Major depression, also known as clinical depression, is a chronic and common type of mood disorder and mental illness. It is characterized by persistent feelings of sadness, loss of interest, lethargy, and feelings of guilt and shame. Depression may also trigger physical problems, like weight gain or insomnia, and thoughts of suicide. Major depression can be treated and managed with medication and psychotherapy.
Major Depression Defined
Major depression, which is also called major depressive disorder, clinical depression, or just depression, is a type of mood disorder. A mood disorder is a mental health condition that causes a person’s mood and emotional state to change, to be distorted, and to be inconsistent. With a mood disorder, a person’s mood or emotions often don’t match their circumstances.
With major depression, a person’s mood is persistently sad, regardless of what is going on in his or her life. It causes loss of interest in normal activities or things once enjoyed. It can also cause many emotions that go beyond sadness, including anger, frustration, and guilt. While everyone experiences a degree of depression from time to time, major depression persists for long periods. A person with this condition cannot simply “get over it” or “snap out of it.” Depression is a chronic illness that requires treatment.
Facts about Major Depression
- Mood disorders are the most common types of mental health conditions diagnosed in American adults.
- Nearly 10 percent of Americans over the age of 18 have some type of mood disorder.
- In 2015, 6.7 percent of the U.S. adult population struggled with major depression.
- Mood disorders, including depression, are the third most common reason for hospitalization for young people and adults between the ages of 18 and 44.
- Major depression is the leading cause of disability for Americans aged 15 to 44.
- The median age of onset for depression is 32, but it can begin at any age.
- More women are diagnosed with depression than men.
Depression Risk Factors
A single, defined cause of depression is not known and cannot be pinpointed in any individual. There are thought to be multiple causes that interact to cause depression to begin, including abnormalities in brain structure and brain chemistry, as well as genetic factors. Hormones are also thought to play a role. Changing levels of hormones during certain times, like pregnancy or menopause, may trigger symptoms of depression. In addition to these biological factors that have been shown to be linked to depression, there are risk factors. Having one or more of these risk factors increases the odds that someone will develop depression but does not guarantee it:
- A family history of depression or other mood disorders, suicide, or substance abuse
- Experiencing a traumatic or stressful event, including childhood trauma or present circumstances like the death of a loved one
- Specific personality traits, including low self-esteem, dependency on others, and pessimism
- A history of other mental health conditions or eating disorders
- Substance abuse
- Severe, terminal, or chronic illness
- Specific medications
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Signs of Depression
There are many different ways in which depression can manifest, some of which may be surprising. For instance, depression can cause physical pain. The overwhelming sign of depression that most people with this condition experience is a persistent feeling of sadness and hopelessness that just can’t be shaken. Other signs that someone may be struggling with major depression include:
- Feeling fatigued or lacking energy
- Lacking interest in normal or previously enjoyable activities
- No longer caring about hygiene
- Sleeping more or less than usual
- Feeling guilty and ashamed
- Changes in appetite that lead to weight loss or gain
- Feeling agitated, restless, or angry
- Withdrawing from family and friends
- Struggling at school or work
- Struggling to concentrate or focus on tasks
- Experiencing unexplained pains, such as headaches or digestive distress
- Feeling bad about yourself, or feeling suicidal
The signs may be different in young people. Children are more likely to have physical pain, to be underweight, to be needy or clingy, and to avoid school. Teens with depression may start to do poorly in school, use drugs or alcohol, sleep too much, engage in self-harm, and become isolated. Older adults also exhibit certain specific signs of depression, including memory problems, changes in personality, social withdrawal, and loss of appetite. Men as compared to women are more likely to experience anger, physical pain, and to engage in reckless behaviors when struggling with depression.
Diagnosing Major Depression
To be diagnosed with major depression requires a psychiatric evaluation by a mental health professional, preferably a psychiatrist. The diagnostic criteria include five out of nine possible symptoms experienced during a period of at least two weeks that cannot be explained by substance abuse or another mental illness. The nine symptoms are:
- A persistent depressed mood
- A significant loss of interest in activities
- Significant weight loss or weight gain
- Insomnia or oversleeping
- Being agitated or slowed down in affect and energy
- Being fatigued
- Feeling worthless or guilty
- A decreased ability to concentrate, to think, or to make decisions
- Recurring thoughts of death, suicidal thoughts, or suicide attempts
To be diagnosed with major depression, two of the five symptoms present must be numbers 1 and 2 above. The five or more symptoms must also be significant and interfere with a person’s ability to function normally in all areas of their life.
Treatment Strategies for Depression
Getting a diagnosis for major depression is important because this illness will not go away on its own. It is chronic, so even when someone with depression starts to feel better it is likely there will be another episode in the future. Consistent treatment is essential to help an individual feel better, manage symptoms, and to be able to function normally again.
The most effective components of treatment for major depression are medications and therapy. Medications called antidepressants can be used to treat depression, and there are several different types of these drugs. A patient with depression may have to try more than one before finding a drug that works best with minimal side effects. It can take several weeks for the effects of an antidepressant to be felt, and stopping an antidepressant suddenly can be dangerous. It is very important for patients to stick with a medication for a certain period of time and to communicate with their doctor about any side effects that are not tolerable.
Medications are effective for many people with depression, but the best treatment also includes therapy. There are various types of psychotherapy that may be helpful, but one of the most commonly used is called cognitive behavioral therapy, or CBT. CBT guided by a professional therapist helps patients recognize and change negative thoughts, manage symptoms, and use problem-solving to change behaviors. Therapy for depression may also be done in a group setting or with family.
Also important in managing depression is self-care. A therapist can help patients learn what they can do at home to support professional treatment. For instance, avoiding alcohol and drugs is important, as is engaging with family and friends and reaching out for support and connection. Other self-care strategies that may help include participation in support groups, stress-management techniques, meditation, yoga, exercise, and a healthy diet.
Complications of Major Depression
Major depression causes certain symptoms characteristic of the condition, but it can also lead to complications. These are even more likely in untreated depression:
- Weight gain, which can cause physical health problems such as diabetes
- Substance abuse
- Self-harm injuries, like wounds from cutting
- Social isolation
- Conflicts with family and unstable relationships
- Academic difficulties or problems at work
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The prognosis for major depression is generally very good. Most people diagnosed with depression who stick with a treatment plan are able to start to feel better and function normally again. Treatment and self-care can even prevent or reduce the severity of future episodes of depression. The best outcome can be achieved when a patient is consistent with treatment, communicates with their doctor about issues with medication, engages in self-care, and seeks social support from loved ones or other people struggling with depression.
Major depression is a very serious mental health condition, but it is treatable. It is crucial to reach out for help or to offer support to others who may be living with depression. A diagnosis will lead to a treatment plan that will most likely include an antidepressant medication and therapy. With consistency in treatment, self-care, and support from loved ones, it is possible to manage and live with depression.