What is “Major” Depression

Depression is a mood disorder that causes feelings of despair and lack of interest. There are varying degrees of depression from mild, to temporary episodes of sadness, to severe, persistent depression. The most severe form of depression is major depression, also known as clinical depression or major depressive disorder. It can affect people of any age, including children.

Antidepressants and psychological counseling, or both, can improve major depression and ease its symptoms.

Depression can be caused by some form of loss (loss of a job or a relationship), death, or medical conditions like thyroid disorders. However, major depression is not the same, and it is much more severe.

What are the symptoms and signs of Major Depression?

Here are some signs and symptoms of depression used to diagnose major depression. They are severe enough to cause problems with day to day routine activities such as school, work, or social duties and can lead to relationship issues with your friends and loved ones.

• You may feel sad, tearful, empty, and hopeless
• Loss of interest in all normal activities: Sports, hobbies, sex
• You may have angry outbursts, frustrations, or irritability even over minor matters
• Sleep disruption
• You may feel tired and lethargic, no energy, making even small tasks feel difficult and effortful.
• Becoming restless and agitated often
• Anxiety
• Loss of appetite and weight loss are common, but some people have food cravings which lead to weight gain
• You may experience what feels like slow thinking, speaking, and moving
• Or have difficulties with concentration, decision making, and memory
• Struggle with feeling worthless and guilty, which may cause self -blame and fixating on past failures
• Unexplained physical ailments like headaches and backaches
• And lastly, thoughts of self-harm or suicide; seek help immediately

These are the most common signs of major depression and are usually intense. People with major depression require immediate attention and care.

And here’s the tricky thing, although a traumatic event can cause major depression or a series of events, it can occur without any obvious crisis or cause. It may occur as a single episode of depression or multiple episodes, which may follow after several symptom-free periods.

What are the causes of major depression?

There’s still no concrete evidence to determine the exact causes of major depression; however, genetic predisposition plays a role. Scientists believe that biological and environmental factors may play a role in the development of major depression. Some trigger factors include dietary problems, sleep issues like obstructive sleep apnoea, medical conditions, childbirth, and seasonal changes.

When should you seek help?

If you feel depressed and it affects your daily activities and relationships with your loved ones, seek help.

How will your doctor diagnose depression?

After taking a detailed medical history, your doctor will do a physical examination to exclude any underlying physical conditions that might be causing the symptoms. Certain blood tests will be ordered, such as full blood count and thyroid function tests.

Your mental health professional will ask about your symptoms, feelings, thoughts, and behaviors. It’s common for a questionnaire to be given for further evaluation.

The American Psychiatric Association has published a Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Many doctors prefer to use the symptom criteria of major depressive disorder in DSM-5 to diagnose major depression.

How is Major depression treated?

Medication and psychotherapy are used to treat people with major depression. Prescription medicines will relieve your symptoms gradually. You may benefit through psychological counseling and behavioral therapy by meeting a psychologist or a mental health provider. Sometimes hospital admission may be necessary for the initial management of major depression.

Here are some of the medications used by your doctor to treat major depression; always discuss the benefits and possible side effects with your health care provider to know what to expect.

• Selective serotonin reuptake inhibitors (SSRIs) – These are safe; side effects are minimal. They help elevate your mood and enlarge the brain’s hippocampus, which is the center for mood and memory. Ex: fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) – duloxetine (Cymbalta), venlafaxine (Effexor XR)
• Tricyclic antidepressants – They are effective but have more side effects when compared to newer antidepressants. Ex: imipramine (Tofranil), amitriptyline, nortriptyline (Pamelor), protriptyline (Vivactil), doxepin, trimipramine (Surmontil), desipramine (Norpramin)
• Atypical antidepressants – bupropion (Wellbutrin XL, Wellbutrin SR, Forfivo XL, Aplenzin),nefazodone, trazodone, mirtazapine (Remeron), and vortioxetine (Trintellix)
• Monoamine oxidase inhibitors (MAOIs) – These are prescribed when other drugs don’t. They can have severe interactions with certain foods like cheeses, wines, and pickles. Therefore, these prescriptions come with dietary advice. Ex: tranylcypromine (Parnate), Selegiline (Emsam), phenelzine (Nardil), and isocarboxazid (Marplan)
• Other medications – Some medications can be added to an antidepressant to enhance the effects of antidepressants. Ex: mood stabilizers or antipsychotics, anti-anxiety, and stimulant medications

Your psychiatrist will decide the length of treatment. It’s believed that combining medication(s) with supportive psychotherapy or cognitive behavioral therapy will give the best benefits in treating major depression. In fact, research has shown that cognitive behavioral therapy is the best treatment for depression; however, many patients respond best to a combination of medicine and therapy.

What is the prognosis for Major depression?

The long-term outlook for patients with major depression is usually good. With appropriate medications and cognitive behavioral therapy, you have a great chance of living a fulfilling and happy life without many recurrent episodes. If you, or someone you love, struggles with depression, please seek help from your health care provider without delay.

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