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