By Heather Sheaffer, MA, LCSW
The DSM-5 explains that major depressive disorder is a condition marked by feelings of sadness, emptiness and guilt; loss of interest in activities; and sleep disturbances. In most cases, individuals with major depressive disorder also experience significant change in weight. Major depressive disorder is diagnosed across the lifespan and is most common among girls and women. Several effective treatment options exist, but when not treated, major depressive disorder can lead to suicide (American Psychiatric Association, 2013).
Symptoms of Major Depressive Disorder
Major depressive disorder is a complex condition with a large range of potential symptoms. The DSM-5 requires that at least five symptoms be present for a two week period or longer to make a diagnosis. The most prevalent symptoms of major depressive disorder are feeling unhappy most of the time and losing interest or pleasure in most activities. The DSM-5 requires that these feelings must be experienced most of the day, every day for a two week period. Feeling unhappy is typically indicated by feelings of sadness, emptiness, guilt or hopelessness, but can sometimes present as anger or anxiety. In children and adolescents, irritable mood is often observed by parents and teachers.
Another common symptom is change in weight. Depressed patients often gain or lose a significant amount of weight without purposeful dieting. Trouble with sleep is another common. Some patients have a very difficult time falling asleep, or will wake up in the middle of the night or hours before morning and be unable to fall back to sleep. Many patients report loss of energy and problems concentrating at work and home. Some people, particularly elderly patients, move and react much more slowly than normal. Many patients with major depressive disorder experience thoughts of death, dying, and suicide. Some patients with major depressive disorder experience recurring episodes, but many patients experience only a single episode. The symptoms presented cannot be related to substance use or illness. If symptoms are related to a trauma or loss, they are considered signs of grief, not major depressive disorder (American Psychiatric Association, 2013).
The DSM-5 notes that major depressive disorder is associated with high mortality. Almost all cases of suicide in the United States is related to a psychiatric illness and half involve mood disorder, such as major depressive disorder (Pompili, 2011) One reason for this is that suicidal thoughts, feelings and actions are a common symptom of major depressive disorder. Suicidal ideation varies greatly in intensity. While some patients have a specific plan for suicide and expect to carry out these plans, many patients have more passive ideations. A desire to not wake up or not exist, for example, indicates depression but no clear plan for suicide. Both acute and non acute suicidal thoughts are caused by a variety of associated feelings. Some feel a desire to give up, others want to end their emotional pain or stop feeling as though they are burden to others. Although most completed suicides are not preceded by unsuccessful attempts, a history of attempt or threats is considered to be the most prominent risk factor. Women are more likely to attempt suicide; men are more likely to complete suicide. Suicide is not the only factor in the high mortality rate of major depressive disorders. Elderly patients who are depressed when admitted to a nursing home are more likely than non-depressed patients to die during the first year (American Psychiatric Association, 2013).
Women are three times more likely than men to experience major depressive disorder. In the United States, the prevalence is about 7% among the general population (American Psychiatric Association, 2013).
Although any individual can develop major depressive disorder, the DSM-5 explains that several risk factors have been identified. Temperament is one well-documented risk factor of major depressive disorder. Individuals with a high level of negativity are more likely to develop depressive symptoms in response to life stressors. Environmental risk factors are also common. People with abusive or otherwise difficult childhoods are at increased risk for developing major depressive disorder. Additionally, life stressors can trigger depressive episodes. Researchers have also found a genetic component related to major depressive disorder. The DSM-5 estimates that heritability is around 40%. Individuals with an immediate family member who suffers from depression are two to four times more likely to have depressive symptoms than the general population (American Psychiatric Association, 2013).
Major depressive disorder has a profound effect on relationships. Because withdrawing from activities is a diagnostic feature of major depressive disorder, patients are likely to withdraw from friends and family. A loss of interest in sex is also common, which can create problems in romantic relationships. Social withdrawal can lead to feelings of isolation, exasperating feelings of loneliness, guilt, and worthlessness. Friends and family members who do not understand depression may inadvertently make the patient feel worse, by creating guilt, or seeing the patient as self-absorbed. Irritability can also create interpersonal problems, as the patient may become easily angry or annoyed. When an individual with major depressive disorder talks about suicide or makes an attempt, great stress is put on the patient’s family. Loved ones may be perpetually frightened of finding the patient dead or seriously injured as a result of suicide. Friends and family may also feel frustrated when they cannot talk the patient out of his feelings or convince him that his life is worth living (Sexton, 2011).
Treatment for Major Depressive Disorder
Because depression is one of the most commonly diagnosed mental disorders, a vast array of treatment options are available. While psychotropic medication tends to be helpful the majority of patients diagnosed with major depressive disorder, psychotherapy is one of the most successful methods of treatment. Although several methods of psychotherapy exist, most methods share the goal of reducing suicidal thoughts while increasing pleasurable behavior. Many forms of therapy also focus on increasing social skills, assertiveness and self-awareness (Leahy, Holland & McGinn, 2011).
In the world of managed care, cognitive therapy is the most common and effective treatment for major depressive disorder. Cognitive therapy is based on the belief that cognitions are related to emotions and feeling. It focuses on the patient’s perspective and automatic thoughts that may lead to an adverse mood. Automatic thoughts refer to the way the patient makes assumptions. For example, a patient may believe that he will not benefit from therapy, or that if he goes to a party, no one will find him interesting. The goal of the therapist is to challenge these beliefs. Core beliefs are another important component of cognitive therapy. Core beliefs refer to the underlying ideas that a patient has about himself or the world. Core beliefs are not always apparent, but an experience therapist can identify them through asking questions about what the patient thinks will happen if he engages in behaviors he is avoiding or that he believes makes him depressed (Leahy, Holland & McGinn, 2011).
Interpersonal therapy is another viable approach to treating major depressive disorder. Interpersonal therapy focuses on the relationship between the patient and other people. The assumption of interpersonal therapy is that depression causes problems in relationships and problems in relationship cause depression. As this cycle continues, so does the depression. Interpersonal therapy identifies sources of conflict, loss, isolation or other interpersonal problems and creates a plan to overcome the issue. During therapy, the patient will also benefit from improving social skills, stronger communication, and understanding the emotions of self and others (Law, 2013).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Law, R. (2013). Defeating depression : how to use the people in your life to open the door to recovery. New York, N.Y.: Constable & Robinson.
Leahy,R.L., Holland, S.J. & McGinn, L.K. (2011). Treatment plans and interventions for depression and anxiety disorders. New York, NY: Guilford Press.
Pompili, M. (2011). Antidepressants therapy and risk of suicide among patients with major depressive disorders. Hauppage, N.Y.: Nova Biomedical Books.
Sexton, L.G.(2011). Half in love: Surviving the legacy of suicide. New York, N.Y.: Counterpoint Publishing
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