Clinical Depression (Major Depressive Disorder)
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OptimistMinds
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In this brief guide, clinical depression along with symptoms, diagnostic criteria, types of depression, causes and treatment will be discussed.
What is Clinical Depression?
Clinical Depression is a term is mostly misused by the layman, but the meanings of clinical depression is different in the mental health field.
As per diagnostic criteria given in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5, 2013), clinical depression is termed as low mood, lack of interest in doing anything, sleep disturbance and emotional dysregulation.
How to know if You have Clinical Depression?
Clinical Depression is more than sadness and the diagnosis needs a number of symptoms.
Without meeting a mental health professional, a person can take help from the self-assessment tests for clinical depression available online for initial screening.
Symptoms of Clinical clinical depression
The symptoms of clinical depression are massive and affect the person’s functioning in different domains of life.
There different types of symptoms, such as psychological, physical, and social symptoms.
Psychological Symptoms
A person experiencing clinical depression experience, low mood, feelings of worthlessness, guilt, irritability, tearful, unable to focus, having no motivation, disturbed sleep pattern.
Physical Symptoms
Unable to perform required tasks, lack of pleasure in the activities they once enjoyed, disturbed appetite, crying spells, and suicidal intention or suicidal attempt.
Social Symptoms
Lack of interest in socialization
Neglecting hobbies
Difficulty in relationships
Diagnosis of clinical depression
Diagnosis can only be given by the professionals in the mental health field on the basis of criteria given in DSM-5 (DSM 5, 2013).
Following this criterion following summary has been extracted:
A. The condition of a person needs to be monitored or reported by themselves considering the last 2 weeks, and five or more symptoms are required to be diagnosed with Major Depressive Disorder.
a. Depressed or low mood either reported by the person or observed by others around.
b. Lack of interest in doing any activity at all, or we can call this anhedonia
c. Increase or decrease in body weight
d. Sleep disturbance, either getting overly sleep or not getting sleepy at all
e. Decreased physical or motor activity, restricted oneself to bed or slowed down
f. Overly exhausted, or tired
g. Excessive feelings of remorse or guilt
h. Extremely low self-esteem and self-worth
i. Inability to concentrate or focus on the tasks at hand, as well as unable to make decisions
j. Continuously or excessively experiencing thoughts of death
B. These symptoms are disabling the person to work efficiently in their environment
C. The condition is not because of any medication or substance use
On the basis of above criteria, mental health practitioners diagnose the client with clinical depression.
Nurses can also diagnose depression, the procedure called nursing diagnosis.
Types of Depression
There are several types of depression which are recognized:
1. Clinical Depression
2. Dysthymia (Persistent Depressive Disorder)
3. Postpartum Depression
4. Seasonal Depression (for example, summer depression)
5. Psychotic Depression
6. Premenstrual Dysphoric Disorder
7. Disruptive Mood Dysregulation Disorder
Clinical Depression
The type of depression discussed above is called the clinical depression or major depressive disorder.
The clinical depression is unipolar and characterized by an intense feeling of sadness and lack of interest.
The symptoms are lack of pleasure in the activities they once enjoyed, disturbed appetite, crying spells, low mood, feelings of worthlessness, guilt, irritability, tearful, unable to focus, having no motivation to work and disturbed sleep pattern.
Dysthymia (Persistent Depressive Disorder)
It is known as persistent because the symptoms of major depression are mild in intensity by the lasts for more than 2 years.
This is also called chronic depression. The person is considered as gloomy, sad, complainer.
Another main condition is that the person didn’t remain without the symptoms for more than 2 months.
Postpartum Depression
This type of depression is linked with the childbirth. This is also known as “baby blues”.
This is quite common and because of hormonal changes, the mother starts feeling down, sad, depressed, anxious for the number of weeks after childbirth.
Seasonal Depression
This is based on the changes in the season, this is experienced at a particular time in year.
Mostly the symptoms appear at the start of winters and remain there for months.
Person experience fatigue, low mood, hopelessness and progress towards getting severe.
Psychotic Depression
This form of depression is experienced in people around 20%.
The depression gets so severe that they start experiencing psychotic symptoms and start having hallucinations, delusions and disorganized thinking.
Premenstrual Dysphoric Disorder
This is based on the cyclic hormonal disturbance during the menstrual cycle.
Around 85% of female experience this disorder but only around 5-6% get the diagnosis of the disorder.
The disorder causes low mood, irritability, frustration, mood disturbance, and anxiety.
Disruptive Mood Dysregulation Disorder
DMDD disorder is for the first time introduced in DSM 5.
This diagnosis is specifically for children and symptoms includes the dysregulation of mood expected for their age.
Excessive temper tantrums, behavioural and emotions disturbances are experienced.
Causes of Clinical Depression
There are a number of different causes of Clinical Depression.
There are a number of factors which plays their role in triggering clinical depression.
The causes of clinical depression are multiple, they range from physiological, to psychological, and environmental.
Brain Structure
The changes in the brain structure and its chemistry can cause clinical depression.
The neurotransmitter dopamine and serotonin are considered to be involved in the levels of clinical depression.
One might also suffer from a different type of depression, called the long term depression due to the inefficiency of neuronal synapses.
Epileptic seizures can also lead to this mental illness thus, epilepsy and depression are said to be linked.
Physiological Causes
The causes can be altered level of hormones due to pregnancy or menstrual cycle, the effect of any medication of substance as well as there can be the genetic causes of clinical depression.
Psychological Causes
These causes include the environmental stresses, traumatic events, and death of loved ones.
An individuals habits can also lead to depression, for instance adult-contents.
Assessment of clinical depression
When the assessment is being done, then there are a number of ways to do it.
Such as mental health professionals do the assessment on the basis of a clinical interview, and standardized tool.
Similarly, self-assessment tools are available as well which helps the person to can the idea regarding his condition and its severity, for example the ‘do i have depression’ test.
Some of the self-assessment tools are available here. While the tools mental health professionals use are based on their preference and expertise.
There are few standardized and validated mostly used in the clinical settings are:
Beck Depression Inventory
This tool was developed by Beck, and this is the most popularly used tool among practitioners.
The tool has 21 question items and it has been revised several times after it was developed in 1961.
This tool was developed according to the diagnostic and statistical manual of mental disorder depression criteria.
The tool is based on the cognitive triad concept used by Cognitive behaviour therapist and developed by Aaron T. Beck.
This theory says that the thoughts are affected by negativity about self, others and the world.
Beck also developed a similar assessment tool for people suffering from anxiety, called as the Beck Anxiety Inventory.
Hamilton Depression Rating Scale
This HAM-D scale is the oldest scale for depression. This is scale is time taking but is validated as BDI.
There is a shorter version of HAM-D as well, but the validity and reliability of that version is not yet fully developed.
Patient Health Questionnaire
The PHQ scale is quite long and takes a lot of time, as it includes the five psychiatric conditions (depression, anxiety, somatoform, alcohol and eating disorders).
The shorter version of PHQ is available which is called PHQ-9, this scale takes only about 3-5 minute of the practitioner.
Treatment of clinical depression
There two different types of evidence-based treatments:
Medication
Medication
Antidepressant use to be prescribed by the psychiatrist.
There are about thirty different types, among which if the client doesn’t respond to one medication the other one is given.
When a person uses medication there are chances of side effects and psychiatric medication usually have adverse side effects.
The person needs to take medication for several months so their effect starts to get visible.
Apart from Antidepressants, the modern medication of SSRIs can be used.
They help the brain to naturally increase the levels of serotonin required for good mood regulation.
Then another type available is Tricyclic Antidepressants (TCAs), they are used to treat the moderate to severe clinical depression.
These help the person to lift their mood by increasing the level of hormones required for mood regulation.
Psychotherapy
Talk therapy can be beneficial and researches have been conducted where psychotherapy give equally effective results to medication or sometimes more efficient and long-lasting results.
In psychotherapy, Cognitive behaviour therapy is the evidence-based therapy which improves the condition of the person.
The focus of CBT is on the present and identification of thinking patterns.
Because according to CBT, the faulty thinking patterns makes one person sad or depressed.
The negative automatic thoughts are considered to be the cause of clinical depression.
There are a number of different psychotherapy which can be used along with the improvement in the lifestyle of the person is required.
Yoga, appropriate diet, exercise, and getting enough sleep also helps in the symptoms of clinical depression.
Recommended Diet for clinical depression
The antioxidant prevents cells from damage, and vitamin C and E enriched food is beneficial in clinical depression.
Fruits such as blueberries, grapefruit, kiwi, peaches, carrots, spinach, sweet potato, as well as nuts, seeds, margarine, and wheat germ are effective in the condition of clinical depression.
Smart carbohydrates also give calming and relaxing effect, these include limited sugar foods such as whole grains, fruits, and healthy fibre.
Protein-rich food is also healthy and beneficial for the alertness and gives the boost of energy.
This includes turkey, tuna, chicken, meat and poultry.
Vitamin D is also the essential ingredient and particularly effective especially for seasonal affective disorder.
Side Note: I have tried and tested various products and services to help with my anxiety and depression. See my top recommendations here, as well as a full list of all products and services our team has tested for various mental health conditions and general wellness.
What we recommend for Depression
Professional counselling
If you are suffering from depression then ongoing professional counselling could be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.
Frequently Asked Questions for Clinical Depression
Is anxiety and depression a disability?
In severe cases of anxiety and depression, when it is difficult for the person to deal with everyday life it becomes a disability
Is MDD a disability?
Sometimes major depressive disorder can be counted as a disability in severe cases.
What is the difference between unipolar and bipolar disorders?
The difference between unipolar and bipolar disorders are that in the unipolar person experience only one extreme of mood and especially depression, while in bipolar the mood shifts from extreme euphoria to depression.
What we recommend for depression
Professional counselling
If you are suffering from depression then ongoing professional counselling may be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.
References
Recommended Readings
Depression: The Way Out of Your Prison
Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions
Depression: A practical guide (The Flag Series Book 2)
Depression (Clinical psychology: A Modular Course)
The 4 Pillar Plan: How to Relax, Eat, Move and Sleep Your Way to a Longer, Healthier Life
Overcome Depression and Find Joy in Life Again with BetterHelp
