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Disorder deep dive

Major Depression

Also known as Clinical Depression

What is it?

We all get down from time to time. Especially after stressful life changes, like getting divorced or losing a loved one. But for some people, feelings of sadness and low mood don’t just happen every once in awhile. They are persistent and intense, and have a huge impact on their daily functioning.

This is called major depressive disorder (MDD) or clinical depression. People with MDD go weeks, months or even years battling their symptoms, and often struggle to maintain healthy relationships, careers and hobbies because of their condition. What they are experiencing is not the same as sadness — an emotion we all feel. Depression/MDD is a condition that impairs important cognitive, social and occupational functions. It is a disorder, not a temporary emotion.  

It is common for MDD to overlap with anxiety or to develop alongside other mental disorders. Luckily, professionals know a lot about MDD due to its prevalence. The National Institute of Mental Health (NIMH) estimates that 16.2 million U.S. adults had at least one major depressive episode in 2016, and the World Health Organization estimates that over 300 million people worldwide suffer from depression. Depression can affect people of all genders, ethnic groups and socioeconomic status.

300 million people worldwide suffer from depression
Source: World Health Organization

What are the symptoms?

Most disorders on the depression spectrum have similar symptoms. When diagnosing a patient, a doctor will focus on two factors: how long their symptoms last, and how intense they are. 

All disorders on the mood disorder spectrum impact different aspects of mood. Many of them share symptoms, just at different levels of severity and frequency. 

In the case of MDD, doctors need to confirm that at least five of the following symptoms have been present for two weeks or longer. During that time, this person’s life has become noticeably harder. They’ll also want to confirm that a person’s symptoms can’t be explained by another medical condition or recent drug use, and that there is no history of mania or hypomania.

Symptoms include:
  • Feeling down, depressed, hopeless and sad 
  • A loss of interest in most or all activities and previously enjoyable hobbies
  • Struggling to find pleasure in enjoyable activities 
  • Gaining or losing a significant amount of weight 
  • Having trouble sleeping (insomnia) or sleeping too much (hypersomnia) 
  • Feeling restless and agitated (psychomotor agitation). This might be demonstrated through feet tapping, speaking rapidly or pacing
  • Feeling emotionally and physically slow (psychomotor retardation)
  • Feeling fatigued almost every day 
  • Feeling worthless, guilty or ashamed 
  • Struggling to concentrate and complete work
  • Having repetitive thoughts about death or suicide 
  • Getting angry or aggravated easily

What are some common warning signs?

MDD is characterized by intense depressive episodes. Because of this, a loved one with MDD may display noticeable changes in their appearance and behaviors. They may socialize less, stay inside more or stop answering text messages. They may get agitated easily or say things that sound negative and self-deprecating. You might even notice physical changes such as dull skin, changes in weight or hair loss.

But sometimes, symptoms are less obvious. People battling chronic mental health conditions can learn to hide their pain from others. It’s possible to appear outwardly fine, while facing mental difficulties in secrecy. It’s important to remember that mental health conditions are invisible illnesses. Just because some people exhibit outward symptoms, doesn’t mean everyone will.

If you think a loved one may have MDD, pay attention to how they’re doing in the different areas of their life, such as at work, home, school and in their personal relationships. Do they seem disinterested or distant? Are they often negative or aggressive to those around them? Have you noticed a change in the effort they put into the things they care about, like their appearance, hobbies or social life? If so, they might be battling undiagnosed depression and you should find time to talk to them.

What causesx MDD?

Like most mental conditions, there is no one cause of MDD. It is often the byproduct of numerous, overlapping factors such as:

GENETICS

Certain people are more likely to develop depression and related conditions if they have a family history of mental health problems.

BRAIN CHEMISTRY

Doctors know that neurotransmitters in the brain - like serotonin, dopamine and norepinephrine - impact our levels of happiness. MDD or other forms of depression can be caused by an imbalance in these chemicals. SSRIs are often prescribed in hopes of rebalancing brain chemistry and stabilizing mood.

HORMONES

Hormonal changes have been associated with depression. People going through puberty, menopause or living with thyroid disorders often see a connection between hormone production and their emotional state.

SEASONAL

Seasonal depression, which used to be called SAD, is often diagnosed during long winter months when people are less active, less social and more fatigued. This can lead to feelings of isolation, hopelessness and apathy. It frequently lets up as the seasons change.

SITUATIONAL

Traumatic events and environments can send someone into a depressive state. For example, people that grew up in abusive households often struggle with depression and anxiety. It can also be caused by scenarios that increase social isolation, stress and lack of self-confidence, such as moving to a new place, starting a difficult job or living in poverty.  

MEDICATION

In some cases, depression may be a side effect of a medication such as fertility drugs, chemotherapy and/or statins (drugs that lower cholesterol).

How is it treated?

There are two primary treatment methods for MDD — medication and psychotherapy. Healthy lifestyle habits can also help people cope. Maintaining a balanced diet, 8 hour sleep schedule, mindfulness regimen (like yoga, meditation or art therapy classes) and staying physically active can ease the intensity of symptoms. However, for many people with serious depression, these adjustments won’t be enough to fully address their disorder. 

SSRIs, or selective serotonin reuptake inhibitors, are a form of antidepressant medication used to treat depression and anxiety. They work by enhancing the brain’s natural serotonin activity in hopes of increasing levels of happiness and pleasure. Well known examples include Lexapro, Prozac, Paxil and Zoloft.

However, SSRIs aren’t the only kind of antidepressant. Alternative options like serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs) might be a better fit for certain people. In some cases, a doctor will prescribe mood stabilizers or antipsychotics in addition to an antidepressant. 

Psychotherapy, also called talk therapy, is often recommended alongside or instead of medication. For mild cases of MDD, a doctor might promote therapy before turning to meds. 

Psychotherapy is a broad term that refers to a range of therapeutic models and approaches. CBT (Cognitive Behavioral Therapy) and IPT (Interpersonal Therapy) are two popular options for treating depressive disorders.

CBT is a form of therapy that challenges negative thinking patterns and behaviors. It’s rooted in the idea that our attitudes greatly impact how we think and behave. In CBT, a therapist will help a person replace negative thinking patterns and behaviors with more positive ones. 

For example, a person with depression might wake up and think “life is so hard, I’m not sure it’s worth trying.” CBT will teach them to recognize that as an unhelpful thought, and replace it with something more productive like “life gets hard, but I have the power to push through.” CBT can be administered one-on-one, or in a group.

A type of CBT called Behavioral Activation is considered a successful coping strategy for depression. Behavioral Activation lifts mood by increasing the number of positive and rewarding activities (like hiking, volunteering or socializing) in a person’s life. Doing so proves to them that their experiences greatly impact how they feel, and that prioritizing enjoyable habits and hobbies can improve their depression.

IPT is a form of therapy that focuses on a person’s interpersonal relationships. In other words, the connections they have with the people around them. IPT is rooted in the idea that our personal relationships, or lack thereof, are a primary factor in the levels of distress we feel. 

It differs from CBT in that it recognizes internal thought patterns and behaviors, but does not focus on them. Rather, it targets the stressors a person faces in their relationships with others, and hopes that by addressing those challenges, inner turmoil will subside. The goal of IPT is to minimize symptoms, improve interpersonal functioning, and increase a person’s support system.

It’s important to remember that treatment plans are personalized. If you’re seeking help, make sure you work one-on-one with a doctor to create a plan that fits your needs. Just because a medication or therapy helps someone else recover, doesn’t mean it’ll be the right solution for you. Don’t ever feel guilty about asking for help, taking meds or going to therapy. Addressing your mental health is a productive and courageous thing to do.

What It Feels Like To Have Depression

A young man navigates his education under the shadow of his depression, undergoing extraordinary personal growth as he learns to open up about his mental health battle.

How can I help a loved one with MDD?

It can be hard to know how to react when someone you love isn’t doing well. Do they want to talk about it, or would they prefer to keep their experiences private? Will you push them away by starting the conversation? 

There are no easy answers to these questions. Every person handles their mental health differently. That said, we all want to feel loved and supported. Showing someone that you’re invested in their wellbeing can make a world of difference. Here are some ways to do so: 

Educate yourself

Read up on symptoms, treatment options, and healthy living recommendations. Try and understand what your loved one is going through so you are better equipped to talk to them about it. This will also make you a valuable resource when it comes time to find treatment. 

Encourage healthy living

Sleeping well, eating nutritional foods, staying active and limiting substance use can be game changers for someone with MDD. If they’re surrounded by people who promote this kind of lifestyle, they’re more likely to form healthy habits of their own. Try joining a fitness class together, or cooking meals at home using healthy ingredients. 

Advocate treatment

Asking for help can be hard. Societal stigma often keeps people from opening up to others about their symptoms. Support your loved one by helping them research different treatment methods, or doctors in their area. If they’d like, go to a few sessions with them. Remind them that there’s nothing weird about getting help, and that you’re proud of them for following through. 

Listen

It’s common for people battling depression to feel alone. Make time for meaningful conversations. Ask them how they’re doing. Let them talk and make sure to not discount their emotions. It is not your job to fix them, just to be there. Avoid saying things like “this is just a phase” or “it could be worse.” Oftentimes, people with depression are worried about being “burdensome” and this kind of language can make them feel as if those fears are true.

Indulge their interests

It can be hard to get excited about anything when you’re in the midst of a depressive episode. If something does trigger joy, like a game, TV show or book, ask them about it. Let them ramble. Participate if possible. Having outlets for fun is important. 

Be honest with them

Don’t sugar coat their symptoms or avoid giving your honest opinion. You want to support your loved one, but not indulge the negative habits their depression wants them to form. Ignoring red flags will often lead to bigger issues later down the line. 

Be patient

Don’t take it personally if they lash out at you, don’t answer text messages or socialize less. They are battling something that’s very hard to overcome. Their distance has nothing to do with who you are as a person. Keep showing up for them even when it feels like it’s not helping. The act alone lets them know that they have people in their life who care.

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