Major Depressive Disorder (MDD)

Major depressive disorder (MDD) also known as clinical depression is a mood disorder presenting with feeling depressed, sad, or miserable, loss of interest or pleasure in daily activities and symptoms should interfere with the person’s quality of life significantly and last for at least two weeks. This mood must represent a contrast from the person’s normal mood. The change in mood must severely impair or affect a person’s social, occupational, educational, or other important functioning. An example would be a person who missed work or school because of extreme depression. In other cases, a person may completely stop working or going to school because of depressed mood, isolation, fear, low energy, or psychomotor slowing.

If the depressed mood is caused by drugs, alcohol, or medications, or if caused by a general medical condition, then MDD diagnosis cannot be used. Major depressive disorder diagnosis cannot be given to persons with a history of manic or hypomanic episodes, bipolar or schizoaffective disorders. Typically, a person grieving over the loss of an important loved one may not be diagnosed of major depressive disorder. Pathological bereavement is a term used for grieving or bereavement beyond cultural norms.

Symptoms

Although feeling sad, down, or depressed sometimes during life can be accepted as normal, clinical depression is characterized by depressed mood lasting most of the day, and with the presence of other symptoms such as loss of interest in regular activities, hobbies, and relationships, sleep and appetite problems, feelings of guilt, worthlessness, helplessness, etc.

Depression symptoms in Children and Teens

Children and teens with depression may have different symptoms from the symptoms of depressed adults. Irritability, sadness, hopelessness, and constant worrying are commonly seen in younger children, while adolescents and teens may exhibit symptoms of anxiety, avoidance of social interaction, and anger more frequently. Adults and adolescents may also have sleep and thinking changes.

Depression in children and teens may commonly co-occur along with mental health conditions and other behaviour problems like anxiety or attention deficit hyperactivity disorder or ADHD. Children’s school performance and work may significantly be affected because of depression.

Depression Symptoms in Older Adults

Depression may go undiagnosed in older adults because the symptoms that manifest might be mixed up with the symptoms of aging and other illnesses – loss of appetite, fatigue, loss of sexual desire, and sleep problems. Depression in older adults manifest itself with less obvious symptoms – they are dissatisfied with life in general, they feel helpless or worthless, they want to stay at home isolated rather than to go out and socialize.  If older adults entertain suicidal thoughts, it may be a sign of extreme depression and suicidal ideation or plans should be asked and addressed in all depressed patients.

Diagnosis

Doctors and licensed mental health care providers evaluate the person suspected of having major depressive disorder and ask questions about their moods, feelings, and thoughts to establish the diagnosis. Some questionnaires may be used to check for depression symptoms or measure the severity of depressive symptoms

The person may need to undergo medical and psychological tests in order to rule out other problems, medical or otherwise and to help clearly pinpoint a diagnosis and check for any related complications. The doctors and mental health professionals may ask the person to get the following exams and tests:

• Physical exam. This is a comprehensive physical assessment which includes height and weight measurements, vital signs checking – heart rate, temperature and blood pressure; heart and lung sounds and checking of abdomen.
• Laboratory tests. Complete blood count (CBC), thyroid hormone, complete metabolic panel are minimally needed tests to rule out physical.
• Mental Status Evaluation. The doctor or licensed mental health provider assesses the person’s thoughts and feelings or behavioural patterns. Medical history will be checked for previous similar episodes. They should also check for any suicidal ideation or tendencies.

The American Psychiatric Association has set criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is used for the diagnosis of mental conditions. DSM 5 will be published in 2013 which will revise some of the criteria in DSM-IV.

In order for the diagnosis to qualify, a person suspected of major depressive disorder must have at least five of the following symptoms over a two-week period. At least one of the symptoms must be either depressed mood or loss of interest or pleasure (anhedonia).

• Every day feeling loss of energy and fatigue
• Almost every day feeling worthless or guilty
• Loss of concentration, indecisiveness.
• Insomnia or hypersomnia
• Significant diminished interest or pleasure in everyday activities
• Being restless and feeling slowed down
• Suicidal thoughts
• Marked loss or gain of weight or appetite

It is important to note that the symptoms are determined not to be caused by a mixed episode — simultaneous mania and depressive symptoms that can occur in bipolar disorder; must be severe enough to interrupt day-to-day activities, such as work, school, social activities, or relationships; drug abuse, taking other medications for other medical conditions and grieving or temporary sadness after a loss of a loved one are not causing the symptoms.

Treatment

Major depressive disorder like most mental conditions usually is treated with medication and/or therapy.

• Medications. There are a number of antidepressants available for treatment of major depressive disorder. They are classified according to the effects on the chemicals in the brain associated with mood changes. Some of the most commonly recommended medications include:

1. Selective serotonin reuptake inhibitors (SSRIs). This is the primary group of medications prescribed by the doctor due to its fewer side effects. Decreased sexual desire and delayed orgasm are two of the most common side effects of SSRIs. Other side effects can include digestive problems, jitteriness, restlessness, headache, and insomnia.
2. Serotonin and norepinephrine reuptake inhibitors (SNRIs).  These drugs are as effective as, if not more than the SSRIs and may exhibit side effects similar to those caused by SSRIs including excessive sweating, dry mouth, fast heart rate, and constipation.
3. Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) is one of the few antidepressants which do not have common sexual side effects. However if given on high doses, bupropion may increase the risk of having seizures.

• Psychotherapy. This is another treatment option for major depressive disorder where a psychotherapist would talk to the person about the condition and its causes in order to understand the condition better. Identifying negative thought and behaviour patterns which are causing the depression can be learned during the therapy. Psychotherapy can help the person regain happiness and ease other depression symptoms such as hopelessness and anger. Effective and healthy coping mechanisms can also be learned during psychotherapy.