In Depression, Physical & Mental Health

Exploring Major Depressive Disorder

major depressive disorder

Everyone has bad days. Often people can be overwhelmed with emotions or situations for days at a time. Sadness is not necessarily an indicator that one is falling into depression. There are specific parameters that dictate whether someone is experiencing a little sadness or a major depressive episode. Learn more about what Major Depressive Disorder is here. 

What Is Major Depressive Disorder?

Major depressive disorder (MDD) is a mental disorder characterized by persistent and pervasive depressed mood associated with low self-esteem and a lack of interest in life. This disorder can interfere with sleep, school, work, appetite, and quality of life. It can affect thought patterns, behaviors, emotions, and even physical well-being. Other terms for this disorder include severe depression, recurrent depression, and manic depressive disorder.

Major Depressive Disorder Symptoms

There are multiple symptoms for major depressive disorder, often experienced daily. These include:

  • Slower thinking or movements
  • Feelings of emptiness, unhappiness, or sadness
  • Unexplained physical complaints
  • Sleep issues (sleeping too little OR too much)
  • Lack of energy, small household tasks take an enormous amount of energy
  • Trouble concentrating, thinking, or making decisions
  • Appetite changes – eating too much or not eating at all
  • Loss of enjoyment or interest in everyday activities or hobbies
  • Restlessness, anxiety, or agitation – hand wringing, pacing, excessive worrying, or not being able to sit still
  • Feelings of guilt or worthlessness, blaming self for everything that goes wrong, whether one is in control of the situation or not
  • Suicidal ideation – active or passive

All of these symptoms do not have to be present in order to diagnose someone with MDD. Often symptoms are debilitating to the point of hospitalization. Others, however, may just feel generally unhappy or miserable without being able to explain why.


The causes of depression are very ambiguous and undefined. There are a variety of factors that may contribute to the onset of a depressive episode:

  • Life events – Death of a loved one, high stress, financial problems, childhood trauma, and any other type of trauma can contribute to feelings of sadness or hopelessness.
  • Hormones – More often seen with postpartum depression, changes in hormonal balance can trigger depression. In addition, conditions such as menopause or thyroid problems can also contribute to the hormonal imbalance.
  • Biological differences – Depression sufferers appear to have physical anomalies in their brain biology.
  • Brain chemistry – Chemical neurotransmitters such as dopamine and serotonin are very likely to affect depression in individuals. When they are not balanced they are often associated with symptoms of depression.
  • Inherited traits – Family history can be a determining factor for depression, often moving through entire families.

Tests and Diagnosis

When meeting with a doctor, patients should expect a comprehensive exam. Doctors must rule out other problems before diagnosing with depression.

  • Lab tests – Doctors must see that everything is functioning properly and that there are no infections present. A complete blood count, a thyroid test, hormone levels all need to be checked to rule out a physical issue.
  • Physical exam – In addition to the blood work a doctor must also complete a physical exam, again, to rule out any other physical conditions.
  • Psychological evaluation – Most importantly, a doctor must discuss symptoms, feelings, behavior, and thoughts with patients experiencing depression symptoms.

In order to diagnosed with major depressive disorder certain criteria must be met, established by the Diagnostic and Statistical Manual of Mental Disorders, used by mental health professionals to diagnose a variety of mental illnesses.

By definition, to be diagnosed with major depressive disorder a patient must have at least 5 of the following symptoms with a duration of two weeks and an intensity level of most of the day, almost every day, impacting day to day life. Either a depressed mood or a loss of interest must be one of the symptoms. Other necessary symptoms include:

  • Noticeable weight changes
  • Depressed mood, sad, tearful, empty, or irritability (especially in teens and children)
  • Loss of energy
  • Trouble thinking or concentrating
  • Restlessness or slowed behavior
  • Sleep problems
  • Considerably diminished interest
  • Suicidal ideation

Medications and Treatments

Treatment options are numerous and varied, much like the patients who suffer depression. Medications and psychotherapy are the most often treatments. However, the type and intensity of each can be varied.

Medication Types

  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs)
  • Tricyclic antidepressants
  • Atypical antidepressants
  • Other medications such as mood stabilizers, anti-anxiety, stimulants, or antipsychotics

Psychotherapy: Benefits

  • Learn to set realistic goals
  • Delve into relationships and experiences, develop positive interactions with others
  • Coping skills
  • Replace negative, destructive thoughts and behaviors with healthier options
  • Adjust to crisis and difficulty
  • Identify triggers and develop a plan to deal with them
  • Help ease symptoms of depression by regaining control of life

Alternative Therapies

  • Electroconvulsive therapy (ECT) – Once referred to as electro-shock therapy, this procedure uses electrical currents, passed through the brain. This treatment is typically used when other treatments haven’t worked.
  • Transcranial magnetic stimulation (TMS) – This can be used as an option when antidepressants aren’t working. This procedure is similar to ECT except it uses magnetic pulses instead of electric currents.

Sometimes symptoms are so severe that an outpatient plan of care is not possible and individuals must go into an inpatient treatment center. Depending on the severity of the symptoms, patients may go into a 7 – 10 day crisis stabilization unit which could be enough to stabilize and get a patient involved in an outpatient program. Rarely though, longer inpatient treatment is necessary. Treatment centers and day treatment programs are also alternatives.

Managing and Coping

Someone suffering from depression must change poor habits and lifestyle choices in order to heal:

  • Be aware of symptoms
  • Avoid alcohol and drugs
  • Get plenty of sleep
  • Learn, be educated about your illness
  • Stick to the treatment plan established by you and your mental health professionals
  • Be aware of warning signs and triggers
  • Stay active

There are many relaxation techniques that patients can do to help speed recovery and cope with symptoms:

  • Yoga/tai chi
  • Exercise
  • Music or art therapy
  • Relaxation techniques
  • Spirituality
  • Massage therapy
  • Acupuncture
  • Meditation
  • Guided imagery

Along with these mind-body techniques there are things patients and their families can to do cope with the day to day struggles of living with depression:

  • Schedule your day and stick to it.
  • Simplify life
  • Journaling
  • Don’t make important decisions when you are in a depressive state
  • Relax/manage stress
  • Read self-help books
  • Connect with a local support group or organization
  • Take care of you
  • Don’t isolate yourself

Major depressive disorder is not a death sentence. When someone is in the middle of an episode it is easy to think that it will never end, things will always be bad. Being aware and educated about the disorder is key to overcoming and thriving and moving on with life.

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