Major Depressive Disorder and Related Conditions

• Major Depressive Disorder is a common yet serious medical condition that affects both the mind and body.
• It creates physical (body), psychological (mind), and social symptoms.
• Informally, we often use the term "depression" to describe general sadness. The term Major Depressive Disorder is defined by a formal set of medical criteria which describe symptoms that must be present before the label may be appropriately used.
• According to the World Health Organization, depression is a common illness worldwide, with an estimated 15% of people affected.
• Depressive disorders are a leading cause of absenteeism and lost productivity.
• We also know that people who are depressed cannot simply will themselves to snap out of it. Getting better often requires appropriate treatment.

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• Symptoms can vary a great deal from one person to the next. Typical symptoms include:
• Trouble sleeping or sleeping too much
• Being tired and have no energy
• A dramatic change in appetite resulting in weight loss or gain
• Feelings of worthlessness, self-hate, and guilt
• Inability to concentrate, think clearly, or make decisions
• Agitation, restlessness, and irritability
• Inactivity and withdrawal from typical pleasurable activities
• Feelings of hopelessness and helplessness
• Thoughts of suicide or death
• Symptoms can also change over time, such as with someone who is initially withdrawn and sad becoming very frustrated and irritable as a result of decreased sleep and the inability to accomplish simple tasks or make decisions.
• When depression is severe, people may even experience symptoms, such as hallucinations and delusions.

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• The biopsychosocial model says that biological, psychological and social factors are all interlinked causes of depression.
• Depression has been linked to problems or imbalances in the brain with regard to the neurotransmitters serotonin, norepinephrine, and dopamine.
• A person who has a parent or sibling with depression is almost three times more likely to develop Major Depression than someone with no history of depression in their parents or siblings, which suggests that genetics play a role in the causes of depression.
• Long-term stress that lasts for a year or more can affect the body's immune system and lead to an increased risk of developing physical illnesses and an increased likelihood of becoming depressed.
• Psychological factors influencing depression include negative patterns of thinking, low coping skills, judgment problems, and difficulty in understanding and expressing emotions.
• Personality factors, history and early experiences; and relationships with others are seen as important factors in causing depression.
• People can also become depressed as a result of social factors such as: experiencing traumatic situations (a family death, divorce, job loss, abusive relationship, etc.), lack of social support/relationships, or harassment (bullying).

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• If your depressed mood lasts for more than two weeks, or is seriously interfering with your ability to function at work, with your family, and in your social life, you should consult with a mental health professional as soon as possible.
• If you find yourself thinking seriously about suicide, you should make an appointment with a mental health doctor (a psychiatrist, or psychologist) as soon as you can.
• If you are feeling like you will commit suicide within hours or days unless you receive some relief, then skip making an appointment with a doctor and go immediately to your local hospital emergency room and tell them there that you are feeling suicidal.

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• The diagnosis process often starts with a visit to a primary care doctor who may ask simple questions about your feelings and experiences.
• A physical examination, medical history and lab tests will be done to determine if your depression is related to a physical condition.
• If a physical condition is ruled out, then you should see a mental health professional, such as a psychologist or psychiatrist, who will talk with you to learn more about your current problems and symptoms, as well as to obtain a complete history of previous symptoms, a family history, a history of significant stressful life events, and information concerning your lifestyle, social support, alcohol or drug use, and any suicidal thoughts or tendencies you may be experiencing.
• In order to compare your symptoms to those of other people in order to determine the severity of your symptoms, you may be asked to complete one or more standardized questionnaire forms.

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• It is important to know that depression is a HIGHLY treatable condition.
• There is no single therapy that works equally well for every depressed person.
• Depression is most often treated with a combination of medication and psychotherapy.
• Antidepressants help with some of the brain chemistry causes of depression. Typically this will include either a SSRI (selective serotonin reuptake inhibitor), such as Prozac, Zoloft, or Paxil, or a SNRI (serotonin norepinephrine reuptake inhibitor), such as Wellbutrin or Effexor.
• Psychotherapy helps people understand and then change the behavioral, cognitive and social patterns that cause or contribute to the depressed mood.
• More severe cases of depression may require different and more frequent therapy than milder cases.
• People with severe depression who may be engaging in self-destructive behavior, such as attempting suicide, refusing to eat, refusing to get out of bed, or may be showing signs of psychotic behavior, such as hallucinations and delusions, may require inpatient hospitalization.
• People sometimes turn to Complementary and Alternative Medicine (CAM) techniques such as traditional Chinese Medicine, Acupuncture, Homeopathy, and Herbal Therapy for relief from their symptoms. Very few of these approaches have been tested in clinical trials for depression, so there is often little scientific evidence to support these practices.
• One of the best studied and most famous CAM remedies for depression is St. John's Wort, which is an herbal preparation of a plant extract. Research does support this as a stand-alone alternative treatment for depression and in parts of Europe this herb is often the preferred remedy for treating depression.
• If you are interested in CAM approaches, the best plan is to consult with a qualified CAM practitioner who can help determine which combination of treatments, and in what dosages, would be most beneficial for you.

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• Self-help approaches to treating depression are best thought of as additions to professional treatments.
• People should not delay treating depression professionally, or attempt to treat it solely on their own.
• The more that you take an active role in helping yourself recover, the better your chances of recovery are likely to be.
• It is important to accept your diagnosis and to take the medications and other therapies that have been prescribed for you regularly.
• Accept invitations to social events and maintain your typical social schedule as best you can even if you are not enjoying it as much as you used to.
• One way to reduce the amount of stress you experience is to prioritize the demands you are facing and then to do only the most pressing tasks.
• Talk about what is bothering you with a therapist or with friends or family members. If you don't feel comfortable talking, then keep a journal and vent through writing.
• Regular physical exercise is thought to have an antidepressant effect.
• One way to regain a sense of control is to educate yourself about your illness.
• Choosing to make positive improvements in your sleep, eating, drug and alcohol use, exercise, social and spiritual habits can end up helping you improve your mood.

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