All About MDD: Major Depression Disorder

May was Mental Health Awareness Month and in honor of that, we shared information on our socials during May about various mental health topics. This series of blog posts is an expansion on those social media posts. Our last post was about compassion fatigue and why self-care and mental health is so important as a clinician. This post is about major depression disorder, more commonly just referred to  as depression. 

MDD is one of the most common mental health disorders in the world and one of the leading causes of disability globally. 3.8% of the global population and 29% of Americans experience depression at least once in their lives. 18% of Americans are currently experiencing depression. This disorder has been most commonly associated in adults in the past but more recently has been acknowledged in children. Depression is also proportionally higher in the LGBTQIA+ population than the general population.

While women and people assigned female at birth are 50% more likely to be treated for depression than men and people assigned male at birth, it’s unclear if this is due to genetic differences (meaning that depression is more common in one group or the other biologically) or societal differences. Men and people assigned male at birth are less likely to seek treatment for mental health disorders, primarily due to societal stigma, which may be skewing data in this area. 

There is some data that suggests that depression could be genetic, with people who have at least one biological relative with depression being at higher risk than those who don’t. Those who have experienced trauma or stress as children are also more likely to develop depression as adults. Substance use (alcohol, drugs) has also been linked to higher rates of depression. Some physical illnesses, such as diabetes, are also associated with higher risk for developing depression.

Symptoms of Depression

In order to be diagnosed with depression, an individual must have five or more of the following symptoms:

  • Sadness, hopelessness, emptiness
  • Fatigue
  • Feeling restless or lethargic
  • Sleep issues (sleeping too much or too little)
  • Appetite changes which can contribute to weight gain or loss
  • Anxiety or irritability
  • Difficulty concentrating
  • Feeling guilty, ashamed, or like a burden
  • Social isolation
  • Lack of pleasure in doing things (anhedonia)
  • Thoughts of dying or attempting suicide

Some people may only have five of the symptoms while others could have many more. The important part is that these symptoms must be present most days for at least two weeks for the person to qualify for a depression diagnosis. Other possibilities must also be ruled out, such as vitamin deficiencies or a physical illness.

Most people go to their primary physician first at the onset of symptoms, especially for sleep disturbances and fatigue. This could be because of lack of education about mental health disorders such as depression or because of the stigma that is attached to depression. Physicians can help but usually their understanding of psychiatric treatments are limited in comparison to psychiatrists.

The majority of people experience major depression disorder once with many experiencing recurring episodes of depression. The more episodes of major depression disorder someone experiences, the more likely it is that the depression will be more chronic in nature. With proper treatment, most people start to feel better within a few weeks to three months. For most, MDD can go into remission in about 6 to 9 months. Without treatment, however, symptoms can last months or years and could be more severe than for those who are getting medication and/or therapy for their depression. This is one of the many reasons early diagnosis and treatment are so important. It can help avoid someone’s life being so impacted by depression that they become disabled or attempt (/complete) suicide. 

An important thing to note is that depression and grief are not the same thing. Grief, which can come with sadness, is a natural response to loss. However, they can co-occur, which can prolong symptoms of grief and make them more severe. Accurate diagnosis is crucial in this area in order to make sure someone gets the proper treatment most likely to help them. 

Treatment Options for Major Depression Disorder

Major depression disorder is very treatable in most people and there are a variety of of treatment approaches that are available:

  • Treatments include a variety of medications that can be tried (SSRIs, SNRIs, TCAs, MAOIs, etc)
  • Various forms of talk therapy are also available for treating MDD (CBT, family therapy, interpersonal therapy, etc)
  • For treatment resistant depression, brain stimulation therapies exist that can help severe MDD (ECT, rTMS, VNS)
  • Esketamine is a newer, FDA approved treatment for MDD that has not responded to other forms of treatment.
  • A combination approach is usually the most effective way of treating MDD (therapy plus medication, for example)

When trying medications it is important to remember that it can take at least 6-8 weeks to feel the full benefits of a medication. If side effects are intolerable, discuss with your doctor before discontinuing treatment. 

Along with these traditional treatments, a variety of self-care activities can be done in conjunction (not instead of) to help alleviate symptoms more quickly or avoid a recurrence of a depressive episode:

  • Regular exercise
  • Eating nutritious and balanced meals
  • Mindfulness, such as journaling or meditation
  • Spending more time in nature
  • Remaining connected with your social circle and confiding in trusted people
  • Setting realistic goals 
  • Break down tasks into smaller steps
  • Avoid using substances such as alcohol and drugs not prescribed to you

Self-care is incredibly important when treating depression, especially in those who have recurrent depressive episodes. While it can be difficult to get into a self-care routine while depressed, it can be crucial to helping shorten the depressive episode. It’s especially important for staving off future episodes. 

Ending mental health stigma is an important step in ensuring that people are more likely to seek help for their depression sooner rather than later, which can help with achieving the ideal prognoses. The more we discuss mental health and educate others about it, the more likely people are to seek help in a timely manner and get back to being able to live their lives more fully again.

Resources:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/major-depression

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression

https://www.ncbi.nlm.nih.gov/books/NBK559078

https://www.nimh.nih.gov/health/topics/depression

https://www.psychiatry.org/patients-families/depression/what-is-depression

https://www.samhsa.gov/mental-health/depression

https://www.who.int/news-room/fact-sheets/detail/depression

The Importance of Clinician Mental Health

An image with a teal background and white text. The text reads "Clinician Mental Health". There is a flower wreath and inside of it is a calandar, watch, and the sillhouette of a human head with a lightbulb growing out of it.

The topic of clinician mental health came to us when May was Mental Health Awareness Month and we shared information on our socials about various mental health topics. This is an expansion on those posts to give more information about things of note related to mental health.

Mental Health Awareness Month is usually focused on raising awareness of different mental health disorders, the type of help available, and trying to reduce the stigma attached to mental health disorders. While this is partially aimed at educating the general public it can also be a way of encouraging people to seek out the mental health care they need. 

One important group we often fail to mention in these conversations is that of the helping professionals, or mental health practitioners. Those who work in the mental health field need to be just as aware of their mental health and needs as anyone else. This allows us to do our jobs for longer and do them better. It also lets us get the most out of our profession and everyday lives. Not taking care of our mental health can lead to things like burnout and compassion fatigue.  Focusing on clinician mental health can help avoid both of these concerns.

A teal image with white text that reads "Compassion Fatigue". There is a person slumped over at a desk with an empty battery above their head.

Compassion Fatigue

Burnout and compassion fatigue can look very similar. Burnout usually comes from overwork and low job satisfaction while compassion fatigue is more associated with vicarious or secondary trauma. Compassion fatigue usually comes on suddenly while burnout occurs slowly over time. When thinking about the differences in their symptoms, burnout usually involves resentment towards the job or coworkers, and can feel like wanting or needing a new job or a different job. Compassion fatigue involves self-contempt, as opposed to contempt of others and it can feel like you’re not working hard enough or doing enough to help others. It can also leave you feeling like the therapeutic relationship is uneven, with you giving much more to your work and clients than you receive in job satisfaction.

Despite these differences, they do have some overlap of symptoms. Both involve feelings of job satisfaction, bringing “work home” (an inability to stop thinking about work during off-hours), mental and physical exhaustion, headaches, trouble sleeping, poor eating habits, depression, and anxiety. 

Certain clinicians are more likely to develop compassion fatigue. If you work with victims of trauma often, if your caseload is made up primarily of severely depressed clients, or if you work heavily with grief and bereavement, you’re at higher risk of developing compassion fatigue. 

The first step to avoiding burnout or compassion fatigue is to be aware of how you’re feeling. Being able to notice changes in how you approach work or others can be one of the early signs that you may need to take extra care of yourself or change how you approach your professional life. If you, or others around you, notice any of those symptoms becoming a problem for you, then it’s time to step back and evaluate your work load and your self-care routine. These are important aspects of promoting clinician mental health.

A teal image with white text that reads "Self Care". There is a person hugging themselves surrounded by images of a sleep mask, painting, a journal, a candle, a cup of tea, and a phone that has been powered off.

Self-Care

We all know that self-care is important for many of our clients. However, it’s just as important for those who work in the mental health field. This is critically important when it comes to being able to not just do our jobs, but to do them well.

There are a lot of different things you can do to take care of yourself both before and after developing compassion fatigue or burnout:

  • Consider getting therapy if this is heavily impacting your day to day; we all know how important therapy is for our clients and it can be just as important for us, too. This is especially true if you find yourself “bringing work home with you” a lot.
  • Take regular days off and vacations, if possible, in order to relax and decompress from your work. While work will still be there when you get back, this can be a good way to reset yourself and give yourself more mental resources in order to tackle your caseload efficiently.
  • Consider a smaller case load, if needed, or changing the types of clients you see. Sometimes it really is that we’ve reached a point where our caseload is hurting us more than we’re helping others. 
  • Try bringing mindfulness into your every day, such as meditation or journaling. This can also be a great way to catch the signs of compassion fatigue before it starts to impact you.
  • Exercising regularly and making sure to eat a nutritious diet can also help as it’s easier to tackle the day when you’re taking care of yourself physically, too
  • Make sure to get enough sleep regularly.
  • Make time for things that bring you joy.
  • Spend some more time in nature.
  • Make sure to stay connected to your support system – compassion fatigue can sometimes make us want to isolate and this can make things worse.
  • Engage in hobbies you love or find a new one – games, books, movies, gardening, anything that brings you a sense of peace or you’ve been curious about trying.
  • Practice gratitude, both for the things around you and for yourself and what you bring to the world.

Prioritizing self-care can be hard, especially for the types of people who are so drawn to helping in the first place. It can be easy to feel guilty or compare ourselves to others, even more so if we have clients who are unable to engage in self-care themselves. It’s deeply important that we practice self-care, however, because this is how we can better take care of ourselves. And others, too. You need to take care of yourself before you can fully take care of others. Like we’re always told on planes, you need to put your oxygen mask on first before helping someone else put on theirs. It’s not selfish, it just ensures that we’re best able to provide that help to someone else. 

Mental health care is incredibly important, not just for our clients, but for us, too. It’s especially important because we are tasked with listening to the worries of others. If we cannot keep ourselves healthy, it becomes much more difficult to do this day in and day out. Clinician mental health is something we should make sure we make time for and focus on.

Curious if you’re at risk for compassion fatigue? Take the Professional Quality of Life test developed to measure compassion fatigue AND compassion satisfaction.

Resources:

https://compassionfatigue.org/index.html

https://www.goodtherapy.org/blog/the-cost-of-caring-10-ways-to-prevent-compassion-fatigue-0209167

https://positivepsychology.com/self-care-therapists

https://www.samhsa.gov/blog/mental-health-awareness-month-time-self-care