You want the truth. All this sadness, weight gain, fatigue, sleeping all the time, and lousy concentration. Millions have been diagnosed with major depressive disorder and millions are wondering if they have it. Here's what you need to know... Our friend above has major depressive disorder. You may say, "She looks alright to me." Of course she does. She just happens to be managing a depressive disorder. I've been posting a lot of "need to know" articles on assorted conditions over the past few months. There's so much harmful misinformation out and about, and I feel obligated to present the facts. It's gratifying that the pieces have been popular. And now it's time to set the record straight on major depressive disorder.

What is major depressive disorder?

Major depressive disorder (MDD), what may be referred to as "clinical depression," is one of eight depressive disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Given variations, the DSM-5 presents 14 MDD diagnoses. Half of them pertain to single episode and the other half apply to recurrent episode. Let's turn to edited DSM-5 criteria to see what MDD looks like. First and foremost: Five or more of the following have to present during the same two week period. And there has to be a change from previous functioning. One of the first two, depressed mood or loss of interest or pleasure, has to be present for a diagnosis.

Depressed mood most of the day, nearly every day, as indicated by either self-report or observation by others. Can be irritable mood in children and adolescents.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, as indicated by either self-report or observation by others.
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day. Can be failure to make expected weight gain in children.
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every day. Must be observed by others.
Fatigue or loss of energy nearly every day.
Feeling of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day, as indicated by either self-report or observation by others.
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.

The symptoms have to cause significant distress in social, occupational, or other important areas of functioning. There can be no history of manic or hypomanic episodes. Of course, symptoms that are attributable to other emotional, mental, or physical conditions are excluded. Earlier I mentioned the variations that result in so many MDD diagnoses. For both single and recurrent episode these include in full or partial remission, mild, moderate, severe, unspecified, and with psychotic features (hallucinations, delusions). Finally, because of the potential for suicide, in medical terms major depressive disorder can be a terminal illness.

What causes major depressive disorder?

How I wish I could tell you exactly what causes MDD. Well, I can't because nobody knows for sure. I do, however, believe it's being well-researched. For our purposes, we'll stick with the frustrating explanation typically offered for the cause of emotional/mental disorders: combinations of genetics, biology, environment, and psychology. But at least I can toss in some risk factors...

Being female (70% more likely than male)
Family history of MDD, especially parents and siblings
Prior major depressive episodes (50% recurrent)
History of troubling stress
Being a substance abuser
Having poor social support
Having a chronic illness

How is major depressive disorder treated?

[caption id="attachment_35993" align="alignleft" width="272"] what is major depressive disorder

"It isn't by choice. But as long as I have it, I'll do my best to manage it."[/caption] When it comes to treatment for MDD, a meds/therapy combo is always the best way to go. But the hard fact is, outcomes may not meet expectations. And I think this especially applies to meds. Understandably, so many who are suffering badly look to meds as the fix, if you will. Hey, in some cases they can be lifesavers, but in others they can be disappointing. Just being honest. According to drugs.com, here are commonly prescribed meds for MDD... sertraline (Zoloft), bupropion (Wellbutrin), vortioxetine (Trintellix), fluoxetine (Prozac), escitalopram (Lexapro), duloxetine (Cymbalta), brexpiprazole (Rexulti): atypical antipsychotic, aripiprazole (Abilify): atypical antipsychotic, venlafaxine (Effexor), desvenlafaxine (Pristiq), vilazodone (Viibryd), mirtazapine (Remeron), quetiapine (Seroquel): atypical antipsychotic, paroxetine (Paxil) You'll notice three atypical antipsychotics. These are often prescribed as augmenting agents to an antidepressant. Among other meds, your doc may also consider the tricyclic and MAOI antidepressants, as well as other antipsychotics and anticonvulsants. Always be mindful of black box warnings. Suicide risk can't be ignored. When it comes to therapy, cognitive behavioral therapy (CBT) rules the roost. Other appropriate therapies include interpersonal psychotherapy, problem-solving therapy, psychodynamic therapy, social skills training, and behavioral activation. Individual and/or group work may be used. Stimulators and devices are available to treat MDD. To name a few: Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), the Fisher Wallace Stimulator, and light lamps/boxes. In treatment resistant MDD cases, the following may be alternatives: repetitive transcranial magnetic stimulation (rTMS), ketamine infusions, electroconvulsive therapy (ECT), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). As with any other mood or anxiety disorder, healthy lifestyle habits, quality sleep, exercise, and a healthy diet are ongoing necessities. Carefully selected supplements may also be helpful. Note: Not all of the interventions mentioned are FDA-approved for the treatment of MDD.

Moving Forward

I seriously doubt that having major depressive disorder would be anyone's choice. But it happens - a lot. And for those whose door it knocks upon, diagnosis, professional treatment, education, support, and continuing management are the only way to go. Perhaps you're already being treated. If you aren't, and this piece has hit home, get yourself some help. You deserve it. Looking for some inspirational reading? Check-out my eBook, Feelings & Rhymes Through Treacherous Times. Hundreds of Chipur articles are here to educate and help. Peruse the titles.

Meds, Supplements, Devices