Depression, or a depressive disorder, is a type of mood disorder. Mood disorders include MDD, bipolar disorder and seasonal affective disorder, among others. More than just a bad day or two, all of them can affect your social, family, school and work life. As our experts, Dr. Anker and Dr. Marshall, explain in this video, mood disorders can last for a week or two or may persist for several months or years.
While major depressive disorder (MDD) is like other mood or depressive disorders in many ways, it tends to be much more serious and cause more difficulty in daily life. A death or job loss or divorce may trigger MDD in someone who has a genetic inclination to depression. In other people, the same events may make them very sad and tearful for a while, but then they carry on with their lives. If you have MDD, you may cry over almost anything and moving on with your life can be very difficult. Other kinds of depression include a low-level, long-lasting depression called dysthymia (which people may not even recognize as abnormal), depression caused by medical conditions or medicines, and premenstrual dysphoric disorder.
MDD can make you feel sad or hopeless and increase your risk of suicide. Drs. Anker and Marshall also explain in this video that if you suffer from it for a long time, it can increase your risk of dying from heart disease and developing many other diseases, too.
In this video discussion, Dr. Anker and Dr. Marshall discuss the genetic and environmental factors that put people at risk for major depressive disorder (MDD). Some people seem to be able to face one problem after another and never lose sleep, lose hope, lose energy or feel depressed. They can’t become depressed because they do not have the brain chemistry or genetics for it. Other people inherit a predisposition for depression. That means that if you have MDD, you probably have close relatives who had depression or another mood disorder. For people with a family tendency to depression, an illness, job loss or divorce can trigger MDD. For others, severe depression can occur without any clear cause. If you have MDD, no matter what caused it, you need to get treatment just as you would for any other serious illness, by contacting your healthcare provider.
While we don’t know exactly what causes depression, we know that something goes wrong with the communication among nerve cells via their neurotransmitters - the messenger signals - in the brain. A problem with these signals from nerve cells quickly causes more problems because each nerve cell stimulates 10,000 other nerve cells in the brain. Each of those cells have four or more waves of reaction. We are just starting to understand how those changes in the brain cause what we see as the symptoms of depression.
In this video discussion, Dr. Anker and Dr. Marshall explain the symptoms most likely to affect you if you have major depressive disorder (MDD). These include:
Alcohol and drugs can cause depression or they can make it worse. In this video, Drs. Anker and Marshall discuss how alcohol can worsen depression and keep the medications used to treat depression from working well. Some prescription drugs can also cause depression as a side effect. If you have depression, you should discuss with your doctor what medications you take as well as whether you drink or take drugs.
Diagnosing MDD is not as simple as having a blood test, as Dr. Anker and Dr. Marshall explain in this video discussion. Your doctor may give you a screening questionnaire to see if you have the symptoms of depression. If he or she thinks you have MDD, you will probably be referred to a psychiatrist who will ask questions about your health history, examine you, talk to you about how you feel, and possibly run some other tests. Some changes in hormones are often seen in people who have depression, but no test can absolutely tell whether you have MDD or not.
The primary goal in treating depression is to achieve remission or give a patient complete relief from all symptoms. Drs. Anker and Marshall explain in this video that a partial remission can also be a good outcome of treatment. If the symptoms are easier to deal with and milder than before, then you can go back to work, take care of your children and generally resume your life. With counseling, you may find that with full or partial remission you function even better than you did before treatment for MDD.
Lifestyle makes a big difference in managing and reducing the risk of major depressive disorder, explain Dr. Anker and Dr. Marshall in this video. If you have a genetic tendency toward depression, controlling your environment to reduce stress and provide structure is very important. A few steps can really help:
If you have MDD, finding the right counselor and the best therapy can really help. As Drs. Anker and Marshall explain in this video, every patient has unique issues that make them better suited to some therapies than to others. If you have experienced intense grief that led to MDD, someone with grief counseling experience may be most helpful. If you feel hopeless and have trouble finding anything positive in your life, cognitive-behavioral therapy may help you find new hope and a more positive perspective. A psychiatrist can also provide support and help empower you to find new solutions to long-standing problems.
Dr. Anker and Dr. Marshall discuss the major classes of antidepressants in this video and the value of psychotherapy. If you have a milder form of MDD, psychotherapy may be the best treatment. It helps patients learn how to solve problems, reduce and manage their responses to stressors, and make positive lifestyle changes. If you have moderate to severe MDD, psychotherapy remains important, but you should also start on an antidepressant medication to manage the symptoms. Older antidepressants include tricyclics (TCAs) and monoamine oxidase inhibitors (MAOIs). Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) make up the newer classes of antidepressants. These generally have fewer side effects than the older drugs. While research has shown that all the antidepressants reduce symptoms of depression in many people, you may need to try one or two or more before you find one that works well for you. Alternatively, you may need to take more than one antidepressant to fully manage your symptoms. Communicate regularly with your psychiatrist about how you feel and any side effects you experience as you work together to find a medication regimen that works for you.
In this video, Dr. Anker and Dr. Marshall discuss the role of Electroconvulsive Shock Therapy (or ECT) in management of MDD. Many people fear ECT based on misconceptions promoted by popular culture. In truth, it may be more effective for many patients with MDD than any available antidepressant. Often patients can achieve complete or significant remission for MDD within just three or four weeks. The use of powerful medications that can temporarily paralyze the muscles has made ECT much safer than in the past, eliminating the risk of broken bones or suffocation patients faced 50 years ago. ECT applies a low-level shock to one or both temples that causes a seizure that lasts at least 30 seconds. The patient is put to sleep and the procedure takes place in a preoperative area with an anesthesiologist available. Typically, a patient receives three sessions a week for a total of 12 to 16 sessions. Side effects may include headache and short-term memory loss. It is very safe and may be the treatment of choice for patients who are pregnant, actively suicidal or need rapid relief from MDD for other reasons.
If you have MDD, you need to work with a doctor who looks at your treatment as a partnership. As Drs. Anker and Marshall explain in this video, your doctor should be willing to spend time discussing how you are feeling and talking to you about treatment options and lifestyle changes. Other topics you want to make sure to discuss include whether you are taking the right dosage or the right medicine based on your response, and whether you are experiencing any side effects from medication. To start with, you will ideally see your psychiatrist every week during a major depressive episode—at a minimum, every other week—for an hour initially, then for at least 20-30 minutes a visit until you start to feel better.