Living with Chronic Pain
Understanding Major Depressive Disorder
Everyone feels sad or depressed from time to time. It can happen during major life changes, such as: the loss of a family member, the loss of a job, the breakup of a relationship, and being diagnosed with a life changing medical issue. For most people, the sadness or depression, lessens with time. For individuals who experience feelings of sadness or depression for longer than 2 weeks, something more may be going on. The sadness may have changed to what people often refer to as clinical depression, or the name it is properly known by, Major Depressive Disorder, MDD.
MDD can affect many aspects of a person’s life such as: trouble sleeping, changes in appetite, losing or gaining weight, loss of interest in activities that were once enjoyed, fatigue or lack of energy, difficulty concentrating, loss of interest in sex, and possibile thought of harming oneself.
Major depressive disorder is not always easy to spot in individuals, especially teenagers. MDD may wreck havoc on relationships, as an individual with the disorder withdrawals from friends and family. It can be very difficult for children who have a parent with MDD.
The cause of MDD is not well understood. It is thought to be a combination of factors, such as genetics and stress having an effect on the brain's chemistry. Changes in hormone levels are thought to also play a part, with conditions such as hypothyroidism, cancer and long-term pain. Medications, like steroids, can cause depressive symptoms. It may also be triggered by stressful life events, alcohol or drug use.
Diagnosing major depressive disorder can be difficult. It relies on the patient self-reporting symptoms to the doctor, as currently there is no diagnostic test available to confirm that an individual is depressed. The doctor will take a full medical history to check for: a family history of depression, any medications, other conditions which can cause depression, such as chronic pain; use of drugs or alcohol, and blood work to check for hypothyroidism. The individual may be asked to complete a psychological inventory or test, such as the Beck Depression Inventory (BDI), which can be used to determine if an individual's depressive symptoms have reached the level of major depressive disorder.
Major depressive disorder is generally managed with the use of antidepressants and/ or psychotherapy, aka talk therapy, which is used to help the individual deal with the depressive symptoms. The most typical type of talk therapy that is used is cognitive-behavioral therapy or CBT. Antidepressant medications can take several weeks to start, so it is important for individuals to understand this and give the medication time to work. This type of medication should never be stopped suddenly, a doctor should be consulted before discontinuing it. Special attention should be paid to anyone under age 25 who is placed on an antidepressant, as the medication has a risk of increasing suicidal thinking and behavior in this age group.
For individuals who do not respond to multiple antidepressants, electroconvulsive therapy (ECT), or what was once known is as electroshock therapy or shock therapy, is a valid treatment. ECT is typically reserved for severe major depression disorder or treatment resistant depression.
It is important to note that certain herbal remedies cannot be taken along with antidepressants as they may cause a fatal interaction called serotonin syndrome. Individuals should check with their doctor and pharmacist before taking an herbal remedy for depression with an antidepressant.
Statistically speaking between 20% to 25% of adults may experience major depression disorder at some time in their lives. Once an individual has experienced a bout of major depression disorder, they can be at risk for having it again. For individuals who have had more than one episode of major depression disorder, it is important to keep on top of their depression. They should be doing things such as: being vigilant about possible triggers for depression, keeping an eye out for signs that happen before a depressive episode, make sure to take depression medication properly, and to talk to the doctor as soon as signs of depression are noticeable.