Major depression is a very serious but also common mental illness and mood disorder. It is characterized by episodes of sadness and hopelessness and can cause loss of interest in activities, changes in eating and sleeping habits, thoughts of suicide, and difficulty functioning normally. Depression must be diagnosed by a mental health professional, and it can be treated. Medications and therapy are important in managing the symptoms and episodes of depression. With a commitment to ongoing care it is possible to live well with this condition and to minimize the occurrence and severity of relapses.
What Is Major Depression?
Major depression, which is also known as major depressive disorder and often just depression, is a mental illness. It belongs to a category of conditions known as mood disorders, because it impacts mood, generally causing feelings of sadness and hopelessness for periods of two weeks or longer. Symptoms are severe enough to cause dysfunction at home, at work, and in relationships.
This is a chronic illness, which means there are periods of no symptoms, but then the depression often recurs, and for this reason it should be treated on an ongoing basis. There may be times when less support is needed and periods during which more intensive care can help. But, in general depression is managed over the long-term. With ongoing therapy and often with medication as well, it is possible to control symptoms and minimize relapses.
Types of Major Depression
Major depressive disorder is a separate diagnosis from other types of depression and one of the most commonly diagnosed types of mental illness. But there are also several related conditions that are categorized with it as depressive disorders:
- Persistent Depressive Disorder. Also known as dysthymia, this type of depression is sometimes described as being a high-functioning condition. It causes less severe symptoms of depression so that individuals can still function, but they persist for two years or longer.
- Premenstrual Dysphoric Disorder. A severe type of premenstrual syndrome, this condition affects some women between ovulation and the start of menstruation.
- Postpartum Depression. When the onset of depression is during or soon after pregnancy, it is referred to as postpartum or perinatal depression.
- Seasonal Affective Disorder. Some people experience episodes of depression seasonally, most often in fall and winter. Rarer cases occur in the spring.
Facts and Statistics
Major depression is a type of mood disorder, and mood disorders are the most common mental illnesses in the U.S.
- A recent survey of American adults found that eight percent, or one in 12 people, over the age of 20 experienced depression in the previous two weeks.
- According to the survey, depression was present in twice as many women as men.
- Depression and other mood disorders are cited as the third most common reason for hospitalization among adults between the ages of 18 and 44.
- More than one-third of adults with depression do not get treatment.
- Major depression is also the most common reason for disability in people between ages 15 and 44.
- The onset of depression can be at any age, but the median is 32.
- In any given year, more than 16 million adults in the U.S. struggle with major depression.
Symptoms and Diagnosis of Major Depression
The symptoms of depression are easy to understand, because everyone experiences this low type of mood sometimes. The big differences between ordinary low moods and major depression include the duration of the episodes, severity of symptoms, the impairment caused by symptoms, and the recurring nature of depressive episodes. The diagnostic criteria that mental health professionals use for major depressive disorder are:
- A depressed, low mood characterized by sadness, emptiness, and hopelessness that is significant and observable by other people
- Loss of interest in normal activities and inability to find pleasure in activities once enjoyed
- Changes in weight as a result of loss of appetite or overeating
- Changes in sleeping patterns, either oversleeping or insomnia
- Behavioral changes that are either agitated or slowed down
- Extreme fatigue
- Feelings of guilt, shame, or worthlessness
- Difficulty thinking, concentrating, or making decisions
- Thoughts of death or suicide, with possible suicidal behaviors
To be diagnosed with major depression, a person must have at least five of these symptoms over a two week period. One of the symptoms has to be either a depressed mood every day or loss of interest in activities.
Other requirements are that the symptoms cause significant impairment, such as difficulty at work or problems in relationships. To be diagnosed, the symptoms of depression cannot be caused by a medical condition, a medication, or substance abuse.
In some cases, a person with depression may experience symptoms of psychosis, such as hallucinations or delusions. They typically reflect a depressed mood, for example delusions related to guilt and self-blame.
Causes and Risk Factors
There is no single cause of depression for anyone, but there are risk factors and contributing factors that can make one person more likely to develop it. Family history is one of the most important risk factors, which indicates that genetics plays a role in depression. The structure and chemistry of the brain is also noted to have significant differences in people with depression, so there are also physiological causes. However, there is also evidence that several environmental conditions contribute to depression. Some of these known risk factors include:
- Having another mental illness, especially when untreated
- Substance abuse and struggling with a substance use disorder
- Exposure to traumatic events and experiences or ongoing stressful situations, such as a major accident or domestic abuse
- Specific personality traits like pessimism, being dependent on others, or being self-critical and having low self-esteem
- Having a serious, life-threatening, or chronic illness
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Depression often co-occurs with other conditions, including other mental illnesses. Anxiety disorders are also common mental illnesses and may occur with depression in many people. Personality disorders also often occur with depression. Bipolar disorder is a related condition that causes periods of mania and depression. Because depression is such a common mental illness, it is one of the most likely to co-occur with other conditions.
Co-occurring disorder also refers to mental illnesses like depression along with substance use disorders. This is very common, possibly because depression and substance abuse have some of the same risk factors. It is also likely that someone with depression will use alcohol or drugs as a type of self-medication in an attempt to alleviate symptoms. Substance use can also trigger and worsen symptoms of depression or make it more likely to occur in someone who has other risk factors, such as family history.
Treatment and Prognosis of Major Depression
Treatment for major depression is crucial for managing symptoms, reducing the risk of complications, and preventing or minimizing the severity of relapses of depressive episodes. As a chronic condition, depression requires long-term professional care or it may recur and cause severe and debilitating episodes.
There are two main elements of depression treatment: medication and therapy. Antidepressant medications can be useful for managing symptoms, but they should only be used along with therapy. The most commonly used antidepressants are SSRIs and SNRIs. Only when these newer medications fail to work will others be prescribed, because older antidepressants, like those in the atypical and tricyclic classes, cause more severe side effects in most people.
Antidepressants take several weeks to begin working, so it is important to stick with one medication for long enough to find out if it is effective and what side effects it causes. Stopping use of antidepressants suddenly can cause serious and dangerous side effects, so it is important to only stop using the medication with a doctor’s supervision.
Along with the right medication, behavioral therapies can also help control depression. With the right therapist, a patient can learn to recognize the signs of an oncoming episode and take steps to reduce the severity. Therapists help patients set goals, change negative thinking patterns, change negative behaviors, manage relationships, function better with depressive symptoms, and make positive lifestyle changes.
Depression patients may also benefit from spending time in a rehabilitation facility. Rehab can provide a safe environment in which to really focus on treatment. It can also offer additional services like group therapy, family therapy, creative and alternative therapies, nutrition and exercise, recreation, and more intensive therapy.
A lot of people struggle with depression, but there is hope. The prognosis for most people diagnosed with major depression is excellent. With ongoing treatment that includes the right antidepressant and dedicated therapy, it is possible to live very well with this condition. There may be times when it is worse and periods when symptoms go away entirely, but treatment helps to make the condition more manageable and episodes less severe and less common.