Major Depressive Disorder
We can all feel sad and low at times. For most people, experiencing these things is transient, and they are relatively mild. For someone who experiences depression these symptoms are severe in their intensity and last for at least two weeks – but usually are longer.
Signs & symptoms
Someone who is depressed will experience changes in emotions, they can be teary, more self critical and feel pessimistic and hopeless. They lose interest in things they usually do, have a lack of energy and can find it hard to go to work or school, even get out of bed or shower. To be diagnosed with major depression using the DSM-5 (2013) a person must experience 5 of the following symptoms for 2 weeks, and it must have a significant impact on a persons life. One of these symptoms must be either depressed mood, or a loss of interest or pleasure in things.
- Low (depressed mood) for the majority of the day, on most days
- Loss of interest or enjoyment in things
- Difficulty or changes in sleeping. This might be sleeping a lot (hypersomnia), or having difficulty in being able to sleep (insomnia)
- Feeling keyed up, uneasy, might find it difficult to sit still, or quite the opposite, like limbs are heavy and difficult to move
- Tired and having no energy
- Feeling they are pointless, or feeling responsible and guilt ridden for things that are not their fault
- Significant loss of weight that is not due to dieting, or there can be a significant gain in weight
- Difficulty in thinking or focusing, or being undecided and unable to make decisions easily
- Thoughts or plans of suicide
Depression has a high prevalence in Australia. One in seven Australians will have depression in their lifetime. Women experience depression at slightly higher rates than men (one in six women, compared to one in ten for men). There is a great deal of variability in depression rates across age groups, with US data indicating that 18-29 year olds having 3 times higher the rate of depression than for those above 60 years of age.
There are a number of different psychological and medical treatments available for depression. Often a combination of these treatments are used.
- A number of different psychological approaches have found to be helpful for depression. In particular the research evidence to date is most supportive of Cognitive Behaviour Therapy (CBT), Behaviour Therapy (BT), Interpersonal Therapy (IPT) and Mindfulness based cognitive therapy (MBCT). CBT explores patterns of thinking and behaving that might be impeding becoming well. When unhelpful patterns are identified they are modified to a more healthy alternative. Behavioural therapy is an element of CBT, but purely focuses on behaviour. This is usually around increasing pleasurable or achievement based activities. Mindfulness based cognitive therapy also uses some behavioural techniques, specifically around meditation and learning to be ‘in the moment’ rather than allowing the mind drift off to negative thoughts. A different approach is taken by Interpersonal Therapy as it focuses on relationships and improving skills in this area.
- Medical treatments are provided by a doctor or psychiatrist and involve medication, as well as treatments such as electroconvulsive treatment (ECT). Antidepressants are the main type of medication used to treat depression. There are many different types of antidepressants that act in slightly different ways. All antidepressants however target brain chemicals (neurotransmitters) concerned with emotion and motivation. It can take time to find the one that works best, and this always needs to be done in conjunction with your general practitioner or psychiatrist. Electroconvulsive Therapy (ECT) is used for very severe depression that has not responded to other treatments, or where there is a high risk of suicide. ECT involves electrical currents to stimulate parts of the brain. It is given under a general anesthetic.