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Depression

Major Depression

Symptoms

Major Depressive Disorder (MDD) refers to a cluster of symptoms that significantly impair one’s functioning. To meet the diagnosis, one must either feel depressed or have an inability to experience pleasure. Along with this, one must have a number of symptoms such as suicidal thoughts or behavior, pessimism or guilt, lack of energy, abnormal sleep patterns, suppression of sexual interest, fatigue, hopelessness, sleep difficulties, crying spells, loss of concentration, weight changes, unexplained physical symptoms, agitation, irritability, and a feeling of worthlessness.

Professionals who are evaluating a client for possible MDD attempt to rule out medical conditions such as hypothyroidism or the side effect of medications (e.g., some blood pressure medications commonly cause depression). They also try to determine whether or not trauma, mania, substance abuse or other such factors are pertinent to the diagnostic picture.

Prevalence

MDD is a highly prevalent disorder, affecting nearly 10 percent of the adult population in the U.S. (nearly 20 million people). Lifetime prevalence is approximately 17 percent of women and 8 percent of men. MDD prevalence increases with age, affecting about 1 in 5 older adults.

Clinical Course

The course of MDD is variable and difficult to predict. Most people first experience MDD in their twenties. For some, MDD manifests as one incident and never recurs; for others, MDD is a life-long challenge with multiple recurrences, some of which may be clustered together over a 2-4 year period. About a quarter of patients experience short-lived symptoms; about a third suffer a chronic course; and about half will suffer at least one recurrence. With proper medication and therapy, the majority of suffers show significant improvement.

Other Co-Occurring Conditions

Substance abuse, suicidal ideation or behavior, other mood disorders, and various problems with anxiety often occur with MDD.

Medication Treatment

Antidepressants are the medications of choice for most cases of MDD. These drugs balance the brain’s neurotransmitters responsible for mood regulation and are neither addictive nor euphoric. They may begin working in as little as 2 weeks but often take a month or two to reach maximum effectiveness. Once an adequate trial of antidepressants has shown a positive effect, the patient is usually encouraged to remain on the medication for another year or so due to research indications that this may prevent subsequent relapse.

Medications which primarily affect the neurotransmitter Serotonin (the Serotonergics) include Paxil, Prozac, Zoloft, Celexa, Lexapro, and Luvox. Medications which primarily affect the neurotransmitter Norepinephrine (the tricyclics) include Anafranil, Sinequan, Elavil, Ludiomil, Morpramin, Pamelor, Tofranil, and Vivactil. Medications which may affect 2 or more neurotransmitters concurrently include Effexor, Remeron, Serzone, and Wellbutrin.

Side effects are common with these medications and may be short lived or prolonged. For the serotonergics, side effects include nausea, vomiting, diarrhea, agitation, insomnia, sexual dysfunction, headaches and temporary weight loss. For the tricyclics, side effects include blurred vision, dry mouth, constipation, sexual dysfunction, weight gain, low blood pressure, dizziness, and sedation.

Due to side effects and other factors, compliance with antidepressants is disappointingly low, with only about half of patients reliably refilling their prescriptions. This of course seriously compromises the effectiveness of antidepressant drugs.

Psychotherapy

By far the most well researched form of psychotherapy for depression is known as cognitive therapy, cognitive-behavior therapy, cognitive restructuring, or behavior therapy. Many types of benefits have been shown by this form of therapy, including immediate response, compliance, long-term benefit, stability of improvement, and resistance to relapse. Please see our description of Cognitive-Behavioral Therapy in this Specialties section.

Dysthymia

Dysthymia or chronic depression is less acute and severe than MDD but tends to last longer. One must have 2 symptoms of the disorder (e.g., appetite disturbance, sleep disturbance, fatigue, low self-esteem, hopelessness, and impairment of concentration) for at least 2 years in order to qualify for the diagnosis. The treatment options for MDD also pertain to Dysthymia.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) is indicated when the symptoms of Major Depression occur only during the winter. In addition to the treatment options noted above, full-spectrum light therapy and supplementation with vitamin D may also be indicated.

Adjustment Disorder with Depressed Mood

This refers to depression subsequent to a specific and very challenging circumstance (such as divorce, death, or other loss) which either is lingering longer than is normal or is more severe. Psychotherapy is the usual treatment recommendation for this problem.