Sadness is an emotion experienced by all people at different times of their life. This emotion becomes of concern under certain circumstances. For example, if a person experiences sadness every day for weeks on end, if the sadness is accompanied by a number of additional symptoms, or if the sadness begins to interfere with the person’s relationships or their livelihood. Under these circumstances, then a person may be experiencing a clinical condition known as Major Depressive Disorder (MDD). Important warning signs of MDD include a number of tell-tale symptoms such as experiencing less pleasure from everyday activities, a reduced interest in sex, unintentionally losing weight or gaining weight from excessive eating, no appetite or a larger appetite than normal, excessive or inappropriate feelings of guilt about past actions, feeling worthless, feeling hopeless, sleeping very little or sleeping a lot, having little energy to complete everyday activities, difficulty with memory or concentration, and feeling as if your mind drifts. Some individuals with MDD may even have recurrent thoughts of death or thoughts of suicide such as “life is no longer worth living.” In very severe cases, people may begin to have perceptual disturbances like hallucinations. When several of these tell-tale symptoms present along with feelings of sadness for a prolonged period of time (more than two weeks), it is very important to seek professional help. As there are a number of medical conditions and substances that result in a similar cluster of symptoms as MDD, it is also crucial to rule out other causes. Only skilled professional help will assist in this process.
MDD is a very common disorder. Some people have even called MDD the “common cold” of mental health conditions. It is estimated that 10-25% of women and 5-12% of men will be diagnosed with MDD once in their life. Women are more often diagnosed with MDD than men, although the cause for this gender difference is still not clear. All people with MDD are not alike; some individuals may experience mild symptoms while others may suffer from severe symptoms.
There are a number of different factors that cause MDD. It is pretty safe to say that there is no single cause for MDD. First, there seems to be a biological predisposition to the development of MDD. In other words, a child of a person who has struggled with MDD is more likely to develop MDD than a child of a person who has never been diagnosed with MDD. Second, there are notable neurobiological differences between people with MDD and people without MDD. Certain brain chemicals such as serotonin and norepinephrine have been found to play a role. Third, people with MDD may think in a way that promotes or maintains their depression. People with MDD may automatically perceive situations in distorted ways and/or they may follow faulty internal “rules” they have developed over time that may in turn lead them to feel sad (e.g. “there is no one who can understand me.”) Fourth, the behaviors of people with MDD are another factor. People with MDD may participate in fewer pleasurable activities. They may lack healthy coping skills or social skills. Finally, it is also thought that having unsatisfying and negative relationships may be another factor that causes MDD.
There is help for people with MDD, that’s the fortunate news. Depending on the severity of the symptoms, psychotropic medication and/or Cognitive Behavioral Therapy are the research-backed recipe for relief. In very severe cases, hospitalization may be the best course of treatment for a period of time. For most, however, a combination of medication and CBT is the prescription of choice. Cognitive-Behavioral Therapy (CBT) focuses on the thinking patterns and behaviors that may cause or maintain MDD. CBT provides practical skills to combat thinking errors (e.g., “I fail at everything.” “I’m a loser.”), and to counteract behavioral causes of MDD (e.g., scheduling pleasurable activities, planning rewards). Psycho-education provides a framework to understand the skills taught in CBT, such as the relationships between situations, thoughts, emotions, and behaviors. Revising maladaptive rules or schemas of self, others and the world may prevent the development of future episodes of depression. For most individuals who suffer from MDD, there is much hope for relief from suffering with CBT and/or medications.
Tip: Trace the link from a situation, the automatic thoughts that arose in response to the situation, the emotion (sad, mad, scared, glad) elicited as well as its intensity on a scale from 0 to 100 to the depressive behaviors that ensured. Awareness of this relationship will be a good start to facing the challenges of MDD.