Major depressive disorder is a mood disorder in the diagnostic and statistical manual of mental illnesses. It is among the most commonly seen psychiatric disorders. Mood underlies and influences our thoughts, feelings, and perceptions, but also can be influenced by thoughts, feelings, and perceptions. Moods are longer lasting than emotions and particular moods can last days, weeks, months, and longer. Individuals, by virtue of their personality, genetics, and experiences, can be more inclined to certain moods over others. Stress, prolonged and negative emotions, and other factors can impact moods, and lead to an individual’s mood destabilizing and becoming labile, or prone to sudden and abnormal swings or changes. When the mood becomes labile, thoughts, feelings, and perceptions follow suit and are similarly affected, because our mood colors our thoughts, feelings, and perceptions. We may experience the very same situation entirely differently depending on the mood we are in. When mood is unstable, individuals may experience decreased resilience and find it more difficult to tolerate distress.
Depression is a mood state of hopelessness, helplessness, and apathy where neurologic activity is depressed, slowed, suppressed, etc. There is still much we don’t know about depression and the brain. In the past depression was believed to be a chemical imbalance of neurotransmitters, yet newer research has revealed this hypothesis to be only partially correct. Researchers have discovered structural changes in depressed brains which differ from normal controls, ranging from shrinkage to inflammation in key areas associated with depressive symptoms. They have also discovered increased activity in the HPA (hypothalamic-pituitary-adrenal) axis, which produces cortisol to help the body deal with stress. There have been other significant discoveries in recent years, but the precise underlying mechanisms and molecular processes resulting in depression and how to reverse them are complex and still not fully understood.
How do I know if I’m depressed?
As unusual as it may sound, it is common for people to experience depressive symptoms and not realize it until their condition worsens. Depression often initially manifests with some combination of milder symptoms of low motivation, fatigue, apathy, loss of interest in pleasurable activities, concentration problems, and sleep and appetite disturbances. Sad or depressed moods may come, or be recognized, later on as the illness progresses. Individuals with milder symptoms often appear to be able to function normally, but it may take great effort to do so. They may sleep more or less than usual, and appetite may be increased or decreased. Individuals may soon reach a point where they feel overwhelmed easily and have crying spells for no identifiable reason. Mood stability and resilience are decreased and individuals may find themselves struggling to cope with everyday stressors. Feelings of depression or agitation become more pervasive and some of the initial symptoms of concentration, sleep, appetite, motivation, etc. may worsen.
It is common for individuals to begin to feel hopeless, and feel like they wish they were dead, or wish they could go to sleep and not wake up. They often may feel like a burden or feel that others are better off without them. Depression produces and magnifies existing feelings of shame, worthlessness, and guilt. An outside observer may notice the distorted perceptions of depressed individuals and their unrealistic negative perceptions of their own worth, or guilt over minor failures. Painful feelings and moods distort thinking, and distorted thinking further worsens painful feelings and moods.
As individuals slip further into depression, psychomotor depression becomes increasingly observable and speech, thinking, and bodily movements are markedly slower. Language becomes soft and monotonic and verbal responses delayed and brief. Cognitive and functional tasks become difficult or impossible. Emotional states can become excruciating and unbearable. Given these symptoms it is understandable that warning signs of depression include social isolation, staying in bed, weight gain or loss, lower performance in occupation and school, among others. Individuals may also exhibit uncharacteristic irritability, anger, and blaming. Because depression and anxiety share many of the same pathways in the brain, they often co-occur, and individuals can experience increased anxiety during a depressive episode.
Suicidality is common and may progress from passive feelings and thoughts to active suicidality which includes method selection, planning, intent, and finally behaviors. Not all individuals who are depressed are suicidal, and not all individuals who are suicidal are depressed, but some degree of suicidality is a common symptom of major depressive disorder. It is not something that a person should feel ashamed about, but it is something they may need to monitor and work to improve. Most individuals who experience depression and suicidality don’t progress from passive to active suicidality, and may experience unwanted and intrusive thoughts, feelings, and urges while depressed.
Some individuals may have a pattern of depression where they experience frequent ups and downs, mood swings, and certain depressive symptoms which come and go. They often describe experiencing “deep, dark” lows, and then feeling better and motivated, and then depressed again shortly thereafter. This may happen regularly every week or month, or every few days, and it may be a continuous pattern. These low periods may or may not be accompanied by urges to self harm and/or suicidal ideation. The individual may also exhibit reckless and impulsive behaviors. The individual may or may not have experienced a history of trauma, neglect, abuse, bullying, etc. These symptoms are not consistent with a major depressive episode, but rather is indicative of affective instability related to low self-worth. It may be helpful to review the subheading “shame” under the addiction resource tab for a better understanding of the emotions which drive this process. Psychotherapy is important for this type of affective instability, and medications may not have a lasting effect.
Be aware if, in addition to depression, you have ever experienced a period of several consecutive days where you felt wired, energized, had a reduced need for sleep, and maybe felt like you weren’t in control of yourself. These prolonged periods of abnormally high energy could be indicative of a manic or hypomanic episode, which occurs in bipolar disorder, formerly known as manic depression. For more information on bipolar disorder, see the resource page for bipolar disorder under the services tab of this website.
How long does depression last?
Remember that it takes time for the brain to recover from a depressive episode and return to a stable mood. According to the DSM V, 2 out of every 5 individuals will begin to recover within 3 months of onset of symptoms, and four out of five individuals will begin to recover within 1 year of onset of symptoms. Individuals with severe or anxious presentations, or who experience psychosis concurrently or have a personality disorder may experience longer bouts of depression. Therapy can be very helpful for individuals experiencing major depression, especially when the individual is presenting with mild to moderate depression. Therapy tends to be less helpful for individuals with severe depressive symptoms, and medication is recommended. Medication may also be helpful in moderate cases, however one should consider the risks versus the benefits of taking medications and decide whether or not it is necessary and appropriate for mild depressive symptoms.
What should I do if I’m depressed?
If you are experiencing a depressive episode, remember, first of all, that it is going to take time to recover. Be patient and try to stay motivated. Avoid napping, isolation, and excessive stress as much as you are able. Arise early if possible and be active. Seek out spiritual and interpersonal connection as much as you can, and try to remain connected to others. Share your feelings and struggles with supportive people. Exercise can be a powerful mood stabilizer with immediate effects. You will have ups and downs, and as life becomes stressful or negative events occur you may slip back down, but remember to be patient. Have faith that your brain will do its job in stabilizing itself, and do what you can to help it. Medication can be helpful and important in major depression.
Practice mindfulness and avoid negative thinking. Remember that a depressed mood will often produce painful thoughts and feelings. Challenge those thoughts and feelings and “flip the script” to more positive thinking. Don’t allow yourself to believe that others are better off without you, that you’re a burden, and/or that things will never get better. A depressed mood makes those thoughts more painful and more believable, so be sure to resist them and challenge them. Try to find a good balance in how much you are doing. Avoid inactivity, but avoid overexertion as well. Do not allow yourself to entertain suicidal thoughts. They may come, but they don’t have to remain there. Make the commitment that you will not allow them to stay.
What should I do during a crisis?
It may be helpful to create a safety plan for yourself , perhaps with the help of your clinician. A conventional safety plan has seven steps. This template may be helpful in assisting you to create and customize your own. When one step doesn’t work, move on to the next to try and resolve the situation.
1. Warning signs that a crisis might be developing
-Constant negative thoughts, Feeling helpless, isolating self, nightmares, sleep issues, self medicating
2. Coping Strategies
-Call friend/family, watch TV/listen to music, Take a walk/go outside, Journaling/reading, etc.
3. Places to go to distract myself
-Friend’s house, work, area in my house, outside/nature, Gym, etc.
4. People whom I can ask for help
-Name and phone
5. Agencies and service numbers I can contact
– Local urgent care or crisis center, National Suicide prevention (988), Crisis text line (Home to 741-741), dial 911
6. Making the environment safe
– Remove access to weapons, remove pills, keep door open, have someone with me at home, etc.
7. Reasons for living
-Children, family, desire to be healthy again/feel better, faith/spirituality, etc.
Remember to be patient. Many individuals who have experienced depression for long periods of time may begin to feel tired of the struggle. It is normal to feel this way, but remember to continue having faith that things will improve.
