Major depression is also known as clinical depression, unipolar depression, and major depressive disorder. People who experience major depression feel persistently sad. They do not take pleasure in activities that were once enjoyable. Other physical and mental problems often experienced include sleep problems, loss of appetite, inability to concentrate, memory problems, and aches and pains.
People who suffer from this condition often feel worthless, helpless, and hopeless about their ability to fix things. They often welcome sleep and experience their waking life as a living nightmare. No matter how hard they try to snap out of it, they feel as though they are falling into an abyss with nothing to hold on to.
Major depression usually strikes people between the ages of 25 and 44, although it can affect any person at any age. For most people, episodes of major depression last from six to nine months. Sometimes, even if major depression goes untreated, it will run its course and leave by itself. Doctors are not sure why this happens, but it is often attributed to the body’s tendency to correct abnormal situations.
What Causes Major Depression
The dramatic success of antidepressant drug therapy for severe major depression has made many scientists question if depression has a strong biological, rather than psychological, basis. Thus many are questioning whether genetics or stress plays the major role in causing major depression. Recent research has shown that both play a major role in major depression.
Surprisingly, stress has been shown to play a major role in the patient’s first two episodes of major depression, but not in later episodes. Genetics and temperament appear to play the most important role for later episodes of a patient’s depression.
It appears that major depression often requires stress to “get the ball rolling”, but after a few episodes, the illness develops its own momentum and no longer needs stress to “keep rolling”. This is a familiar pattern seen in many medical illnesses. Thus, the treatment of major depression must address the major contribution that stress, genetics and temperament play in this disorder. Unfortunately, most current therapies lack this well-rounded approach.
Symptoms of Major Depression (MDD)
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either: (1) depressed mood or (2) loss of interest or pleasure. (Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.)
- depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
- markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
- significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
- recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Revision date: July 9, 2011
Last revised: by Andrew G. Epstein, M.D.