Major Depressive Disorder

What is Major Depressive Disorder?

Major Depressive Disorder, also commonly known as Major Depression, is a mood disorder that causes persistent and intense feelings of sadness, hopelessness, guilt, worthlessness, and loss of interest or pleasure in most or all normal activities. Major depression can affect your mood, thoughts, feelings, behaviour, physical health, and overall functioning. It can interfere with your ability to work, study, sleep, eat, and enjoy life. Major depression is not the same as feeling sad or blue occasionally. It is a serious condition that requires professional treatment.

Major depression is one of the most common mental health disorders in the world. According to the World Health Organization (WHO), more than 264 million people of all ages suffer from depression globally. Depression is the leading cause of disability worldwide and a major contributor to the overall global burden of disease. Depression can affect anyone at any age, but it is more common among women than men. Depression can also occur along with other mental health problems, such as anxiety disorders, bipolar disorder, substance use disorders, and personality disorders.

Major depression can have a significant negative impact on your physical and mental health, as well as your relationships, career, and quality of life. Therefore, it is important to seek help if you think you may have depression or any other mental health problem.

What are the symptoms of Major Depressive Disorder?

The symptoms of major depression can vary from person to person and may change over time. These typically include:

• Feeling sad, empty, hopeless, or tearful most of the day, nearly every day
• Losing interest or pleasure in most or all normal activities that you used to enjoy
• Having significant changes in your appetite or weight, either gaining or losing weight without trying
• Having trouble falling asleep, staying asleep, or sleeping too much
• Feeling restless, agitated, or slowed down
• Feeling tired, fatigued, or lacking energy
• Feeling worthless, guilty, or ashamed
• Having difficulty thinking, concentrating, remembering, or making decisions
• Having recurrent thoughts of death, suicide, or harming yourself

Some people with major depression may also experience other symptoms, such as:

• Physical pain, such as headaches, backaches, or stomach aches
• Anxiety, panic attacks, or phobias
• Irritability, anger, or frustration
• Loss of libido or sexual problems
• Substance abuse or addiction

What causes Major Depressive Disorder?

There is no single cause of major depression. Most experts believe that it is the result of a complex interaction of biological, psychological, social, and environmental factors. Some of the possible causes or risk factors for developing major depression include:

• Genetic factors: Having a family history of depression or other mental health problems can increase your risk of developing depression. Researchers have identified some genes that may be involved in regulating mood and stress response.
• Brain chemistry: The brain uses chemicals called neurotransmitters to communicate between nerve cells. Imbalances in the levels or activity of these neurotransmitters, such as serotonin, dopamine, and norepinephrine, may play a role in causing or triggering depression.
• Hormonal factors: Changes in hormone levels due to pregnancy, childbirth, menopause, thyroid problems, or other medical conditions can affect mood and trigger depression in some people.
• Psychological factors: Having certain personality traits, such as low self-esteem, pessimism, perfectionism, or excessive self-criticism can make you more vulnerable to depression. Experiencing stressful life events, such as loss of a loved one, divorce, abuse, trauma, financial problems, or chronic illness can also trigger or worsen depression.
• Social factors: Feeling lonely, isolated, unsupported, or discriminated can contribute to depression. Having poor relationships with family members, friends, co-workers, or romantic partners can also affect your mood and self-worth.
• Environmental factors: Living in poverty, violence, war zones, or areas with high pollution can increase your exposure to stress and adversity and lower your quality of life. Lack of access to adequate health care, education, employment opportunities can also limit your coping resources and increase your risk of depression.

These factors can interact and influence each other in different ways. For example, genetic factors may make you more prone to depression, but environmental factors may trigger it. Or psychological factors may cause you to have negative thoughts about yourself, but hormonal factors may amplify them. Therefore, it is important to understand the causes of your depression and how they affect you personally. This can help you find the best treatment and prevention strategies for your condition.

How is Major Depressive Disorder diagnosed?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the Diagnostic Criteria for Major Depressive Disorder is as follows:

A. Five (or more) of the following symptoms have been present during the same 2-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.

Note: Do not include symptoms that are clearly attributable to another medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain(e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly everyday.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. 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 to another medical condition.

Note: Criteria A–C represent a major depressive episode.

Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.

D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

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

Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.

How can you manage your Major Depressive Disorder?

In addition to getting professional treatment, there are some things you can do to manage your major depression and improve your quality of life. Some of these include:

• Seek support: You are not alone in your struggle with depression. Reach out to your family members, friends, co-workers, or other people who care about you and can offer you emotional support, practical help, or companionship. You can also join a support group for people with depression, where you can share your feelings and experiences with others who understand what you are going through.
• Take care of yourself: Major depression can affect your physical health as well as your mental health. Therefore, it is important to take care of your body and mind by following a healthy lifestyle. This means eating a balanced diet, drinking enough water, getting enough sleep, engaging in regular physical activity, avoiding alcohol and drugs, and managing stress. These habits can help boost your mood, energy, and self-esteem, as well as prevent or reduce the risk of other health problems.
• Do things you enjoy: Major depression can make you lose interest or pleasure in the things you used to enjoy. However, it is important to keep doing the activities that make you happy or give you a sense of accomplishment. This can help you cope with negative emotions, distract you from your worries, and improve your mood and confidence. You can try hobbies, sports, arts, music, games, reading, writing, volunteering, or anything else that sparks your interest. You can also set small and realistic goals for yourself and celebrate your achievements.
• Challenge negative thoughts: Major depression can make you think in negative and distorted ways about yourself, your situation, and your future. These thoughts can make you feel worse and keep you stuck in a vicious cycle of depression. However, you can learn to challenge and change these thoughts by using psychotherapeutic techniques. This involves identifying the negative thoughts that trigger or worsen your depression, evaluating their accuracy and validity, and replacing them with more positive and realistic thoughts that reflect the facts and evidence. You can also use positive affirmations, gratitude journals, or inspirational quotes to boost your mood and self-esteem.
• Seek professional help: Sometimes, self-help strategies may not be enough to cope with major depression. If you feel that your depression is affecting your daily functioning, relationships, or quality of life, or if you have thoughts of harming yourself or others, you should seek professional help as soon as possible. There is no shame in asking for help when you need it. There are many effective treatments available for major depression that can help you recover and live a fulfilling life.

I hope this article has helped you understand more about major depressive disorder and how to manage it. If you have any questions, please feel free to ask.