Major Depressive Disorder, or MDD, is a common mental health diagnosis, and can include the following experiences:
- depressed mood
- loss of interest or pleasure in activities
- significant weight loss or weight gain
- disrupted sleep or sleeping too much
- agitation or slowing in movement
- loss of energy
- feelings of worthlessness
- difficulty concentrating or making decisions
- recurrent thoughts of death or thoughts of suicide
Several medical professionals can diagnose MDD, but primary care providers are a great place to start, because they can tell what is MDD, and what might be one of several other medical problems that can mimic depression and might need attention.
Why do they call it ‘depression’ if there are so many other symptoms besides just depressed mood? Well an early theory about depression stated that when the brain experiences continued, severe stress, it ‘shuts down’ or ‘depresses’ emotion, thought, and behavior. It does this to prevent additional stress. In other words, an organism that isn’t very active has less chance of experiencing additional stress and trauma. It will also conserve its resources.
In any one-year time span, about 7% of people in the US will experience a major depressive episode. MDD is three times more common in 18-29-year olds than in persons over 60, and females experience depression up to three times more than males, beginning in adolescence. Depression can occur at most ages, but is most common for people in their 20s. Adverse childhood experiences such as neglect and abuse significantly increase the risk of experiencing MDD as an adult.
MDD intensity ranges from ‘mild’ to ‘severe’ depending on the number of symptoms present, and treatment recommendations vary according to intensity. For mild to moderate depression, the American Psychiatric Association recommends either medication, psychotherapy, or in some cases a combination of both. For severe forms of depression, either medication, or medication in combination with psychotherapy are recommended.
The American Psychological Association (APA) recognizes multiple forms of psychotherapy as effective in treating depression in adults, to include behavioral therapy, cognitive therapy, interpersonal psychotherapy, mindfulness-based cognitive therapy, psychodynamic therapy, and supportive therapy. For children and adolescents, APA recommends cognitive-behavioral therapy and interpersonal psychotherapy, and for older adults, group cognitive-behavioral therapy, interpersonal psychotherapy, and group life-review / reminiscence therapy.
Nearly all medication for depression is prescribed by primary care providers, so referral to a psychiatrist is usually only necessary for severe or difficult to treat depression. For psychotherapy, clinical psychologists are the most skilled with evidence-based treatments, but many master’s level therapists can also treat depression using evidence-based psychotherapies.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. American psychiatric association.
Gelenberg, A. J., Freeman, M. P., Markowitz, J. C., Rosenbaum, J. F., Thase, M. E., Trivedi, M. H., & Van Rhoads, R. S. (2010). American Psychiatric Association practice guidelines for the treatment of patients with major depressive disorder. Am J Psychiatry, 167(Suppl 10), 9-118.
American Psychological Association. (2019). Clinical practice guideline for the treatment of depression across three age cohorts. Retrieved from https://www.apa.org/depression-guideline.
Hollon, S. D., Andrews, P. W., Singla, D. R., Maslej, M. M., & Mulsant, B. H. (2021). Evolutionary theory and the treatment of depression: It is all about the squids and the sea bass. Behaviour research and therapy, 143, 103849.