Major Depressive Disorder

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Major Depressive Disorder.

Major depressive disorder is a type of unipolar disorder, often also referred to as clinical depression, major or severe depression, or unipolar depression. It is probable that when someone is said to ‘have depression’, they suffer from major depressive disorder.

The percentage of people who will experience one or more episodes of major depression during their lives varies by country, from as low as 3% in Japan, to as high as 17% in North America, with a global average occurrence of 8-12%.^[1] The condition is approximately twice as frequent in woman as it is in men, though more men commit suicide as a result of major depression than do women.^[2]

Major depression frequently co-exists with other psychiatric problems, often anxiety (at a rate of around 51%),^[3] the added symptoms of which can delay recovery, and both increase the risks of relapse and suicide.^[4]

Symptoms

Major depression is a serious illness which can negatively impact a sufferers day-to-day functioning, work and family relationships, and general health.

Symptoms of the condition can include:

• Feelings of intense sadness.
• Constant low mood.
• Anhedonia.
• Thoughts and feelings of worthlessness, and overall low self-esteem.
• Feelings of hopelessness, futility and the inability to see any point in activities or life in general.
• Insomnia or hypersomnia.
• A decrease or increase in appetite, with accompanying weight loss or gain.
• Psychomotor agitation or psychomotor retardation.
• Concentration and memory problems.
• Physical symptoms such as fatigue, headaches or digestive problems.^[5]
• Recurring thoughts of death or suicide, either with or without a plan for suicide, or a suicide attempt.
• In severe cases, the manifestation of psychosis.^[6]

People suffering from major depressive disorder often feel that they can never be cured, or return to a normal life. An analogy used by some sufferers is that they feel as if they are sliding deeper and deeper into a black hole, and there’s no way out.

These thoughts can become all-pervasive, worsening the depressive condition, and escalating the risk of suicide.

Diagnosis

A diagnosis of major depressive disorder may be carried out by a general practitioner, psychiatrist or psychologist, and begins by examining the patient’s current circumstances and symptoms, biographical history, and whether or not there is a family history of mood disorders. Attempts are usually made to rule out other medical causes, or substance abuse which may be causing the depression-like symptoms.

There are a number of charts, scales and check-lists for diagnosing major depressive disorder^[7], including the ‘Mental Status Examination’ (MSE) which considers the patients appearance, mood, attitude, behaviour, thought processes and other factors.^[8]

The most common tool for diagnosis however seems to be the DSM-IV-TR.^[6] When used to diagnose major depressive disorder, the DSM-IV-TR requires:

• A minimum of five symptoms of those listed above, present during the same two week period, and which represent a change from previous functioning.
• One of these symptoms must be either:
1. A highly prevalent depressed mood, or
2. Anhedonia.

Getting Help

Getting help for major depression can be extremely difficult, not because help is not available, but because the condition itself can disable the sufferer to the point where actively seeking assistance becomes impossible. Sometimes the depressed person has sunk so far into the ‘black hole’, the only way to begin the climb out is with the care and assistance of family or friends.

If you are suffering from major depressive disorder yourself, and reading this, then there is a good chance you are able to take the first step towards getting the help you need. Contact your doctor or local mental health service, or if that is too daunting or confusing, or you are feeling suicidal, call your country’s emergency services number (911, 000, etc), and let them know you need help. They will help you, and it is ok to ask for help.

If someone you know suffers from or seems likely to be suffering from major depressive disorder, it is imperative that they get help, and they may need you to help them get it. Take the time to navigate the mental health care system on their behalf, and you may literally be saving a life.

References

Andrade L, Caraveo-Anduaga JJ, Berglund P (2003), The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005), Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication, Archives of General Psychiatry

Kessler RC, Nelson C, McGonagle KA (1996), Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey, British Journal of Psychiatry

Hirschfeld RMA (2001), The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care, Primary Care Companion to the Journal of Clinical Psychiatry

Patel V, Abas M, Broadhead J (2001), Depression in developing countries: Lessons from Zimbabwe

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc

Sharp LK, Lipsky MS (September 2002), Screening for depression across the lifespan: a review of measures for use in primary care settings, American family physician

Trzepacz, PT; Baker RW (1993), The Psychiatric Mental Status Examination, Oxford University Press