Major depressive disorder, also called MDD or clinical depression, is a common diagnosis in the mental health profession. It’s thought that nearly 300 million people worldwide suffer from major depressive disorder at one point or another. Clinical depression is a mental disorder that involves pervasive and persistent low mood and loss of interest that will get in the way of a person’s ability to maintain his or her normal life at home, with friends, at work, and/or at school. Depression is considered a chronic illness, and it often requires long-term treatment to alleviate the symptoms.
There is no diagnostic test for clinical depression. Rather, the diagnosis comes from self-reports from the patient, reports from the patient’s loved ones, and a mental health exam conducted by a doctor. The most common cluster of symptoms associated with MDD includes feeling low, lacking self-esteem, and having no interest in activities that used to be enjoyable. People with major depressive disorder may become overwhelmed by, or find unavoidable, thoughts of worthlessness, hopelessness, self-hatred, regret, and/or helplessness. These may cause social withdrawal, decreased interest in sex, and even thoughts of death or suicide. Difficulty concentrating and memory problems are also common in patients with MDD.
In addition to the mental or “invisible” symptoms, depression involves changes in physical habits or capabilities. These can include changes in eating or sleeping habits and overall health. Insomnia is commonly something that people with clinical depression experience, present in more than 80% of diagnosed cases. Most often, these patients wake early and are unable to get back to sleep. Feelings of fatigue, headaches, lethargy or even agitation, and previously absent gastrointestinal issues are commonly reported physical complains for people diagnosed with clinical depression. Depression patients may also see unintended weight loss as a result of low appetite or loss of interest in food, though some people with MDD will have the opposite experience and gain weight by overeating.
Major depression often occurs alongside chronic pain, cardiovascular disease, and other mental disorders. Frequently depression is present in a person who deals with anxiety, attention-deficit hyperactivity disorder, and post-traumatic stress disorder. Substance abuse and dependence often occur alongside depression, as well. Being aware of the symptoms of depression independent of symptoms of other issues, such as chronic pain or lifelong anxiety, is an important part of making an accurate and timely diagnosis and finding effective treatment.
There are three main approaches to treatment for depression: psychotherapy, medication, and electroconvulsive therapy. Psychotherapy is a treatment option that presents a wide range of possibilities and methods of delivery, including one-on-one, family, and group therapy. Mental health professionals including psychiatrists, psychologists, psychotherapists, social workers, and trained counselors are able to offer therapy to people dealing with clinical depression, and therapy can be delivered in conjunction with medication or as a stand-alone approach to treatment. The most studied approach to psychotherapy as a treatment for major depressive disorder is cognitive behavioral therapy, or CBT, which is the preferred primary treatment for children and adolescents diagnosed with clinical depression (but it is shown to be effective at all ages). CBT teaches patients to change their counter-productive behaviors and self-defeating mental patterns that are a significant part of depression. Cognitive behavioral therapy also is an effective method for preventing relapse into depression.
Medications known as antidepressants are a very effective form of treatment in severe cases of major depression, but studies indicate that the effect of antidepressants on mild and less severe depression is minimal. The typical patient experiences remission from MDD in 6 to 8 weeks after beginning a course of antidepressants, and many patients are medicated anywhere from 16-20 weeks up to a year following remission, in an effort to sustain the remission and prevent a relapse. Some patients who experience chronic depression may choose to stay on medication indefinitely.
Electroconvulsive therapy is the “last resort” treatment option for severe depression and emergency situations, such as when a person has become so depressed that he or she stops eating. The procedure involves sending shock waves to a certain part of the brain and inducing a seizure. While the science of its efficacy is not well understood and the treatment itself is highly controversial, some patients find ECT to be highly effective.
There are also holistic approaches to treating clinical depression, many of which can be very effective on mild to moderate depression. Exercise is often recommended to alleviate the symptoms of depression, and studies show that it can be quite effective in milder cases, often having the same degree of efficacy as psychotherapy or medication in many patients. Some research also indicates that fish oil can provide some of the same benefits to the brain as certain antidepressants. Actively maintaining a social life and taking on new responsibilities at work and at home, despite “not feeling like it,” are also thought to alleviate depression.