Everything You Need to Know About Depression (Major Depressive Disorder)

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What is depression?

 

 

Depression is classified as a mood disorder. It may be described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities.

It’s also fairly common. Data from the Centers for Disease Control and Prevention estimates that 18.5 %t of adults had symptoms of depression in any given 2-week period in 2019.

Though depression and grief share some features, depression is different from grief felt after losing a loved one or sadness felt after a traumatic life event. Depression usually involves self-loathing or a loss of self-esteem, while grief typically does not.

In grief, positive emotions and happy memories of the deceased typically accompany feelings of emotional pain. In major depressive disorder, the feelings of sadness are constant.

People experience depression in diverse ways. It may interfere with your daily work, resulting in lost time and lower productivity. It can also influence relationships and some chronic health conditions.

Conditions that can get worse due to depression include:

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• arthritis

• asthma

• cardiovascular disease

• cancer

• diabetes

• obesity

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It’s important to realize that feeling down at times is a normal part of life. Sad and upsetting events happen to everyone. But if you’re feeling down or hopeless on a regular basis, you could be dealing with depression.

Depression is considered a serious medical condition that can get worse without proper treatment.

 

Depression symptoms

 

Depression can be more than a constant state of sadness or feeling “blue.”

Major depression can cause a variety of symptoms. Some affect your mood and others affect your body. Symptoms may also be ongoing or come and go.

 

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 symptoms of depression nearly every day for at least 2 weeks, you may be living with depression:

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• feeling sad, anxious, or “empty”

• feeling hopeless, worthless, and pessimistic

• crying a lot

• feeling bothered, annoyed, or angry

• loss of interest in hobbies and interests you once enjoyed

• decreased energy or fatigue

• difficulty concentrating, remembering, or making decisions

• moving or talking more slowly

• difficulty sleeping, early morning awakening, or oversleeping

• appetite or weight changes

• chronic physical pain with no clear cause that does not get better with treatment (headaches, aches or pains, digestive problems, cramps)

• thoughts of death, suicide, self-harm, or suicide attempts

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

 

Males may experience symptoms related to their:

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• moods, such as anger, aggressiveness, irritability, anxiousness, or restlessness

• emotional well-being, such as feeling empty, sad, or hopeless

• behaviour, such as loss of interest, no longer finding pleasure in favourite 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:

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• mood, such as irritability

• emotional well-being, such as feeling sad or empty, anxious, or hopeless

• behaviour, such as loss of interest in activities, withdrawing from social engagements, or thoughts of suicide

• cognitive abilities, such as thinking or talking more slowly

• sleep patterns, such as difficulty sleeping through the night, waking early, or sleeping too much

• physical well-being, such as decreased energy, greater fatigue, changes in appetite, weight changes, aches, pain, headaches, or increased cramps

 

Children may experience symptoms related to their:

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• moods, such as irritability, anger, rapid shifts in mood, or crying

• emotional well-being, such as feelings of incompetence (e.g., “I can’t do anything right”) or despair, crying, or intense sadness

• behaviour, such as getting into trouble at school or refusing to go to school, avoiding friends or siblings, thoughts of death or suicide, or self-harm

• cognitive abilities, such as difficulty concentrating, decline in school performance, or changes in grades

• sleep patterns, such as difficulty sleeping or sleeping too much

• physical well-being, such as loss of energy, digestive problems, changes in appetite, or weight loss or gain

 

Depression causes

 

There are several possible causes of depression. They can range from biological to circumstantial.

 

Common causes include:

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• Brain chemistry. There may be a chemical imbalance in parts of the brain that manage mood, thoughts, sleep, appetite, and behaviour in people who have depression.

• Hormone levels. Changes in female hormones estrogen and progesterone during different periods of time like during the menstrual cycle, postpartum period, perimenopause, or menopause may all raise a person’s risk for depression.

• Family history. You’re at a higher risk for developing depression if you have a family history of depression or another mood disorder.

• Early childhood trauma. Some events affect the way your body reacts to fear and stressful situations.

• Brain structure. There’s a greater risk for depression if the frontal lobe of your brain is less active. However, scientists don’t know if this happens before or after the onset of depressive symptoms.

• Medical conditions. Certain conditions may put you at higher risk, such as chronic illness, insomnia, chronic pain, Parkinson’s disease, stroke, heart attack, and cancer.

• Substance use. A history of substance or alcohol misuse can affect your risk.

• Pain. People who feel emotional or chronic physical pain for long periods of time are significantly more likely to develop depression.

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Risk factors

 

Risk factors for depression can be biochemical, medical, social, genetic, or circumstantial. Common risk factors include:

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• Sex. The prevalence of major depression is twice as high in females as in males. 

• Genetics. You have an increased risk of depression if you have a family history of it.

• Socioeconomic status. Socioeconomic status, including financial problems and perceived low social status, can increase your risk of depression.

• Certain medications. Certain drugs including some types of hormonal birth control, corticosteroids, and beta-blockers may be associated with an increased risk of depression.

• Vitamin D deficiency. Studies have linked depressive symptoms to low levels of vitamin D.

• Gender identity. The risk of depression for transgender people is nearly 4-fold that of cisgender people, according to a 2018 study.

• Substance misuse. About 21% of people who have a substance use disorder also experience depression.

• Medical illnesses. Depression is associated with other chronic medical illnesses. People with heart disease are about twice as likely to have depression as people who don’t, while up to 1 in 4 people with cancer may also experience depression.

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The causes of depression are often tied to other elements of your health.

 

Treatment for depression

 

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

It’s common to combine medical treatments (speak to your doctor regarding appropriate medications) and lifestyle therapies, including the following:

 

Psychotherapy

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Speaking with a therapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions.

Psychotherapy, also known as “talk therapy,” is when a person speaks to a trained therapist to identify and learn to cope with the factors that contribute to their mental health condition, such as depression.

Psychotherapy has been shown to be an effective treatment in improving symptoms in people with depression and other psychiatric disorders.

Psychotherapy is often used alongside pharmaceutical treatment. There are many different types of psychotherapy, and some people respond better to one type than another.

 

Cognitive behavioural therapy (CBT)

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In cognitive-behavioural therapy (CBT), a therapist will work with you to uncover unhealthy patterns of thought and identify how they may be causing harmful behaviours, reactions, and beliefs about yourself.

Your therapist might assign you “homework” where you practise replacing negative thoughts with more positive thoughts.

 

Dialectical behaviour therapy (DBT)

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Dialectical behaviour therapy (DBT) is similar to CBT, but puts a specific emphasis on validation, or accepting uncomfortable thoughts, feelings, and behaviours, instead of fighting them.

The theory is that by coming to terms with your harmful thoughts or emotions, you can accept that change is possible and make a recovery plan.

 

Psychodynamic therapy

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Psychodynamic therapy is a form of talk therapy designed to help you better understand and cope with your day-to-day life. Psychodynamic therapy is based on the idea that your present-day reality is shaped by your unconscious, childhood experiences.

In this form of therapy, your therapist will help you reflect on and examine your childhood and experiences to help you understand and cope with your life.

 

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Natural remedies and lifestyle tips

 

Exercise

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Aim for 30 minutes of physical activity 3 to 5 days a week. Exercise can increase your body’s production of endorphins, which are hormones that improve your mood.

 

Avoid alcohol and substance use

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Drinking alcohol or misusing substances may make you feel better for a little bit. But eventually, these substances can make depression and anxiety symptoms worse.

 

Learn how to set limits

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Feeling overwhelmed can worsen anxiety and depression symptoms. Setting boundaries in your professional and personal life can help you feel better.

 

Take care of yourself

 

You can also improve symptoms of depression by taking care of yourself. This includes getting plenty of sleep, eating a healthy diet, avoiding negative people, and participating in enjoyable activities.

Sometimes depression doesn’t respond to medication. Your healthcare professional may recommend other treatment options if your symptoms don’t improve.

 

Depression test

 

There isn’t a single test to diagnose depression. But your healthcare provider can make a diagnosis based on your symptoms and a psychological evaluation.

In most cases, they’ll ask a series of questions about your:

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• moods

• appetite

• sleep pattern

• activity level

• thoughts

 

Because depression can be linked to other health problems, your healthcare professional may also conduct a physical examination and order blood work. Sometimes thyroid problems or a vitamin D deficiency can trigger symptoms of depression.

 

It’s important not to ignore the symptoms of depression. If your mood doesn’t improve or gets worse, seek medical help. Depression is a serious mental health illness with the potential for complications.

 

If left untreated, complications can include:

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• physical pain

• substance use disorder

• panic attacks

• relationship problems

• social isolation

• thoughts of suicide

• self-harm

• weight gain or loss

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Types of depression

 

Depression can be broken into categories depending on the severity of the symptoms. Some people experience mild and temporary episodes, while others experience severe and ongoing depressive episodes.

There are two main types: major depressive disorder and persistent depressive disorder.

 

Major depressive disorder

Major depressive disorder (MDD) is the more severe form of depression. It’s characterized by persistent feelings of sadness, hopelessness, and worthlessness that don’t go away on their own.

In order to be diagnosed with clinical depression, you must experience five or more of the following symptoms over a 2-week period:

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• feeling depressed most of the day

• loss of interest in most regular activities

• significant weight loss or gain

• sleeping a lot or not being able to sleep

• slowed thinking or movement

• fatigue or low energy most days

• feelings of worthlessness or guilt

• loss of concentration or indecisiveness

• recurring thoughts of death or suicide

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There are different subtypes of major depressive disorder, which the American Psychiatric Association refers to as “specifiers.”

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These include:

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• atypical features

• anxious distress

• mixed features

• peripartum onset, during pregnancy or right after giving birth

• seasonal patterns

• melancholic features

• psychotic features

• catatonia

• Persistent depressive disorder

• Persistent depressive disorder (PDD) used to be called dysthymia. It’s a milder, but chronic, form of depression.

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In order for the diagnosis to be made, symptoms must last for at least 2 years. PDD can affect your life more than major depression because it lasts for a longer period.

It’s common for people with PDD to:

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• lose interest in normal daily activities

• feel hopeless

• lack productivity

• have low self-esteem

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Depression can be treated successfully, but it’s important to stick to your treatment plan.

Living with depression can be difficult, but treatment can help improve your quality of life. Talk to your doctor about a viable option.

 

Postpartum depression

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Postpartum depression refers to depression that happens after childbirth. It is a common disorder after pregnancy, affecting 1 in 9 new parents.

It’s common for people to experience “baby blues,” or feelings of sadness or emptiness after childbirth. For many people, these symptoms go away in a couple of days.

But if you feel sad, hopeless, or empty for longer than 2 weeks post-childbirth, you may have postpartum depression.

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Symptoms of postpartum depression can range from mild to severe and can include:

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• feeling restless or moody

• feeling sad, hopeless, or overwhelmed

• having thoughts of hurting the baby or yourself

• not having an interest in the baby, feeling disconnected, or as if your baby is someone else’s

• having no energy or motivation

• eating too little or too much

• sleeping too little or too much

• having trouble focusing

• having memory problems

• feeling worthless, guilty, or like a bad parent

• withdrawing from activities you once enjoyed

• withdrawing from friends and family

• having headaches, aches, or stomach issues that don’t go away

• feeling empty, unconnected, or as though you might not love or care for the baby

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Postpartum depression is thought to be triggered by the dramatic hormonal changes that take place after pregnancy.

 

Depression and anxiety

 

Depression and anxiety can occur in a person at the same time. In fact, research has shown that over 70 % of people with depressive disorders also have symptoms of anxiety.

Though they’re thought to be caused by different things, depression and anxiety can produce several similar symptoms, which can include:

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• irritability

• difficulty with memory or concentration

• sleep problems

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The two conditions also share some common treatments. Both anxiety and depression can be treated with:

therapy, like cognitive behavioural therapy medication alternative therapies, including hypnotherapy

If you think you’re experiencing symptoms of either of these conditions or both of them, make an appointment to talk with your doctor. You can work with them to identify coexisting symptoms of anxiety and depression and how they can be treated.

 

Depression and obsessive-compulsive disorder (OCD)

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Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. It causes unwanted and repeated thoughts, urges, and fears (obsessions).

These fears cause you to act out repeated behaviours or rituals (compulsions) that you hope will ease the stress caused by the obsessions.

People diagnosed with OCD frequently find themselves in a loop of obsessions and compulsions. If you have these behaviours, you may feel isolated because of them. This can lead to withdrawal from friends and social situations, which can increase your risk for depression.

 

It’s not uncommon for someone with OCD to also have depression. Having one anxiety disorder can increase your odds of having another. Up to 80% of people with OCD also have major depressive episodes.

This dual diagnosis is a concern with children, too. Their compulsive behaviours, which may have first developed at an early age, can make them feel unusual. That can lead to withdrawing from friends and can increase the chance of a child developing depression.

 

Depression with psychosis

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Some individuals who have been diagnosed with major depression may also have symptoms of another mental disorder called psychosis. When the two conditions occur together, it’s known as depressive psychosis.

Depressive psychosis causes people to see, hear, believe, or smell things that aren’t real. People with the condition may also experience feelings of sadness, hopelessness, and irritability.

The combination of the two conditions is particularly dangerous. That’s because someone with depressive psychosis may experience delusions that cause them to have thoughts of suicide or to take unusual risks.

It’s unclear what causes these two conditions or why they can occur together, but treatment can successfully ease symptoms. Treatments include medications and electroconvulsive therapy (ECT).

Understanding the risk factors and possible causes can help you be aware of early symptoms.

 

Depression in pregnancy

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Pregnancy is often an exciting time for people. However, it can still be common for a pregnant woman to experience depression.

Symptoms of depression during pregnancy include:

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• changes in appetite or eating habits

• feeling hopeless

• anxiety

• losing interest in activities and things you previously enjoyed

• persistent sadness

• troubles concentrating or remembering

• sleep problems, including insomnia or sleeping too much

• thoughts of death or suicide

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Treatment for depression during pregnancy may focus entirely on talk therapy and other natural treatments.

While some women do take antidepressants during their pregnancy, it’s not clear which ones are the safest. Your healthcare provider may encourage you to try an alternative option until after the birth of your baby.

The risks for depression can continue after the baby arrives. Postpartum depression, which is also called major depressive disorder with peripartum onset, is a serious concern for new mothers.

Recognising the symptoms may help you spot a problem and seek help before it becomes overwhelming.

 

Depression and alcohol

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Research has established a link between alcohol use and depression. People who have depression are more likely to misuse alcohol.

Drinking alcohol frequently can make symptoms of depression worse, and people who have depression are more likely to misuse alcohol or become dependent on it.

 

Preventing depression

 

Depression isn’t generally considered to be preventable. It’s hard to recognize what causes it, which means preventing it is more difficult.

But once you’ve experienced a depressive episode, you may be better prepared to prevent a future episode by learning which lifestyle changes and treatments are helpful.

Techniques that may help include:

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• regular exercise

• getting plenty of sleep

• maintaining treatments

• reducing stress

• building strong relationships with others

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Outlook for depression

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Depression can be temporary, or it can be a long-term challenge. Treatment doesn’t always make your depression go away completely.

However, treatment often makes symptoms more manageable. Managing symptoms of depression involves finding the right combination of medications and therapies.

If one treatment doesn’t work, talk with your healthcare professional. They can help you create a different treatment plan that may work better in helping you manage your condition.

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Schedule an appointment and speak to a Counsellor/Therapist