, or licensed therapist, can assess the individual’s condition and recommend the most appropriate therapy or combination of therapies for their specific situation. Early intervention and ongoing support are key to managing MDD effectively.

Preventions of Major Depressive Disorder (MDD)

Preventing Major Depressive Disorder (MDD) can be challenging because it’s influenced by a complex interplay of genetic, biological, psychological, and environmental factors. However, there are strategies and approaches that can reduce the risk of developing MDD or help manage depressive symptoms. Here are some prevention strategies:

Early Intervention

Early recognition and intervention are crucial. If you or someone you know is experiencing depressive symptoms, seek help from a mental health professional. Early treatment can prevent the worsening of symptoms and the development of a full-blown depressive episode.

Cognitive-Behavioral Therapy (CBT):

CBT can be used not only as a treatment but also as a preventive measure, particularly for individuals at risk of recurrent depressive episodes. Learning to identify and reframe negative thought patterns can help reduce the risk of future episodes.

Mindfulness and Stress Reduction Techniques:

Mindfulness meditation and stress reduction techniques can improve resilience to stress and may help prevent the onset of MDD. These practices promote self-awareness and emotional regulation.

Physical Activity:

Regular exercise has been shown to have a positive impact on mood and can reduce the risk of depression. Aim for at least 150 minutes of moderate-intensity exercise per week.

Healthy Diet:

A balanced diet rich in whole grains, fruits, vegetables, lean protein, and omega-3 fatty acids can support overall well-being. Avoid excessive sugar and processed foods, which can negatively affect mood.

Adequate Sleep:

Maintain a consistent sleep schedule and ensure you get enough quality sleep, as sleep disturbances can contribute to depression. Good sleep hygiene practices can help.

Limit Alcohol and Substance Use:

Excessive alcohol and drug use can increase the risk of MDD. Reducing or abstaining from these substances is important for both prevention and treatment.

Social Support:

Maintain strong social connections and seek support from friends and family. A robust social support network can be a protective factor against depression.

Positive Coping Strategies:

Develop healthy coping strategies for managing stress, such as problem-solving, emotional expression, and seeking help when needed.

Early Recognition of Stressors:

Be attentive to life stressors and recognize when they are impacting your well-being. Early recognition can help you take action to manage stress and prevent it from leading to depression.

Set Realistic Goals and Expectations:

Avoid setting unrealistically high expectations for yourself. Perfectionism and excessive self-criticism can be risk factors for depression. Set achievable goals and be kind to yourself.

Work-Life Balance:

Maintain a healthy work-life balance. Excessive work-related stress and long hours can contribute to depression. Prioritize self-care and leisure activities.

Address Past Trauma:

If you have a history of trauma or unresolved issues, consider therapy or counseling to work through these experiences. Addressing past trauma can reduce the risk of depression.

Education and Awareness:

Understand the signs and symptoms of depression and educate yourself and others about mental health. Reducing the stigma around seeking help for mental health issues can encourage early intervention.

It’s important to note that while these prevention strategies can reduce the risk of MDD, they may not guarantee immunity from the disorder. Some individuals may develop MDD despite taking preventive measures, and it’s essential to seek help promptly if depressive symptoms arise. Mental health professionals can provide personalized guidance and support for both prevention and treatment.