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Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD)

When someone has a physical injury, people easily recognize their pain and suffering and understand that recovery can be a slow process with possible hurdles throughout the journey. When it comes to mental health, however, the same level of understanding is often not just absent, it is commonly replaced by stigma and shame. But worldwide, millions of people live with depression,[1] which is a medical illness, just like cancer or a skin disease, that requires compassionate, professional medical care. You cannot will yourself to just get over it.[2]


What is Major Depressive Disorder (MDD)?

Being in a bad mood or feeling sad because something terrible happened is part of a normal, emotionally balanced human life.

There are different types of depression and Major Depressive Disorder or MDD is one of them.

Major Depressive Disorder (MDD) is a long-lasting, biologically based mood disorder.[1] It is a serious health condition characterized by depressive episodes such as depressed mood or feelings of hopelessness and/or loss of interest or pleasure in almost all activities.[3][4] As a result, MDD doesn't just impact the person affected but can have a ripple effect across every aspect of their life, from relationships with family and friends to performance at work.[3][4]

The symptoms of MDD are defined as lasting at least two weeks, but they usually last much longer - months or even years - and so people living with MDD may delay seeking help.[1][5] This can have long-term effects, as MDD can increase the risk of other health problems, such as cardiovascular disease.[1][5]

“Accepting that I have depression has helped me see that this sadness isn’t who I am as a person. It may always be with me but I know that if I let people help, I can have more good days.”

– Clara, 23[6]

How do I know if I have a depressive disorder?

Being depressed goes well beyond feeling down. When you’re depressed, you’ll experience physical, emotional and cognitive symptoms for a prolonged period of time.[1] These include having a depressed mood, loss of interest and enjoyment, reduced energy and lack of motivation.[1] When you’re depressed, you may also experience anxiety, lack of appetite, insomnia, poor concentration, feelings of guilt or low self-worth,[1] and a compulsion to contemplate death and suicide.[7]

Several factors may contribute to or increase your risk of developing MDD. These include:

  • Chronic illness - people with long-term or disabling illnesses are at higher risk of developing depression.[8][4]
  • Age - the rate of first onset peaks in the 20s, with the overall prevalence being highest between the ages of 55 and 74.[4][9]
  • Family history - first-degree relatives of people with MDD have a 2-4 fold higher risk of developing the condition.[8][4]
  • Major life changes, trauma, or stress.[8][4]

The biological causes of depression are not yet fully understood. However, it is thought that decreased neuroplasticity - the ability of the nervous system to develop new connections - and the dysfunction of networks of neurons associated with mood regulation may play a role.10

How common is depression?

Depression is a leading cause of disability worldwide.11 Globally, more than 264 million people of all ages suffer from depression,11 44.3 million of whom live in Europe.[1] So, know that you are not alone – and that probably more people in your circle of family and friends suffer from this devastating disease than you may realize.

Depression has a massive impact on the lives of those struggling with it, those around them, and society as a whole. It is the main contributor to mental health problems in Europe. Up to 50% of chronic sick leaves in the EU are due to depression/anxiety. The cost of mood disorders and anxiety in the EU is about €170 billion per year. And yet, about 50% of major depressions remain untreated.12

Treatment and Care

Depression is often a lifelong struggle and 60-70% of people who suffer from MDD will relapse.13 And while a large number of people with depression never seek help, there are several types of treatment options available:[1]

  • Psychotherapy: also known as counselling, this route includes cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) and should be the first line of treatment for cases of mild depression.
  • Pharmacotherapy: also known as antidepressant medication, can be effective and is appropriate for moderate to severe depression.
  • Electroconvulsive Therapy: ECT involves brief electrical stimulation of the brain under anaesthesia and is most commonly used to treat severe major depression when other treatments have failed.14

Prevention programmes are also incredibly important. School programmes to enhance patterns of positive thinking, interventions for caregivers, exercise programmes for the elderly, etc. These all have been shown to reduce depression.11

What to ask your doctor?

The list below includes example questions to help start a conversation with your health care provider. There may be other relevant questions based on your symptoms, stage, and medical history that are not listed here.

  • What type of depression do I have?
  • What are my treatment options?
  • What are the different types of therapy?
  • How will I know if therapy is right for me?
  • Do I need medication, or can I be treated effectively without it? I’m concerned about side effects or the medication interacting with other medication I’m taking.
  • What kinds of medication are available and what are their different effects?
  • How long do I need to take the medication until I am well again?
  • What can I do to improve my condition outside of medication and therapy?
  • Should another type of mental health specialist be involved in my care?
  • What types of illnesses can coexist with depression?
  • Should I make any special accommodations for school, home, or my work? How should I explain my condition?
  • What should I do if I feel like I might hurt myself or if I need emergency help?
  • What can I do to improve my condition/wellbeing outside of medication and therapy?
  • How long do I need to take the medication until I am well again? Can I stop my medication once I feel better?
  • ...

How to care for someone with depression

It can be painful to see someone you love struggle with depression, and you can’t fix someone’s depression for them. You can’t just take them out for dinner and expect them to cheer up. But that doesn’t mean that companionship isn’t crucial.

Learn all you can about depression and how to talk about it and offer love and support. Understand that it is a serious medical condition that can have a severe impact on their physical health. Remember not to take it personally when they are not connecting with you. Often, people with depression have no energy or interest in doing any activities, even thinking of doing something may feel draining, and they may even lash out at you.

Have patience as you support your loved one in their recovery, and do not judge them when they relapse. Talk to them about depression to help them cope, and don’t shy away from even the darkest conversations. Talking openly and honestly about suicidal thoughts and feelings can help save a life.15

Meanwhile, look after your own emotional health too. You’ll need it to provide the full support your loved one needs.16

Glossary

  • Dysphoria: a depressed mood
  • Anhedonia: a loss of pleasure
  • Comorbidity: When more than one disease or condition is present in a person at the same time.
  • Cognition: the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.
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