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

July 5, 2024July 5, 2024

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.

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.

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

June 28, 2024July 5, 2024

Men’s Mental Health

By: Kerry Moran

June is Men’s Mental Health Awareness Month and we decided to bring you a blog post about this. Here we detail some of the statistics, potential reasoning behind those statistics, and what can be done to help. Men’s mental health is an important topic in the mental health world and yet is severely misunderstood.

Many people in the United States are diagnosed with a mental illness every year. However, women are diagnosed almost twice as often as men with depression and other mental health disorders. It can be easy to look at that and think that women are just more prone to mental illness. Despite that, men make up almost 80% of all suicides each year, making them 4x as likely to complete suicide. Why is that, if they’re not being diagnosed at a higher rate than women?

There are many things to consider when it comes to this statistic. At least 1 in 10 men experience depression, but less than half seek treatment. This means that while women have higher rates of diagnosis, there are many men going undiagnosed every year. Men also make up 10% of bulimia and anorexia diagnoses and 35% of binge eating diagnoses each year. However, we also know that men are less likely to seek care, which means these figures could be higher.

A blue image with gold text that reads "Why do men fall through the cracks?" There is a silhouette of a man along with gold and blue details.

Why Does Men’s Mental Health Fall Through the Cracks?

So why do men so often fall through the cracks? Societal stigma against mental illness cannot be ignored. It’s what keeps so many people, regardless of gender, from seeking mental health care. Until this is something we eliminate as a society, there will always be people who go untreated for mental illness. We also have very strict societal ideas about what men should be and how they should act. This includes being non-emotional, that anger is an acceptable solution to many problems, that heavy drinking is normal. And, of course, that men shouldn’t cry. These factors not only contribute to why men don’t seek mental health care but also actively harm their mental health.

We don’t socialize men to be able to recognize their feelings or discuss them. This means they’re more likely to lack the verbiage to be able to clearly say that they need help. Sometimes, as a society, we can downplay when someone says they’re not feeling well if it doesn’t seem serious. It’s likely that because of the lack of socioemotional education for men that they have a hard time expressing just how seriously unwell they’re feeling. On the outside, it can look like they’re just having a bad day. However, inside, they could be very seriously depressed.

They’re also not socialized to have these types of conversations with each other. Often, we showcase that men should have relationships with other men based on shared hobbies. This makes it difficult to “ruin the fun” and bring up something difficult during what is supposed to be a low-key outing. They’re also not encouraged to ask other people, especially men, about how they’re feeling. This can lead to the false sense that men don’t suffer. Or, that they don’t recognize the suffering of others. Neither of these things are true.

Mental health affects men in many different areas of their lives, which could then contribute to worsening mental health. For example, it can affect their work lives and make their jobs difficult or cause lower productivity or job satisfaction. It can result in problems in romantic or platonic relationships, which can contribute to loneliness in men. It can also affect their families who may experience the brunt of some of the symptoms that many men experience.

There is also the issue that men’s symptoms, especially for depression, most often present as physical. For example, they often report headaches, digestive issues, fatigue, or general aches and pains as opposed to low mood. This means they’re more likely to seek help for what they perceive as a physical ailment from a doctor than reach out to a mental health professional for depression. They also often have a difficult time distinguishing depression from stress, as they present very similarly in men, and often have similar causes (relationship problems, work issues, family dynamics, etc.).

We also see that men are more likely to self-medicate when they’re depressed or anxious. This means they turn to drugs and alcohol more often. Unfortunately, it is considered societally normal for men to use alcohol to deal with stress or difficulties, which can encourage this behavior but also means that depression is going unnoticed. We see it as a man just trying to unwind from a hard day as opposed to a man experiencing depression. Even worse, these methods of self-medicating often make the problem worse, causing a vicious cycle.

Not only this, but physicians and mental health care providers are also less likely to realize the severity of symptoms in men. This is partially due to how gender differences play into presentation of symptoms but also due to inherent bias that all of us carry with us in our everyday lives. There is an unspoken understanding that men just don’t experience depression as often and so when they seek help, they are more likely to be dismissed as the problem being less severe than it actually is. Often, men are blamed for their own symptoms by society, with a focus being on their attitudes about mental health and masculinity (which are all influenced by the cultures in which they live).

We do not focus on addressing these societal issues and instead focus on how those experiencing mental illness should do better. Especially paired with how their symptoms are often different, these men who do seek care often do not get the level of care they need. In fact, almost half of all men who died by suicide sought mental health care in the year before completing suicide. Clearly, there is something missing in how health care professionals, including mental health professionals, are being trained in this particular area.

Barriers for Men of Color

Men of color have even more barriers to mental health care than their white counterparts. Indigenous men have the highest rates of suicide of all demographics and are more likely to report feelings of hopelessness, for example. Racism and racial trauma adds an extra stressor to the lives of men of color that contributes to poor mental health. Racial biases still exist in the health field, which could also contribute to a reluctance on the part of men of color to reach out for help from a predominantly white pool of health professionals.

Not only that, but historically, white medical professionals have used Black individuals for experimentation, often against their will and without their knowledge, harming their health permanently or killing them. This has contributed to lack of trust in the medical field. We also have to consider the impact that lack of resources have on men of color’s ability to even seek care. Many men of color live in areas with low density of mental health practitioners, heavily limiting their access. Many also cannot afford mental health care, which further causes impediments in seeking help for mental illness.

How does depression often present in men? We associate depression with low mood and excessive sleeping or eating, feelings of hopelessness, or other things that we associate with people being “sad”. However, we have seen that men often exhibit other symptoms when depressed:

Escapist behavior: spending more time at work, spending more time on hobbies such as sports.
Physical symptoms: muscle aches or pain, fatigue, headaches, nausea and other GI complaints.
Self-medicating by heavy use of alcohol or drugs.
Abusive behavior such as violence, controlling behavior, or emotional manipulation.
Anger, irritability, or aggressiveness that seems to not line up with expectations for the situation.
Risky behavior: use of illicit drugs, reckless driving (such as speeding), many sexual encounters.
Noticeable changes in mood or appetite.
Difficulty concentrating.
Feeling restless or on edge and an inability to relax.

So what can we do? One of the things we have to work on as a society is how we approach mental health stigma. While many strides have been made in this area, not enough has been done to address the stigma specifically aimed at men. We also have to, as a society, work to address how we see masculinity and the way we expect men to behave.

Our current gender roles are actively contributing to men’s poor mental health and their deaths. While these are big tasks, smaller tasks we can do is work on how health professionals are trained. We need to make them more able to recognize symptoms of depression in men. And to be able to meet men where they are to work with them towards better mental health. We need more access to mental health care, especially for men of color. We also need to encourage people to check in on their male friends and be prepared to have difficult conversations.

There are two organizations that are working on addressing men’s mental health and how people can have these conversations with men in their lives. They are Man Therapy and Movember. Man Therapy approaches men’s mental health with humor in the hopes of destigmatizing access and encouraging men to reach out for help. They also offer resources to help men recognize their symptoms and to recognize if a friend could be struggling. Movember also works towards this and has resources to help men talk to other men about mental help, including ALEC and R U Okay? Movember is working on releasing an online education program called Men in Mind . This is for mental health professionals to help them be better equipped to help male clients.

Men’s mental health is something we need to talk more about. And we need to work towards the end of stigmatization and approaching men with a focus on their unique needs. Men are dying at incredible rates from preventable mental health consequences. There is more we could be doing as a society and mental health professionals to address this.

Resources:

https://www.aamc.org/news/men-and-mental-health-what-are-we-missing

https://adaa.org/find-help/by-demographics/mens-mental-health

https://online.hpu.edu/blog/the-importance-of-mens-mental-health-awareness

https://www.medicalnewstoday.com/articles/mens-mental-health-man-up-is-not-the-answer

https://mhanational.org/infographic-mental-health-men

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444121