Depression & Mood Disorder
WHAT IS A DEPRESSION OR A MAJOR DEPRESSIVE EPISODE?
A depression or a major depressive episode is an unusual psychological and physical condition for the individual who has been affected, characterized by a sad or depressed mood, a markedly diminished or loss of interest or pleasure to what is usually pleasant or desired (non-reactive mood), psychomotor slowing and other symptoms that indicate a lower level of energy, a disturbance of the sleep/wake cycle, and self-destructive attitudes. In major depressive disorder with melancholic features, cardinal features also include early-morning awakening, appetite loss and/or weight loss, and the depression being worse in the morning. The intensity of the major depressive episode can vary, from mild, posing therefore a limited handicap to social and professional life, to severe, therefore prohibiting normal activity. Melancholic depression is an extremely severe form of depression, which tends to recur and be accompanied by psychotic features in 10%-15% of patients, and more common after 50 years of age.
WHAT ARE THE COMMON SYMPTOMS OF DEPRESSION (MAJOR DEPRESSIVE EPISODE)?
People with depression (major depressive disorder) usually have a combination of symptoms such as:
- Persistent sadness
- Loss of interest for activities that the individual usually enjoys.
- Psychomotor slowing with physical and mental fatigue (at its worst the individual remains lying in bed), loss of creative capacity, difficulty reading, difficulty concentrating, poor memory.
- Decrease of self-care, or hygiene neglect.
- Social withdrawal, irritability in their interactions with the social environment.
- Increase or loss of appetite with weight gain or loss.
- Sleep disorders: Insomnia or hypersomnia.
- Worsening of symptoms in the morning, while there is an improvement in the late afternoon.
- Destructive behaviors (self-cutting, overdose) sometimes leading to suicide attempt.
This episode occurs outside of bereavement or medical or drug cause (some medications can cause depression).
In depression, "rumination" is an actively or automatically chosen strategy with the goal to understand personal problems and their meaning and to find solutions. It consists of repetitive thoughts oriented towards the past, unanswerable questions, with low effectiveness with respect to real world solutions. There is a focus on past failures or bad memories, leading to a cascade of negative thoughts, making it difficult to find meaningful solutions. It can be understood as problem solving "gone awry".
If major depressive episodes of severe intensity are easily diagnosed, the mild episodes may go unnoticed: fatigue, sluggishness, loss of creativity, mild social withdrawal. These mild presentations are no less destructive to the individual's quality of life or to their professional and social life.
A major depressive episode may remain isolated or repeat itself either because a trial of psychotherapy has not been effective, or because the individual is dealing with a recurrent depression or bipolar disorder, predominantly Bipolar Disorder II.
WHAT IS THE TREATMENT FOR DEPRESSION OR A MAJOR DEPRESSIVE EPISODE?
Depression or a major depressive disorder is usually treated with psychotherapy, medication management or both. Antidepressants usually provide a net relief of symptoms after 21-42 days of treatment. The treatment is usually extended over a period of several months because early cessation increases the risk of relapse.
Cognitive Behavioral therapies (CBT) have their efficacy particularly well documented in numbers of publications, but other approaches may be indicated such as analytical therapies, interpersonal psychotherapy, EMDR, group therapy etc. Given the reluctance of some individuals to take antidepressant medications, one can turn to other treatments such as St. John's wort that seems particularly used in some countries but is not devoid of side effects (photosensitivity, inhibition of the action of certain contraceptive pills). Studies were able to show the effectiveness of the electro-acupuncture practiced by Chinese experts.
In the case of resistant depression, new techniques have been developed such as transcranial magnetic stimulation.
When depression reaches an alarming intensity or chronicity, and in cases of suicide risk, one should not hesitate to hospitalize.
If you have a friend, relative or loved one who suffers with depression (major depressive disorder), the goal is to get them to agree to seek treatment. And of course, this is even more important when the depressive episode is severe.