What is Major Depressive Disorder?

Major Depressive Disorder is characterized by intense sadness and/or loss of interest in activities that the person usually enjoys. Major depression is diagnosed when this sadness or loss of interest is intense and present daily for at least a 2 week period of time and is accompanied by other related symptoms. Other common symptoms include: sleep disturbance, appetite/weight change, low energy, concentration problems, feelings of hopelessness and worthlessness, and suicidal thoughts. Major depression is a severe form of the “blues” that usually doesn’t go away naturally like other forms of sadness (such as grief over the passing of a loved one). This clinical depression interferes significantly with an individual’s functioning and daily activities and can continue to be a problem unless treated. However, not everyone experiences the exact same symptoms depression.

What causes it?

No one knows for certain what causes major depression, but it likely is multi-determined. There are many possible factors and they often differ from person to person. The scientific research suggests that both biological and environmental factors are probably involved. People with a family history of depression are at greater risk for developing major depression themselves. This may be the result of certain genetic factors or may be the result of growing up with depressed relatives. Brain chemistry and levels of cortisol, a stress hormone, also can affect a person’s mood and may become dysregulated in some individuals experiencing clinical depression. Depression can also develop following early life experiences such as childhood trauma (for example, abuse or neglect). Other major life stressors (for example, loss of a job) or relationship problems appear to be important in triggering depression as well. Furthermore, people with major depression often avoid things or isolate and withdraw from others, which may serve to maintain and worsen mood problems. The good news is that regardless of its causes, major depression is quite treatable.

How common is it?

Major depression is one of the most common types of psychological problems. Research indicates that up to 25% of women and 12% of men will experience major depression at some time during their lives.

When does it begin?

Depression can start at any time in a person’s life, from childhood through old age. The average age of onset of major depression is typically in early adulthood. It also tends to reoccur in individuals who have already experienced it earlier in life. After their first depressive episode, it is estimated that about 60% of individuals will have another episode at some other point in their life.

How is it treated?

The good news is that there are quite a few different treatment options currently available for people suffering from depression which are supported by scientific research. Biological therapies, like medication or electroconvulsive therapy, have been shown by research to be effective. The other main type of effective treatment is psychotherapy or counseling. Specific types of psychotherapy that have been shown by research to be effective for treating even severe depression including cognitive therapy, behavior therapy/behavioral activation, and interpersonal psychotherapy.

There are some advantages and disadvantages to each of these treatment modalities. Medications require relatively little effort on the part of the patient. There is the possibility of side effects, but these can usually be minimized. The biggest disadvantage of using medications as the sole treatment for clinical depression is that patients can be at greater risk for relapse unless they continue taking the medication. In other words, when one eventually stops the medication the problems can come back faster after medication treatment. The greatest advantage of psychotherapy is that the changes achieved through treatment are more likely to be sustained even after treatment is over. However, psychotherapy requires work on the part of the patient. In addition to weekly therapy sessions, the person may need to complete “homework” between sessions to practice new ways of coping with depression and stress.

Modern electroconvulsive therapy is also an effective and safe treatment option, but is usually only offered to those with more severe forms of depression who do not obtain full relief from their symptoms after trying medication or psychotherapy first because of potential side effects. Light aerobic exercise or certain self-help programs have been found to be effective options for those with milder forms of depression.

Finally, there is the option of combined treatment with medications and psychotherapy. This option does not appear necessary for all forms of depression, but evidence suggests that if patients fail to respond to either medication or psychotherapy alone, or if their depression is particularly severe and additional psychological problems are present, combined treatment may be the best approach. Recent research suggests that many of these treatments for depression work about equally well, so it’s important to match patients with the treatment approach that they find most acceptable and preferable.

What is chronic depression?

Dysthymia refers to a more chronic form of depression that is less intense than major depression but still causes impairment and distress. It is estimated that approximately 6% of individuals will experience this condition in their lifetime. The treatments options are similar to those for major depression. Some individuals have periods of time when they experience lower-grade depression or dysthymia, as well as other times when they experience more severe major depressive episodes during their lifetime.

What other problems are commonly associated with depression?

It is common for clinical depression to co-occur with other psychological problems. For example, various forms of anxiety are very common with depression. Depression also can be associated with drug or alcohol abuse. Some individuals experience bipolar disorder, which is a related condition in which the person can experience not only the lows of depression, but also uncharacteristically elevated, irritable, or “high” moods which can be equally impairing and lead to dangerous and impulsive behavior that causes further problems (see section on Bipolar Disorder). The potential for suicidal thinking and behavior is also a frequent concern in clinical depression (see section on suicide). Depression and other co-occurring problems require more tailored treatment plans that address the multiple problem areas.