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Depression / Major Depression

Most people get sad once in a while. But when sadness occurs 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, it is not normal—it is clinical depression.

Most individuals with clinical depression, but more females than males, have what is diagnosed as Major Depressive Disorder (MDD) in DSM-5. Important warning signs of MDD include a number of telltale 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. When several of such symptoms are 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 (e.g. alcohol) that can result in a similar cluster of symptoms as MDD, it is also crucial to rule them out before making this diagnosis. Of course, self-medicating for MDD with alcohol or other substances is always of concern, and only makes a bad situation worse in the long run. Some individuals with MDD may 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, or become acutely suicidal. In such cases, immediate intervention is needed.

There are a number of different factors that cause MDD, no single cause has been found. 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. 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 seem to participate in fewer pleasurable activities. Finally, it is also thought that having unsatisfying and negative relationships may be another factor in 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 most research-backed approaches. In very severe cases, hospitalization may be the best course of treatment for MDD. 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 withdrawal and avoidant behaviors associated with 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.

Other diagnoses related to depression are: postpartum depression (following childbirth); seasonal affective disorder (SAD), and a persistent, lower intensity form of depression called Persistent Depressive Disorder, which was previously known as dysthymia. All of these conditions have severe forms that warrant professional assessment and treatment.

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