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What Is A Major Depressive Episode

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What is Major Depressive Disorder?

MDD is more than simply feeling sad, experiencing grief, or being super drained of energy. Those feelings are totally valid, but like most feelings, theyll eventually pass. MDD is an often-debilitating mental illness that presents as a cluster of depressive symptoms. For most people, clinical depression wont go away on its own and you cant just snap out of it.

While melancholy and exhaustion are part of depression, there are other symptoms to look for, including losing interest in things you once enjoyed, trouble sleeping, sudden crying spells, withdrawing from others, hopelessness, thoughts of self-harm or suicide, and more. Depressive episodes vary in severity and duration, but they must last for two weeks or more to qualify for an MDD diagnosis.

Many people with clinical depression do their best to conceal symptoms from the people around them. They may feel vulnerable and embarrassed for showing weakness, or worry that their friends and colleagues might judge them or just plain ghost them. Remember: MDD is not a negative attitude, a character flaw, or a sign of weakness.

Some people with depression cant recognize depression in themselves. Theyre not necessarily imperceptive. Symptoms can pop up gradually and, before you know it, you havent been to work, showered, or changed out of pajamas in three days. Classic depression attributes like hopelessness and suicidal comments are easy to spot, but some signs are less obvious.

Can Depression Be Prevented

You can help prevent depression by getting enough sleep, eating a healthy diet and practicing regular self-care activities such as exercise, meditation and yoga.

If youve had depression before, you may be more likely to experience it again. If you have depression symptoms, get help. Care can help you feel better sooner.

How Is Depression Syndrome Diagnosed

Everyone may feel sad or down from time to time. However, clinical depression has more intense symptoms that last two weeks or longer.

To determine whether you have clinical depression, your healthcare provider will ask questions. You may complete a questionnaire and provide a family history. Your healthcare provider may also perform an exam or order lab tests to see if you have another medical condition.

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Are Women At Higher Risk For Major Depression

Almost twice as many women as men have major or clinical depression hormonal changes during puberty, menstruation, pregnancy, miscarriage, and menopause, may increase the risk.

Other factors that boost the risk of clinical depression in women who are biologically vulnerable to it include increased stress at home or at work, balancing family life with career, and caring for an aging parent. Raising a child alone will also increase the risk.

What Is Major Or Clinical Depression

What is a depressive episode and 12 tips for dealing with one

Most people feel sad or low at some point in their lives. But clinical depression is marked by a depressed mood most of the day, sometimes particularly in the morning, and a loss of interest in normal activities and relationships — symptoms that are present every day for at least 2 weeks. In addition, according to the DSM-5 — a manual used to diagnose mental health conditions — you may have other symptoms with major depression. Those symptoms might include:

  • Fatigue or loss of energy almost every day
  • Feelings of worthlessness or guilt almost every day
  • Impaired concentration, indecisiveness
  • Insomnia or hypersomnia almost every day
  • Restlessness or feeling slowed down
  • Recurring thoughts of death or suicide
  • Significant weight loss or gain

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Track Triggers And Symptoms

Keeping track of moods and symptoms might help a person understand what triggers a depressive episode. Spotting the signs of depression early on may help them avoid a full-blown depressive episode.

Use a diary to log important events, changes to daily routines, and moods. Rate moods on a scale of 1 to 10 to help identify which events or activities cause specific responses. See a doctor if symptoms persist for 14 days or more.

What Does Mdd Look Like In Older Adults

Spotting MDD in people age 65 and older isnt as easy as it seems. Many older adults have medical conditions like heart disease, stroke, cancer, and arthritis, which are strongly linked to depressive symptoms and can lead to social isolation.

Their activity level may already be low for physical reasons. They may not be comfortable talking about mental health . Some older adults with no prior history of depression may develop vascular depression, caused by restricted blood flow to the brain.

Along with the usual signs, a depressed older adult is likely to:

  • Experience confusion and memory problems

  • Avoid social activity

  • Demand assistance or frequently seek help

  • Lose their appetite or lose weight

  • Have delusions or hallucinations

MDD is a beast of an illness. And, not surprisingly, it can be really difficult to ask for help when you are experiencing the symptoms weve discussed. If you or someone you know is showing signs of MDD, know that treatment can and will help.

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Depressive Episodes: Times Of Acute Depression

The American Psychiatric Association defines a depressive episode as a period in ones life of at least two weeks, during which they exhibit the requisite symptoms ofmajor depressive disorder. The symptoms of MDD are diverse, and include the following:

  • Low mood.
  • Sadness .
  • Hopelessness that things might improve.
  • Anhedonia .
  • Distractibility and difficulty concentrating.
  • Emptiness, and sense of longing for something or someone who has been lost.
  • Psychomotor functioning difficulties.
  • Significant weight changes when not dieting.
  • Insomnia or hypersomnia.
  • A sense of worthlessness.
  • Suicidality.

The APAs Diagnostic and Statistical Manuals fifth edition states that a depressive episode must include a number of the above and other symptoms in order to meet the requirements for an official depressive episode diagnosis.

An official MDD diagnosis can be given even after a single depressive episode has been recorded, in which case it would be considered a single-episode instance of MDD. An MDD diagnosis could also include more than one depressive episode, in which case it would be considered a recurrent episode case of MDD.

What Are The Symptoms Of Major Depressive Disorder

Major Depressive Disorder

Your doctor or a mental health professional can diagnose major depressive disorder based on your symptoms, feelings, and behaviors.

Typically, youll be asked specific questions or given a questionnaire so health professionals can better determine whether you have MDD or another condition.

To be diagnosed with MDD, you need to meet the symptom criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition . This manual helps medical professionals diagnose mental health conditions.

According to its criteria:

  • you must experience a change in your previous functioning
  • symptoms must occur for a period of 2 or more weeks
  • at least one symptom is either depressed mood or loss of interest or pleasure

You must also experience 5 or more of the following symptoms in the 2-week period:

  • You feel sad or irritable most of the day, nearly every day.
  • Youre less interested in most activities you once enjoyed.
  • You suddenly lose or gain weight or have a change in appetite.
  • You have trouble falling asleep or want to sleep more than usual.
  • You experience feelings of restlessness.
  • You feel unusually tired and have a lack of energy.
  • You feel worthless or guilty, often about things that wouldnt usually make you feel that way.
  • You have difficulty concentrating, thinking, or making decisions.
  • You think about harming yourself or suicide.

Symptoms parents should be aware of in their teens include the following:

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Depressed Mood And Loss Of Interest

Either depressed mood or a loss of interest or pleasure must be present for the diagnosis of a major depressive episode. Depressed mood is the most common symptom seen in major depressive episodes. Interest or pleasure in everyday activities can be decreased this is referred to as anhedonia. These feelings must be present on an everyday basis for two weeks or longer to meet DSM-V criteria for a major depressive episode. In addition, the person may experience one or more of the following emotions: sadness, emptiness, hopelessness, indifference, anxiety, tearfulness, pessimism, emotional numbness, or irritability. In children and adolescents, a depressed mood often appears more irritable in nature. There may be a loss of interest in or desire for sex, or other activities once found to be pleasant. Friends and family of the depressed person may notice that they have withdrawn from friends, or neglected or quit doing activities that were once a source of enjoyment.

Criteria For Severity/psychotic/remission Specifiers For Current Major Depressive Episode

Note: These criteria are coded for in fifth digit of the DSM-IV diagnostic code. Can be applied to the most recent Major Depressive Episode in Major Depressive Disorder and to a Major Depressive Episode in Bipolar I or II Disorder only if it is the most recent type of mood episode.

.x1Mild: Few, if any, symptoms in excess of those required to make the diagnosis and symptoms result in only minor impairment in occupational functioning or in usual social activities or relationships with others.

.x2Moderate: Symptoms or functional impairment between mild and severe.

.x3Severe Without Psychotic Features: Several symptoms in excess of those required to make the diagnosis, and symptoms markedly interfere with occupational functioning or with usual social activities or relationships with others.

.x4Severe With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent:

.x5In Partial Remission: Symptoms of a Major Depressive Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Major Depressive Episode lasting less than 2 months following the end of the Major Depressive Episode.

.x6In Full Remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.

.x0Unspecified.

Last medically reviewed on May 17, 2016

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What Does Mdd Look Like In Teens

Lets get real: Teenagers act downright bananas most of the time. Even without clinical depression, they can channel the angst of a French existentialist and Evel Knievels self-destructive impulses in the span of an hour.

Some scientists think this is due to their stage of brain development. At this time, their anxiety and fear responses are high, and their ability to regulate emotions is low. The problem starts when they use maladaptive coping strategies .

These unhelpful habits can create or exacerbate depressive symptoms. Its important for teens to get treatment early. Heres a shocking stat: Suicide is the second leading cause of death for people age 15 to 24.

Along with the usual signs, a depressed teen is likely to:

  • Complain of headaches and stomachaches

  • Argue or fight with family and friends

  • Start skipping meals or eating everything in the house

  • Miss classes or after-school appointments

  • Self-isolate in their room

  • Not having any interest in social events

  • Extended amount of time spent on the internet and chatrooms

  • Let hygiene slip

  • See their grades drop

  • Start vaping, smoking, drinking, or doing drugs

  • Act recklessly

  • Talk or joke about suicide, research suicide methods, seek out weapons

How Is Depression Syndrome Treated

Major depressive episodes are way more common than we knew ...

Depression can be serious, but its also treatable. Treatment for depression includes:

  • Self-help: Regular exercise, getting enough sleep, and spending time with people you care about can improve depression symptoms.
  • Counseling: Counseling or psychotherapy is talking with a mental health professional. Your counselor helps you address your problems and develop coping skills. Sometimes brief therapy is all you need. Other people continue therapy longer.
  • Alternative medicine: People with mild depression or ongoing symptoms can improve their well-being with complementary therapy. Therapy may include massage, acupuncture, hypnosis and biofeedback.
  • Medication: Prescription medicine called antidepressants can help change brain chemistry that causes depression. Antidepressants can take a few weeks to have an effect. Some antidepressants have side effects, which often improve with time. If they dont, talk to your provider. A different medications may work better for you.
  • Brain stimulation therapy: Brain stimulation therapy can help people who have severe depression or depression with psychosis. Types of brain stimulation therapy include electroconvulsive therapy , transcranial magnetic stimulation and vagus nerve stimulation .

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Identifying Candidates For Treatment

Major depressive disorder , prevalent in approximately 7% of the general population, is disproportionately common in patients with kidney disease, with up to 2025% of both nondialysis- and dialysis-dependent CKD patients meeting Diagnostic and Statistical Manual of Mental Disorders criteria.1015 Diagnostic criteria for MDD include the presence, for at least 2 weeks, of at least 5 of 9 symptoms of depression , one of which has to be sadness or anhedonia. Some of the physical symptoms can also be attributed to uremia .16 CKD patients may experience psychosocial stressors associated with their disease process, such as pain and fear or dislike of dialysis.17,18 The symptom overlap between CKD and MDD can present a challenge to the clinician in identifying patients who may benefit from treatment for depression.

Figure 68.1. Similarities and differences in symptoms of depression and uremia.

Figure 68.2. Identification of chronic kidney disease patients who may benefit from treatment of major depressive disorder .

Alexandria S. Coles BA, … Roger S. McIntyre MD, FRCP, in, 2020

Causes Of Major Depressive Episode In Teens

Experts have a number of theories about why major depression in teens is increasing so dramatically. Most important, they believe that teenagers may be affected by a combination of several factors.

Poor coping skills: Parents try to shield adolescents from experiencing failure and disappointment. Therefore, teens have fewer chances to build resilience. Thus, they dont learn how to cope with emotional challenges. As a result, they are more vulnerable to depression.

Social media:Social comparison is a primary source of anxiety and pressure for adolescents. Teens become depressed when they compare their lives unfavorably to the peers they follow on Facebook, Twitter, and Instagram.

Academic pressures: An uncertain economy and tough competition for college, grad school, and jobs increase stress for todays teens. Thus, the likelihood of a major depressive episode increases.

Too much screen time: scientists have found correlations between screen time and depression. According to researchers, adolescents have spent more time on new media screen activities over the past decade. Hence, they spend less time on beneficial unplugged activities. This may account in part for increases in depression and suicide.

A brain in development:The adolescent brain is still growing. Hence, teens have an immature prefrontal cortex, the part of the brain that controls self-regulation. Consequently, they may have trouble navigating their emotions.

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Alcohol Tobacco And Other Drugs

Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. SAMHSAs 2020 National Survey on Drug Use and Health reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.

Barriers To Treatment: Not Everyone Gets The Help They Need

3 Kinds of Depressive Episodes

Major depression is very treatable, especially when the approach is tailored to an individuals body and lifestyle. Yet approximately 35 percent of adults and 60 percent of adolescents who have it dont receive any treatment.

This is worrisome given that depression raises the risk of many other illnesses, including heart disease, diabetes, stroke, and Alzheimers disease, and has been linked to substance abuse.

Depression also increases the risk of suicide, the 10th leading cause of death in the United States, according to the NIMH.

Reasons for not getting treatment vary. A lot of people suffer in silence because we dont yet live in a culture where its easy to talk authentically about it, says psychotherapist Hilary Jacobs Hendel, a licensed clinical social worker and author of Its Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self. People feel a lot of shame and guilt.

Another reason is that depression encourages the belief that nothing could ever be of help. As journalist Susan Cheng explained in an essay she wrote about her depression, Sometimes you fight back, but most days you just sit there in quiet resignation, trying your best to breathe. And because the illness is a part of you, engrained so deeply in your being, you start to believe that this is just how everyone must feel.

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What Is Major Depressive Disorder

Sadness is a natural part of the human experience. People may feel sad or depressed when a loved one passes away or when theyre going through a life challenge, such as a divorce or serious illness.

These feelings are usually short-lived. When someone experiences persistent and intense feelings of sadness for extended periods, then they may have a mood disorder such as major depressive disorder .

MDD, also referred to as clinical depression, is a significant medical condition that can affect many areas of your life. It impacts mood and behavior as well as various physical functions, such as appetite and sleep.

MDD is one of the most common mental health conditions in the United States. Data suggests that more than 7.8 percent of U.S. adults experienced a major depressive episode in 2019.

Some people with MDD never seek treatment. However, most people with the disorder can learn to cope and function with treatment. Medications, psychotherapy, and other methods can effectively treat people with MDD and help them manage their symptoms.

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