Major Depressive Disorder

What is Major Depressive Disorder?

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Key Takeaways

Understanding Major Depressive Disorder:

  • Comprehensive Diagnosis: Characterized by persistent and severe symptoms affecting daily life.
  • Diverse Treatments: Includes psychotherapy, medication, and innovative therapies like TMS and ketamine.
  • Multiple Types: Encompasses various forms, including persistent depressive disorder and postpartum depression.

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Major depressive disorder is often simply called depression, clinical depression, or major depression. It is a relatively common – but serious – mood disorder, which comes with severe depressive symptoms that can impact one’s ability to handle normal daily activities. U.S. clinicians first introduced this condition in the mid-1970s. The term was adopted by the American Psychiatric Association and added to the DSM-III in 1980. 

According to the National Institute of Mental Health, there are five different types of depression, some of which are dependent upon specific conditions.

Major depression

This type of depression is characterized by experiencing symptoms of depression most of the time for at least two weeks. With major depression, the symptoms typically interfere with one’s ability to work, sleep, study, and eat. 

Persistent depressive disorder

This type of depression is also called dysthymia, and it often involves less severe symptoms of depression that last longer, typically at least two years. 

Perinatal depression

Also called postpartum depression, this type of major depression is experienced during pregnancy or after the birth of an infant. 

Seasonal affective disorder (SAD)

SAD is experienced during the changing seasons, with depressive symptoms generally occurring in the fall and going away in the spring or summer; though this can also occur in the summer for some individuals.

Depression with symptoms of psychosis

Depression with symptoms of psychosis is a form of severe depression in which a person also experiences symptoms of psychosis, such as delusions or hallucinations; during the depressed episode. 

Unfortunately, individuals with many other mental disorders or mental health conditions, such as bipolar disorder, also have depressive episodes. Depressive symptoms, such as feelings of sadness, indifference, or hopelessness, characterize these episodes.

Symptoms of Major Depressive Disorder

There are several types of depression, and it’s essential to understand that some patients only experience it for a short period once or twice in their lives. In contrast, others may struggle with symptoms nearly every day. Depressive episodes commonly include symptoms such as:

  • Feelings of sadness, emptiness, or hopelessness
  • Anger, irritability, or frustration
  • Loss of interest or pleasure in normal activities
  • Sleeping issues, including insomnia and excessive sleeping
  • Tiredness and a lack of energy
  • Reduced appetite or weight loss
  • Anxiety, agitation, or restlessness
  • Slowed thinking, speaking, or movement
  • Feelings of worthlessness or guilt
  • Trouble thinking, concentrating, or remembering
  • Frequent thoughts of death or suicide
  • Unexplained health conditions or physical problems, such as headaches or back pain

For many people with depression, these symptoms are severe enough to interfere with daily activities. Many people with depression are at higher risk of substance abuse. 

Treating Major Depressive Disorder

Depression is generally treated with psychotherapy, such as, cognitive behavioral therapy (to name one modality of therapy), and medications. Common medications used to treat depression include:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Atypical antidepressants, such as bupropion, mirtazapine, and others
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors (MAOIs)
  • Other medications, such as mood stabilizers, anti-psychotics, anti-anxiety, or stimulant medications

While antidepressants can work effectively at helping with a depressed mood, there are side effects and drawbacks with many of these medications, such as:

  • Finding the proper medication or combination of medications that works may take a long time.
  • It can take several weeks to see an effect. 
  • Stopping treatment abruptly can cause a worsening of symptoms.
  • Antidepressants may come with an increased risk for suicidal thoughts or behaviors, especially when first starting a medication or when the dose is changed. 

Because antidepressants may have severe side effects, many patients struggling with depression have sought alternative treatments, including: 

Transcranial magnetic stimulation (TMS)

TMS is an FDA-approved, non-invasive treatment for major depressive disorder, other mental disorders. TMS uses gentle magnetic pulses to stimulate specific parts of the brain responsible for mood and emotion regulation. TMS is often more effective than traditional antidepressants, with fewer side effects. 

Electroconvulsive therapy (ECT)

With ECT, electrical currents are passed through the brain to affect the neurotransmitters responsible for depressive symptoms. ECT is generally used for people who do not respond to antidepressants, can’t take them for health reasons, or are at high risk of suicide. 

Ketamine therapy:

Ketamine has been used as an FDA-approved anesthetic since the 1960s. It has since been considered a breakthrough therapy to treat mood disorders and pain. It is usually administered by IV, IM or as a nasal spray. 

Depression is a common mental health condition. However, the symptoms may be so severe that those with depression cannot function. If you think you may have a major depressive disorder, you must discuss it with your primary care physician so that they may refer you for psychiatric care with a mental health professional. Ignoring depression will never result in a good outcome. 

If you are feeling suicidal, it’s also vital to contact a suicide crisis line or the veteran’s crisis line immediately for assistance. 

Picture of Yvette Kaunismaki

Yvette Kaunismaki

Yvette Kaunismaki, MD, specializes in psychiatry with a holistic approach, focusing on integrating therapy and medication for women’s issues, depression, anxiety, and bipolar disorder. She emphasizes a team-based method, aiming for balanced mental health through collaborative care with experienced therapists.

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