Major Depression

Major Depression

Behavioral & Mental Health
Men's Health
Contributed byKrish Tangella MD, MBAMay 21, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Clinical Depression
  • Depressive Psychosis
  • Endogenous Depression

What is Major Depression? (Definition/Background Information)

  • Depression is a term used to commonly indicate a feeling of sadness, being unhappy, or down. Most of us, at one time or the other, may have felt depressed, typically for a short amount of time.
  • Major Depression, on the other hand, is a feeling of sadness of a long duration, which critically affects one’s daily life activities.
  • It is a chronic illness that usually requires long-term treatment. Major Depression generally affects women during early adulthood (in their 20s or 30s).
  • The causes of Major Depression are not exactly known. It is believed that some chemical changes in the brain are responsible; some genetic factors may also play a role. A depression is usually triggered by some stressful event in one’s life.
  • A few risk factors associated with Major Depression includes a past experience that may have been very stressful, childhood trauma, serious illnesses, being alone or isolated, and a family history of depression.
  • The signs and symptoms of Major Depression may include lack of sleep or excessive sleep, emotional outbursts, sadness, low sexual drive, feeling useless, always being tired, appetite loss, and harboring suicidal thoughts (that may culminate in suicide, a serious complication of the condition).
  • Major Depression can be treated using both psychotherapy and medication. With proper treatment, support, and encouragement to change, the outcome is generally good.

Who gets Major Depression? (Age and Sex Distribution)

  • Major Depression can affect any individual at any age, even in childhood
  • The condition is commonly observed in women who are in their 20s or 30s. The higher incidence in women is thought to be due to the fact that men are less likely to seek treatment due to cultural and emotional stigma
  • No ethnic or racial preference is observed

What are the Risk Factors for Major Depression? (Predisposing Factors)

The risk factors associated with Major Depression include:

  • Stressful experiences
  • Trauma as a child
  • Having a serious and chronic illness such as HIV or cancer
  • Family history of depression
  • Not having close friends or relations
  • Taking certain medications
  • Alcohol, illegal drug, and nicotine abuse

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Major Depression? (Etiology)

Causes of Major Depression are not exactly known. It is believed that certain chemical changes in the brain are responsible for the condition. In some cases, genetic factors may also play a role. Depression is usually triggered by some stressful event in one’s life.

Many factors are strongly believed to be linked to Major Depression disorder. These include:

  • Hormonal influences such as underactive thyroid
  • Certain medications such as steroids
  • Chronic illness such as depression or long-term pain
  • Early childhood trauma such as childhood abuse or neglect
  • Loneliness
  • Break-up with a partner

What are the Signs and Symptoms of Major Depression?

The signs and symptoms of Major Depression may include, but are not limited to:

  • Insomnia, sleeping excessively
  • Irritability, frustration
  • Crying or anger outbursts
  • Sadness
  • Reduced sex drive
  • Loss of interest in generally enjoyable or pleasurable hobbies and activities
  • Feeling of worthlessness
  • Fatigue, always feeling tired
  • Loss of appetite
  • Fixation on suicidal thoughts or death

How is Major Depression Diagnosed?

A case of Major Depression cannot be diagnosed without first meeting the criteria of depression set by the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA). After ruling out all other possibilities, a qualified healthcare professional, such as a psychiatrist or a psychologist, will determine if the criteria for Major Depression are met or not.

  • Five or more of the following symptoms over a two-week period must be experienced:
  • Diminished interest or no pleasure in all activities most of the day, nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive inappropriate guilt nearly every day
  • Insomnia or increased desire to sleep nearly every day
  • Significant weight loss (when not dieting), weight gain, or decrease or increase in appetite nearly every day. In children, failure to gain weight as expected can be a sign of depression
  • Restlessness or slowed behavior that is observed by others
  • Recurrent thoughts of death or suicide, or a suicide attempt
  • Trouble making decisions, thinking, or concentrating nearly every day
  • Depressed mood (most of the day or nearly every day) such as feeling sad, empty or tearful. In children and adolescents, depressed mood can appear as constant irritability

At least one of the symptoms (of the affected individual) must either be a depressed mood or a loss of interest or pleasure.

Also in the diagnostic criteria:

  • Symptoms are not due to a mixed episode (meaning simultaneous mania and depression that can occur in bipolar disorder)
  • Symptoms must be severe enough to cause noticeable problems in day-to-day activities such as affecting work, school, relationships, etc.
  • Symptoms are not due to grieving such as the loss of a loved one

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Major Depression?

Certain complications of Major Depression include:

  • Increased chance of health problems
  • Increased alcohol use or abuse
  • Increased use or abuse of illegal drugs
  • Recurrence (relapse) of the disorder even after treatment
  • Suicide

Apart from the above, the medications used for the treatment may cause some side effects.

How is Major Depression Treated?

Major Depression can be treated using various approaches. The best treatment plan incorporates both psychotherapy and medication.

  • Psychotherapy may be recommended to help address emotional issues. Routine sessions should be utilized to explore underlying issues of depression
  • Medications prescribed to manage symptoms may include:
    • Atypical antidepressants
    • Selective serotonin reuptake inhibitors: Examples may include Prozac, Lexapro, Zoloft, and Celexa
    • Norepinephrine and dopamine reuptake inhibitors such as Wellbutrin
    • Serotonin and norepinephrine reuptake inhibitors such as Cymbalta and Pristiq
    • Monoamine oxidase inhibitors (MAOIs) that are typically used as a last resort. These include Parnate and Nardil
    • Tricyclic antidepressants                           
  • Electroconvulsive therapy, also called ECT or shock therapy, may be used if medications fail to work. Patient candidates for ECT may have a high risk for suicide. Also, they cannot take medications for reasons such as pregnancy
  • If symptoms persist and emotions cannot be managed alone, an in-hospital or residential treatment plan may be recommended

There are a wide variety of residential treatment plans for individuals affected by Major Depressive Disorder. Open and honest communication with the health professionals will help get the best plan according to the needs of the patient.

How can Major Depression be Prevented?

Preventive methods to reduce the risk of Major Depression may include:

  • Talking to a trusted friend or family member when feeling down and upset
  • Maintaining sleep pattern routinely
  • Refraining from alcohol or illegal drug use
  • Exercising regularly, working out your mind and body
  • Exploring productive activities that bring pleasure and joy

What is the Prognosis of Major Depression? (Outcomes/Resolutions)

The prognosis of Major Depression depends on several factors and it varies case by case.

  • The main symptoms are sometimes reduced only after weeks of medications and treatment. However in most cases, medication is typically needed for periods lasting from 4 to 9 months for individuals to fully recover
  • Individuals who suffer from chronic episodes of depression (or are severely depressed) may need to be on medication indefinitely
  • With proper treatment, support from friends and family members, and a motivation to change, the prognosis is good; individuals can go about their regular daily activities
  • Sometimes, individuals recover from depression even in the absence of medication or without any treatment

Additional and Relevant Useful Information for Major Depression:

  • The DSM is a manual published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions
  • Postpartum depression is a mood disorder that can affect women, and in smaller numbers men, after the birth of their child

The following article link will help you understand postpartum depression:

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team


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