Major Depressive Disorder What Is It

Recurrence Of Early Depression

According to the AmericanAcademyofChildandAdolescentPsychiatry practice parameters for depressive disorders in childhood and adolescence, a history of a previous depressive episode, subsyndromal symptoms of depression, dysthymia, and anxiety disorders increase the risk for future depression. In a study of an epidemiologic sample of 776 adolescents by Pine and associates, symptoms of majordepressioninadolescencestrongly predicted episodes of major depression in adulthood.

What Are The Signs And Symptoms

Major depression symptoms vary from person to person. To receive a diagnosis of major depressive disorder, some of these signs and symptoms must be present for at least two weeks. Anyone who has questions should consult their doctor.

• Continued feelings of sadness, hopelessness, pessimism, emptiness
• Fatigue, lack of energy
• Insomnia or other sleep issues such as waking up very early or sleeping too much
• Anxiety, irritability, restlessness
• Lack of interest or joy in hobbies and activities
• Changes in appetite, leading to weight loss or weight gain
• Moving, talking, or thinking more slowly
• Forgetfulness
• Trouble concentrating, thinking clearly, or making decisions
• Vague aches and pains, such as headaches, joint pain, back pain, or digestive problems
• Thoughts of death or suicide, or suicide attempts

Diagnosis Of A Depressive Episode

After taking the affected personââ¬â¢s medical history and performing a physical examination, a doctor or the mental health specialist to which the person is referred to, can diagnose a depressive episode based on the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition .

A major depressive episode is characterized by five or more of the following symptoms being present every day, or almost every day, for a minimum of two weeks:

• Depressed mood for most of the day
• Loss of interest or enjoyment in all or most activities
• Significant unexplained weight loss or gain, or appetite changes
• Sleep disturbances, including insomnia or sleeping too much
• Restlessness or sluggishness
• Tiredness or lack of energy
• Feelings of worthlessness or excessive guilt
• Difficulty thinking, concentrating or making decisions
• Thoughts of death or suicide ââ¬â there may be suicide plans or suicide attempts

These symptoms should indicate a marked difference from the affected personââ¬â¢s previous functioning. For the diagnosis to be made, at least one of the symptoms needs to be depressed mood or loss of interest in most activities. It is also necessary for the symptoms to cause significant distress or impairment in social and job functioning.

If the symptoms are attributed to another mental health condition, the diagnosis and treatment may be different to that detailed here for a depressive episode.

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Prevalence Of Major Depressive Episode Among Adolescents

• Figure 2 shows the past year prevalence of major depressive episode among U.S. adolescents in 2019.
• An estimated 3.8 million adolescents aged 12 to 17 in the United States had at least one major depressive episode. This number represented 15.7% of the U.S. population aged 12 to 17.
• The prevalence of major depressive episode was higher among adolescent females compared to males .
• The prevalence of major depressive episode was highest among adolescents reporting two or more races .

Figure 2

Persons of Hispanic origin may be of any race all other racial/ethnic groups are non-Hispanic | AI/AN = American Indian/Alaska Native. Note: Estimates for Native Hawaiian / Other Pacific Islander groups are not reported in the above table due to low precision.

Demographic
2 or more Races	20.9

*Persons of Hispanic origin may be of any race all other racial/ethnic groups are non-Hispanic | AI/AN = American Indian/Alaska Native.Note: Estimates for Native Hawaiian / Other Pacific Islander groups are not reported in the above table due to low precision.

Genetics Biology And Environment

• Genetics: Like other mood disorders, genetics can cause clinical depression. People are more prone to the disorder if members of their family experienced it.
• Biology: According to a 2018 article , changes in brain structure can occur as a person ages. This may increase the risk of depression.
• Environment: Environmental factors such as trauma or a significant loss may trigger stress, anxiety, and depression in people who have genetic features that increase their risk.

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Enhancing Healthcare Team Outcomes

An interdisciplinary approach is essential for the effective and successful treatment of MDD. Primary care physicians and psychiatrists, along with nurses, therapists, social workers, and case managers, form an integral part of these collaborated services. In the majority of cases, PCPs are the first providers to whom individuals with MDD present mostly with somatic complaints. Depression screening in primary care settings is very imperative. The regular screening of the patients using depression rating scales such as PHQ-9 can be very helpful in the early diagnosis and intervention, thus improving the overall outcome of MDD. Psychoeducation plays a significant role in improving patient compliance and medication adherence. Recent evidence also supports that lifestyle modification, including moderate exercises, can help to improve mild-to-moderate depression. Suicide screening at each psychiatric visit can be helpful to lower suicide incidence. Since patients with MDD are at increased risk of suicide, close monitoring, and follow up by mental health workers becomes necessary to ensure safety and compliance with mental health treatment. The involvement of families can further add to a better outcome of the overall mental health treatment. Meta-analyses of randomized trials have shown that depression outcomes are superior when using collaborative care as compared with usual care.

General Signs And Symptoms

Not everyone with depression will experience the same symptoms. Symptoms can vary in severity, how often they happen, and how long they last.

If you experience some of the following signs and of depression nearly every day for at least 2 weeks, you may be living with depression:

• feeling sad, anxious, or empty
• feeling hopeless, worthless, and pessimistic
• crying a lot

The symptoms of depression can be experienced differently among males, females, teens, and children.

Males may experience symptoms related to their:

• mood, such as anger, aggressiveness, irritability, anxiousness, or restlessness
• emotional well-being, such as feeling empty, sad, or hopeless
• behavior, such as loss of interest, no longer finding pleasure in favorite activities, feeling tired easily, thoughts of suicide, drinking excessively, using drugs, or engaging in high-risk activities
• sexual interest, such as reduced sexual desire or lack of sexual performance
• cognitive abilities, such as inability to concentrate, difficulty completing tasks, or delayed responses during conversations
• sleep patterns, such as insomnia, restless sleep, excessive sleepiness, or not sleeping through the night
• physical well-being, such as fatigue, pains, headache, or digestive problems

Females may experience symptoms related to their:

Children may experience

Common causes include:

You may successfully manage symptoms with one form of treatment, or you may find that a combination of treatments works best.

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What Are The Types Of Major Depression

There are several types of depressive disorders:

Postpartum Depression affects women after having a baby. It causes intense, long-lasting feelings of anxiety, sadness, and fatigue, making it difficult for mothers to care for themselves and/or their babies, as well as handle daily responsibilities. Postpartum depression can start anywhere from weeks to months after childbirth.

Psychotic Depression is a form of depression with psychosis, such as delusions and/or hallucinations .

Seasonal Affective Disorder is triggered by changes in seasons. This form of depression usually occurs during the fall and winter months when there is less sunlight.

Melancholic Depression is a severe form of depression where people have a complete loss of pleasure in almost all activities.

Treatment Options For Clinical Depression

Therapy and medication are the primary treatments for major depression.

The American Psychiatric Association notes that while both therapy and antidepressants can help ease symptoms, a combined approach may have the most benefit.

Medication can improve symptoms, but a therapist can teach long-term coping skills to help navigate distress in a way that works for you.

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Bipolar Disorder Depression Major Depressive Episodes And Mixed Episodes

Major depressive episodes are characterized by five or more of the following symptoms, all of which must be present in a more or less uninterrupted manner for at least a two week period:

• A pervasive depressed mood that colors and tones daily experience
• A diminished ability to take pleasure from activities that used to be pleasurable
• Appetite changes , which may be accompanied by weight loss or gain.
• Sleep changes
• Psychomotor agitation or retardation either cant sit still, or can hardly move.
• Constant complaints of fatigue and low energy
• Thoughts of the affected persons worthlessness, guilt or shame plague him or her
• Concentration becomes more difficult to achieve than before
• Thoughts of the desirability of death and suicide

There is no corollary to a hypomanic episode for depression no short-term hypodepressive episode that can be diagnosed. There is a related condition known as Dysthymic Disorder or Dysthymia, which describes a long-lasting mild depression. Dysthymia cannot be diagnosed at the same time as bipolar disorder, however, because in order to qualify for a diagnosis of Dysthymia, you have to show evidence of consistently mild depressive symptoms occurring more days than not over a period of at least two years. The presence of manic or hypomanic episodes during the two year period would disqualify any dysthymic disorder diagnosis.

What You Can Do: Daily Habits Make A Difference

These healthy lifestyle habits, along with professional treatment, can help you manage the symptoms of major depression:

Treatment Works. SAMHSA Can Help You Find It.

Effective treatments for major depressive disorder are available in your area. The earlier that you begin treatment, the greater likelihood of a better outcome. For confidential and anonymous help finding a specialty program near you, visit SAMHSAs Early Serious Mental Illness Treatment Locator.

If you have been diagnosed and are receiving treatment for a serious mental illness, but moved to a new location, help is available. Use SAMHSAs Behavioral Health Treatment Services Locator to locate a new program.

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Symptoms Of Major Depressive Disorder

These are some of the symptoms of major depressive disorder you may experience:

• Feeling sad or low
• Having difficulty paying attention, remembering, or making decisions
• Having difficulty sleeping, waking up too early, or oversleeping
• Experiencing unplanned changes in eating habits and weight
• Experiencing headaches, cramps, digestive issues, or other aches and pains that dont have a clear cause and dont get better with treatment
• Talking about death, having thoughts of suicide, or attempting self-harm

Everyone experiences depression differently. While some people may have a few symptoms, others may have many. The frequency, severity, and duration of the symptoms can also vary from person to person.

What Causes Major Depressive Disorder Symptoms

A single cause of major depression is as yet unknown nor could a single cause be identified in a particular depressed individual. However, research suggests that several genetic, environmental, biological and psychological factors can combine to cause depression, including an imbalance in brain chemistry or extreme changes in hormone levels during certain times like pregnancy or menopause.

Additionally, there are other risk factors that have been shown to be linked to depression. Having one or more of these factors may, though not always, make a person more prone to major depressive disorder symptoms:

• A personal or family history of depression or substance abuse
• Going through a traumatic or stressful event, such as childhood trauma or current situations like the death of a loved one.
• Certain personality traits like low self-esteem and pessimism
• A history of other mental health conditions or eating disorders
• Substance abuse
• Severe, terminal, or chronic illness
• Certain medications, including some antidepressants

Major depressive disorder symptoms can begin at any age, but typically develops in adulthood. In children and adolescents, one prominent symptom of depression is irritability, rather than a low mood.

Also Check: National Institute Of Mental Health Depression

What Does Mdd Look Like In Children

As much as we hate thinking about kids experiencing MDD, the harsh truth is that around 5% of children and adolescents experience depression at any given time. The number may be much higher, since the symptoms arent always the ones parents expect and they may not seek help.

Along with the usual signs, a depressed kid is likely to:

• Be irritable, frustrated, angry, and on edge

• Have frequent crying fits and temper tantrums

• Being aloof and not having any interest in interacting with peers or classmates

• Become super-sensitive to scolding or criticism

• Complain of recurring tummy aches or headaches

• Try to get out of going to school, after-school activities, and on playdates

• See a decline in school performance

• Experiment with vaping, smoking, or alcohol

With Treatment How Long Does It Take To Overcome Depression

When I started my treatment, I started with therapy alone, so things were slow going.

However, once I got on antidepressants, I started to notice things moving in the right direction. The antidepressants brought me to a place that allowed me to focus better on my therapy treatment, so the two forms of treatment worked well together.

While I still experience on and off symptoms of depression, I feel that after one year of treatment, my life is finally at a point where I am feeling more like a normal person. The feelings of sadness and hopelessness are significantly reduced, I am performing well at work again and I am able to enjoy my time with my friends.

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Prevalence Major Depressive Disorder

Depression is the leading cause of disability for individuals aged 1544 in the United States.4 Based on 2017 surveys, it was estimated that more than 17 million adults experienced at least one major depressive episode in the past year in the U.S. alone.5 According to the American Psychiatric Association, one in 6 individuals will experience depression at some point in the lives.6

Women experience this disorder more frequently than men. Women more frequently have internalizing symptoms of depression , while men tend to have externalizing symptoms, such as reckless behaviors and substance abuse.4,7

Children and teenagers also tend to experience certain symptoms of depression. In a younger child, depression can present itself with symptoms such as clinging to a parent, acting sick, refusing to go to school, and worrying about their parent dying. In older children and teenagers, depression may manifest as irritability, sulkiness, problems at school, or drug/alcohol use.8

How Is Depression Syndrome Diagnosed

Everyone may feel sad or down from time to time. However, clinical depression has more intense symptoms that last two weeks or longer.

To determine whether you have clinical depression, your healthcare provider will ask questions. You may complete a questionnaire and provide a family history. Your healthcare provider may also perform an exam or order lab tests to see if you have another medical condition.

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What Is Used To Treat Major Depression

Pro Tip

Sometimes people feel scared by how dark their thoughts can becomethoughts they have never had before. This is a symptom, not you. If you even feel like hurting yourself or someone else, call 911 or go to your local emergency room and ask for the psychiatrist on-call. Dr. Wegner

Treatment may include a combination of therapy, medications, and lifestyle changes. The good news is that 80% to 90% of people with depression eventually respond well to treatment.

Risk Factors For Depression

Depression is one of the most common mental health disorders in the United States. Depression can develop from biological, environmental, or psychological factors. Although depression can happen at any age, it is most likely to begin in adulthood. Depression may look different depending on the age of the individual experiencing it, but one risk factor for developing chronic mood or anxiety disorders as an adult begins with having high levels of anxiety as a child. Depression often co-occurs with other serious medical illnesses such as diabetes, cancer, Parkinsons disease, and heart disease. Depression can often make chronic medical conditions worse if left untreated. Other risk factors for depression may include:

• History of depression in self or family members
• Life events
• Trauma
• Medications, as depression could be a side effect
• Motherhood or having a child
• Substance use issues
• Social isolation
• Childhood abuse or neglect

While genetic factors can play a crucial role in the development of depression, non-genetic factors can also be significant. Depression can be triggered through life events, even when those events seem generally positive. When a mix of genetic susceptibilities and overwhelming environmental factors combine, the more likely an individual is to develop major depressive disorder.

Treatment for Major Depressive Disorder

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Tips For Living Well With Major Depressive Disorder

Living with major depression can feel lonely. People may be fearful or ashamed of being labeled with a serious mental illness, causing them to suffer in silence, rather than get help. In fact, most people with major depression never seek the right treatment. But those struggling with this illness are not alone. Its one of the most common and most treatable mental health disorders. With early, continuous treatment, people can gain control of their symptoms, feel better, and get back to enjoying their lives.

Life Expectancy And The Risk Of Suicide

Depressed individuals have a shorter life expectancy than those without depression, in part because people who are depressed are at risk of dying of suicide. Up to 60% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and borderline personality disorder. About 2â8% of adults with major depression die by suicide, and about 50% of people who die by suicide had depression or another mood disorder. The lifetime risk of suicide associated with a diagnosis of major depression in the US is estimated at 3.4%, which averages two highly disparate figures of almost 7% for men and 1% for women . The estimate is substantially lower than a previously accepted figure of 15%, which had been derived from older studies of people who were hospitalized.

Depressed people have a higher rate of dying from other causes. There is a 1.5- to 2-fold increased risk of cardiovascular disease, independent of other known risk factors, and is itself linked directly or indirectly to risk factors such as smoking and obesity. People with major depression are less likely to follow medical recommendations for treating and preventing cardiovascular disorders, further increasing their risk of medical complications.Cardiologists may not recognize underlying depression that complicates a cardiovascular problem under their care.

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