What is Major Depressive Disorder?

As of recent research, 300 million individuals worldwide struggle with depression, that's just under the population of the entire United States. Also, it's important to know that suicide is the second leading cause of death in young adults age 15-29, after accidental injury (WHO 2018). This is a disorder that is on the rise and has been steadily increasing in recent years. Luckily there is a lot of research on the subject and a lot that can be done to detect and treat the symptoms.

Symptoms

The symptoms of depression can depend upon the form of depression an individual may have. Below I have listed common symptoms of major depressive disorder (MDD). Mentioned below are symptoms related to major depressive disorder, other depressive disorders are listed further on. Be aware that this is not an exhaustive list, depression is often comorbid* with other mental illnesses in which it can share characteristics.

- Anhedonia (loss of interest or pleasure in activities that were once fulfilling and a normal part of life)

- Suicidal ideation or persistent thoughts related to death - If you feel you or a loved one experiencing suicidal ideation and live in the U.S contact the National Suicide Prevention Lifeline (1-800-273-8255), contact a loved one, and/or contact your doctor. If you or a loved one is at risk of attempting suicide or has made an attempt call 911.

- Guilt

- Sleep problems (insomnia or sleeping to often)

- Changes in appetite (eating too much or too little)

- Fatigue

- Feelings of sadness, worthlessness, hopelessness

- Self-harm

- Difficulty concentrating

Diagnosis

Despite major depressive disorder having symptoms that can be very evident to the individual and those around them, it is very important to seek a professional diagnosis. This is for two reasons, for one, identifying the problem is often a push to become aware of it and make a change. Depression can be very hard to come to terms with and treatment is necessary to get better. The second big reason for doing so is that there are certain physiological ailments/diseases or medications that can cause symptoms of depression. These can include thyroid dysfunction, Cushing's syndrome, Addison's disease, Lyme disease, etc.

When seeking a diagnosis for depression, an individual typically would see their primary care doctor first. A primary care doctor can diagnose an individual with MDD because it is such a common disorder they are typically better versed on it than say, OCD. A doctor will usually begin by asking about symptoms (be honest, they are there to help you and will not judge you). There is no physiological test for depression, but a doctor might order blood labs or other tests to rule out a physiological condition if there are common enough symptoms. Despite there being no tests to determine if the patient is depressed there are ques they can look for. A big one is psychomotor retardation*. In several mental illnesses it isn't uncommon to have this side effect and it is easier to note visually and aurally. After all of this, if the patient has depression the doctor will often diagnose them. It's important to know that primary care doctors don't have expertise in psychology or psychopharmacology* so they will typically refer an individual to see a therapist. See my post of different types of mental health professionals to understand their differences and similarities to know what's right for you.

Once referred to a therapist they will do further intake and screening to confirm the diagnosis for themselves. It isn't uncommon for bipolar disorder and substance abuse to be mistaken as depression. Therapists when diagnosing a mental illness reference the DSM-5*. The manual has specific criteria when diagnosing any disorder and for depression the most important part is that five or more of their listed symptoms (which are very similar to the ones listed above) have been going on for at least two weeks. This is important to rule out grief or shorter term life stresses as the cause of these symptoms.

Other Kinds of Depression

- Dysthymia

- Depression in Bipolar Disorder

- Postpartum Depression

- Seasonal Affective Disorder

- Premenstrual Dysphoric Disorder

Treatment

If the therapist confirms the diagnosis then they will typically advise psychotherapy and prescribed antidepressants, as this combination has been seen to be the most effective. If the therapist does not posses the qualifications to provide medication they will provide therapy and refer the individual to a psychiatrist or psychiatric nurse. Luckily there are a lot of different antidepressants available. It's important to note that an individual won't start seeing results immediately from medication, most antidepressants take 2-6 weeks or more to see positive results. If someone is a risk to themselves they may be hospitalized and possibly placed in inpatient care but that is typically for extreme cases. There are additionally two medical procedures that exist for severe, chronic cases of MDD electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). ECT is not used today in the same way it was used to to torture patients in the early to mid-20th century. ECT uses short electrical currents and TMS uses short magnetic pulses into the brain. These treatments are reserved for patients who haven't responded to medication or psychotherapy.

What can you do?

Individual with depression

Do not blame yourself for what you are suffering with. Depression is not a sign of weakness, it is a complex disorder caused by a myriad of factors that are no fault of your own.
Do not be afraid to seek help, things won't get better if you don't. Therapists are understanding and ethically bound to remain judgement free, empathetic, and confidential. Anything you say to a therapist (aside from threatening to harm oneself or others) is held in complete confidence between you and the therapist.
Asking for help does not make you weak, you can't get over other diseases without going to the doctor. Why is this different?
Don't be disappointed if treatment doesn't work immediately, medications and therapy take time to be effective. It also might take time to find the right medication and/or therapist.
Try to make lifestyle changes. There are many smaller factors that people overlook that when combined with proper treatment make is more effective. Things like eating well, exercising, being social, having a schedule, etc.
Don't give up, you've got this :)

Loved one

Stay informed about depression and recognize the symptoms. Recognizing warning signs such as giving personal items away, becoming isolated, and any of the symptoms listed above are important for a loved one to notice and take action.
Talk to that person, don't pressure them if they are uncomfortable but make them aware that you love them and are there for them if they need to talk.
Pay attention to warning signs of suicidal ideation and call the National Suicide Prevention Hotline (1-800-273-8255) if necessary.
Be accepting and understanding, help them understand that this is not their fault and they don't need to seek treatment alone

Removing Stigma

The biggest reason that people don't seek treatment for depression or most mental illnesses is stigma. There has always been an association between depression and helplessness, weakness, and laziness in culture. It is commonly considered a choice rather than an illness caused by biological and environmental factors. Romanticization is something else that is damaging to the perception of mental illness. It has become increasingly worse on social media in recent years. Young adults have become more open online and in everyday life to talk about their struggles with depression. This openness is positive but has somehow sparked a romanticization of the disease with people producing clothing with depression written all over it, and bragging about their mental illnesses online. This, alongside stigma is something that should be challenged to make the world and internet a better place for those suffering with depression. Being an ally is important to removing the social stigma that exists worldwide.

Things you shouldn't say to those with depression:

- Really? you don't seem sad

- Oh really? me too (then proceed to talk about your struggles which aren't consistent with diagnosed depression)

- You just sound lazy

- You should try to be more positive/ just be happy

- Have you tried exercise/herbal supplement/vitamin/meditation?

- Man up (this makes things even harder for men suffering from depression because there is already a social construct that men need to be tough and just get over and take care of things on their own)

- How can you feel this way when there are people in worse situations than you?

Things not to say in general

- "I'm so depressed" when something minorly upsetting happens

- "I'm going to kill myself" when something minorly upsetting happens

Glossary

Comorbid - When an individual has two medical conditions existing at the same time.

DSM-5 - The Diagnostic and Statistical Manual of Mental Disorders edition 5 is a manual used by mental health professionals that provides criteria to diagnose and treat mental illness. The 5th edition was released in 2013.

Psychomotor retardation - The slowing down of cognition which can cause slowed speech, sower reaction time, lessened affect. It can be present in mental illness such as schizophrenia, bipolar disorder, depression, eating disorders, etc. It also can be caused as a side effect of certain medications.

Psychopharmacology - the study of medication, specifically psychotropic medication and its effects of brain functioning, mood, behavior, etc.

Sources

Carroll, V. K. (2018, April 16). Is a medical illness causing your patient's depression? Retrieved from https://www.mdedge.com/psychiatry/article/63655/medical-illness-causing-your-patients-depression

Center for Substance Abuse Treatment. Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2008. (Treatment Improvement Protocol (TIP) Series, No. 48.) Appendix D—DSM-IV-TR Mood Disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64063/

Depression. (2018, March 22). World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression

Shelby Chapman

Interdisciplinary Artist