According to the National Institute of Mental Health estimates, 21 million adults in the United States, or 8.3% of the population, experience major depressive disorder each year. This debilitating disease has been called by the World Health Organization the third-leading cause of disease worldwide.
Not everyone will experience major depression in the same manner as someone else, and that’s to be expected. Each human being is unique in their circumstances, body chemistry, and other factors that impact their experiences. Sometimes, depression can vary in degrees, although the longer it lasts, the worse it tends to get. This is because depression creates a pit where people feel like they are trapped and unable to get out.
But major depression can be treated. Even though it may feel hopeless right now, things can get better with professional help.
Understanding Major Depressive Disorder
The underlying causes and mechanisms behind major depressive disorder (MDD) are still subject to debate. Mainstream theories center around certain sectors of the brain malfunctioning.
The main theories include:
- Hypothalamic‒Pituitary‒Adrenal (HPA) Axis Dysfunction Hypothesis: This theory suggests that abnormalities in the HPA axis, which regulates stress response, contribute to the development of MDD through altered cortisol levels and stress hormone regulation.
- Monoamine Hypothesis: This hypothesis posits that MDD is caused by imbalances in neurotransmitters such as serotonin, norepinephrine, and dopamine, which affect mood regulation.
- Inflammatory Hypothesis: This theory proposes that chronic inflammation and increased levels of pro-inflammatory cytokines are linked to the onset and progression of MDD.
- Genetic and Epigenetic Anomaly Hypothesis: This hypothesis suggests that genetic predispositions and epigenetic modifications, which influence gene expression without altering DNA sequence, play a crucial role in the susceptibility to MDD.
- Structural and Functional Brain Remodeling Hypothesis: This theory indicates that structural changes and functional abnormalities in brain regions involved in mood regulation, such as the prefrontal cortex and hippocampus, are associated with MDD.
- Social Psychological Hypothesis: This hypothesis emphasizes the impact of social and psychological factors, including stress, trauma, and adverse life events, on the development and persistence of MDD.
There is currently no consensus on which of these theories is correct. Many of the mechanisms proposed within the various theories overlap with other theories.
More recently, science has focused on the role astrocytes, a type of brain cell, play in major depression. Experiments have found that removing astrocytes from a specific part of the brain causes depression-like symptoms in animals. Additionally, studies of people who had MDD found fewer glial cells in key brain areas involved in mood regulation, such as the prefrontal cortex, hippocampus, and amygdala.
Definition and Diagnostic Criteria
The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), which outlines symptoms of mental disorders, including clinical depression.
In order for a health care professional to diagnose clinical depression, a person must experience at least five of the following symptoms nearly every day, for a large part of the day over a period of two weeks or longer:
- Persistent sad mood
- Reduced or complete loss of pleasure or interest in activities
- Weight loss, weight gain, or change in appetite
- Changes in sleep, such as insomnia or increased sleeping
- Restlessness or slow movement or speech
- Feeling tired and having no energy
- Feelings of worthlessness
- Difficulty making decisions, remembering things or concentrating
- Suicidal thoughts or suicide attempts
At least one of the clinical depression symptoms must be a loss of interest or pleasure in activities or a depressed mood.
Other common signs of clinical depression include:
- Leaving the house less often than usual
- Reduced motivation at school or work
- Becoming withdrawn from family and friends
- Alcohol abuse
- Loss of confidence
- Experiencing aches and pains
- Feeling hopeless
- Physical problems like heart disease or chronic pain
- No longer taking pride in physical appearance
- Recurrent thoughts of death
If you think you or someone you know may attempt suicide, seek treatment immediately.
Other Symptoms of MDD
Other common signs of clinical depression include:
- Leaving the house less often than usual
- Reduced motivation at school or work
- Becoming withdrawn from family and friends
- Alcohol abuse
- Loss of confidence
- Experiencing aches and pains
- Feeling hopeless
- Physical problems like heart disease or chronic pain
- No longer taking pride in physical appearance
- Recurrent thoughts of death
If you think you or someone you know may attempt suicide, seek treatment immediately.
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Stages of Major Depression
These phases are based on the symptoms of the depression itself. However, the real experiences may differ significantly from person to person.
Some people will experience all five stages, while others will skip steps entirely. The following five stages of depression provide a loose outline of what most people will go through.
- Negative Thought Patterns: Depression often starts with a pattern of negative thoughts that are damaging, disruptive, and difficult to dismiss. These negative thoughts may be about your appearance, your work, or your social standing. Your negative thoughts may also be focused on the world around you. You may find yourself preoccupied with poverty in developing countries, the war in the Middle East, or climate change, and feel that situations are so hopeless, they’ll never get better, and there’s no point in going on with life. You may feel anxiety, wondering, “What’s the use of living if everyone is doomed?” Incessant reflection on this sort of negativity may trigger major depression.
- Changes in Appetite: Many people who go through depression experience changes in appetite. Some lose their appetite entirely, while others may begin to eat more as a coping mechanism, risking the development of an eating disorder or food addiction. Some people have no changes in appetite at all. It depends on the individual and their typical eating habits. These are frequent signs of depression that can lead to weight fluctuations, either increase or decrease.
- Changes in Sleep Patterns: Almost everyone with depression experiences changes in sleep patterns because the brain is looking for an escape from the stress and pain of the illness. This causes a shift in the hormone levels, wreaking havoc with your sleep patterns. However, this also differs from person to person, just like hunger does. Some people experience some depression symptoms, such as insomnia, because the negative thoughts consume them at night, making sleep impossible. As a result, they’re left feeling tired, fatigued, and sluggish during the day. Conversely, some people feel so drained from the barrage of negative thoughts that they struggle to get out of bed.
- Self-Blame: You might find you’re blaming yourself for things beyond your control. You may even blame yourself for being depressed. You may feel embarrassed and guilty about being unable to keep up with your normal activities and duties. It turns into a vicious cycle of feeling unworthy, helpless, like a failure. You feel as though you have nobody to blame but yourself. As the symptoms worsen, you sink even lower, and your depression becomes more severe until you begin to feel that life may not be worth living. This can easily lead to a higher risk of self-harm.
- Suicidal Thoughts and Behaviors: As the severity of the illness increases, so do the chances of suicidal behavior or self-harm. Not everyone gets to this stage because they choose to get help before their disorder worsens. And for some, this stage is about wanting the despair to go away rather than yearning for death. Regardless, when you’ve reached this stage or the point where you’re having any thoughts regarding suicide, such as making a plan or giving away personal belongings, you need to seek professional mental health treatment immediately.
If you or someone you know is experiencing suicidal thoughts, it’s crucial to seek professional help immediately. Speak with a mental health professional, phone a suicide prevention hotline, or visit the local emergency hospital. Major depressive illness can be treated and recovered with the correct help.
Remember that you are not alone, and there are tools available to assist you in getting through this tough time.
The Impact of Major Depressive Disorder
Major Depressive Disorder has far-reaching effects that extend beyond the individual suffering from the condition. Its impact is profound and multifaceted, affecting emotional well-being, physical health, relationships, and societal structures.
On Individuals
For those experiencing MDD, the emotional toll is significant. Persistent feelings of sadness, hopelessness, and worthlessness can lead to a diminished sense of self and purpose. The physical symptoms, such as chronic fatigue, changes in appetite, and sleep disturbances, further exacerbate the condition, making daily functioning challenging.
Cognitive impairments, including difficulties in concentration and decision-making, can hinder personal and professional life, reducing overall productivity and quality of life.
On Families and Loved Ones
The effects of MDD ripple out to families and loved ones, who often experience emotional strain and changes in family dynamics. The burden of caregiving, coupled with the distress of seeing a loved one suffer, can lead to feelings of helplessness and frustration.
It is crucial for families to understand the importance of support and seek resources to cope with the challenges of living with someone who has MDD.
On Society
There are economic costs to major depression as well. Springer Journal estimates the economic burden MDD places on the United States at $382.4 billion dollars. This is mainly due to lost economic output, as people with MDD are unable to do their jobs effectively, as well as the costs of treatment.
Footprints to Recovery Mental Health provides outpatient treatment programs in New Jersey.
Major Depression Treatment Options
Thankfully, there are a lot of treatment options for major depression available. One of the most important is therapy. Cognitive Behavioral Therapy (CBT) is a structured, time-limited therapy that helps individuals identify and change negative thought patterns and behaviors. It has been shown to reduce symptoms of depression, improve emotional regulation, and equip individuals with coping strategies for managing stress.
Another effective therapy is Interpersonal Therapy (IPT), which focuses on improving interpersonal relationships and social functioning to help alleviate depressive symptoms. This is particularly beneficial for those whose depression is linked to relationship issues and life transitions. Other therapies, such as psychodynamic therapy, dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT), may also be beneficial depending on individual needs.
Along with therapy, medication is another common method for addressing major depression.
These medications, known as antidepressants, come in a few different varieties:
- Selective Serotonin Reuptake Inhibitors (SSRIs): Commonly prescribed due to their effectiveness and relatively mild side effects (e.g., fluoxetine, sertraline).
- Serotonin-norepinephrine reuptake Inhibitors (SNRIs): Effective for patients who do not respond to SSRIs (e.g., venlafaxine, duloxetine).
- Atypical Antidepressants: Include medications like bupropion and mirtazapine, which work differently than SSRIs and SNRIs.
- Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs): Older classes of antidepressants, used less frequently due to side effects but can be effective for treatment-resistant depression.
Some more recent developments in major depression treatment include ketamine infusions and psilocybin therapy, which are being researched for their rapid and sustained antidepressant effects.
The diverse treatment options for Major Depressive Disorder reflect the complexity of the condition and the need for a personalized approach. Combining various therapies, medications, lifestyle modifications, and innovative treatments can significantly improve the quality of life for individuals with MDD. Collaboration with healthcare providers is essential to developing an effective treatment plan tailored to individual needs and circumstances.
Major Depression Treatment in New Jersey
Footprints Mental Health can help you overcome your major depression. We take a comprehensive and personalized approach to mental health treatment, focusing on your unique needs and circumstances. Our cross-disciplinary team of mental health professionals, including psychiatrists, psychologists, counselors, and more, will work together to develop tailored treatment plans to help you meet your goals. Contact us today to get started on your recovery.
References:
- Depressive disorder (depression)
- Major Depression – National Institute of Mental Health (NIMH)
- The Economic Burden of Adults with Major Depressive Disorder in the United States (2019) | Advances in Therapy
- Major depressive disorder: hypothesis, mechanism, prevention and treatment | Signal Transduction and Targeted Therapy
