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Everyone has bad days. Often people can be overwhelmed with emotions or situations for days at a time. Sadness is not necessarily an indicator that one is falling into depression. There are specific parameters that dictate whether someone is experiencing a little sadness or a major depressive episode. Learn more about what a Major Depressive Disorder is here.

What is Major Depressive Disorder?

Major depressive disorder (MDD) is a mental disorder characterized by persistent and pervasive depressed mood associated with low self-esteem and a lack of interest in life. This disorder can interfere with sleep, school, work, appetite, and quality of life. It can affect thought patterns, behaviors, emotions, and even physical wellbeing. Other terms for this disorder include severe depression, recurrent depression, and manic depressive disorder.

Major Depressive disorder symptoms

There are multiple symptoms for major depressive disorder, often experienced daily. These include:

Slower thinking or movements
Feelings of emptiness, unhappiness, or sadness
Unexplained physical complaints
Sleep issues s (sleeping too little OR too much)
Lack of energy, small household tasks take an enormous amount of energy
Trouble concentrating, thinking, or making decisions
Appetite changes – eating too much or not eating at all
Loss of enjoyment or interest in everyday activities or hobbies
Restlessness, anxiety, or agitation – hand wringing, pacing, excessive worrying, or not being able to sit still
Feelings of guilt or worthlessness, blaming self for everything that goes wrong, whether one is in control of the situation or not
Suicidal ideation – active or passive
All of these symptoms do not have to be present in order to diagnose someone with MDD. Often symptoms are debilitating to the point of hospitalization. Others, however, may just feel generally unhappy or miserable without being able to explain why.


The causes of depression are very ambiguous and undefined. There are a variety of factors that may contribute to the onset of a depressive episode:

Life events – Death of a loved one, high stress, financial problems, childhood trauma, and any other type of trauma can contribute to feelings of sadness or hopelessness.
Hormones – More often seen with postpartum depression, changes in hormonal balance can trigger depression. In addition, conditions such as menopause or thyroid problems can also contribute to the hormonal imbalance.
Biological differences – Depression sufferers appear to have physical anomalies in their brain biology.
Brain chemistry – Chemical neurotransmitters such as dopamine and serotonin are very likely to affect depression in individuals. When they are not balanced they are often associated with symptoms of depression.
Inherited traits – Family history can be a determining factor for depression, often moving through entire families.
Tests and diagnosis

When meeting with a doctor, patients should expect a comprehensive exam. Doctors must rule out other problems before diagnosing with depression.

Lab tests – Doctors must see that everything is functioning properly and that there are no infections present. A complete blood count, a thyroid test, hormone levels all need to be checked to rule out a physical issue.
Physical exam – In addition to the blood work a doctor must also complete a physical exam, again, to rule out any other physical conditions.
Psychological evaluation – Most importantly, a doctor must discuss symptoms, feelings, behavior, and thoughts with patients experiencing depression symptoms.
In order to diagnosed with major depressive disorder certain criteria must be met, established by the Diagnostic and Statistical Manual of Mental Disorders, used by mental health professionals to diagnose a variety of mental illnesses.

By definition, to be diagnosed with major depressive disorder a patient must have at least 5 of the following symptoms with a duration of two weeks and an intensity level of most of the day, almost every day, impacting day to day life. Either a depressed mood or a loss of interest must be one of the symptoms. Other necessary symptoms include:

Noticeable weight changes
Depressed mood, sad, tearful, empty, or irritability (especially in teens and children)
Loss of energy
Trouble thinking or concentrating
Restlessness or slowed behavior
Sleep problems
Considerably diminished interest
Suicidal ideation
Medications and Treatments

Treatment options are numerous and varied, much like the patients who suffer depression. Medications and psychotherapy are the most often treatments. However, the type and intensity of each can be varied.

Medication types

Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Selective serotonin reuptake inhibitors (SSRIs)
Monoamine oxidase inhibitors (MAOIs)
Norepinephrine and dopamine reuptake inhibitors (NDRIs)
Tricyclic antidepressants
Atypical antidepressants
Other medications such as mood stabilizers, anti-anxiety, stimulants, or antipsychotics
Psychotherapy – Benefits

Learn to set realistic goals
Delve into relationships and experiences, develop positive interactions with others
Coping skills
Replace negative, destructive thoughts and behaviors with healthier options
Adjust to crisis and difficulty
Identify triggers and develop a plan to deal with them
Help ease symptoms of depression by regaining control of life
Alternative Therapies

Electroconvulsive therapy (ECT) – Once referred to as electro-shock therapy, this procedure uses electrical currents, passed through the brain. This treatment is typically used when other treatments haven’t worked.
Transcranial magnetic stimulation (TMS) – This can be used as an option when antidepressants aren’t working. This procedure is similar to ECT except it uses magnetic pulses instead of electric currents.
Sometimes symptoms are so severe that an outpatient plan of care is not possible and individuals must go into an inpatient treatment center. Depending on the severity of the symptoms patients may go into a 7 – 10 day crisis stabilization unit is enough to stabilize and get a patient involved in an outpatient program. Rarely though, longer inpatient treatment is necessary. Treatment centers and day treatment programs are also alternatives.

Managing and Coping

Someone suffering from depression must change poor habits and lifestyle choices in order to heal:

Be aware of symptoms
Avoid alcohol and drugs
Get plenty of sleep
Learn, be educated about your illness
Stick to the treatment plan established by you and your mental health professionals
Be aware of warning signs and triggers
Stay active
There are many relaxation techniques that patients can do to help speed recovery and cope with symptoms:

Yoga/tai chi
Music or art therapy
Relaxation techniques
Massage therapy
Guided imagery
Along with these mind-body techniques there are things patients and their families can to do cope with the day to day struggles of living with depression:

Schedule your day and stick to it.
Simplify life
Don’t make important decisions when you are in a depressive state
Relax/manage stress
Read self-help books
Connect with a local support group or organization
Take care of you
Don’t isolate yourself
Major depressive disorder is not a death sentence. When someone is in the middle of an episode it is easy to think that it will never end, things will always be bad. Being aware and educated about the disorder is key to overcoming and thriving and moving on with life.