Depression. It’s not fun. Not even a bit. Fortunately for most people that suffer with depression it’s a temporary state. For those of us that are less fortunate, it can be chronic. Just think of everything I talked about on Thursday, and extend that over a period of time that lasts for weeks, months, and often years, and years, and years.
Major depressive disorder (MDD) (also known as recurrent depressive disorder, clinical depression, major depression, unipolar depression, orunipolar disorder) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities.
It’s a disabling condition that affects millions of people in the U.S. and magnitudes more around the world. In the U.S. alone nearly 3.4% of people with major depression commit suicide, and up to 60% of people who have committed suicide had depression or another mood disorder.
The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status examination.
The causes of depression, as we understand, are still incomplete. Like many mental health issues and disorders though the causes may include psychological trauma, psycho-social, hereditary, evolutionary, and biological factors. Not to mention certain types of long-term drug or alcohol use can both cause and worsen depressive symptoms.
How do you know if it’s MDD and not just depression?
First for it to be a Major Depressive Disorder there needs to be a depressed mood or loss of pleasure or interest in daily activities consistently for at least a 2 week period. This change of mood should also represent a change from the person’s normal mood. It must also be accompanied by the negative impairment of social, occupation, educations, or other important functioning. < --- Causing a significant impact on the person’s life is what makes all of these issues a disorder, and not just “like the disorder”.
Clinical depression is characterized by the presence of the majority of these symptoms:
· Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.) - Check √
· Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day - Check √
· Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. – My eating disorders would get more severe when I was more depressed.
· Insomnia or hypersomnia nearly every day - Check √
· Psychomotor agitation or retardation nearly every day
o Psychomotor agitation is a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one's hands, pulling off clothing and putting it back on and other similar actions. In more severe cases, the motions may become harmful to the individual, such as ripping, tearing or chewing at the skin around one's fingernails or lips to the point of bleeding. - Check √especially as of late I’ve been doing this more and more as I’ve recently written about.
· Fatigue or loss of energy nearly every day - Check √
· Feelings of worthlessness or excessive or inappropriate guilt nearly every day - Check √
· Diminished ability to think or concentrate, or indecisiveness, nearly every day
· Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide – Check √
Other Symptoms may include:
· Preoccupation with, or ruminating over, thoughts and feelings of worthlessness – Check √
· Inappropriate guilt or regret – Check √
· Helplessness, hopelessness, and self-hatred – Check √
In severe cases, depressed people may have symptoms of psychosis. These symptoms include
· Delusions or, less commonly, hallucinations, usually unpleasant.
Other symptoms of depression include:
· Poor concentration and memory (especially in those with melancholic or psychotic features) - Check √
· Withdrawal from social situations and activities - Check √
· Reduced sex drive – Check √ especially during periods of high stress.
· Insomnia is common among the depressed. In the typical pattern, a person wakes very early and cannot get back to sleep. Insomnia affects at least 80% of depressed people. Check √ < ---- I suffered with insomnia at my most depressed, solidly from around the 8th grade up until college. I had periods of adjustment where I slept better, especially now, but I still have bouts of insomnia.
· Hypersomnia, or oversleeping, can also happen. – For me this was less of an issue. But I had periods of this for sure.
There is also a distinction that is made between MDD and grief or bereavement. Grief and bereavement can certainly cause or contribute to depression and may eventually lead to MDD, but that’s a different kind of depression. No less significant in any way, just different than MDD.
Depression is debilitating. And when it’s chronic, it’s no wonder thoughts of suicide can be such an issue. After a while depression feels like the only way you remember ever being. When it seems like you’ve always been this way, and you are literally incapable of envisioning yourself or your life feeling any other way… what is the point of having a bleak, dark, meaningless existence for a countless number of years and no hope of it ever getting better? One of the worst things about depression is it steals your hope. There’s no end because you don’t know any other way.
The times when you’re flat out miserable are debilitating. It’s almost worse when it’s not debilitating; those times when there’s no all-consuming sadness, when it’s just… bleak. There’s not even sadness to look forward to. Just an endless expanse of nothing.
It’s insidious because it doesn’t go away, it doesn’t seem like there’s anything causing it, or any reason for it. Which can also make you feel guilty, especially when the people around you just want you to be happy. Which leads to pretending to be happy. Which leads to resenting the people that make you pretend to be happy for their sake.
Depression leads to guilt. Guilt leads to Pretend Happiness. Pretend Happiness leads to Resentment. Resentment leads to being pissed off at everyone, and becoming a hermit so you can mope and brood by yourself, in bed, in the dark, where no one can bother you at all. And it never gets better ever.
Fortunately there are plenty of things you can do to fight depression. I’m just not going to talk about them today. Hah!